23: Z

Z

zafirlukast

za-feer′-loo-kast

Do not confuse Accolate with Accupril or Aclovate.

Category and Schedule

Pregnancy Risk Category: B

Drug Class:

Selective leukotriene receptor antagonist

Mechanism of Action

An antiasthmatic that binds to leukotriene receptors, inhibiting bronchoconstriction caused by sulfur dioxide, cold air, and specific antigens, such as grass, cat dander, and ragweed.

Therapeutic Effect: Reduces airway edema and smooth muscle constriction; alters cellular activity associated with the inflammatory process.

Uses

Prophylaxis and chronic treatment of asthma

Pharmacokinetics

Rapidly absorbed after PO administration (food reduces absorption). Protein binding: 99%. Extensively metabolized in the liver. Primarily excreted in feces. Unknown if removed by hemodialysis. Half-life: 10 hr.

Indications and Dosages

Bronchial Asthma

PO

Adults, Elderly, Children 12 yr and older.

20 mg twice a day.

Children 5–11 yr.

10 mg twice a day.

Side Effects/Adverse Reactions

Frequent

Occasional

Nausea, diarrhea

Rare

Generalized pain, asthenia, myalgia, fever, dyspepsia, vomiting, dizziness

Precautions and Contraindications

Hypersensitivity, hepatic dysfunction with prior use of zafirlukast

Caution:

Not for acute bronchospasm, food decreases bioavailability, pregnancy category B, lactation, patients younger than 7 yr, hepatic impairment, liver enzyme elevation, elderly (increased infection); if liver dysfunction suspected, discontinue use and measure liver enzymes, serum ALT (SPGT)

Drug Interactions of Concern to Dentistry

• Increased PT with concurrent use of warfarin

• Reduced plasma levels: erythromycin, terfenadine, theophylline

• Increased plasma levels with aspirin

• Inhibits CYP2C9 and CYP3A4: use with caution when drugs metabolized by these enzymes are used

Serious Reactions

! Concurrent administration of inhaled corticosteroids increases the risk of upper respiratory tract infection.

Example: Zafirlukast (generic name), 10 mg

Dental Considerations

General:

• Midday appointments and a stress-reduction protocol may be required for anxious patients.

• Avoid prescribing aspirin-containing products and NSAIDs.

• Acute asthmatic episodes may be precipitated in the dental office. Sympathomimetic inhalants should be available for emergency use. A stress-reduction protocol may be required.

• Be aware that aspirin or sulfite preservatives in vasoconstrictor-containing products can exacerbate asthma.

• Consider semisupine chair position for patients with respiratory disease or if GI side effects occur.

Consultations:

• Medical consultation may be required to assess disease control.

Teach Patient/Family to:

• Use powered tooth brush if patient has difficulty holding conventional devices.

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

zalcitabine

zal-site′-ah-been

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Synthetic pyrimidine antiviral

Mechanism of Action

A nucleoside reverse transcriptase inhibitor that inhibits viral DNA synthesis.

Therapeutic Effect: Prevents replication of HIV-1.

Uses

Treatment of advanced HIV infection in combination with zidovudine

Pharmacokinetics

Readily absorbed from the GI tract (absorption decreased by food). Protein binding: less than 4%. Undergoes phosphorylation intracellularly to the active metabolite. Primarily excreted in urine. Removed by hemodialysis. Half-life: 1–3 hr; metabolite, 2.6–10 hr (increased in impaired renal function).

Indications and Dosages

HIV Infection (in Combination with Other Antiretrovirals)

PO

Adults, Children 13 yr and older.

Children younger than 13 yr.

0.01 mg/kg q8h. Range: 0.005–0.01 mg/kg q8h.

Dosage in Renal Impairment

Dosage and frequency are modified on the basis of creatinine clearance.

Creatinine Clearance	Dose
10–40 ml/min	0.75 mg q12h
Less than 10 ml/min	0.75 mg q24h

Side Effects/Adverse Reactions

Frequent

Peripheral neuropathy, fever, fatigue, headache, rash

Occasional

Diarrhea, abdominal pain, oral ulcers, cough, pruritus, myalgia, weight loss, nausea, vomiting

Rare

Nasal discharge, dysphagia, depression, night sweats, confusion

Precautions and Contraindications

Moderate or severe peripheral neuropathy

Caution:

Lactation, children younger than 13 yr, renal impairment, hepatic impairment, risk of serious peripheral neuropathy, risk of severe hepatic impairment, CHF

Drug Interactions of Concern to Dentistry

• Increased peripheral neuropathy: metronidazole, dapsone, or other drugs associated with peripheral neuropathy

Serious Reactions

! Peripheral neuropathy (characterized by numbness, tingling, burning, and pain in the lower extremities) occurs in 17% to 31% of patients. These symptoms may be followed by sharp, shooting pain and progress to a severe, continuous, burning pain that may be irreversible if the drug is not discontinued in time.

! Pancreatitis, leukopenia, neutropenia, eosinophilia, and thrombocytopenia occur rarely.

Dental Considerations

General:

• Examine oral cavity for side effects if on long-term drug therapy.

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

• Palliative medication may be required for management of oral side effects.

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

• Prophylactic antibiotics may be indicated to prevent infection if surgery or deep scaling is planned.

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

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.

• Use caution to prevent injury when using oral hygiene aids.

• See dentist immediately if secondary oral infection occurs.

• 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.

zaleplon

zal′-eh-plon

(Sonata, Stamoc[can])

Category and Schedule

Pregnancy Risk Category: C

Controlled Substance: Schedule IV

Drug Class:

Example: Zaleplon (generic name), 10 mg

Mechanism of Action

A nonbenzodiazepine that enhances the action of the inhibitory neurotransmitter gamma-aminobutyric acid.

Therapeutic Effect: Induces sleep.

Uses

Short-term treatment of insomnia

Pharmacokinetics

PO: Rapid absorption, bioavailability 30%, peak plasma levels 1 hr, wide tissue distribution, rapid hepatic metabolism (CYP3A4 minor pathway), excretion in urine; heavy, high-fat meal significantly delays absorption

Indications and Dosages

Insomnia

PO

Adults.

10 mg at bedtime. Range: 5–20 mg.

Elderly.

5 mg at bedtime.

Side Effects/Adverse Reactions

Expected

Somnolence, sedation, mild rebound insomnia (on first night after drug is discontinued)

Frequent

Nausea, headache, myalgia, dizziness

Occasional

Abdominal pain, asthenia, dyspepsia, eye pain, paresthesia

Rare

Tremors, amnesia, hyperacusis (acute sense of hearing), fever, dysmenorrhea

Precautions and Contraindications

Severe hepatic impairment

Caution:

Abuse potential similar to benzodiazepines, elderly, debilitated, smaller patients adjust dose downward; lactation, children

Drug Interactions of Concern to Dentistry

• Caution when using dental drugs that inhibit or induce cytochrome P-450 enzymes; this drug is a minor substrate for CYP3A4; however, use caution (see Appendix I).

• CNS depression: all CNS depressant drugs.

Serious Reactions

! Zaleplon may produce altered concentration, behavior changes, and impaired memory.

! Taking the drug while up and about may result in adverse CNS effects, such as hallucinations, impaired coordination, dizziness, and light-headedness.

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

Dental Considerations

General:

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

• Determine why patient is taking the drug.

• 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:

• When chronic dry mouth occurs, advise patient to:

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

• Use daily home fluoride products for anticaries effect.

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

zanamivir

za-na′-mi-veer

Category and Schedule

Pregnancy Risk Category: B

Drug Class:

Mechanism of Action

An antiviral that appears to inhibit the influenza virus enzyme neuraminidase, which is essential for viral replication.

Therapeutic Effects: Prevents viral release from infected cells.

Uses

Treatment of uncomplicated influenza in adults and children older than 7 yr with symptoms of no more than 2 days; more effective against influenza type A virus.

Pharmacokinetics

Inhalation: 4%–17% of inhaled dose is absorbed, peak serum levels 1–2 hr, low plasma protein binding (less than 10%), excreted unchanged in urine.

Indications and Dosages

Influenza Virus

Inhalation

Adults, Elderly, Children 7 yr and older.

2 inhalations (one 5-mg blister per inhalation for a total dose of 10 mg) twice a day (about 12 hr apart) for 5 days.

Prevention of Influenza Virus

Inhalation

Adults, Elderly.

2 inhalations once a day for the duration of the exposure period.

Side Effects/Adverse Reactions

Occasional

Diarrhea, sinusitis, nausea, bronchitis, cough, dizziness, headache

Rare

Malaise, fatigue, fever, abdominal pain, myalgia, arthralgia, urticaria

Precautions and Contraindications

Hypersensitivity

Caution:

Teach use of inhaler to patient; chronic obstructive pulmonary disease or asthma does not preclude influenza vaccine, safety in children younger than 12 yr not established

Drug Interactions of Concern to Dentistry

• None reported

Serious Reactions

! Neutropenia may occur. Bronchospasm may occur in those with a history of COPD or bronchial asthma.

Dental Considerations

General:

• Acute influenza patients are unlikely to be seen in the dental office except for dental emergencies.

• Use precautions to prevent spread of flu virus in office.

ziconotide

zi-koe′-no-tide

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Mechanism of Action

A synthetic peptide that selectively binds to and blocks N-type voltage-sensitive calcium channels located on afferent nerves in the spinal cord.

Therapeutic Effect: Blocks excitatory neurotransmitter release, reducing sensitivity to painful stimuli.

Uses

Reduction of chronic pain in the body

Pharmacokinetics

Elimination Half-life: 4.6 hr after intrathecal administration. 50% bound to plasma proteins; metabolized in multiple organs. Excreted in urine as proteolytic degradation products.

Indications and Dosages

Pain Control

Intrathecal

Adults, Elderly.

Initially, 2.4 mcg/day (0.1 mcg/hr). May titrate to maximum of 19.2 mcg/day (0.8 mcg/hr).

Side Effects/Adverse Reactions

Frequent

Dizziness, nausea, somnolence, weakness, diarrhea, confusion, ataxia, headache, vomiting, gait disturbance, memory impa/>

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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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