9: Pharmacology

CHAPTER 9 Pharmacology

PHARMACOLOGICAL PRINCIPLES AND CONCEPTS

Understanding a pharmacological effect on a patient and possible interaction with other drugs is essential to safe dental care. Thorough medical history helps identify adverse effects and potential drug interactions with current prescription (Rx) drugs, dental drugs, over-the-counter (OTC) drugs. Dental settings are advised to have the current Physician’s Desk Reference (PDR) Index for reference information concerning drug information by brand and generic names, product categories, manufacturers.

See Chapters 6, General and Oral Pathology: disease states; 14, Pain Management: physical classification system; 8, Microbiology and Immunology: antibiotics; 10, Medical and Dental Emergencies: allergy-related emergencies in a dental setting; 11, Clinical Treatment: contraindications, xerostomia.
E. Reactions to drugs:

Prescription Writing

Effective prescription writing requires accurate diagnosis; proper selection of drug, dosage form and route of administration; proper size and timing of dose; precise dispensing; accurate labeling; and correct packaging. Prescription is provided by a physician, osteopath, dentist, or other approved practitioner. Note that OTC drugs do not require a prescription but must be included with drug history.

Table 9-1 Pharmacological abbreviations for prescription writing

Abbreviation Meaning
a.c. Before meals
b.i.d. Twice daily
h.s. At bedtime
q.d. Once per day
q.i.d. 4 times per day
q.o.d. Every other day
q6h Every 6 hours
p.c. After meals
p.o. By mouth
p.r.n. As needed
sl. Sublingual
stat Immediately
supp Suppository
t.i.d. 3 times per day
u.d. As directed

ADRENERGICS

Adrenergics stimulate α- and β-receptors and include epinephrine, levonordefrin, isoproterenol, ephedrine, dopamine III.

See Chapters 11, Medical and Dental Emergencies: emergency kit for the dental setting; 14, Pain Management: vasoconstrictor use.

ADRENERGIC BLOCKERS

Adrenergic blockers inhibit α- and β-receptors, including (1) α-adrenergic blockers such as tolazoline (Priscoline) and phentolamine (Regitine); (2) β-adrenergic blockers, including nonspecific blockers such as propranolol (Inderal) and nadolol (Corgard) and specific blockers such as metoprolol (Lopressor) and atenolol (Tenormin); (3) α- and β-adrenergic blockers such as labetalol (Normodyne, Trandate). See later discussion of patient with CVD.

ANTICHOLINERGICS

Anticholinergics (parasympathomimetics) inhibit body functions by blocking muscarinic cholinergic receptors. Include atropine (oral, Sal-Tropine; ophthalmic, Atropair) and propantheline bromide (Pro-Banthine).

ANXIETY AND PAIN MANAGEMENT

Management of pain and anxiety during dental treatment uses antianxiety drugs, analgesics, anesthetics, sedatives.

Antianxiety Drugs

Main purpose of antianxiety (tranquilizer) drugs is to decrease anxiety through depression of the CNS. Drugs are also noted with therapeutic uses.

A. Benzodiazepines (BZDs) (suffixes “-lam,” “-pam”):

B. Barbiturates (among first antianxiety drugs):

CLINICAL STUDY

Age 45 YRS SCENARIO
Sex image Male image Female The patient is scheduled for an oral prophylaxis today. He has generalized dental biofilm and slight calculus deposits throughout, with only slight to moderate gingivitis.
B/P 105/57
Chief Complaint “I hate being here but I know that I have to keep up my mouth.”
Medical History

Current Medications

Social History Science fiction writer

Analgesics

Analgesics inhibit perception of pain. Nonopioids reduce pain perception by inhibiting prostaglandin synthesis; MORE effective if they are taken before onset of pain. Opioids depress pain perception in CNS by binding with opioid receptors (Tables 9-3, 9-4, and 9-5).

See Chapter 11, Medical and Dental Emergencies: emergency kit (aspirin).
A. Nonopioids:

1. Salicylates: aspirin (Bayer, Ecotrin, Empirin, Bufferin) and long-acting diflunisal (Dolobid).

2. NSAIAs (NSAIDs): naproxen (Naprosyn; OTC: Aleve, Anaprox), ibuprofen (OTC: Advil, Motrin, Pamprin), etodolac (Lodine), ketorolac (Toradol), indomethacin (Indocin), celecoxib (Celebrex).

B. Opioids: morphine (MS Contin), hydromorphone (Dilaudid), meperidine (Demerol), propoxyphene (Darvon), codeine (various cough preparations), oxycodone (OxyContin; with acetaminophen [Percocet], with aspirin [Percodan]) (Table 9-4).

Table 9-3 Drug interactions with commonly used analgesics

Drug Interactions
NSAIA

Salicylates (aspirin [Bayer, Ecotrin, Empirin, Bufferin]) Acetaminophen (Tylenol)

ACE, Angiotensin converting enzyme; NSAIA, nonsteroidal antiinflammatory agent; VA, valproic acid.

Anesthetics and Sedatives

Anesthetic, local (with or without vasoconstrictors) and systemic, as well as sedatives to control pain.

See Chapter 14, Pain Management: local anesthetics, vasoconstrictors, drug for reversal of local anesthesia, nitrous oxide sedation.
A. Local anesthetics:

2. Therapeutic uses:

B. Vasoconstrictors (inclusion in some local anesthetics): epinephrine, levonordefrin (Neo-Cobefrin).

D. General anesthetics:

1. Nitrous oxide, inhalation gas (relatively odorless, colorless).

Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 9: Pharmacology
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