V
Drug Class:
Indications and Dosages
Prevention of Genital Herpes
PO
Dosage in Renal Impairment
Dosage and frequency are modified on the basis of creatinine clearance.
| Creatinine Clearance | Herpes Zoster | Genital Herpes |
| 50 ml/min or higher | 1 g q8h | 500 mg q12h |
| 30–49 ml/min | 1 g q12h | 500 mg q12h |
| 10–29 ml/min | 1 g q24h | 500 mg q24h |
| Less than 10 ml/min | 500 mg q24h | 500 mg q24h |
Precautions and Contraindications
Hypersensitivity to or intolerance of acyclovir, valacyclovir, or their components
Dental Considerations
General:
• Determine why the patient is taking the drug.
• Be aware of general discomfort associated with shingles; acute symptoms may preclude patient’s routine dental visit or mandate short appointments.
• Patients on chronic drug therapy may rarely have symptoms of blood dyscrasias, which can include infection, bleeding, and poor healing.
Drug Class:
Indications and Dosages
Prevention of CMV after Transplant
PO
Dosage in Renal Impairment
Dosage and frequency are modified on the basis of creatinine clearance.
| Creatinine Clearance | Induction Dosage | Maintenance Dosage |
| 60 ml/min or more | 900 mg twice a day | 900 mg once a day |
| 40–59 ml/min | 450 mg twice a day | 450 mg once a day |
| 25–36 ml/min | 450 mg once a day | 450 mg every 2 days |
| 10–24 ml/min | 450 mg every 2 days | 450 mg twice a wk |
Dental Considerations
General:
• Patients on chronic drug therapy may rarely have symptoms of blood dyscrasias, which can include infection, bleeding, and poor healing.
• Examine for oral manifestation of opportunistic infection.
• Place on frequent recall to evaluate healing response.
• Consider local hemostasis measures to control excessive bleeding.
Drug Class:
Side Effects/Adverse Reactions
Drug Interactions of Concern to Dentistry
• Increased effects: CNS depressants; carbamazepine, phenobarbital levels may be increased; phenothiazines can lower the seizure threshold
• Increased bleeding and toxicity: salicylates, NSAIDs
• Increased blood levels: erythromycin
• Increased serum levels of amitriptyline, nortriptyline (start with low dose and monitor)
Dental Considerations
General:
• Patients on chronic drug therapy may rarely have symptoms of blood dyscrasias, which can include infection, bleeding, and poor healing.
• Evaluate for clotting ability during gingival instrumentation because inhibition of platelet aggregation may occur.
• Consider semisupine chair position for patient comfort if GI side effects occur.
• Place on frequent recall if gingival overgrowth occurs.
• Ask about type of epilepsy, seizure frequency, and quality of seizure control.
Teach Patient/Family to:
• Encourage effective oral hygiene to prevent soft tissue inflammation and minimize gingival overgrowth.
• Use caution to prevent injury when using oral hygiene aids.
• Use powered tooth brush if patient has difficulty holding conventional devices.
• Schedule frequent oral prophylaxis if gingival overgrowth occurs.
Drug Class:
Side Effects/Adverse Reactions
Precautions and Contraindications
Perforated bladder, sensitivity to valrubicin, severe irritated bladder, small bladder capacity, UTI
Dental Considerations
General:
• If additional analgesia is required for dental pain, consider alternative analgesics (NSAIDs or acetaminophen) 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.
• Offer patient frequent breaks if urinary frequency is a concern.
• Avoid prescribing drugs that could cause urinary retention, such as drugs with anticholinergic activity.
Drug Class:
Angiotensin II receptor (AT1) antagonist
Mechanism of Action
Therapeutic Effect: Causes vasodilation, decreases peripheral resistance, and decreases B/P.
Dental Considerations
General:
• Monitor vital signs at every appointment because of cardiovascular side effects.
• Limit use of sodium-containing products, such as saline IV fluids, for patients with a dietary salt restriction.
• Stress from dental procedures may compromise cardiovascular function; determine patient risk.
• Short appointments and a stress-reduction protocol may be required for anxious patients.
• Use precaution if sedation or general anesthesia is required; risk of hypotensive episode.
Drug Class:
Glycopeptide-type antiinfective
Indications and Dosages
Treatment of Bone, Respiratory Tract, Skin, and Soft Tissue Infections; Endocarditis, Peritonitis, and Septicemia; Prevention of Bacterial Endocarditis in Those at Risk (If Penicillin Is Contraindicated) When Undergoing Biliary, Dental, GI, GU, or Respiratory Surgery or Invasive Procedures
Dental Considerations
General:
• Monitor vital signs at every appointment because of cardiovascular side effects.
• Administer IV slowly over 1 hr; administration that is too rapid can lead to a fall in B/P (monitor) and a red rash on the face, neck, and chest caused by local histamine release. No specific treatment is required for this reaction; evaluate recovery progress.
Drug Class:
Indications and Dosages
Precautions and Contraindications
Concurrent use of α-adrenergic blockers, sodium nitroprusside, or nitrates in any form
Drug Interactions of Concern to Dentistry
• Dose adjustments caused by potential drug interactions—do not exceed the maximum single dose of 2.5 mg in a 72-hr period: ritonavir
• Do not exceed 2.5 mg in a 24-hr period: indinavir, ketoconazole (400 mg), itraconazole (400 mg)
• Do not exceed 5 mg in a 24-hr period: ketoconazole (200 mg), itraconazole (200 mg), erythromycin
• Increased plasma levels: drugs that are potent inhibitors of CYP3A4 (e.g., erythromycin, ketoconazole)
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