Drug dictionary for dentistry potx

Drug dictionary

for dentistry

J.G. Meechan

R.A. Seymour

OXFORD UNIVERSITY PRESS

Drug dictionary

for dentistry

Dose schedules are being continually revised and new side effects

recognized. Oxford University Press makes no representation,

express or implied, that the drug dosages in this book are correct.

For these reasons the reader is strongly urged to consult the phar￾maceutical company’s printed instructions before administering any

of the drugs recommended in this book.

J.G. Meechan

and

R.A. Seymour

1

Drug dictionary

for dentistry

Great Clarendon Street, Oxford

1

OX2 6DP

Oxford University Press is a department of the University of Oxford.

It furthers the University’s objective of excellence in research,

scholarship, and education by publishing worldwide in

Oxford New York

Auckland Bangkok Buenos Aires Cape Town Chennai

Dar es Salaam Delhi Hong Kong Istanbul Karachi

Kolkata Kuala Lumpur Madrid Melbourne Mexico City

Mumbai Nairobi São Paulo Shanghai Singapore Taipei

Tokyo Toronto

with an associated company in Berlin

Oxford is a registered trade mark of Oxford University Press

in the UK and in certain other countries

Published in the United States

by Oxford University Press Inc., New York

© Oxford University Press, 2002

The moral rights of the authors have been asserted

Database right Oxford University Press (maker)

First published 2002

All rights reserved. No part of this publication may be reproduced,

stored in a retrieval system, or transmitted, in any form or by any

means,without the prior permission in writing of Oxford University

Press, or as expressly permitted by law, or under terms agreed with the

appropriate reprographics rights organization. Enquiries concerning

reproduction outside the scope of the above should be sent to the

Rights Department, Oxford University Press, at the address above

You must not circulate this book in any other binding or cover

and you must impose this same condition on any acquirer

A catalogue record for this title is available from the British Library

Library of Congress Cataloging in Publication Data

Meechan, J. G.

Drug dictionary for dentistry/J. G. Meechan, R. A. Seymour.

p. cm.

1. Dental pharmacology–Dictionaries. 2. Dental therapeutics–

Dictionaries. I. Seymour, R. A. II. Title.

RK701.M442002 617.6'061'03–dc21 2001052052

ISBN 0 19 263274 4

10 9 8 7 6 5 4 3 2 1

Typeset by Newgen Imaging Systems (P) Ltd., Chennai, India

Printed in Great Britain on acid-free paper by

The Bath Press, Avon

This book is dedicated to:

The memory of my father (JGM)

Gayle, Tom and Oliver (RAS)

This page intentionally left blank

Drug therapy has an effect on the management of patients in

dentistry. Many drugs produce oro-dental problems; in addition

concurrent medication can interact with drugs which the dentist may

prescribe. The aim of this dictionary is to draw together the effects of

drugs on the teeth, oral and perioral structures and highlight drug

interactions which impact on dental treatment. Drugs taken by out￾patients which may be encountered in general dental practice and

interactions with drugs contained in the Dental Practitioners Formu￾lary have been included. Interactions which may occur with medica￾tion prescribed by dentists working in the hospital service have also

been covered. Drugs which the dentist may prescribe have been anno￾tated in greater detail to include any significant interactions that have

been recorded. Drugs have been listed alphabetically by their Rec￾ommended Non-proprietary Name (rINN) rather than their British

Approved Name (BAN). In those cases where it is still recommended

that both the BAN and rINN should appear then drugs commonly

found in dental out-patients are listed under both names.

It is hoped that this pocket-sized volume will act as a ready refer￾ence source for those dealing with dental patients taking medication.

J.G. Meechan

R.A. Seymour

October, 2001

How to use this dictionary

The drugs are listed in alphabetical order by their approved name in

this dictionary. An alphabetical list of trade-names is provided in the

Appendix in order to cross-reference to the approved name used in

the dictionary.

Preface

Acknowledgement

The authors are pleased to acknowledge the assistance of Mrs Renata

Taylor in the compilation of this dictionary.

ABACAVIR • ACAMPROSATE CALCIUM 1

Abacavir (Ziagen)

Description

A nucleoside reverse transcriptase inhibitor.

Indications

Used in the management of HIV infection.

Effects on oral and dental structures

This drug may produce oral ulceration.

Effects on patient management

Sensitive handling of the underlying disease state is essential. Excel￾lent preventive dentistry and regular examinations are important in

patients suffering from HIV, as dental infections are best avoided.

HIV will interfere with postoperative healing and antibiotic prophy￾laxis prior to oral surgery may be advisable.

Drug interactions

None of importance in dentistry.

Acamprosate calcium (Campral EC)

Description

An anti-dependence drug.

Indications

Used in the management of alcohol dependence.

Effects on oral and dental structures

None known.

Effects on patient management

A history of alcohol dependence may cause bleeding disorders and

affect drug metabolism.

Drug interactions

None relevant.

2 ACARBOSE • ACEBUTOLOL

Acarbose (Glucobay)

Description

An inhibitor of intestinal alpha glucosidases.

Indications

Diabetes mellitus inadequately controlled by diet or by diet and oral

hypoglycaemic agents.

Effects on oral and dental structures

None reported.

Effects on patient management

Hypoglycaemia can be a problem in patients taking acarbose, espe￾cially if they are also on insulin. Before commencing dental treat￾ment, it is important to check that patients have had their normal

food intake. If there is any doubt, give the patient a glucose drink. As

with any diabetic patient try and treat in the first half of the morning

and ensure that patients can eat after dental treatment. If a patient

on acarbose requires a general anaesthetic then refer to hospital.

Drug interactions

Systemic corticosteroids antagonize the hypoglycaemic actions of

acarbose. If these drugs are required, then consult the patient’s phy￾sician before prescribing.

Acebutolol (Sectral)

Description

A beta-adrenoceptor blocking drug. Also combined with a diuretic,

hydrochlorothiazide (Secadrex).

Indications

Hypertension.

Effects on oral and dental structures

Xerostomia and lichenoid eruptions can be produced.

Effects on patient management

Xerostomia will make the dentate patient more susceptible to dental

caries (especially root caries) and will cause problems with denture

retention. Postural hypotension may occur, and patients may feel

dizzy when the dental chair is returned to the upright position after

they have been treated in the supine position.

Drug interactions

NSAIDs such as ibuprofen may antagonize hypotensive action of

acebutolol; possible interaction between epinephrine and acebutolol

which may cause a slight increase in blood pressure. Do not exceed

ACECLOFENAC • ACEMETACIN 3

more than 3 cartridges of epinephrine containing local anaesthetic

solution per adult patient.

Aceclofenac (Preservex)

Description

A peripherally acting, non-steroidal anti-inflammatory analgesic.

Indications

Pain and inflammation associated with musculoskeletal disorders, e.g.

rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.

Effects on oral and dental structures

Patients on long-term NSAIDs such as aceclofenac may be afforded

some degree of protection against periodontal breakdown. This

arises from the drug’s inhibitory action on prostaglandin synthesis.

The latter is an important inflammatory mediator in the pathogene￾sis of periodontal breakdown.

Effects on patient management

Rare unwanted effects of aceclofenac include angioedema and throm￾bocytopenia. If the platelet count is low (
100,000) then the socket

should be packed and sutured. Persistent bleeding may require a plate￾let transfusion. The latter may cause an increased bleeding tendency

following any dental surgical procedure.

Drug interactions

Ibuprofen, aspirin and diflunisal should be avoided in patients tak￾ing aceclofenac due to an increase in unwanted effects, especially

gastrointestinal ulceration, renal and liver damage. Systemic corti￾costeroids also increase the risk of peptic ulceration and gastrointes￾tinal bleeding.

Acemetacin (Emflex)

Description

A peripherally acting, non-steroidal anti-inflammatory analgesic.

Indications

Pain and inflammation associated with musculoskeletal disorders,

e.g. rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.

Postoperative analgesia.

Effects on oral and dental structures

Patients on long-term NSAIDs such as acemetacin may be afforded

some degree of protection against periodontal breakdown. This arises

from the drug’s inhibitory action on prostaglandin synthesis. The

latter is an important inflammatory mediator in the pathogenesis of

4 ACETAZOLAMIDE

periodontal breakdown. Acemetacin has also been implicated for

inducing oral lichenoid eruptions and oral ulceration. The drug does

have a higher incidence of bone marrow suppression when compared

to other NSAIDs. This can cause agranulocytosis, leucopenia, aplastic

anaemia, and/or thrombocytopenia. Such depression of bone mar￾row function will affect the oral mucosa (high risk of ulceration), the

periodontal tissue (high risk of gingival bleeding and periodontal

breakdown) and healing after any dental surgical procedure.

Effects on patient management

The risk of thrombocytopenia will cause an increased bleeding ten￾dency following dental surgical procedures. If the platelet count is

low (
100,000) then the socket should be packed and sutured. Per￾sistent bleeding may require a platelet transfusion.

Drug interactions

Ibuprofen, aspirin and diflunisal should be avoided in patients tak￾ing acemetacin due to an increase in unwanted effects, especially

gastrointestinal ulceration, renal, and liver damage. Systemic corti￾costeroids increase the risk of peptic ulceration and gastrointestinal

bleeding.

Acetazolamide

Description

A carbonic anhydrase inhibitor.

Indications

Used to treat glaucoma, as a prophylaxis against mountain sickness,

as an add-on drug in epilepsy and in the emergency management of

retrobulbar haemorrhage. Although it is a diuretic it is not used for

that purpose.

Effects on oral and dental structures

Xerostomia, taste disturbance (metallic taste), paraesthesia, and

Stevens–Johnson syndrome may occur.

Effects on patient management

Acetazolamide increases the toxicity of the local anaesthetic procaine,

however this local anaesthetic agent is rarely used in modern dentistry.

Acetazolamide can cause both thrombocytopenia and anaemia. Throm￾bocytopenia may cause postoperative bleeding. If the platelet count is

low (
100,000) then the socket should be packed and sutured. Persis￾tent bleeding may require a platelet transfusion. Anaemia may result in

poor healing. Any anaemia will need correction prior to elective gen￾eral anaesthesia and sedation.

Avoid high dose aspirin for postoperative pain control as a serious

metabolic acidosis may occur. If the patient is receiving the drug for

ACETYLSALICYLIC ACID 5

epilepsy control then fits are possible, especially if the pateint is

stressed, therefore sympathetic handling and perhaps sedation should

be considered for stressful procedures. Emergency anticonvulsant

medication (diazepam or midazolam) must be available.

Drug interactions

The interactions with aspirin and procaine were mentioned above.

Acetazolamide increases the plasma concentration of carbamazepine

and increases the chances of osteomalacia when combined with pheny￾toin and phenobarbitone. It also increases the toxicity of ephedrine.

Combined therapy with corticosteroids increases the chances of

hypokalaemia.

Acetylsalicylic acid (Aspirin)

Description

A peripherally acting, non-steroidal analgesic.

Indications

Pain with a significant inflammatory component (e.g. postoperative

pain after dental surgical procedures). Also used in the management

of musculoskeletal pain, headache, and dysmenorrhoea, as an anti￾pyretic, and for its antiplatelet actions in the prophylaxis for cere￾brovascular disease or myocardial infarctions.

Presentations

(i) A 300 mg tablet.

(ii) Dispersible aspirin 300 mg.

(iii) A 75 mg tablet used for antiplatelet action.

Dose

Analgesia and antipyresis 300–900 mg every 4–6 hours.

Antiplatelet action 75–300 mg per day.

Contraindications

Cannot be prescribed to asthmatics (can precipitate bronchoconstric￾tion), children under 12 years (risk of Reye’s syndrome), patients with

a history of peptic ulceration (aspirin is ulcerogenic), uncontrolled

hypertension, patients suffering from gout (aspirin is uricosuric),

patients with disorders of haemostasis (aspirin reduces platelet aggre￾gation, therefore increases bleeding time), or patients with known

hypersensitivity to the drug.

Precautions

Pregnancy and breastfeeding mothers.

6 ACICLOVIR

Unwanted effects

Aspirin is ulcerogenic to the gastric mucosa and can cause the

so-called ‘aspirin burn’ if a tablet is held against the oral mucosa.

The effect of the drug on platelets can lead to an increase in bleeding

time and possible problems with haemostasis. Local measures usu￾ally resolve an aspirin-induced bleed, but if these fail, the patient will

need a platelet transfusion. High doses of aspirin can cause tinnitus

due to a raise in labyrinthine pressure. Reducing the dose usually

resolves the problem. The drug is also uricosuric and can precipitate

an attack of gout.

Drug interactions

Aspirin should not be prescribed to patients taking anticoagulants

since there is an increased risk of impaired haemostasis. Aspirin also

enhances the effect of the antiepileptic drugs phenytoin and sodium

valproate. Both aspirin and corticosteroids are ulcerogenic and should

thus be avoided, especially in patients with a history of peptic ulcera￾tion. Aspirin reduces the renal excretion of the cytotoxic drug meth￾otrexate and thus increases the unwanted effects of this drug. The

diuretic actions of spironolactone and acetazolamide are reduced by

aspirin. Metaclopramide and domperidone increase the rate of aspirin

absorption by their actions on gastric emptying. The uricosuric effects

of aspirin will reduce the actions of probenecid and sulfinpyrazone.

Can produce hypoglycaemia, combined use with oral hypoglycaemic

agents should be avoided.

Aciclovir [Acyclovir] (Zovirax)

Description

An antiviral drug.

Indications

Used in the treatment of herpes simplex and varicella-zoster

infections.

Presentations

(i) 200 mg, 400 mg and 800 mg tablets.

(ii) 200 mg, 400 mg and 800 mg dispersible tablets.

(iii) Oral suspensions of 200 mg/5 mL and 400 mg/5 mL.

(iv) A 5% cream.

(v) 250 mg powder for reconstitution for intravenous infusion.

Dose

Adults: 200–400 mg 5 times daily (or topical application to lesion 5

times daily).

Children under 2 years: half adult dose.