37: Prescribed and Nonprescribed Medications: Assessment, Analysis, and Associated Dental Management Guidelines


Prescribed and Nonprescribed Medications: Assessment, Analysis, and Associated Dental Management Guidelines

The following are medications that should be evaluated during patient assessment:

  • Prescribed medications
  • Over-the-counter (OTC) medications
  • Drugs associated with or causing allergic reactions
  • Corticosteroids (discussed in Chapter 40)
  • Recreational drugs
  • Herbal medications


As discussed in Chapter 1, you must obtain a complete list of medications prescribed by the patient’s physician and determine the DDIs with the anesthetics, analgesics, and antibiotics (AAAs) used in dentistry. The ideal way to assess prescribed medications is presented in Chapter 2, where digoxin (Lanoxin) and theophylline (TheoDur) are discussed.


Review the history and determine the over-the-counter (OTC) medications the patient is taking.

Aspirin or NSAIDS

Aspirin permanently affects the platelet cyclo-oxygenase system causing decreased platelet cohesiveness. Always determine if the patient is taking the 81mg or the 325mg strength aspirin. Check with the patient’s physician if either aspirin strength can be stopped temporarily prior to major dentistry. Physicians prefer not to stop aspirin intake in high risk for thrombosis patients, and in such situations, the dental provider must control bleeding using local hemostatic materials. NSAIDS also affect the same system but the effect is temporary. The platelet function returns to normal once the NSAID has cleared the system.

Nasal Decongestants, Cough or Cold Preparations, and Appetite Suppressants

All these preparations contain sympathomimetic agents, epinephrine or neosynephrine. The epinephrine in local anesthetics can synergize with the sympathomimetic agents in these preparations and cause an epinephrine overdose-type reaction resulting in blood pressure elevation, especially if the patient is using the cough/cold preparations multiple times during the day. Obviously it is best to avoid routine dental treatment for the short term if the patient is too sick. However, if you have to treat the patient for a dental emergency, use 3% mepivacaine (Carbocaine) or 4% prilocaine HCL (Citanest Plain) instead.


Check for laxative use. Laxatives do not interfere with dental treatment when used in therapeutic doses. Do not prescribe codeine or other narcotic analgesics that cause constipation to a patient who is habitually on laxatives. Laxative overuse is not uncommon in patients with eating disorders, such as anorexia and bulimia. Laxative overuse or abuse can cause significant hypokalemia or low potassium level.

The normal serum potassium is 3.5–5.5 mEq/dL, and the patient becomes symptomatic in the presence of hypokalemia. Muscle cramps, muscle weakness, tingling numbness in the hands and feet, and irregular pulse can occur with hypokalemia. Do not give any local anesthetic during the hypokalemia state because cardiac arrhythmias could occur. Be aware that hypokalemia can also occur in a patient with a history of severe vomiting and/or diarrhea.


Sulfites, bisulfites, sulpha antimicrobials, aspirin, NSAIDS, penicillins, cephalosporins, codeine, or morphine can all cause allergies, and you must determine the presence of an allergy history to these medications, before you begin any dental treatment.

Anaphylactic reactions can be mild, moderate, or severe. The longer it takes for reactions to occur, the better the prognosis. Acute reactions occur within the first hour of taking the drug. Most frequently, however, the reaction occurs within minutes after taking the drug.

Acute Anaphylactic Reaction

Anaphylaxis Diagnosis and Treatment

Anaphylaxis is highly likely when one of the following three criteria is fulfilled:

1. Sudden onset of an illness (within minutes to several hours), with involvement of the skin, mucosal tissue, or both. The patient can present with hives, itching, flushed feeling, and swollen lips, tongue, uvula, or floor of the mouth. The patient can have a rash, sudden respiratory symptoms and signs, a sudden drop in the blood pressure, collapse, and incontinence. So in addition to the rash, the patient has to have either respiratory symptoms (SOB, wheezing, stridor, respiratory distress) or a sudden drop in the BP and associated collapse.
2. Two or more of the following symptoms and signs, as previously outlined, occurring suddenly within minutes to hours following exposure to a known or unknown allergen: sudden skin or mucosal symptoms and signs, sudden respiratory symptoms and signs, sudden drop in the BP, and sudden gastrointestinal symptoms resulting in abdominal cramping, abdominal pain, and/or vomiting.
3. The adult patient experiences a drop in the systolic blood pressure below />

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Jan 4, 2015 | Posted by in General Dentistry | Comments Off on 37: Prescribed and Nonprescribed Medications: Assessment, Analysis, and Associated Dental Management Guidelines
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