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Drug dictionary for dentistry PDF

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Drug dictionary for dentistry J.G. Meechan R.A. Seymour OXFORD UNIVERSITY PRESS Drug dictionary for dentistry Dose schedules are being continually revised and new side effects recognized. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. For these reasons the reader is strongly urged to consult the phar- maceutical company’s printed instructions before administering any of the drugs recommended in this book. J.G. Meechan and R.A. Seymour 1 Drug dictionary for dentistry 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Bangkok Buenos Aires Cape Town Chennai Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi São Paulo Shanghai Singapore Taipei Tokyo Toronto with an associated company in Berlin Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2002 The moral rights of the authors have been asserted Database right Oxford University Press (maker) First published 2002 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means,without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer A catalogue record for this title is available from the British Library Library of Congress Cataloging in Publication Data Meechan, J. G. Drug dictionary for dentistry/J. G. Meechan, R. A. Seymour. p. cm. 1. Dental pharmacology–Dictionaries. 2. Dental therapeutics– Dictionaries. I. Seymour, R. A. II. Title. RK701.M442002 617.6'061'03–dc21 2001052052 ISBN 0 19 263274 4 10 9 8 7 6 5 4 3 2 1 Typeset by Newgen Imaging Systems (P) Ltd., Chennai, India Printed in Great Britain on acid-free paper by The Bath Press, Avon This book is dedicated to: The memory of my father (JGM) Gayle, Tom and Oliver (RAS) This page intentionally left blank Drug therapy has an effect on the management of patients in dentistry. Many drugs produce oro-dental problems; in addition concurrent medication can interact with drugs which the dentist may prescribe. The aim of this dictionary is to draw together the effects of drugs on the teeth, oral and perioral structures and highlight drug interactions which impact on dental treatment. Drugs taken by out- patients which may be encountered in general dental practice and interactions with drugs contained in the Dental Practitioners Formu- lary have been included. Interactions which may occur with medica- tion prescribed by dentists working in the hospital service have also been covered. Drugs which the dentist may prescribe have been anno- tated in greater detail to include any significant interactions that have been recorded. Drugs have been listed alphabetically by their Rec- ommended Non-proprietary Name (rINN) rather than their British Approved Name (BAN). In those cases where it is still recommended that both the BAN and rINN should appear then drugs commonly found in dental out-patients are listed under both names. It is hoped that this pocket-sized volume will act as a ready refer- ence source for those dealing with dental patients taking medication. J.G. Meechan R.A. Seymour October, 2001 How to use this dictionary The drugs are listed in alphabetical order by their approved name in this dictionary. An alphabetical list of trade-names is provided in the Appendix in order to cross-reference to the approved name used in the dictionary. Preface Acknowledgement The authors are pleased to acknowledge the assistance of Mrs Renata Taylor in the compilation of this dictionary. ABACAVIR • ACAMPROSATE CALCIUM 1 Abacavir (Ziagen) Description A nucleoside reverse transcriptase inhibitor. Indications Used in the management of HIV infection. Effects on oral and dental structures This drug may produce oral ulceration. Effects on patient management Sensitive handling of the underlying disease state is essential. Excel- lent preventive dentistry and regular examinations are important in patients suffering from HIV, as dental infections are best avoided. HIV will interfere with postoperative healing and antibiotic prophy- laxis prior to oral surgery may be advisable. Drug interactions None of importance in dentistry. Acamprosate calcium (Campral EC) Description An anti-dependence drug. Indications Used in the management of alcohol dependence. Effects on oral and dental structures None known. Effects on patient management A history of alcohol dependence may cause bleeding disorders and affect drug metabolism. Drug interactions None relevant. ACARBOSE • ACEBUTOLOL 2 Acarbose (Glucobay) Description An inhibitor of intestinal alpha glucosidases. Indications Diabetes mellitus inadequately controlled by diet or by diet and oral hypoglycaemic agents. Effects on oral and dental structures None reported. Effects on patient management Hypoglycaemia can be a problem in patients taking acarbose, espe- cially if they are also on insulin. Before commencing dental treat- ment, it is important to check that patients have had their normal food intake. If there is any doubt, give the patient a glucose drink. As with any diabetic patient try and treat in the first half of the morning and ensure that patients can eat after dental treatment. If a patient on acarbose requires a general anaesthetic then refer to hospital. Drug interactions Systemic corticosteroids antagonize the hypoglycaemic actions of acarbose. If these drugs are required, then consult the patient’s phy- sician before prescribing. Acebutolol (Sectral) Description A beta-adrenoceptor blocking drug. Also combined with a diuretic, hydrochlorothiazide (Secadrex). Indications Hypertension. Effects on oral and dental structures Xerostomia and lichenoid eruptions can be produced. Effects on patient management Xerostomia will make the dentate patient more susceptible to dental caries (especially root caries) and will cause problems with denture retention. Postural hypotension may occur, and patients may feel dizzy when the dental chair is returned to the upright position after they have been treated in the supine position. Drug interactions NSAIDs such as ibuprofen may antagonize hypotensive action of acebutolol; possible interaction between epinephrine and acebutolol which may cause a slight increase in blood pressure. Do not exceed ACECLOFENAC • ACEMETACIN 3 more than 3 cartridges of epinephrine containing local anaesthetic solution per adult patient. Aceclofenac (Preservex) Description A peripherally acting, non-steroidal anti-inflammatory analgesic. Indications Pain and inflammation associated with musculoskeletal disorders, e.g. rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Effects on oral and dental structures Patients on long-term NSAIDs such as aceclofenac may be afforded some degree of protection against periodontal breakdown. This arises from the drug’s inhibitory action on prostaglandin synthesis. The latter is an important inflammatory mediator in the pathogene- sis of periodontal breakdown. Effects on patient management Rare unwanted effects of aceclofenac include angioedema and throm- bocytopenia. If the platelet count is low (�100,000) then the socket should be packed and sutured. Persistent bleeding may require a plate- let transfusion. The latter may cause an increased bleeding tendency following any dental surgical procedure. Drug interactions Ibuprofen, aspirin and diflunisal should be avoided in patients tak- ing aceclofenac due to an increase in unwanted effects, especially gastrointestinal ulceration, renal and liver damage. Systemic corti- costeroids also increase the risk of peptic ulceration and gastrointes- tinal bleeding. Acemetacin (Emflex) Description A peripherally acting, non-steroidal anti-inflammatory analgesic. Indications Pain and inflammation associated with musculoskeletal disorders, e.g. rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Postoperative analgesia. Effects on oral and dental structures Patients on long-term NSAIDs such as acemetacin may be afforded some degree of protection against periodontal breakdown. This arises from the drug’s inhibitory action on prostaglandin synthesis. The latter is an important inflammatory mediator in the pathogenesis of ACETAZOLAMIDE 4 periodontal breakdown. Acemetacin has also been implicated for inducing oral lichenoid eruptions and oral ulceration. The drug does have a higher incidence of bone marrow suppression when compared to other NSAIDs. This can cause agranulocytosis, leucopenia, aplastic anaemia, and/or thrombocytopenia. Such depression of bone mar- row function will affect the oral mucosa (high risk of ulceration), the periodontal tissue (high risk of gingival bleeding and periodontal breakdown) and healing after any dental surgical procedure. Effects on patient management The risk of thrombocytopenia will cause an increased bleeding ten- dency following dental surgical procedures. If the platelet count is low (�100,000) then the socket should be packed and sutured. Per- sistent bleeding may require a platelet transfusion. Drug interactions Ibuprofen, aspirin and diflunisal should be avoided in patients tak- ing acemetacin due to an increase in unwanted effects, especially gastrointestinal ulceration, renal, and liver damage. Systemic corti- costeroids increase the risk of peptic ulceration and gastrointestinal bleeding. Acetazolamide Description A carbonic anhydrase inhibitor. Indications Used to treat glaucoma, as a prophylaxis against mountain sickness, as an add-on drug in epilepsy and in the emergency management of retrobulbar haemorrhage. Although it is a diuretic it is not used for that purpose. Effects on oral and dental structures Xerostomia, taste disturbance (metallic taste), paraesthesia, and Stevens–Johnson syndrome may occur. Effects on patient management Acetazolamide increases the toxicity of the local anaesthetic procaine, however this local anaesthetic agent is rarely used in modern dentistry. Acetazolamide can cause both thrombocytopenia and anaemia. Throm- bocytopenia may cause postoperative bleeding. If the platelet count is low (�100,000) then the socket should be packed and sutured. Persis- tent bleeding may require a platelet transfusion. Anaemia may result in poor healing. Any anaemia will need correction prior to elective gen- eral anaesthesia and sedation. Avoid high dose aspirin for postoperative pain control as a serious metabolic acidosis may occur. If the patient is receiving the drug for ACETYLSALICYLIC ACID 5 epilepsy control then fits are possible, especially if the pateint is stressed, therefore sympathetic handling and perhaps sedation should be considered for stressful procedures. Emergency anticonvulsant medication (diazepam or midazolam) must be available. Drug interactions The interactions with aspirin and procaine were mentioned above. Acetazolamide increases the plasma concentration of carbamazepine and increases the chances of osteomalacia when combined with pheny- toin and phenobarbitone. It also increases the toxicity of ephedrine. Combined therapy with corticosteroids increases the chances of hypokalaemia. Acetylsalicylic acid (Aspirin) Description A peripherally acting, non-steroidal analgesic. Indications Pain with a significant inflammatory component (e.g. postoperative pain after dental surgical procedures). Also used in the management of musculoskeletal pain, headache, and dysmenorrhoea, as an anti- pyretic, and for its antiplatelet actions in the prophylaxis for cere- brovascular disease or myocardial infarctions. Presentations (i) A 300 mg tablet. (ii) Dispersible aspirin 300 mg. (iii) A 75 mg tablet used for antiplatelet action. Dose Analgesia and antipyresis 300–900 mg every 4–6 hours. Antiplatelet action 75–300 mg per day. Contraindications Cannot be prescribed to asthmatics (can precipitate bronchoconstric- tion), children under 12 years (risk of Reye’s syndrome), patients with a history of peptic ulceration (aspirin is ulcerogenic), uncontrolled hypertension, patients suffering from gout (aspirin is uricosuric), patients with disorders of haemostasis (aspirin reduces platelet aggre- gation, therefore increases bleeding time), or patients with known hypersensitivity to the drug. Precautions Pregnancy and breastfeeding mothers. ACICLOVIR 6 Unwanted effects Aspirin is ulcerogenic to the gastric mucosa and can cause the so-called ‘aspirin burn’ if a tablet is held against the oral mucosa. The effect of the drug on platelets can lead to an increase in bleeding time and possible problems with haemostasis. Local measures usu- ally resolve an aspirin-induced bleed, but if these fail, the patient will need a platelet transfusion. High doses of aspirin can cause tinnitus due to a raise in labyrinthine pressure. Reducing the dose usually resolves the problem. The drug is also uricosuric and can precipitate an attack of gout. Drug interactions Aspirin should not be prescribed to patients taking anticoagulants since there is an increased risk of impaired haemostasis. Aspirin also enhances the effect of the antiepileptic drugs phenytoin and sodium valproate. Both aspirin and corticosteroids are ulcerogenic and should thus be avoided, especially in patients with a history of peptic ulcera- tion. Aspirin reduces the renal excretion of the cytotoxic drug meth- otrexate and thus increases the unwanted effects of this drug. The diuretic actions of spironolactone and acetazolamide are reduced by aspirin. Metaclopramide and domperidone increase the rate of aspirin absorption by their actions on gastric emptying. The uricosuric effects of aspirin will reduce the actions of probenecid and sulfinpyrazone. Can produce hypoglycaemia, combined use with oral hypoglycaemic agents should be avoided. Aciclovir [Acyclovir] (Zovirax) Description An antiviral drug. Indications Used in the treatment of herpes simplex and varicella-zoster infections. Presentations (i) 200 mg, 400 mg and 800 mg tablets. (ii) 200 mg, 400 mg and 800 mg dispersible tablets. (iii) Oral suspensions of 200 mg/5 mL and 400 mg/5 mL. (iv) A 5% cream. (v) 250 mg powder for reconstitution for intravenous infusion. Dose Adults: 200–400 mg 5 times daily (or topical application to lesion 5 times daily). Children under 2 years: half adult dose.

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