F

famciclovir

fam-si′-klo-veer

(Famvir)

Do not confuse Famvir with Femhrt.

Category and Schedule

Pregnancy Risk Category: B

Drug Class:

Antiviral

Indications and Dosages

Herpes Zoster

PO

Adults.

500 mg q8h for 7 days.

Recurrent Genital Herpes

PO

Adults.

125 mg twice a day for 5 days.

Suppression of Recurrent Genital Herpes

PO

Adults.

250 mg twice a day for up to 1 yr.

Recurrent Herpes Simplex

PO

Adults.

500 mg twice a day for 7 days.

Dosage in Renal Impairment

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

Creatinine Clearance	Herpes Zoster	Genital Herpes
40–59 ml/min	500 mg q12h	125 mg q12h
20–39 ml/min	500 mg q24h	125 mg q24h
Less than 20 ml/min	250 mg q24h	125 mg q24h

Dosage in Hemodialysis Patients

For adults with herpes zoster, give 250 mg after each dialysis treatment; for adults with genital herpes, give 125 mg after each dialysis treatment.

Side Effects/Adverse Reactions

Frequent

Headache, nausea

Occasional

Dizziness, somnolence, numbness of feet, diarrhea, vomiting, constipation, decreased appetite, fatigue, fever, pharyngitis, sinusitis, pruritus

Rare

Insomnia, abdominal pain, dyspepsia, flatulence, back pain, arthralgia

Precautions and Contraindications

Hypersensitivity

Caution:

Children younger than 18 yr, lactation, elderly, hepatic and renal function impairment

Drug Interactions of Concern to Dentistry

• None reported in otherwise uncompromised patients

Example: Famciclovir (generic name), 250 mg

Serious Reactions

! None known

Dental Considerations

General:

• Determine why the patient is taking the drug.

• Consider semisupine chair position for patient comfort because of GI effects of drug.

• Be aware of general discomfort associated with shingles; acute symptoms may preclude patient’s routine dental visit or mandate short appointments.

Consultations:

• Medical consultation may be required to assess disease control and patient’s ability to tolerate stress.

famotidine

fam-oh′-tah-deen

(Amfamox[aus], Novo-Famotidine[can] Pepcid, Pepcid AC, Pepcidine[aus], Ulcidine[can])

Category and Schedule

Pregnancy Risk Category: B

OTC (10 mg tablets)

Drug Class:

Histamine H₂-receptor antagonist

Mechanism of Action

An antiulcer agent and gastric acid secretion inhibitor that inhibits histamine action at H₂ receptors of parietal cells.

Therapeutic Effect: Inhibits gastric acid secretion when fasting, at night, or when stimulated by food, caffeine, or insulin.

Uses

Short-term treatment of active duodenal ulcer, maintenance therapy for duodenal ulcer, Zollinger-Ellison syndrome, multiple endocrine adenomas, benign gastric ulcers, gastroesophageal reflux disease (GERD); OTC: heartburn, acid indigestion

Pharmacokinetics

Rapidly, incompletely absorbed from the GI tract. Protein binding: 15%–20%. Partially metabolized in the liver. Primarily excreted in urine. Not removed by hemodialysis.

Half-life: 2.5–3.5 hr (increased with impaired renal function).

Indications and Dosages

Acute Treatment of Duodenal and Gastric Ulcers

PO

Adults, Elderly, Children 12 yr and older.

40 mg/day at bedtime.

Children 1–11 yr.

0.5 mg/kg/day at bedtime. Maximum: 40 mg/day.

Duodenal Ulcer Maintenance

PO

Adults, Elderly.

20 mg/day at bedtime.

GERD

PO

Adults, Elderly, Children 12 yr and older.

20 mg twice a day.

Children 1–11 yr.

1 mg/kg/day in 2 divided doses.

Children 3–11 mo.

0.5 mg/kg/dose twice a day.

Children younger than 3 mo.

0.5 mg/kg/dose once a day.

Example: Famotidine (generic name), 20 mg

Esophagitis

PO

Adults, Elderly, Children 12 yr and older.

2–40 mg twice a day.

Hypersecretory Conditions

PO

Adults, Elderly, Children 12 yr and older.

Initially, 20 mg q6h. May increase up to 160 mg q6h.

Acid Indigestion, Heartburn (OTC)

PO

Adults, Elderly, Children 12 yr and older.

10–20 mg 15–60 min before eating. Maximum: 2 doses per day.

Usual Parenteral Dosage

IV

Adults, Elderly, Children 12 yr and older.

20 mg q12h.

Dosage in Renal Impairment

Dosing frequency is modified on the basis of creatinine clearance.

Creatinine Clearance	Dosage Interval
10–50 ml/min	q24h
Less than 10 ml/min	q36–48h

Side Effects/Adverse Reactions

Occasional

Headache

Rare

Constipation, diarrhea, dizziness

Precautions and Contraindications

Hypersensitivity

Caution:

Lactation, children, severe renal disease, severe hepatic function, elderly, RPD tablets contain aspartame (caution: phenylketonuria)

Drug Interactions of Concern to Dentistry

• Decreased absorption of ketoconazole or itraconazole (take doses 2 hr apart)

Serious Reactions

! None known

Dental Considerations

General:

• Avoid prescribing aspirin-containing products in patients with active GI disease.

• Consider semisupine chair position for patient comfort because of GI effects of disease.

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

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent gingival inflammation.

• 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.

febuxostat

feb-ux′-oh-stat

(Uloric)

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Xanthine oxidase inhibitor

Example: Uloric (brand name), 40 mg

Mechanism of Action

A non-purine, selective inhibitor of xanthine oxidase.

Therapeutic Effect: Decreases serum uric acid.

Uses

Hyperuricemia in patients with gout

Pharmacokinetics

Partially absorbed. Protein binding: 99.2%. Extensively metabolized by both conjugation via uridine diphosphate glucuronosyltransferase enzymes and oxidation via CYP enzymes, including CYP1A2, 2C8, and 2C9. Partially excreted in urine; partially excreted in feces. Half-life: 5–8 hr.

Indications and Dosages

Hyperuricemia in Patients with Gout

PO

Adults.

40 mg a day. May increase to 80 mg/day in patients who do not achieve serum uric acid < 6 mg/dl after 2 wk of 40-mg treatment.

Side Effects/Adverse Reactions

Rare (≤1%)

Dizziness, rash, nausea, abnormal liver function tests (LFTs), arthralgia

Precautions and Contraindications

Hypersensitivity to febuxostat or its components

Drugs metabolized by xanthine oxidase (e.g., azathioprine, mercaptopurine, theophylline)

Caution:

Hepatic impairment

Renal impairment

Pregnancy

Cardiovascular disease

Drug Interactions of Concern to Dentistry

• Drugs metabolized by xanthine oxidase (e.g., azathioprine, mercaptopurine, theophylline): May increase plasma concentrations of these agents.

Serious Reactions

! Elevated transaminases have been reported.

! Cardiovascular thromboembolic events (cardiovascular deaths, non-fatal myocardial infarctions, and non-fatal strokes) may occur.

! Gout flares may occur during the initiation of treatment.

Dental Considerations

General:

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

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.

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent soft tissue inflammation.

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

felbamate

fel′-ba-mate

(Felbatol)

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Anticonvulsant (carbamate derivative)

Mechanism of Action

An anticonvulsant, structurally similar to meprobamate, that weakly blocks repetitive, sustained firing of neurons by enhancing the ability of γ-aminobutyric acid (GABA) and antagonizes the strychnine-insensitive glycine recognition site of the N-methyl-D-aspartate receptor-ionophore complex.

Therapeutic Effect: Decreases seizure activity.

Uses

Used alone or as adjunct therapy in partial seizures; also for partial seizures associated with Lennox-Gastaut syndrome in children; because of severe side effects use only for severe seizures when other therapy is inadequate

Pharmacokinetics

Rapidly and almost completely absorbed after PO administration. Protein binding: 22%–25%, primarily to albumin. Partially excreted unchanged in the urine. Half-life: 20–23 hr.

Indications and Dosages

Monotherapy or Adjunctive Therapy in the Treatment of Partial Seizures, with and without Generalization

PO

Adults, Children older than 14 yr.

Initially, 1200 mg/day in divided doses 3–4 times a day. At week 2, increase the felbamate dosage to 2400 mg/day while reducing the dosage of other antiepileptic drugs (AEDs) up to an additional one-third of their original dosage. At week 3, increase the felbamate dosage up to 3600 mg/day and continue to reduce the dosage of other AEDs as clinically indicated.

Adjunctive Therapy in the Treatment of Partial Seizures, with and without Generalization

PO

Adults, Children older than 14 yr.

Add 1200 mg/day in divided doses 3–4 times a day while reducing present AEDs by 20% in order; control plasma concentrations of concurrent phenytoin, valproic acid, and carbamazepine and its metabolites. Increase dosage by 1200 mg/day increments at weekly intervals to 3600 mg/day.

Side Effects/Adverse Reactions

Frequent

Somnolence, dizziness, headache, fatigue, nausea, anorexia, vomiting, constipation

Occasional

Chest pain, palpitations, tachycardia, depression and behavioral changes, anxiety, nervousness, ataxia, malaise, agitation, rash, acne, pruritus, diarrhea, weight gain, tremors, abnormal vision, diplopia, sinusitis, difficulty with coordination, taste perversion

Rare

Delusion, bradycardia, hallucinations, urinary retention, acute renal failure

Precautions and Contraindications

History of any blood dyscrasia or hepatic dysfunction, hypersensitivity to felbamate, its ingredients, or known sensitivity to other carbamates

Example: Felbamate (generic name), 400 mg

Caution:

Lactation, warning of increased risk of aplastic anemia, hepatic failure; safety and efficacy in children with other types of seizures has not been established

Drug Interactions of Concern to Dentistry

• Decreased effects of carbamazepine

• Increased photosensitization: drugs causing photosensitivity (e.g., tetracyclines)

Serious Reactions

Alert

! Aplastic anemia has been reported during felbamate therapy.

! Hepatic failure resulting in death has been reported.

Dental Considerations

General:

• Examine for evidence of oral manifestations of blood dyscrasia (infection, bleeding, poor healing).

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

• Determine type of epilepsy, seizure frequency, and quality of seizure control. A stress reduction protocol may be required.

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

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

• Advise patient if dental drugs prescribed have a potential for photosensitivity.

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.

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

• 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.

felodipine

fell-oh′-da-peen

(AGON SR[aus], Felodur ER[aus], Plendil, Plendil ER[aus], Renedil[can])

Do not confuse Plendil with Pletal, or Renedil with Prinivil.

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Calcium channel blocker

Mechanism of Action

An antihypertensive and antianginal agent that inhibits calcium movement across cardiac and vascular smooth-muscle cell membranes. Potent peripheral vasodilator (does not depress SA or AV nodes).

Therapeutic Effect: Increases myocardial contractility, heart rate, and cardiac output; decreases peripheral vascular resistance and B/P.

Example: Felodipine (generic name), 10 mg

Uses

Essential hypertension, alone or with other antihypertensives, chronic angina pectoris

Pharmacokinetics

Rapidly, completely absorbed from the GI tract. Protein binding: greater than 99%. Undergoes first-pass metabolism in the liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 11–16 hr.

Indications and Dosages

Hypertension

PO

Adults.

Initially, 5 mg/day as single dose.

Elderly, Patients with impaired hepatic function.

Initially, 2.5 mg/day. Adjust dosage at no less than 2-wk intervals. Maintenance: 2.5–10 mg/day.

Side Effects/Adverse Reactions

Frequent

Headache, peripheral edema

Occasional

Flushing, respiratory infection, dizziness, light-headedness, asthenia (loss of strength, weakness), gingival enlargement

Rare

Paresthesia, abdominal discomfort, nervousness, muscle cramping, cough, diarrhea, constipation

Precautions and Contraindications

Hypersensitivity, sick sinus syndrome, second- or third-degree heart block

Caution:

CHF, hypotension less than 90 mm Hg systolic, hepatic injury, lactation, children, renal disease, elderly

Drug Interactions of Concern to Dentistry

• Decreased effect: NSAIDs, phenobarbital, carbamazepine

• Increased effect: parenteral and inhalational general anesthetics, other drugs with hypotensive actions

• Increased effects of nondepolarizing muscle relaxants, diazepam, midazolam

• Increased plasma levels: itraconazole, erythromycin, carbamazepine

Serious Reactions

! Overdose produces nausea, somnolence, confusion, slurred speech, hypotension and bradycardia.

Dental Considerations

General:

• Monitor cardiac status; take vital signs at each appointment because of cardiovascular side effects. Consider a stress reduction protocol to prevent stress-induced angina during the dental appointment.

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

• Place on frequent recall to monitor gingival condition.

• Limit use of sodium-containing products, such as saline IV fluids, for patients with a dietary salt restriction.

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

• Use vasoconstrictors with caution, in low doses and with careful aspiration. Avoid use of gingival retraction cord with epinephrine.

• Use precaution if sedation or general anesthesia is required; risk of hypotensive episode.

Consultations:

• Medical consultation may be required to assess disease control.

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

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent gingival inflammation and minimize enlargement.

• Schedule frequent oral prophylaxis if enlargement 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 for anticaries effect.

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

fenofibrate

fee-no-fye′-brate

(Apo-Fenofibrate[can], Lofibra, TriCor)

Do not confuse TriCor with Tracleer.

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Antihyperlipidemic

Mechanism of Action

An antihyperlipidemic that enhances synthesis of lipoprotein lipase and reduces triglyceride-rich lipoproteins and VLDLs.

Therapeutic Effect: Increases VLDL catabolism and reduces total plasma triglyceride levels.

Uses

Treatment of hyperlipidemia, types IV and V, as an adjunct to diet therapy

Pharmacokinetics

Well absorbed from the GI tract. Absorption increased when given with food. Protein binding: 99%. Rapidly metabolized in the liver to active metabolite. Excreted primarily in urine; lesser amount in feces. Not removed by hemodialysis. Half-life: 20 hr.

Indications and Dosages

Reduction of Very High Serum Triglyceride Levels in Patients at Risk for Pancreatitis

PO

Adults, Elderly.

Initially, 67 mg/day (capsule); may increase to 200 mg/day. Or initially, 48 mg/day (tablet); may increase to 145 mg/day.

Hypercholesterolemia

PO

Adults, Elderly.

200 mg/day (capsule) with meals. Or 145 mg/day (tablet) with meals.

Side Effects/Adverse Reactions

Frequent

Pain, rash, headache, asthenia or fatigue, flu symptoms, dyspepsia, nausea or vomiting, rhinitis

Occasional

Diarrhea, abdominal pain, constipation, flatulence, arthralgia, decreased libido, dizziness, pruritus

Rare

Increased appetite, insomnia, polyuria, cough, blurred vision, eye floaters, earache

Example: Fenofibrate (generic name), 160 mg

Precautions and Contraindications

Gallbladder disease, hypersensitivity to fenofibrate, severe renal or hepatic dysfunction (including primary biliary cirrhosis, unexplained persistent liver function abnormality)

Caution:

Monitor liver function; may lead to cholelithiasis; can be associated with myositis, myopathy, or rhabdomyolysis; avoid if lactating; safe use in children unknown; discontinue use if no response in 2 mo; increased anticoagulant effect with oral anticoagulants

Drug Interactions of Concern to Dentistry

• None reported

Serious Reactions

! Fenofibrate may increase excretion of cholesterol into bile, leading to cholelithiasis.

! Pancreatitis, hepatitis, thrombocytopenia, and agranulocytosis occur rarely.

Dental Considerations

General:

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

• Consider semisupine chair position for patient comfort because of GI side effects of drug.

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

• Avoid dental light in patient’s eyes; offer dark glasses for patient comfort.

Consultations:

• In a patient with symptoms of blood dyscrasias, request a medical consultation for blood studies and postpone treatment until normal values are reestablished.

Teach Patient/Family to:

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

• Prevent trauma when using oral hygiene aids.

fenoprofen calcium

fen-oh-proe′-fen

(Nalfon)

Do not confuse Nalfon with Naldecon.

Category and Schedule

Pregnancy Risk Category: B (D if used in third trimester or near delivery)

Drug Class:

Nonsteroidal antiinflammatory, propionic acid derivative

Mechanism of Action

An NSAID that produces analgesic and antiinflammatory effects by inhibiting prostaglandin synthesis.

Therapeutic Effect: Reduces the inflammatory response and intensity of pain.

Uses

Treatment of mild-to-moderate pain, osteoarthritis, rheumatoid arthritis, acute gout, arthritis, ankylosing spondylitis, nonrheumatic inflammation, dysmenorrhea

Pharmacokinetics

PO: Peak 2 hr. Half-life: 3–3.5 hr; 99% plasma protein binding; metabolized in liver; excreted in urine (metabolites), breast milk.

Example: Fenoprofen calcium (generic name), 600 mg

Indications and Dosages

Mild-to-Moderate Pain

PO

Adults, Elderly.

200 mg q4–6h as needed.

Rheumatoid Arthritis, Osteoarthritis

PO

Adults, Elderly.

300–600 mg 3–4 times a day.

Side Effects/Adverse Reactions

Frequent

Headache, somnolence, dyspepsia, nausea, vomiting, constipation

Occasional

Dizziness, pruritus, nervousness, asthenia, diarrhea, abdominal cramps, flatulence, tinnitus, blurred vision, peripheral edema and fluid retention

Precautions and Contraindications

Active peptic ulcer disease, chronic inflammation of GI tract, GI bleeding or ulceration, history of hypersensitivity to aspirin or NSAIDs, significant renal impairment

Caution:

Lactation, children, bleeding disorders, GI disorders, cardiac disorders, hypersensitivity to other antiinflammatory agents

Drug Interactions of Concern to Dentistry

• GI bleeding, ulceration: salicylates, alcohol, corticosteroids, other NSAIDs, bisphosphonates

• May decrease effects of fenoprofen: phenobarbital

• Nephrotoxicity: acetaminophen (prolonged use)

• Possible risk of decreased renal function: cyclosporine

• Probable increased bleeding risk: warfarin

• Suspected increased risk for methotrexate toxicity

• First-time users of SSRIs also taking NSAIDs may have a higher risk of GI side effects; avoid use of NSAIDs in these patients

Serious Reactions

! Overdose may result in acute hypotension and tachycardia.

! Rare reactions with long-term use include peptic ulcer disease, GI bleeding, gastritis, severe hepatic reaction (jaundice), nephrotoxicity (hematuria, dysuria, proteinuria) and a severe hypersensitivity reaction (bronchospasm, angioedema).

Dental Considerations

General:

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

• Avoid prescribing in pregnancy.

• Possibility of cross-allergenicity when patient is allergic to aspirin.

• 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 years or older, or when NSAIDs are taken longer than directed. Warn patients of the potential for severe stomach bleeding.

Consultations:

• Medical consultation may be required to assess disease control.

Teach Patient/Family to:

• Encourage effective oral hygiene to prevent gingival inflammation.

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

• Warn patient of potential risks of NSAIDs.

• 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.

fentanyl, buccal

fen′ta nil bu′ck-al

(Onsolis)

Do not confuse fentanyl with alfentanil or sufentanil.

Category and Schedule

Pregnancy Risk Category: C

Drug Class:

Opioid analgesic

Mechanism of Action

Interacts with opioid receptors in the CNS to alter pain perception.

Therapeutic Effect: Alters pain perception and increases pain threshold.

Uses

Management of breakthrough cancer pain in patients with malignancies who are using or tolerant to opioids

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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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