Essentials of Pharmacology for Dentistry

525 Pages·3.85 MB·English

by  Tripathi K.D.

Essentials of
Pharmacology
for Dentistry

Essentials of
Pharmacology
for Dentistry
2ND EDITION
KD TRIPATHI MD
Ex-Director-Professor and Head of Pharmacology
Maulana Azad Medical College and associated
LN and GB Pant Hospitals
New Delhi, India
®
JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD
New Delhi • Panama City (cid:129) London
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© 2011 KD Tripathi
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission
of the publisher.
Inquiries for bulk sales may be solicited at: [email protected]
This book has been published in good faith that the contents provided by the author contained herein are original, and
is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher
and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or
application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author.
Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Publisher: Jitendar P Vij
Publishing Director: Tarun Duneja
Managing Editor: M. Tripathi
Essentials of Pharmacology for Dentistry
First Edition: 2005
Second Edition: 2011
ISBN-13: 978-93-5025-385-4
Printed at Replika Press, Kundli
Preface to the Second Edition
With phenomenal growth of information on mechanism of action and clinical application of drugs,
as well as rapid introduction of new drugs, pharmacology, the science of drugs (medicines), has
become increasingly important to all health professionals who prescribe/administer drugs. Practice
of dentistry utilizes drugs both as primary treatment modality as well as facilitator of dental
procedures. Dentists may have to manage a medical emergency arising in their clinic. Moreover,
many dental patients could be receiving other medication that may have orodental implications,
or may interact with drugs prescribed by the dentist. As such, a broad knowledge of pharmacology
with emphasis on certain aspects is needed by the dentist.
This book is divided into three sections. The first describes the general pharmacological principles
with which all professionals involved in drug therapy must be conversant. The second on systemic
pharmacology presents a brief account of drugs acting on various organ systems and used in the
treatment of common disorders affecting the systems. Each chapter is organised systematically. The
opening sentence defines the class of drugs, followed by their classification. The ‘prototype’ approach
is followed by describing the representative drug of the class. In these chapters, matters particularly
relevant to dental therapeutics have been highlighted by italicizing. Wherever applicable, the
implications in dentistry are prominently elaborated, e.g. drugs and diseases affecting postextraction
haemostasis, dental procedures in patients on corticosteroid therapy or in diabetics, oral
complications of cancer chemotherapy, conscious sedation in dentistry, etc. Management of medical
emergencies like anaphylactic shock, seizures, angina, or asthmatic attack during dental treatment
is outlined.
The third section covers antimicrobials and other drugs which the dentists prescribe or administer
themselves. However, the allocation of topics in sections two and three does not indicate water-
tight distinction, which is impossible, but has been done with a view to focus attention on drugs
that have greater relevance in dentistry. To mention a few, the application of analgesics and NSAIDs
in dental pain, dental anaesthesia, role of each class of antimicrobials in orodental infections,
prophylaxis of postextraction infection and endocarditis in patients at special risk are emphasized.
The highlight of this 2nd edition is a new chapter on drugs and aids having specific application
in dental disorders and in dental care. Drugs for dental plaque, caries tooth, dentine sensitivity
alongwith aids like dentifrices, bleaching agents, disclosing agents, etc. are described pointing out
their current role in practice. The last chapter on drug interactions highlights those that may be
encountered in dental practice.
All chapters in the present edition have been thoroughly updated to include latest information
and new drugs. Presentation and illustrations have been improved. Leading trade names and dosage
forms of drugs generally prescribed by dentists are mentioned distinctively. Thus, the book is oriented
vi Essentials of Pharmacology for Dentistry
to provide core and contemporary pharmacological knowledge based on understanding of the
rationale. It is designed to meet the specific needs of dental students and practitioners.
I am indebted to my colleagues in pharmacology and dentistry as well as to readers of the 1st
edition for their comments and suggestions which helped in orienting the 2nd edition. As always,
the motivational influence of Shri J.P. Vij, Chairman and Managing Director, Jaypee Brothers, was
crucial. The meticulous preparation of the manuscript and illustrations by Ms Sunita Katla, Mr Manoj
Pahuja and others in the editorial section is highly appreciated. The participation and cooperation
of my wife is sincerely acknowledged.
June, 2011 KD Tripathi
Contents
1. Introduction, Routes of Drug Administration............................................................3
Introduction 3
Routes of Drug Administration 5
2. Pharmacokinetics.............................................................................................................10
Drug Transport 11
Drug Absorption 14
Drug Distribution 16
Drug Biotransformation (Metabolism) 20
Drug Excretion 25
Kinetics of Elimination 26
3. Pharmacodynamics..........................................................................................................31
Principles of Drug Action 31
Mechanism of Drug Action 31
Combined Effect of Drugs 45
Drug Dosage 48
Factors Modifying Drug Action 50
4. Adverse Drug Effects......................................................................................................56
5. Drugs Acting on Autonomic Nervous System..........................................................67
(General Considerations, Cholinergic and Anticholinergic Drugs)
General Considerations 67
Cholinergic Drugs (Cholinomimetic, Parasympathomimetic) 72
viii Essentials of Pharmacology for Dentistry
Anticholinesterases 74
Anticholinergic Drugs (Parasympatholytic) 76
Drugs Acting on Autonomic Ganglia 80
6. Drugs Acting on Autonomic Nervous System..........................................................81
(Adrenergic and Antiadrenergic Drugs)
Adrenergic Transmission 81
Adrenergic Drugs (Sympathomimetics) 83
Antiadrenergic Drugs (Adrenergic Receptor Antagonists) 90
7. Autacoids and Related Drugs.......................................................................................98
Histamine 98
H Antagonists (Conventional Antihistaminics) 101
1
5-hydroxytryptamine (5-HT, Serotonin) 105
Drug Therapy of Migraine 107
Prostaglandins and Leukotrienes (Eicosanoids) 109
Platelet Activating Factor (PAF) 115
8. General Anaesthetics and Skeletal Muscle Relaxants........................................117
General Anaesthetics 117
Preanaesthetic Medication 125
Skeletal Muscle Relaxants 126
9. Drugs Acting on Central Nervous System...............................................................133
(Sedative-Hypnotics, Alcohols, Antiepileptics and Antiparkinsonian Drugs)
Sedative-hypnotics 133
Ethyl Alcohol (Ethanol) 139
Antiepileptic Drugs 143
Antiparkinsonian Drugs 149
10. Drugs Acting on Central Nervous System...............................................................155
(Psychopharmacological Agents)
Psychopharmacological Agents 155
Antipsychotic Drugs (Neuroleptics) 156
Antimanic (Mood Stabilizing) Drugs 160
Antidepressant Drugs 163
Antianxiety Drugs 168
11. Cardiovascular Drugs...................................................................................................171
(Drugs Affecting Renin-Angiotensin System, Calcium Channel Blockers,
Drugs for Hypertension, Angina Pectoris and Myocardial Infarction)
Angiotensin 171
Angiotensin Converting Enzyme Inhibitors 173
Calcium Channel Blockers 176
Antihypertensive Drugs 178
Antianginal Drugs 183
Drug Therapy in Myocardial Infarction 188
Contents ix
12. Cardiovascular Drugs...................................................................................................190
(Drugs for Heart Failure and Cardiac Arrhythmia)
Cardiac Glycosides 190
Treatment of Congestive Heart Failure 195
Antiarrhythmic Drugs 197
13. Drugs Acting on Kidney...............................................................................................203
Relevant Physiology of Urine Formation 203
Diuretics 205
Antidiuretics 212
14. Hormones and Related Drugs ....................................................................................215
(Anterior Pituitary Hormones, Antidiabetic Drugs, Corticosteroids)
Introduction 215
Anterior Pituitary Hormones 216
Antidiabetic Drugs 219
Insulin 220
Oral Hypoglycaemic Drugs 224
Corticosteroids 228
15. Hormones and Related Drugs ....................................................................................235
(Sex Hormones, Contraceptives, Drugs Acting on Uterus)
Androgens (Male Sex Hormones) 235
Estrogens 237
Progestins 239
Hormonal Contraceptives 241
Uterine Stimulants (Oxytocics, Abortifacients) 243
Uterine Relaxants (Tocolytics) 245
16. Hormones and Related Drugs ....................................................................................246
(Thyroid Hormone and Thyroid Inhibitors, Hormones Regulating Calcium Balance)
Thyroid Hormone 246
Thyroid Inhibitors 249
Hormones Regulating Calcium 250
17. Drugs Affecting Blood..................................................................................................256
Haematinics 256
Coagulants 260
Anticoagulants 264
Fibrinolytics (Thrombolytics) 268
Antifibrinolytics 269
Antiplatelet Drugs (Antithrombotic Drugs) 269
Hypolipidaemic Drugs 271
x Essentials of Pharmacology for Dentistry
18. Drugs for Gastrointestinal Disorders.......................................................................274
Drugs for Peptic Ulcer 274
Antiemetics 280
Treatment of Gastroesophageal Reflux Disease 284
Laxatives (Aperients, Purgatives, Cathartics) 285
Treatment of Diarrhoeas 288
19. Drugs for Respiratory Disorders................................................................................291
Drugs for Cough 291
Drugs for Bronchial Asthma 292
20. Vitamins...........................................................................................................................299
Fat-soluble Vitamins 300
Water-soluble Vitamins 301
21. Anticancer and Immunosuppressant Drugs...........................................................305
Anticancer Drugs 305
Immunosuppressant Drugs 313
22. Antirheumatoid and Antigout Drugs........................................................................317
Antirheumatoid Drugs 317
Drugs Used in Gout 319
23. Nonsteroidal Antiinflammatory Drugs and Antipyretic-Analgesics...............325
Analgesic/NSAIDs in Dentistry 339
24. Opioid Analgesics and Antagonists..........................................................................341
Opioid Analgesics 341
Complex Action Opioids and Opioid Antagonists 350
25. Local Anaesthetics.........................................................................................................354
Uses and Techniques of Local Anaesthesia 361
Local Anaesthesia in Dentistry 362
26. Antimicrobial Drugs: General Considerations......................................................364
Drug Resistance 367
Superinfection 369
Choice of an Antimicrobial Agent 370
Combined Use of Antimicrobials 373
Prophylactic Use of Antimicrobials 375