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Drug Class:
Long-acting selective β2-adrenergic receptor agonist
Indications And Dosages
Prevention and Maintenance Treatment of Asthma
Prevention of Exercise-Induced Bronchospasm
COPDDental Considerations
General:
• Monitor vital signs at every appointment because of cardiovascular and respiratory side effects.
• Be aware that aspirin or sulfite preservatives in vasoconstrictor-containing products can exacerbate asthma.
• Acute asthmatic episodes may be precipitated in the dental office. Rapid-acting sympathomimetic inhalants should be available for emergency use. Salmeterol is not a rapid-acting drug and is not intended for use in acute asthmatic attacks.
• Consider semisupine chair position for patients with respiratory disease.
• Midmorning appointments and a stress-reduction protocol may be required for anxious patients.
Drug Class:
Salicylate, non-opioid analgesic
Uses
Treatment of mild-to-moderate pain or fever, including arthritis, juvenile rheumatoid arthritis
Rheumatoid Arthritis, Osteoarthritis PainDrug Interactions Of Concern To Dentistry
• Increased risk of GI complaints and occult blood loss: alcohol, NSAIDs, corticosteroids
• Increased risk of bleeding: oral anticoagulants, valproic acid, dipyridamole
• Avoid prolonged or concurrent use with NSAIDs, corticosteroids, acetaminophen
• Increased risk of hypoglycemia: oral antidiabetics
• Increased risk of toxicity: methotrexate, lithium, zidovudine
• Decreased effects of probenecid, sulfinpyrazone
• Suspected reduction in the antihypertensive and vasodilator effects of ACE inhibitors; monitor B/P if used concurrently
Serious Reactions
! Tinnitus may be the first indication that the serum salicylic acid concentration is reaching or exceeding the upper therapeutic range.
! Salsalate use may also produce vertigo, headache, confusion, drowsiness, diaphoresis, hyperventilation, vomiting, and diarrhea.
! Reye’s syndrome may occur in children with chickenpox or the flu.
! Severe overdose may result in electrolyte imbalance, hyperthermia, dehydration, and blood pH imbalance.
! GI bleeding, peptic ulcer, and Reye’s syndrome rarely occur.
Dental Considerations
General:
• Patients on chronic drug therapy rarely have symptoms of blood dyscrasias, which can include infection, bleeding, and poor healing.
• Potential cross-allergies with other salicylates such as aspirin.
• Consider semisupine chair position for patients with inflammatory joint diseases.
• Avoid prescribing aspirin-containing products because this drug is a salicylate.
• If used for dental patients, take with food or milk to decrease GI complaints; give 30 min before meals or 2 hr after meals; take with a full glass of water.
• Severe stomach bleeding may occur in patients who regularly use NSAIDs in recommended doses, when the patient is also taking another NSAID, a blood thinning, or steroid drug, if the patient has GI or peptic ulcer disease, if they are 60 yr or older, or when NSAIDs are taken longer than directed. Warn patients of the potential for severe stomach bleeding.
Teach Patient/Family to:
• Not place directly on a tooth or oral mucosa because of risk of chemical burns.
• Not exceed recommended dosage; acute toxicity may result.
• Read label on other OTC drugs; many contain aspirin.
• Avoid alcohol ingestion; GI bleeding may occur.
• Encourage effective oral hygiene to prevent soft tissue inflammation.
• Use caution to prevent injury when using oral hygiene aids.
• Warn patient of potential risks of increased GI adverse effects of NSAIDs.
Drug Class:
Pharmacokinetics
Absorbed after oral administration.
Metabolized primarily in the liver (CYP3A4); metabolites excreted in urine
Management of PhenylketonuriaPrecautions And Contraindications
Blood phenylalanine levels need to be monitored carefully during therapy
Nonresponders to therapy need to be identified
Monitor carefully in the presence of hepatic impairment
Use with caution with inhibitors of folate metabolism (e.g., methotrexate)
Possible hypotension if used with PDE-5 inhibitors (e.g., sildenafil, vardenafil)
Use with caution in patients taking levodopa (seizures, overstimulation)
Dental Considerations
General:
• Monitor patient carefully for adverse reactions/side effects of drug.
• Phenylketonuric patients frequently exhibit manifestations of neurologic injury, including mental retardation and must be managed accordingly, including knowledge of the patient’s dietary restrictions.
• Early-morning appointments and stress-reduction protocol may be needed for anxious patients.
Drug Class:
Mechanism Of Action
Therapeutic Effect: Interferes with HIV replication, slowing the progression of HIV infection.
Indications And Dosages
HIV Infection in Combination with Other Antiretrovirals
Dosage Adjustments When Given in Combination Therapy
Dental Considerations
Teach Patient/Family to:
• Encourage effective oral hygiene to prevent soft tissue inflammation.
• Use caution to prevent trauma when using oral hygiene aids.
• See dentist immediately if secondary oral infection occurs.
• Update medical/drug history if physician makes any changes in evaluation or drug regimen; include OTC, herbal, and nonherbal drugs in the update.
Drug Class:
Indications And Dosages
Myeloid Recovery Following Bone Marrow Transplant (BMT)
BMT Failure, Engraftment Delay
Stem Cell TransplantDental Considerations
General:
• Caution: graft patients or myelosuppressed patients may be at high risk for infection.
• Provide palliative care for dental emergencies only.
• Oral infections should be eliminated and/or treated aggressively.
• If additional analgesia is required for dental pain, consider alternative analgesics (NSAIDs) in patients taking narcotics for acute or chronic pain.
• Monitor and record vital signs.
• Avoid products that affect platelet function, such as aspirin and NSAIDs.
• Patient on chronic drug therapy may rarely present with symptoms of blood dyscrasias, which can include infection, bleeding, and poor healing. If dyscrasia is present, caution patient to prevent oral tissue trauma when using oral hygiene aids.
• Examine for oral manifestation of opportunistic infection.
• Palliative medication may be required for management of oral side effects.
Consultations:
• Medical consultation should include routine blood counts, including platelet counts and bleeding time.
• Consult physician; prophylactic or therapeutic antiinfectives may be indicated if surgery or periodontal treatment is required.
• 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.
Drug Class:
Antidiabetic agent, Dipeptidyl peptidase 4 inhibitors
Type 2 Diabetes Mellitus
Dosage in Renal Impairment
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.
! Overdose or insufficient food intake may produce hypoglycemia, especially with increased glucose demands.
Dental Considerations
General:
• Short appointments and a stress-reduction protocol may be required for anxious patients.
• Be prepared to manage hypoglycemia.
• Diabetics may be more susceptible to infection and have delayed wound healing.
• Question the patient about self-monitoring of drug’s antidiabetic effect including blood glucose values or finger-stick records.
• Avoid prescribing aspiring-containing products.
• Consider semisupine chair position for patient comfort if GI side effects occur.
Drug Class:
Prevention of Motion Sickness
Postoperative Nausea or VomitingDrug Class:
Insomnia
Preoperative Sedation
Sedation, DaytimeDental Considerations
General:
• Determine why the patient is taking the drug.
• Monitor vital signs at every appointment because of cardiovascular side effects. Evaluate respiration characteristics and rate.
• Patients on chronic drug therapy may rarely have symptoms of blood dyscrasias, which can include infection, bleeding, and poor healing.
• When used for sedation in dentistry:
• Assess vital signs before and after use as sedative.
• Observe respiratory dysfunction: respiratory depression, character, rate, rhythm; hold drug if respirations are less than 10/min or if pupils are dilated.
• After supine positioning, have patient sit upright for at least 2 min before standing to avoid orthostatic hypotension.
• Have someone drive patient to and from dental office when drug used for conscious sedation.
• Barbiturates induce liver microsomal enzymes, which alter the metabolism of other drugs.
• Geriatric patients are more susceptible to drug effects; use a lower dose.
selegiline hydrochloride
seh-ledge′-ill-ene high-droh-klor′-ide
(Apo-Selegiline[can], Eldepryl, Novo-Selegiline[can], Selgene[aus])
Do not confuse selegiline with Stelazine, or Eldepryl with enalapril.
Drug Class:
Adjunctive Treatment for Parkinsonism
Serious Reactions
! Symptoms of overdose may vary from CNS depression, characterized by sedation, apnea, cardiovascular collapse, and death, to severe paradoxic reactions, such as hallucinations, tremor, and seizures.
! Other serious effects may include involuntary movements, impaired motor coordination, loss of balance, blepharospasm, facial grimaces, feeling of heaviness in the lower extremities, depression, nightmares, delusions, overstimulation, sleep disturbance, and anger.
Dental Considerations
General:
• Monitor vital signs at every appointment because of cardiovascular side effects.
• After supine positioning, have patient sit upright for at least 2 min before standing to avoid orthostatic hypotension.
• Assess for presence of extrapyramidal motor symptoms, such as tardive dyskinesia and akathisia. Extrapyramidal motor activity may complicate dental treatment.
• Assess salivary flow as a factor in caries, periodontal disease, and candidiasis.
Drug Class:
Tinea PedisDrug Class:
Mechanism Of Action
Therapeutic Effect: Relieves depression, reduces obsessive-compulsive behavior, decreases anxiety.
Indications And Dosages
Depression
OCD
Panic Disorder, Posttraumatic Stress Disorder, Social Anxiety Disorder
Premenstrual Dysphoric DisorderDrug Interactions Of Concern To Dentistry
• Increased CNS depression: alcohol, CNS depressants, St. John’s wort (herb)
• Increased side effects: highly protein-bound drugs (aspirin), tricyclic antidepressants
• Increased half-life of diazepam
• Possible inhibition of sertraline metabolism: erythromycin, clarithromycin
• Potent inhibitor of CYP2D6; use drugs metabolized by the enzyme only with caution
• Possible risk of serotonin syndrome with tramadol, oxycodone
Dental Considerations
General:
• Monitor vital signs at every appointment because of cardiovascular side effects.
• After supine positioning, have patient sit upright for at least 2 min before standing to avoid orthostatic hypotension.
• Assess salivary flow as a factor in caries, periodontal disease, and candidiasis.
• Avoid dental light in patient’s eyes; offer dark glasses for patient comfort.
• Consider semisupine chair position for patient comfort if GI side effects occur.
Consultations:
• Medical consultation may be required to assess patient’s ability to tolerate stress.
• Physician should be informed if significant xerostomic side effects occur (e.g., increased caries, sore tongue, problems eating or swallowing, difficulty wearing prosthesis) so that a medication change can be considered.
Drug Class:
HyperphosphatemiaDental Considerations
General:
• Patients taking this drug may be undergoing renal dialysis; confirm the medical and drug history to plan appropriate management.
• If you prescribe medications for dental needs, have patient take medication 1 hr before or 3 hr after sevelamer doses.
• Monitor and record vital signs.
• Consider semisupine chair position for patient comfort if GI side effects occur.
• Patient may need assistance getting into and out of dental chair. Adjust chair position for patient comfort.
• Consultation with physician may be necessary if sedation or general anesthesia is required.
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