Information, Sources, Regulatory Agencies, Drug Legislation, and Prescription Writing

evolve.elsevier.com/Haveles/pharmacology

Pharmacology is derived from the Greek prefix pharmaco-, meaning “drug” or “medicine,” and the Greek suffix -logy, meaning “study.” Therefore pharmacology is the study of drugs and their interactions with living cells and systems. Drugs are chemical substances that are used in the diagnosis, treatment, or prevention of disease or other abnormal conditions. They can be used in both humans and animals. Drugs include synthetically derived compounds, vitamins, and minerals as well as herbal supplements—although these last substances are marketed not as drugs but as food supplements. In addition to pharmacology, the dental hygienist should know about its related disciplines, as listed and defined in Table 1-1.

Table 1-1

Disciplines Related to Pharmacology

Area of Pharmacology Definition
Pharmacotherapy The use of medications to treat different disease states
Pharmacodynamics The study of the action of drugs on living organisms
Pharmacokinetics The study of what the body does to a drug; the measurement of the absorption, distribution, metabolism, and excretion of drug from the body
Pharmacy The practice of compounding, preparing, dispensing, and counseling of patients about their medications
Toxicology The study of the harmful effects of drugs on living tissues

History

 

In the beginning, plants were discovered to produce beneficial effects.

Pharmacology had its beginning when our human ancestors noticed that ingesting certain plants altered body functions or awareness. The first pharmacologist was a person who became more astute in observing and remembering which plant products produced predictable results. From this humble beginning, a huge industrial and academic community concerned with the study and development of drugs has evolved. Plants from the rain forest and chemicals from tar have been searched for the presence of drugs. The agents discovered and found to be useful are then prescribed and dispensed through the practice of medicine, dentistry, pharmacy, and nursing. Health care providers who can write prescriptions include physicians (for humans), veterinarians (for animals), dentists (for dental problems), and optometrists (for eye problems). Physicians’ assistants, nurse practitioners, pharmacists, and dental hygienists can prescribe drugs under certain guidelines and in certain states.

Role of the dental hygienist

 

Knowledge of a patient’s medication/health history is necessary in order to provide optimal oral health care.

In today’s ever-changing health care environment, it is important that the dental hygienist know more than the name and color of a medication. Patients rely on the dental hygienist to provide them with the correct information regarding their medication and oral health care. Although, dental hygienists do not prescribe drugs, it is important that they have knowledge of pharmacology and its related disciplines in order to provide more effective care to the patient.

Medication/Health History

As a result of the many breakthroughs in medicine and pharmacy research, more and more diseases can be treated; therefore, more and more people are taking medication. More often than not the dental hygienist is the first health professional in the dental practice to assess the patient’s medication history. Obtaining a medication/health history is the first step in safely treating a patient. Patients may be taking any number of medications that interact with medications used in oral health care or that may adversely affect oral health. An understanding of the actions, indications, adverse reactions, and therapeutic uses of these drugs can help determine potential effects on dental treatment. Comparing the medical conditions of the patient with the medications he or she is taking often raises questions in the interview. Examples include the risk of xerostomia in patients taking calcium channel blockers for hypertension and the increased risk of gingival bleeding in patients taking an aspirin each day to prevent a heart attack or stroke. A detailed health/medication history allows the dental hygienist to provide the best possible health care to the patient (Box 1-1).

 

Box 1-1

Obtaining a Medication History

1. Do you take any medications for_________?
 Heart/high blood pressure/angina
 Lungs/asthma/COPD
 Diabetes/sugar
 Ulcer/reflux/heartburn
 Mental health issues
 Arthritis
 Seizures
2. What are the names of your medicines and how many times a day do you take them?
3. How many times a day did your health practitioner tell you to take them?
4. Have you taken your medicine today?
5. Do you take any medicine that you can buy without a prescription? (for example)
 Acetaminophen, aspirin, ibuprofen, naproxen
 Antihistamines/decongestants
 Omeprazole (Prilosec OTC), lansoprazole (Prevacid 24HR), omeprazole/sodium bicarbonate (Zegerid OTC), nizatidine (Axid AR), famotidine (Pepcid AC), cimetidine (Tagamet HB), ranitidine (Zantac 75)
6. Do you take any herbal supplements? If so please tell me their names and why you are taking them.
7. Have you noticed any problems (side effects) when you take your medicine?
8. Do you have any allergies to medicine? If yes, what medicine?
9. What happened to you when you took the medicine?

Medication Administration

Because the dental hygienist administers certain drugs in the office, knowledge of these agents is crucial. For example, the oral health care provider commonly applies topical fluoride, and in some states, both the dentist and the dental hygienist administer local anesthetics and nitrous oxide. In-depth knowledge of these agents is especially important because of their frequent use.

Emergency Situations

The ability to recognize and assist in dental emergencies requires knowledge of certain drugs. The indications for these drugs and their adverse reactions must be considered. For example, in a patient having an anaphylactic reaction, epinephrine must be administered quickly.

Appointment Scheduling

Patients taking medication for systemic diseases may require special handling in the dental office. For example, asthmatic patients who experience dental anxiety should schedule their appointments when they are not rushed or under pressure early in the morning in order to avoid an asthma attack. Whereas diabetic patients usually have fewer problems with morning appointments schedule 90 minutes after meals and medication administration. Certain patients may need to take medication before their appointments. Patients with a history of infective endocarditis need to be premedicated with antibiotics before some of their dental or dental hygiene appointments.

Nonprescription Medication

More and more patients are self-treating with nonprescription drugs. Also, nonprescription or over-the-counter (OTC) products may be recommended for the patient. The study of pharmacology will assist the oral health care provider in an intelligent selection of an appropriate OTC product. Although patients tend to forget that OTC products are drugs, knowledge of pharmacology will allow the dental hygienist to evaluate the patient for therapeutic OTC drug effects and adverse effects.

Nutritional or Herbal Supplements

Many patients self-treat or are prescribed nutritional or herbal supplements for any number of disease states. Although the vast majority of these supplements do not carry U.S. Food and Drug Administration (FDA) approval for treating disease states, patients still use them. These supplements are drugs and can cause adverse effects and interact with other drugs.

Sources of information

 

Always keep reference guides or electronic devices close by so you can quickly look up information regarding medication therapy.

Many different medications are available, and it is important for the dental hygienist to know where to look for information about prescription medications, nonprescription medications, and herbal supplements. There are many sources, including reference texts, association journals, and the internet, where pertinent drug information can be found. Box 1-2 reviews the different sources of information.

 

Box 1-2

Pharmacologic References and Resources Recommended for the Dental Office

Drug information reference books

American Hospital Formulary Service (AHFS) Drug Information

United States Pharmacopeia-Drug Information (USP-DI)

Drug Facts and Comparison

Physician’s Desk Reference (PDR)

Handbook of Nonprescription Drugs: An Interactive Approach to Health Care

PDR for Nonprescription Drugs, Supplements, and Herbs

PDR for Herbal Medicines

Natural Products: A Case-Based Approach for Health Care Professionals

Merck Manual for Medical Information

Drug Interaction Facts

Goodman and Gilman’s The Pharmacologic Basis of Therapeutics

Dental drug reference books

Mosby’s Dental Drug Reference

Lexi-Comp’s Drug Information Handbook for Dentistry

Selected journals

Journal of Dental Hygiene

Dimensions in Dental Hygiene

RDH Magazine

Pharmacy Today

Drug Topics

New England Journal of Medicine

Journal of the American Dental Association

Websites

www.epocrates.com

www.davis’sdrugguide.com

www.lexicomp.com

www.pdr.net

www.rxlist.com

www.drugs.com

www.fda.gov/medwatch

www.medscape.com

www.mayoclinic.com

www.nlm.nih.gov/medlineplus/

Newsletters

Pharmacist Letter

The Medical Letter

Printed Resources

Each publication type can be selected according to its lack of bias, its publication date (when the current edition was released), its readability (vocabulary, simplicity of explanations, and presence of visual aids), its degree of detail (all you want to know and much more, just the right amount of information, or not enough to understand what is being said), and its price. Some publications are specific for disease states, geriatric or pediatric patients, drug interactions, or prescription drugs or nonprescription drugs. Reference books can be updated monthly, quarterly, and annually. Every dental office should have at least one reference book that lists the names of both prescription and OTC drugs. Further, a standard pharmacology textbook would be helpful in understanding the reference books. Because of the continual release of new drugs, a recent edition (not more than 1 or 2 years old) of a reference book is needed.

Computer and Online Resources

Although books serve as the usual source of information on drugs, many health care providers are using electronic resources, such as computer software and Internet-based services. Computer tablets and smart phones are also being used more and more for recording and storing patient information, calculating drug doses, and consulting medication information databases. Many online resources are available; they include Davis’s Drug Guide (www.drugguide.com/ddo/), Epocrates (www.epocrates.com), and Lexicomp (www.lexicomp.com

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Apr 12, 2015 | Posted by in Dental Hygiene | Comments Off on Information, Sources, Regulatory Agencies, Drug Legislation, and Prescription Writing
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