Pharmacology

Hydrocodone and acetaminophen combination - sold as vicodin and other names - hydrocodone is an opioid with issues of tolerance and dependance. acetaminophen (tylenol) overdose may lead to hepatic necrosis. Is being used for suicide.

Lower cholesterol - no dental considerations

Amlopidine - Calcium Channel blocker - lower blood pressure - rare gingival hyperplasia compared to other CCB's

Metropolol - beta 1 blocker - used to lower HTX and treat angina pectoris

Levothyroxine - thyroid replacement therapy for patients with hypothyroidism - be aware of many dental considerations for patients with hypothyroidism.

Sertraline - Antidepressant - SSRI - increased suicide in young individuals - xerostomia and bruxism reported - no problems with local anesthesia with epi

Broad spectrum antibiotic - used for prophylactic tx - be aware of tightening indication for its use - long term use may lead to candiasis

Escitalopram - Antidepressant SSRI type - same dental consideration and suicide warning as Zoloft

Beta 2 agonist = brochodilator - used for astma and COPD - only dental consideration is the risk of xerostomia

Simvastatin - reduce cholesterol - no dental considerations

Esomeprazole - proton pump inhibitor - Used for erosive esophagitis; symptomatic gastroesophageal reflux disease (GERD) and as part of a multidrug regimen for Helicobacter pylori eradication in patients - Dental consideration: Can cause xerostomia

Generic - thyroid replacement therapy for patients with hypothyroidism

Zolpidem - Non-benzodiazepine hypnotics - used for insomnia - only dental consideration is xerostomia

Montelukast - Leukotriene Receptor Antagonist - Prophylaxis and chronic treatment of asthma; relief of symptoms of seasonal allergic rhinitis - 2% of patients complain of dental pain related to taking the drug - mechanism is unknown

Lansoprazole - Proton pump inhibitor - same issues as with Nexium

Clopidogrel - antiplatelet agent- popular term blood thinner - used to prevent MI, Stroke and DVT's - dental considerations covered later in this lecture

Azithromycin - new macrolide - replaces erythromycin - used for tx of acute otitis media and lower/upper respiratory tract infections and other infections of bacterial origin - dental considerations: no adverse reactions reported

Bisphosphonate - used for osteoporosis - dental considerations are related to osteonecrosis of the jaws and is covered later

Cetirizine - antihistamine used for allergy - may cause changes in salivary flow

Fluticasone and Salmeterol - inhalation steroid - maintenance tx of astma and COPD. Dental considerations: May cause localized infections with Candida albicans or Aspergillus niger have occurred frequently in the mouth and pharynx with repetitive use of oral inhaler of corticosteroids

Pantoprazole - proton pump inhibitor - used for GERD, but no dental considerations in contrast to Nexium and Prevacid

Loop diuretic - management of oedema associated withe CHF and hepatic and renal disease or alone or in combination with other drugs for htx - no dental considerations

Beta 1 blocker used for tx of htx, post MI or angina pectoris - no dental considerations because of selective beta 1 blocking except to avoid prolonged use of NSAID's, which can reduce the antihypertensive effect of the beta 1 blocker

Venlafaxine - Serotonin/Norepinephrine Reuptake Inhibitor (SNRI) - tx of anxiety and panic disorder - ignificant xerostomia (normal salivary flow resumes upon discontinuation); may contribute to oral discomfort, especially in the elderly; taste perversion. Although venlafaxine is not a tricyclic antidepressant, it does block norepinephrine reuptake within CNS synapses as part of its mechanisms. It has been suggested that vasoconstrictor be administered with caution and to monitor vital signs in dental patients taking antidepressants that affect norepinephrine in this way.

Coumadin -"blood thinner" - Used for prophylaxis and treatment of thromboembolic disorders including those after replacement of valves or coming from atrial fibrillation or from an MI - dental considerations are covered elsewhere, but where briefly: The art of doing nothing!

First generation cephalosporin (antibiotic) used for respiratory tract infections, otitis media, skin and skin structure infections, bone infections, and genitourinary tract infections. No special dental considerations except 20% cross allergy reaction with penicillin only when the allergic reaction was immediate

Fluticasone - corticosteriod for inhalation - used prophylactically for astma and non-allergic rhinitis - only dental consideration is the possibility for localzed candida infections

Schedule II opioid (narcotic) - same concerns with APAP as HYCD/APAP. Also consider misuse by overprescribing. Street name oxy, OC and illbilly heroin

Levofloxacin - Quinolone antibiotic, Treatment of mild, moderate, or severe infections caused by susceptible organisms. Includes the treatment of community-acquired pneumonia, including multidrug resistant strains of S. pneumoniae (MDRSP); nosocomial pneumonia; chronic bronchitis. Dental consideration: Use epi with great care because Lavequin prolongs the QT interval and the effect of epi on that is uncertain at this time.

Valsartan - Angiotensin II Receptor Blocker - used for hypertension - no dental considerations