Q

quazepam

kwaz′-eh-pam

(Doral)

Category and Schedule

Pregnancy Risk Category: X

Controlled Substance: Schedule IV

Drug Class:

Benzodiazepine, sedative-hypnotic

Indications and Dosages

Insomnia

PO

Adults (older than 18 yr).

Initially, 15 mg at bedtime. Adjust dose up or down from 7.5 mg to 30 mg at bedtime, depending on initial response.

Elderly, debilitated, liver disease.

Initially, 7.5–15 mg at bedtime. Adjust dose depending on initial response.

Side Effects/Adverse Reactions

Frequent

Muscular incoordination (ataxia), light-headedness, transient mild drowsiness, slurred speech (particularly in elderly or debilitated patients)

Occasional

Confusion, depression, blurred vision, constipation, diarrhea, dry mouth, headache, nausea

Rare

Behavioral problems such as anger, impaired memory; paradoxic reactions, such as insomnia, nervousness, or irritability

Precautions and Contraindications

Pregnancy, sleep apnea, hypersensitivity to quazepam or any component of the formulation

Caution:

Hepatic disease, renal disease, suicidal individuals, drug abuse, elderly, psychosis, children younger than 18 yr, lactation, depression, pulmonary insufficiency

Drug Interactions of Concern to Dentistry

• Increased effects: CNS depressants, alcohol

• Delayed elimination: erythromycin

• Contraindicated with saquinavir, ritonavir

• Increased serum levels and prolonged effect of benzodiazepines: erythromycin, ketoconazole, itraconazole, fluconazole, miconazole (systemic)

Serious Reactions

! Abrupt or too-rapid withdrawal may result in pronounced restlessness, irritability, insomnia, hand tremors, abdominal and muscle cramps, sweating, vomiting, and seizures.

Example: Doral (brand name), 15 mg

! Overdosage results in somnolence, confusion, diminished reflexes, and coma.

! Blood dyscrasias have been reported rarely.

Dental Considerations

General:

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

• Psychological and physical dependence may occur with chronic administration.

• Geriatric patients are more susceptible to drug effects; use a lower dose.

• Avoid using this drug in a patient with a history of drug abuse or alcoholism.

Consultations:

• Medical consultation may be required to assess disease control.

Teach Patient/Family to:

• When chronic dry mouth occurs, advise patient to:

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

• Use daily home fluoride products to prevent caries.

• Use sugarless gum, frequent sips of water, or saliva substitutes.

quetiapine

kwe-tye′-ah-peen

(Seroquel)

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Antipsychotic, atypical

Mechanism of Action

A dibenzothiazepine derivative that antagonizes dopamine, serotonin, histamine, and α₁-adrenergic receptors.

Therapeutic Effect: Diminishes manifestations of psychotic disorders. Produces moderate sedation, few extrapyramidal effects, and no anticholinergic effects.

Uses

Treatment of schizophrenia

Pharmacokinetics

Well absorbed after PO administration. Protein binding: 83%. Widely distributed in tissues; CNS concentration exceeds plasma concentration. Undergoes extensive first-pass metabolism in the liver. Primarily excreted in urine. Half-life: 6 hr.

Indications and Dosages

To Manage Manifestations of Psychotic Disorders, Bipolar Disorder

PO

Adults, Elderly.

Initially, 25 mg twice a day, then 25–50 mg 2–3 times a day on the second and third days, up to 300–400 mg/day in divided doses 2–3 times a day by the fourth day. Further adjustments of 25–50 mg twice a day may be made at intervals of 2 days or longer. Maintenance: 300–800 mg/day (adults); 50–200 mg/day (elderly).

Dosage in Hepatic Impairment, Elderly or Debilitated Patients, and Those Predisposed to Hypotensive Reactions

These patients should receive a lower initial dose and lower dosage increases.

Example: Seroquel (brand name), 200 mg

Side Effects/Adverse Reactions

Frequent

Headache, somnolence, dizziness

Occasional

Constipation, orthostatic hypotension, tachycardia, dry mouth, dyspepsia, rash, asthenia, abdominal pain, rhinitis

Rare

Back pain, fever, weight gain

Precautions and Contraindications

Renal impairment, hepatic impairment, cardiovascular disease, thyroid disease, hyperprolactinemia, neuromalignant syndrome, tardive dyskinesia, seizure disorders, cataracts, dementia, suicide tendency, lactation; patients should be monitored for signs and symptoms of diabetes mellitus, severe CNS depression

Drug Interactions of Concern to Dentistry

• Risk of increased CNS depression: CNS depressants

Serious Reactions

! Overdose may produce heart block, hypotension, hypokalemia, and tachycardia.

Dental Considerations

General:

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

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

• Assess for presence of extrapyramidal motor symptoms, such as tardive dyskinesia and akathisia.

• Extrapyramidal motor activity may complicate dental treatment.

• After supine positioning, have patient sit upright for at least 2 min before standing to avoid orthostatic hypotension.

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

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

• Place on frequent recall because of oral side effects.

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 and patient’s ability to tolerate stress.

• If signs of tardive dyskinesia or akathisia are present, refer to physician.

• Consultation with physician may be necessary if sedation or general anesthesia is required.

• Physician should be informed if significant xerostomic side effects occur (e.g., increased caries, sore tongue, problems eating or swallowing, difficulty we/>

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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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