1: A

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abacavir

ah-bah′-cah-veer

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Antiviral, nucleoside analogue

Mechanism of Action

An antiretroviral that inhibits the activity of HIV-1 reverse transcriptase by competing with the natural substrate deoxyguanosine-5′-triphosphate (dGTP) and by its incorporation into viral DNA.

Therapeutic Effect: Inhibits viral DNA growth.

Uses

Used in combination with other antiviral drugs for treatment of HIV-1 infection

Pharmacokinetics

Rapidly and extensively absorbed after PO administration. Protein binding: 50%. Widely distributed, including to CSF and erythrocytes. Metabolized in the liver to inactive metabolites. Primarily excreted in urine. Unknown if removed by hemodialysis. Half-life: 1.5 hr.

Indications and Dosages

HIV Infection (in combination with other antiretrovirals)

PO

300 mg twice a day.

Children (3 mo–16 yr).

8 mg/kg twice a day. Maximum: 300 mg twice a day.

Dosage in Hepatic Impairment

Mild Impairment.

200 mg twice a day.

Moderate to Severe Impairment.

Not recommended.

Side Effects/Adverse Reactions

Adults

Frequent

Nausea, nausea with vomiting, diarrhea, decreased appetite

Occasional

Children

Frequent

Nausea with vomiting, fever, headache, diarrhea, rash

Occasional

Decreased appetite

Precautions and Contraindications

Hypersensitivity to abacavir or its components

Caution:

Breast-feeding, bone marrow depression, renal or hepatic impairment, use with other antivirals to avoid emergence of resistant viruses, avoid alcohol use

Drug Interactions of Concern to Dentistry

• None reported

Serious Reactions

! A hypersensitivity reaction may be life threatening. Signs and symptoms include fever, rash, fatigue, intractable nausea and vomiting, severe diarrhea, abdominal pain, cough, pharyngitis, and dyspnea.

! Life-threatening hypotension may occur.

! Lactic acidosis and severe hepatomegaly may occur.

Dental Considerations

General:

• Examine for oral manifestation of opportunistic infection.

• Patient on chronic drug therapy may rarely have symptoms of blood dyscrasias, which include infection, bleeding, and poor healing.

• Avoid dental light in patient’s eyes; offer dark glasses for patient comfort.

• Place on frequent recall because of oral side effects.

• Consider semisupine chair position for patient comfort if GI side effects occur.

Consultations:

• In a patient with symptoms of blood dyscrasias, request a medical consultation for blood studies and postpone treatment until normal values are reestablished.

• Medical consultation may be required to assess disease control.

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent soft tissue inflammation.

• Prevent trauma when using oral hygiene aids.

• Be alert for the possibility of secondary oral infection and the need to see dentist immediately if signs of infection occur.

abarelix

ah-bar′-eh-lix

Category and Schedule

Pregnancy Risk Category: X

Drug Class:

Mechanism of Action

A luteinizing hormone-releasing hormone (LHRH) antagonist that inhibits gonadotropin and androgen production by blocking gonadotropin releasing-hormone receptors in the pituitary.

Therapeutic Effect: Suppresses luteinizing hormone, follicle-stimulating hormone secretion, reducing the secretion of testosterone by the testes.

Uses

Treatment of breast cancer, endometrium, and prostate

Pharmacokinetics

Slowly absorbed following intramuscular administration. Distributed extensively. Protein binding: 96%–99%. Half-life: 13.2 days.

Indications and Dosages

Prostate Cancer

IM

Adults, Elderly.

100 mg on days 1, 15, and 29 and every 4 wk thereafter. Treatment failure can be detected by obtaining serum testosterone concentration prior to abarelix administration, day 19 and every 8 wk thereafter.

Side Effects/Adverse Reactions

Frequent

Hot flashes, sleep disturbances, breast enlargement

Occasional

Breast pain, nipple tenderness, back pain, constipation, peripheral edema, dizziness, upper respiratory tract infection, diarrhea

Rare

Fatigue, nausea, dysuria, micturition frequency, urinary retention, UTI

Precautions and Contraindications

This drug should not be used in women and children.

Drug Interactions of Concern to Dentistry

• None reported.

Serious Reactions

! Immediate-onset systemic allergic reaction characterized by hypotension, urticaria, pruritus, periorbital and/or circumoral edema, shortness of breath, wheezing, and syncope may occur.

! Prolongation of the QT interval may occur. Tightening of throat, tongue swelling, wheezing, shortness of breath, and low blood pressure occur rarely.

Dental Considerations

General:

• If additional analgesia is required for dental pain, consider alternative analgesics (NSAIDs) in patients taking opioids for acute or chronic pain.

• This drug may be used in the hospital or on an outpatient basis. Confirm the patient’s disease and treatment status.

Consultations:

• Medical consultation may be required to assess disease control and patient’s ability to tolerate stress.

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent soft tissue inflammation.

• Prevent trauma when using oral hygiene aids.

• Update health and medication history if physician makes any changes in evaluation or drug regimens; include OTC, herbal, and nonherbal remedies in the update.

abatacept

ah-bat′-ah-cept

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Antirheumatic, disease modifying

Mechanism of Action

Selective costimulation modulator; inhibits T-cell activation by binding to CD80 and CD86 on antigen presenting cells, thus blocking the required CD28 interaction and inhibiting autoimmune T-cell activation.

Uses

Rheumatoid arthritis (RA), second-line reduction of signs and symptoms of moderate-to-severe active RA, monotherapy or in combination with other disease-modifying antirheumatic drugs (DMARDs) (e.g., methotrexate).

Juvenile idiopathic arthritis, moderate-to-severe active.

Pharmacokinetics

Absorbed completely following parenteral administration. Distribution: 0.02–0.13 L/kg. Half-life: 13 days (8–25 days).

Indications and Dosages

Rheumatoid Arthritis (moderate to severe) in patients who have had an inadequate response to one or more disease-modifying antirheumatic drugs

IV

Dose is according to body weight. Administer over a 30-min infusion. Repeat dose at 2 and 4 wk after initial dose, and every 4 wk thereafter:

• <60 kg: 500 mg

• 60–100 kg: 750 mg

• >100 kg: 1000 mg

Juvenile idiopathic arthritis (moderate to severe), active, polyarticular.

IV Infusion

Children (6 yr and older; weighing less than 75 kg).

10 mg/kg given by IV infusion over 30 min; repeat doses at 2 and 4 wk after first infusion and every 4 wk thereafter.

Juvenile Idiopathic Arthritis (moderate to severe), active, polyarticular

IV Infusion

Children (6 yr and older; weighing 75–100 kg).

750 mg given by IV infusion over 30 min; repeat doses at 2 and 4 wk after first infusion and every 4 wk thereafter (MAX dose, 1000 mg).

Juvenile Idiopathic Arthritis (moderate to severe), active, polyarticular

IV Infusion

Children (6 yr and older; weighing more than 100 kg).

1000 mg given by IV infusion over 30 min; repeat doses at 2 and 4 wk after first infusion and every 4 wk thereafter (MAX dose, 1000 mg).

Safety and efficacy not established in children less than 6 yr of age.

Screen for tuberculosis (TB) and hepatitis before initiating therapy.

Side Effects/Adverse Reactions

Frequent

Infection, antibody formation, headache, dizziness, nasopharyngitis

Occasional

Nausea, hypertension, fever, urinary tract infection, cough, back pain

Precautions and Contraindications

Hypersensitivity to abatacept or any component of the formulation.

Tuberculosis (TB), active or latent; initiate treatment for TB prior to initiating abatacept therapy.

Hepatitis B reactivation has been associated with abatacept therapy; screen for viral hepatitis before initiating abatacept therapy.

Use with caution in patients with chronic obstructive pulmonary disease (COPD) because of worsening of breathing, COPD exacerbations, cough, and dyspnea.

Drug Interactions of Concern to Dentistry

• None reported

Serious Reactions

! Infections: should be cautious when considering the use of abatacept in patients with a history of recurrent infection, underlying conditions that may increase risks of infections, or chronic, localized infections. These patients should be monitored closely. If a patient develops a serious infection, the treatment should be discontinued.

! Anaphylaxis/hypersensitivity reaction may occur.

Dental Considerations

General:

• Examine for oral manifestation of opportunistic infection.

• Monitor vital signs at every appointment because of cardiovascular side effects.

• Consider semisupine chair position for patients with respiratory disease.

Consultations:

• Consult physician to assess disease control and ability of patient to tolerate dental treatment.

Teach Patient/Family to:

• Encourage effective atraumatic oral hygiene measures to prevent soft-tissue inflammation.

• Use soft tooth brush to reduce risk of bleeding.

• Immediately report any sign of infection to the dentist.

abciximab

ab-six′-ih-mab

(c7E3 Fab, ReoPro)

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Glycoprotein IIb/IIIa receptor inhibitor

Mechanism of Action

A glycoprotein IIb/IIIa receptor inhibitor that rapidly inhibits platelet aggregation by preventing the binding of fibrinogen to GP IIb/IIIa receptor sites on platelets.

Therapeutic Effect: Prevents closure of treated coronary arteries. Prevents acute cardiac ischemic complications.

Uses

Adjunct to aspirin and heparin therapy to prevent cardiac ischemic complications in patients undergoing percutaneous coronary intervention and those with unstable angina not responding to conventional medical therapy.

Pharmacokinetics

Rapidly cleared from plasma. Initial-phase half-life is less than 10 min; second-phase half-life is 30 min. Platelet function generally returns within 48 hr.

Indications and Dosages

Percutaneous Coronary Intervention (PCI)

IV Bolus

0.25 mg/kg 10–60 min before angioplasty or atherectomy, then 12-hr IV infusion of 0.125 mcg/kg/min. Maximum: 10 mcg/min.

PCI (unstable angina)

IV Bolus

0.25 mg/kg, followed by 18- to 24-hr infusion of 10 mcg/min, ending 1 hr after procedure.

Side Effects/Adverse Reactions

Frequent

Nausea, hypotension

Occasional

Rare

Bradycardia, confusion, dizziness, pain, peripheral edema, UTI

Precautions and Contraindications

Active internal bleeding, arteriovenous malformation or aneurysm, cerebrovascular accident (CVA) with residual neurologic defect, history of CVA (within the past 2 yr) or oral anticoagulant use within the past 7 days unless PT is less than 1.2 times control, history of vasculitis, intracranial neoplasm, prior IV dextran use before or during PTCA, recent surgery or trauma (within the past 6 wk), recent (within the past 6 wk or less) GI or GU bleeding, thrombocytopenia (less than 100,000 cells/mcl), and severe uncontrolled hypertension.

Drug Interactions of Concern to Dentistry

• Increased risk of bleeding: drugs that interfere with coagulation or platelet function, such as NSAIDs and aspirin.

Serious Reactions

! Major bleeding complications may occur. If complications occur, stop the infusion immediately.

! Hypersensitivity reaction may occur.

! Atrial fibrillation or flutter, pulmonary edema, and complete atrioventricular block occur occasionally.

Dental Considerations

General:

• Monitor vital signs at every appointment because of cardiovascular side effects.

• For use in hospitals or emergency rooms.

• Review patient’s medical and drug history.

• Provide palliative emergency dental care only during drug use.

• Patients may be at risk of bleeding; check for oral signs.

Consultations:

• Medical consultation may be required to assess disease control and patient’s ability to tolerate stress.

• Medical consultation should include routine blood counts including platelet counts and bleeding time.

• Avoid products that affect platelet function, such as aspirin and NSAIDs.

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent soft tissue inflammation.

• Prevent trauma when using oral hygiene aids.

• Report oral lesions, soreness, or bleeding to dentist.

• Update health and medication history if physician makes any changes in evaluation or drug regimens; include OTC, herbal, and nonherbal remedies in the update.

• Use soft tooth brush to reduce risk of bleeding.

absorbable gelatin sponge

Category and Schedule

Drug Class:

Hemostatic, purified gelatin sponge

Mechanism of Action

Absorbs blood, provides area for clot formation

Uses

Hemostasis adjunct in dental surgery

Pharmacokinetics

IMPLANT: Absorbed in 4–6 wk

Indications and Dosages

Dental Use

Top can be applied dry or moistened with normal saline solution; blot on sterile gauze to remove excess solution, shape to fit with light finger compression; hold pressure until dry. Apply to bleeding surfaces. Material may be cut to appropriate size or secured in extraction sites with sutures.

Side Effects/Adverse Reactions

Precautions and Contraindications

Hypersensitivity, frank infection

Caution:

Avoid use in presence of infection, potential nidus of infection, do not resterilize product.

Dental Considerations

Teach Patient/Family to:

• Immediately report any sign of infection to the dentist.

acamprosate calcium

ah-kam′-proe-sate

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Alcohol-abuse deterrent

Mechanism of Actions

Actual mechanism unknown; may facilitate balance between GABA and glutamate neurotransmitter systems in the CNS to decrease alcohol craving.

Uses

Alcohol-abuse deterrent

Pharmacokinetics

Partially absorbed from GI tract, steady-state levels reached within 5 days of dosing. Protein binding negligible. Half-life: 20–33 hr. Does not undergo metabolism; excreted unchanged in urine.

Indications and Dosages

Maintenance of Alcohol Abstinence

PO

666 mg 3 times a day with or without food.

Side Effects/Adverse Reactions

Oral: Dry mouth

CNS: Headache, somnolence, decreased libido, amnesia, abnormal thinking, tremor

CV: Palpitation, syncope, vasodilation, changes in B/P

GI: Vomiting, dyspepsia, constipation, increased appetite

RESP: Rhinitis, cough, dyspnea, pharyngitis, bronchitis

EENT: Abnormal vision, taste alterations

MS: Myalgia, arthralgia

SYST: Back pain, infection, flu syndrome, chest pain, chills, attempts at suicide (see Precautions)

Precautions and Contraindications

Hypersensitivity, severe renal impairment

Caution:

Renal impairment, depression/suicidal tendency

Drug Interactions of Concern to Dentistry

• None reported

Dental Considerations

General:

• Assess salivary flow as a factor in caries, periodontal disease, and candidiasis.

• After supine positioning, allow patient to sit upright for 2 min to avoid orthostatic hypotension.

Example: Campral (brand name), 333 mg

• Avoid alcohol-containing products (elixirs, mouth rinses) to assist maintenance of alcohol abstinence.

Consultations:

• Consult physician to assess disease control.

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent caries and periodontal disease.

• Use sugarless gum, frequent sips of water, and saliva substitutes if dry mouth occurs.

• Use home fluoride products for anticaries effect.

• Avoid mouth rinses with high alcohol content because of drying effects.

acarbose

ah-car′-bose

(Glucobay[aus], Prandase[can], Precose)

Do not confuse Precose with PreCare.

Category and Schedule

Pregnancy Risk Category: B

Drug Class:

Oral antidiabetic

Mechanism of Action

An alpha-glucosidase inhibitor that delays glucose absorption and digestion of carbohydrates, resulting in a smaller rise in blood glucose concentration after meals.

Therapeutic Effect: Lowers postprandial hyperglycemia.

Uses

Use as single drug or in combination with insulin or oral hypoglycemics (sulfonylureas, metformin) in type 2 diabetes (non–insulin-dependent diabetes mellitus [NIDDM]) when diet control is ineffective in controlling blood glucose levels.

Pharmacokinetics

PO

Limited oral absorption, absorbed dose excreted in urine, metabolized in the GI tract, and major portion of dose excreted in feces.

Indications and Dosages

Diabetes Mellitus

PO

Adults, Elderly.

Initially, 25 mg 3 times a day with first bite of each main meal. Increase at 4- to 8-wk intervals. Maximum: For patients weighing more than 60 kg, 100 mg 3 times a day; for patients weighing 60 kg or less, 50 mg 3 times a day.

Side Effects/Adverse Reactions

Side effects diminish in frequency and intensity over time.

Frequent

Transient GI disturbances: flatulence, diarrhea, abdominal pain

Precautions and Contraindications

Chronic intestinal diseases associated with marked disorders of digestion or absorption, cirrhosis, colonic ulceration, conditions that may deteriorate as a result of increased gas formation in the intestine, diabetic ketoacidosis, hypersensitivity to acarbose, inflammatory bowel disease, partial intestinal obstruction or predisposition to intestinal obstruction, significant renal dysfunction (serum creatinine level greater than 2 mg/dl)

Caution:

Use glucose for hypoglycemia, monitor blood glucose levels, pregnancy category B, avoid use in lactation, children.

Example: Precose (brand name), 25 mg

Drug Interactions of Concern to Dentistry

• None reported

Serious Reactions

Dental Considerations

General:

• Ensure that patient is following prescribed diet and takes medication regularly.

• Type 2 patients may also be using insulin. If symptomatic hypoglycemia occurs while taking this drug, use dextrose rather than sucrose because of interference with sucrose metabolism.

• Place on frequent recall to evaluate healing response.

• Patients with diabetes may be more susceptible to infection and have delayed wound healing.

• Question the patient about self-monitoring the drug’s antidiabetic effect.

• Consider semisupine chair position for patient comfort if GI side effects occur.

Consultations:

• Medical consultation may be required to assess disease control and patient’s ability to tolerate stress.

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent soft tissue inflammation.

acebutolol

a-se-byoo-toe-lole

Do not confused Sectral with Factrel, Septra, or Seconal.

Category and Schedule

Pregnancy Risk Category: B (D if used in second or third trimester)

Drug Class:

Beta-adrenergic blocker (cardioselective); antiarrhythmics, class II

Mechanism of Action

A beta₁-adrenergic blocker that competitively blocks β₁-adrenergic receptors in cardiac tissue; high doses may competitively block both β₁– and β₂-adrenergic receptors. Reduces the rate of spontaneous firing of the sinus pacemaker and delays AV conduction. Exhibits mild intrinsic sympathomimetic activity (ISA) (partial beta-agonist activity).

Therapeutic Effect: Slows heart rate, decreases cardiac output, decreases B/P, and exhibits antiarrhythmic activity.

Uses

Mild-to-moderate hypertension

Ventricular arrhythmias

Pharmacokinetics

Well absorbed from the GI tract. Bioavailability: approximately 40%. Protein binding: 26%. Undergoes extensive first-pass metabolism to active metabolite. Eliminated via bile and excretion into GI tract through intestinal wall, as well as partly excreted in urine. Removed by hemodialysis. Half-life: 3–4 hr (parent drug); 8–13 hr (metabolite).

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Tags: Mosbys Dental Drug Reference 11e

Jan 5, 2015 | Posted by mrzezo in General Dentistry | Comments Off

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