A Drug / day

A Drug / day

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Good morning/evening!




I'm going to post a topic about drugs,

A drug per day !

where information can be beneficial.

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Hope you enjoy it !

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The drug for today is ,...

{Nifedipine = Adalat, Angiopine, Coracten,
Corday, Fortipine, Solfedipine, Tensipine }


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Description

A calcium-channel blocker.

Indications

Hypertension and angina prophylaxis.

Effects on oral and dental structures

Nifedipine can cause gingival overgrowth, especially in the anterior
part of the mouth: taste disturbances can occur through inhibition of
calcium-channel activity that is necessary for normal function of
taste and smell receptors.

Effects on patient management

None of any significance.

Drug interactions

None of any dental significance.


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see you tomorrow with another drug.

Tetracycline = (Achromycin, Deteclo)

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Description

A bacteriostatic antibiotic.

Indications

Tetracyclines are rarely indicated in the management of dental infections
but are used in the treatment of periodontal disease.

Presentations

(i) 250 mg tablets.
(ii) 250 mg capsules.
(iii) Incorporation into slow release devices for application into
periodontal pockets.

Dose

250 mg four times daily to treat infections. When used in the management
of periodontal disease the duration of therapy is two weeks.

Contraindications

Pregnancy.
Breastfeeding.
Children under 12 years.
Kidney disease.
Systemic lupus erythematosus.

Precautions

Liver disease.

Unwanted effects

Staining of teeth and bones.
Lichenoid reactions.
Fixed drug eruptions.
Opportunistic fungal infections (‘tetracycline sore mouth’).
Hypersensitivity.
Photosensitivity.
Facial pigmentation.
Headache and visual disturbances.
Anaemia.
Hepatotoxicity.
Pancreatitis.
Gastrointestinal upset including pseudomembranous colitis.

Drug interactions

As tetracycline chelates calcium and other cations a number of drugs
(and foodstuffs such as dairy products) which contain cations reduce
the absorption of tetracycline. Among the drugs which reduce the
absorption of tetracycline are the ACE-inhibitor quinapril, antacids,
calcium, and zinc salts, ulcer-healing drugs such as sucralfate and
the ion-exchange resin colestipol. Similarly tetracyclines inhibit the
absorption of iron and zinc. Tetracyclines reduce the efficacy of
penicillins and cephalosporins.
Tetracycline raises blood urea levels and this effect is exacerbated
with combined therapy with diuretics. Tetracycline may enhance the
anticoagulant effect of warfarin and the other coumarin anticoagulants.
Tetracycline may interfere without the action of oral contraceptives
and alternative methods of contraception should be advised
during therapy. Tetracyclines have a hypoglycaemic effect and their
administration to patients receiving insulin or oral hypoglycaemics
should be avoided.
Tetracycline may increase the serum levels of digoxin, theophylline
and the anti-malarial medication mefloquine. Tetracycline may also
increase the risk of methotrexate toxicity. Combined therapy with
ergotamine can produce ergotism (the most dramatic effect of ergotism
is vasospasm which can cause gangrene). Patients who use a
contact lens cleaner containing thiomersal have reported ocular
irritation during tetracycline therapy. Cranial hypertension leading
to headache and dizziness may result with the combined use of tetracycline
and retinoids.

Diazepam = (Dialar, Diazemuls, Rimapam,
Stesolid, Tensium, Valclair, Valium)

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Description

A benzodiazepine sedative and anxiolytic drug with anticonvulsant
properties.

Indications

Used in dental sedation and preoperative anxiolysis (although it has
now been superseded by midazolam when intravenous techniques
are employed: for oral sedation temazepam is the drug of choice).
Also indicated in the emergency treatment of epilepsy in the dental
surgery.

Presentations

(i) 2 mg, 5 mg, and 10 mg tablets.
(ii) Oral solutions of 2 mg/5 mL and 5 mg/5 mL.
(iii) Solution for injection 5 mg/mL.
(iv) 10 mg suppositories.
(v) Solutions for rectal administration 2 mg/mL and 4 mg/mL

Dose

(i) To treat anxiolysis
2 mg–10 mg three times daily.
(ii) As premedication prior to dental treatment
5–10 mg 1–2 hours prior to the appointment.
(iii) For intravenous dental sedation
incremental doses of 2.5 mg/minute until a satisfactory endpoint
(Verrill’s sign which is drooping of the upper eyelid to
cover half of the pupil). Midazolam has now superseded diazepam
as the intravenous benzodiazepine for dental sedation.
(iv) In the emergency treatment of epilepsy (status epilepticus) in
the dental surgery
5 mg over 1 minute increments intravenously repeated if necessary
up to a dose of 20 mg.

Contraindications

Severe respiratory disease.
Severe liver disease.
Porphyria (although should be used in emergency management of
status epilepticus).

Precautions

History of drug abuse.
Severe liver disease.
Severe muscle weakness (myasthenia gravis).
Pregnancy and breastfeeding.

Unwanted effects

Xerostomia.
Respiratory depression.
Hypotension.
Visual disturbances.

Headache.
Occasionally skin rashes (anaphylaxis is unusual).
Thrombophlebitis after intravenous use.
May produce condition similar to foetal alcohol syndrome including
cleft lip and palate.
Drug dependence.
Sexual fantasy.

Drug interactions

There is synergy with all CNS depressant drugs (including alcohol
and opioid analgesics) leading to an enhanced effect and thus combined
use is best avoided. The antidepressant drugs fluoxetine and
fluvoxamine enhance the effects of diazepam. Severe hypotension and
respiratory depression may occur when diazepam is administered
simultaneously with the antipsychotic drug clozapine and combined
therapy is not recommended.
Cimetidine and omeprazole inhibit the metabolism of diazepam,
thus increasing its sedative effect. In addition the gut motility stimulant
cisapride and the anti-emetic drug metoclopramide enhance the
action of oral diazepam. Similarly, oral contraceptives, the antialcohol
drug disulfiram, the muscle relaxant baclofen, and the cannabinoid
nabilone all increase the effect of diazepam. Beta-adrenergic
drugs reduce metabolism of diazepam but there appears to be little
clinical risk from combined therapy. Similarly, although paracetamol
reduces the excretion of diazepam this is of no clinical importance.
The antibacterials isoniazid and ciprofloxacin inhibit the metabolism
of diazepam whereas rifampicin increases metabolism of the
benzodiazepine. Smoking increases the metabolism of diazepam.
Diazepam affects the metabolism of phenytoin in an inconsistent
manner, in some individuals the anticonvulsant plasma level is
increased in others it is reduced. Carbamazepine possibly reduces the
effects of diazepam, whereas sodium valproate enhances the effect of
the benzodiazepine.
Diazepam can increase the effects of neuromuscular blockers
tubocurarine, vecuronium, and atracurium. It reduces the effects of
levodopa. Diazepam may increase the plasma concentration of the
local anaesthetic bupivacaine. Flumazenil antagonizes the action of
diazepam. Aminophylline also has some antagonistic properties.
Caffeine can counteract some of the hypnotic effects of diazepam.

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Paracetamol = (Acetaminophen,
Panadol, Calpol)

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Description

A non-opioid analgesic.

Indications

Mild to moderate pain (e.g. headache) and to reduce pyrexia.

Presentations

(i) A 500 mg tablet.
(ii) A 500 mg soluble (dispersible) tablet.
(iii) Oral suspension 120 mg/5 ml and 250 mg/5 ml.
(iv) Suppositories 60 mg, 125 mg and 500 mg.

Doses

Adults: 0.5–1 g every 4–6 hours.
Children: 3 months–1 year 60–120 mg every 4–6 hours.
1–5 years, 120–250 mg every 4–6 hours.
6–12 years, 250–500 mg every 4–6 hours.

Contraindications

Patients with renal failure, since chronic use of paracetamol and
overdose can cause both papillary and tubular necrosis. The problem
of renal failure is compounded when paracetamol is combined with
centrally acting analgesics. Paracetamol can cause bronchoconstriction
in asthmatics, although the incidence is much lower than for
aspirin or other NSAIDs. Paracetamol is hepatotoxic in overdose
(see later) and should be avoided in patients with liver failure.

Precautions

Impaired liver function and asthmatics.

Unwanted effects

The main unwanted effect of paracetamol is hepatotoxicity in overdose.
The problem is compounded if there is a history of alcohol
abuse. Following overdose with paracetamol, the normal pathways
for metabolism (glucuronidation and sulphation) become saturated.
As a consequence, metabolism of the drug is directed to the formation
of a reactive metabolite, N-acetyl-p-benzoquinoneimine. Thismetabolite is toxic to hepatocytes leading to necrosis and fulminant
liver failure. The problem of paracetamol overdose is further compounded
by the lack of obvious signs and symptoms in the early
overdose stages. The patient may feel nauseous and vomit, which
may reassure them that the paracetamol has been eliminated. This is
followed by a period of apparent recovery until signs of hepatic
necrosis supervene 48–72 hours after ingestion of the tablet. Hepatic
damage almost invariably accompanies ingestion of 15 g or more.
Measuring a patient’s INR is a good indicator of liver damage.
Paracetamol overdose has to be treated promptly to avoid progressive
liver damage. The compounds used are methionine 2.5 g orally
every 4 hours for 16 hours or N-acetylcysteine 150 mg/kg IV.

Drug interactions

Prolonged use of paracetamol may enhance the anticoagulant action
of warfarin. The mechanism of this drug interaction is due to
paracetamol (only with prolonged use) causing damage to the hepatic
parenchymal cells which will lead to reduced synthesis of the
Vitamin K-dependant clotting factors (II, VII, IX and X). Warfarin
also exerts its anticoagulant action by inhibiting the synthesis of the
Vitamin K clotting factors. Drugs that effect gastric emptying (metoclopramide
and domperidone) increase the absorption of paracetamol.
This has been used therapeutically to improve the onset of
action for paracetamol, e.g. in the treatment of migraine.


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Epinephrine = (adrenaline)

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Description

A catecholamine sympathomimetic agent.

Indications

Used in dental local anaesthetic solutions to increase their efficacy
and duration and to aid in haemostasis.

Presentations

Epinephrine is contained in local anaesthetic solutions in concentrations
of 1 : 80,000 (12.5 g/mL), 1 : 100,000 (10 g/mL) and 1 :
200,000 (5 g/mL).

Dose

The maximum recommended dose over one visit in dental local
anaesthetic solutions is 200
g.

Contraindications

Severe cardiac disease such as uncontrolled arrhythmias and unstable
angina are contraindications to the use of epinephrine. The unusual
catecholamine-secreting tumour of the adrenal gland known as
phaeochromocytoma and thyroid storm (an acute hyperthyroid
episode) are other contraindications to epinephrine in dental local
anaesthesia.

Precautions

Dose reduction is wise when cardiac disease exists (see also drug
interactions below).

Unwanted effects

Excessive dosage or inadvertent intravascular injection will produce
symptoms of fear and anxiety such as tachycardia and tremors.
Systolic blood pressure can rise and diastolic blood pressure may
fall. Epinephrine, even at doses used in dentistry, can produce a
hypokalaemia (reduction in plasma potassium) and this can lead to
cardiac arrhythmias.

Drug interactions

Many drug interactions with epinephrine are theoretical, however
some have been shown to produce effects that are clinically important.
Tricyclic antidepressant drugs increase the pressor effects of
epinephrine twofold; as the pressor effects are negligible at the doses
used in dental local anaesthetics then simple dose reduction is all
that is required.
Adrenergic beta-blocking drugs such as propranolol can lead to
unopposed increases in systolic blood pressure and dose reduction of
epinephrine-containing local anaesthetics is advised. Non-potassium
sparing diuretics exacerbate the hypokalaemia produced by epinephrine
and this is apparent at the doses used in dental local anaesthesia;
thus for patients receiving such diuretic therapy epinephrine dose
reduction is advised. The volatile anaesthetics such as halothane
increase cardiac sensitivity to the effects of epinephrine and a 50%
dose reduction in the amount of catecholamine used is advised. Any
agent with sympathomimetic properties has the potential to increase
the toxicity of epinephrine and among these agents are drugs of
abuse such as cocaine, cannabis, and amphetamines.

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Metronidazole (Anabact, Elyzol
Flagyl, Metrogel, Metrolyl, Metrotop,
Rozex, Zadstat)

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Description

A nitroimidazole antimicrobial drug.

Indications

Anaerobic bacterial infections such as dental abscesses, acute pericoronitis
and acute ulcerative gingivitis.

Presentations

(i) 200 mg and 400 mg tablets.
(ii) An oral suspension (200 mg/5 mL).
(iii) An intravenous infusion (5 mg/mL).
(iv) A topical preparation for application in the gingival sulcus.
(v) 500 mg suppositories.

Dose

400 mg orally three times daily for 7 days, or 500 mg twice daily
intravenously.

Contraindications

Hypersensitivity.
High doses contraindicated in pregnancy and during breastfeeding.

Precautions

Avoid alcohol as severe side effects occur (disulfiram-like [antabuse]
reaction).
Liver disease.

Unwanted effects

Hypersensitivity reactions.
Blackening of tongue.
Altered (metallic) taste.
Gastrointestinal upset.
Headache, dizziness, and ataxia.
Dark urine.
Prolonged therapy can produce seizures, neuropathy, and leucopenia.

Drug interactions

The disulfiram reaction with alcohol is very unpleasant. This is
caused by metronidazole inhibiting the metabolism of alcohol, leading
to a build-up of aldehydes which produce nausea and vomitting.
Similarly, metronidazole interacts with disulfiram and can cause
psychosis and confusion. In addition a disulfiram-like reaction may
occur during concurrent therapy with the antiviral agent ritinovir.
Ritinovir increases the serum level of metronidazole.
The anticoagulant effect of warfarin is significantly increased by metronidazole.
The anti-cholesterol drug cholestyramine and the antacid
aluminium hydroxide reduce the absorption of metronidazole and
thus dosing of these agents should be separated. Corticosteroids and
barbiturates increase metronidazole loss and increased dosing of the
antimicrobial is necessary. Similarly rifampicin increases the loss of
metronidazole but the importance of this is unknown.
Metronidazole may increase the serum levels of carbamazepine and
increase the toxicity of the latter drug. Similarly, plasma levels of
phenytoin rise with combined therapy with metronidazole. Metronidazole
may decrease the efficacy of oral contraceptives and other
means of contraception are advised during antibiotic therapy. Metronidazole
may increase serum ciclosporin levels and combined
therapy should be closely monitored. Metronidazole increases the
toxicity of lithium carbonate and the cytotoxic drug 5-fluorouracil.

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Description

An amide local anaesthetic.

Indications

Local anaesthesia (topical and by injection). Lidocaine with epinephrine
is the ‘gold standard’ local anaesthetic for dental anaesthesia.

Presentations

(i) 2.0 mL or 2.2 mL cartridges for injection of a 2% solution
(containing 40 and 44 mg lidocaine respectively).
(ii) 1.8 mL, 2.0 mL or 2.2 mL cartridges for injection of a 2% solution
with 1 : 80,000 epinephrine [adrenaline] (containing 36,
40, and 44 mg lidocaine and 22.5, 25 and 27.5
g epinephrine
respectively).
(iii) Topical preparations containing 1%, 4%, 5% and 10% lidocaine
for intra-oral use.
(iv) As a component of EMLA cream which is a topical anaesthetic
for skin use (EMLA is a 5% mixture of lidocaine and prilocaine).

Dose

Recommended maximum dose is 4.4 mg/kg with an absolute ceiling
of 300 mg.

Contraindications

Allergy to amide local anaesthetics.
Acute porphyria.
EMLA should not be used in infants under one year of age.

Precautions

Reduce dose in hepatic disease.
Epinephrine-containing solutions have additional precautions (see
epinephrine).

Unwanted effects

Central nervous and cardiovascular system depression at high dose.

Drug interactions

Lidocaine prolongs the period of apnoea produced by succinylcholine.
Beta-adrenergic blocking drugs, especially propranolol, increase
the toxicity of lidocaine by inhibiting the liver enzymes that metabolize
the local anaesthetic. Similarly, the calcium-channel blocker
verapamil increases the toxicity of lidocaine. Midazolam reduces the
central nervous system toxicity of lidocaine. Lidocaine and phenytoin
both have depressant effects on the heart, the clinical relevance
of this is probably only important at high doses. The protease inhibitor
drugs used in the management of HIV appear to increase the
plasma levels of lidocaine and potentially increase cardiotoxicity.
Thus the use of alternative local anaesthetics or administration of
minimal doses of lidocaine appears wise.
Liothyronine sodium (Tertroxin)

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Tranexamic acid (Cyklokapron)

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Description


An anti-fibrinolytic drug which inhibits plasminogen activation and
fibrinolysis.

Indications

To facilitate haemostasis in haemophilia, menorrhagia, and in
thrombolytic overdose. Also useful in hereditary angioedema.

Effects on oral and dental structures


None reported.

Effects on patient management


None of any significance.

Drug interactions

None of any dental significance.

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Bupivacaine (Marcain)

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Description

An amide local anaesthetic.

Indications

Used to provide local anaesthesia, especially long-lasting anaesthesia
after regional block injection.

Presentations

(i) 10 mL vials of 0.25%, 0.375%, 0.5% or 0.75% bupivacaine
for injection (containing 25, 37.5, 50 and 75 mg bupivacaine
respectively).
(ii) 10 mL vials of 0.25% and 0.5% bupivacaine with 1 : 200,000
epinephrine for injection (containing 25 and 50 mg bupivacaine
respectively with 50
g epinephrine).

Dose

Recommended maximum dose is 1.3 mg/kg with an absolute ceiling
of 90 mg.

Contraindications

Allergy to amide local anaesthetics.

Precautions

Reduce the dose in hepatic disease. Epinephrine-containing solutions
have additional precautions (see epinephrine).

Unwanted effects

Bupivacaine is more cardiotoxic than lidocaine.

Drug interactions

Success of bupivacaine when used as a regional (spinal) anaesthetic is
reduced by concomitant administration of the anti-rheumatic drug
indomethacin and in individuals who abuse alcohol (the mechanism
is not understood). The depressant effect on the heart produced by
bupivacaine is exacerbated by calcium-channel blockers but this is
probably only important if accidental intravascular injection of
the local anaesthetic occurs. As with lidocaine beta-blocking drugs,
especially propranolol, increase the plasma concentration of bupivacaine.
Serum levels of bupivacaine are also increased by diazepam.
The toxicity of bupivacaine has been reported to be increased when
used in combination with mepivacaine (probably due to displacement
of bupivacaine from its binding sites).

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Ferrous gluconate



Description

An iron salt.

Indications

Iron deficiency anaemia.

Effects on oral and dental structures


None reported.

Effects on patient management


Nothing of significance.

Drug interactions


Iron salts chelate tetracyclines which in turn prevent their absorption.
The two drugs should not be given together.

Salbutamol (Accuhaler, Aerolin, Airomir,
Asmasal, Easi-breathe, Evohaler, Nebules,
Rotacaps, Ventodisks, Ventolin)

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Description

A beta2-adrenoceptor stimulant.

Indications

Used in the management of asthma, and obstructive airway disease.

Effects on oral and dental structures

Xerostomia, taste alteration, and discolouration of the teeth may
occur.

Effects on patient management

Patients may not be comfortable in the supine position if they have
respiratory problems. Aspirin-like compounds should not be prescribed
as many asthmatic patients are allergic to these analgesics.
Similarly, sulphite-containing compounds (such as preservatives in
epinephrine-containing local anaesthetics) can produce allergy in
asthmatic patients. Xerostomia may increase caries incidence and
thus a preventive regimen is important. If the xerostomia is severe,
artificial saliva may be indicated. The use of a rubber dam in patients
with obstructive airway disease may further embarrass the airway. If
a rubber dam is essential then supplemental oxygen via a nasal cannula
may be required.

Drug interactions

The hypokalaemia which may result from large doses of salbutamol
may be exacerbated by a reduction in potassium produced by high
doses of steroids and by epinephrine in dental local anaesthetics.

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Vancomycin (Vancocin)

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Description

A glycopeptide antibiotic.

Indications

The only indication in dentistry is for the prophylaxis of endocarditis in
those having a general anaesthetic and who cannot receive amoxicillin.
Presentations
(i) 250 mg and 500 mg capsules.
(ii) Powder for reconstitution for injection in vials containing
250 mg or 500 mg.

Dose

As prophylaxis for endocarditis 1 g given by slow intravenous infusion
over 100 minutes prior to the procedure (gentamycin must be
administered in conjunction with this treatment at induction of
general anaesthesia). For children under 10 years the dose of vancomycin
is 20 mg/kg.

Contraindications

History of deafness.
Pregnancy and breastfeeding.
Precautions
Renal disease.

Unwanted effects

Renal toxicity including kidney failure.
Ototoxicity.
Neuromuscular blockade.
Hypersensitivity reactions.
Haematological disorders (such as reduction in white cells and platelets)
may occur after prolonged use.
Rapid intravenous infusion can cause a number of reactions including
severe hypotension leading to shock and cardiac arrest. In addition
dramatic flushing may occur (‘red man’ syndrome).

Drug interactions

The nephrotoxic effects of vancomycin appear to be additive with
the adverse renal effects produced by the aminoglycosides such asgentamicin, amphotericin B, bacitracin, polymixin N, colistin, ketorolac,
viomycin, and cisplatin. The ototoxic effect of vancomycin is exacerbated
by aminoglycoside antibiotics such as gentamicin and by loop
diuretics. Vancomycin produces some neuromuscular blockade and
can thus enhance the action of neuromuscular blocking drugs such as
vecuronium and suxamethonium. The hypotension produced by rapid
intravenous infusion of vancomycin may be exacerbated by vasodilatory
drugs such as the calcium-channel blocking agent nifedipine.
Vancomycin enhances the anticoagulant effect of warfarin but not
to a significant degree. However monitoring of coagulation is advised
if vancomycin is administered to a warfarinized patient. The
reduction in white cell count produced by long term use of vancomycin
is exacerbated by concurrent therapy with the HIV treatment
drug zidovudine. When used to treat pseudomembranous colitis the
action of vancomycin in the gut is reduced when administered
concurrently with the ion-exchange resin cholestyramine. This effect
is not important when the antibiotic is administered parenterally.

Ibuprofen (Brufen, Nurofen, Fenbid)


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Description

A peripherally acting, non-steroidal anti-inflammatory analgesic that
is derived from propionic acid.

Indications

Pain with a significant inflammatory component (e.g. postoperative
pain after dental surgical procedures). Also used in the management
of musculoskeletal pain, dysmenorrhoea, and to reduce fever.

Presentations

A 200, 400 and 600 mg tablet.
As a suspension (Ibuprofen 100 mg/5 ml).
Effervescent granules (Ibuprofen 600 mg).

Dose

Analgesia for adults, Ibuprofen 1.2–1.8 g daily in divided doses. For
children, 20–40 mg/kg.

Contraindications

Ibuprofen is contraindicated in patients with a history of allergy to
aspirin or any other NSAID. The drug should not be prescribed to
asthmatics (can precipitate bronchoconstriction) or patients with a
history of angioedema and urticaria. Ibuprofen should not be prescribed
to patients with active peptic ulceration (ibuprofen is ulcerogenic)
or to patients with haemorrhagic disorders since it will affect
platelet aggregation. Ibuprofen should be used with caution in patients
who exhibit renal, cardiac or hepatic impairment since the repeated use
of the drug can result in a deterioration in renal function.

Precautions

Elderly, pregnancy, and breastfeeding mothers.

Unwanted effects


Ibuprofen is ulcerogenic although of all the NSAIDs, it has one of the
lowest risk of gastrointestinal irritation. This unwanted effect can be further
reduced by taking the drug with food or milk. Other rare unwanted
effects include blood disorders, fluid retention, renal damage, eye
changes, and the precipitation of Stevens–Johnson syndrome. Patients
who suffer from systemic lupus erythematosus may be susceptible to a
NSAID-induced aseptic meningitis. Excessive high doses of ibuprofen
can cause a metabolic acidosis; if untreated, this can lead to coma.

Drug interactions

Ibuprofen should not be given with other NSAIDs or aspirin since
using such combinations will increase the risk of unwanted effects.
The anticoagulant effects of both warfarin and heparin are enhanced
by ibuprofen and could increase the risk of haemorrhage. Ibuprofencan antagonize the hypotensive effects of the ACE inhibitors (e.g.
captopril, lisinopril). There is the additional increased risk of renal
impairment and hyperkalaemia with these drugs and ibuprofen. Antidiabetic
drugs such as the sulphonylureas are extensively protein
bound and can be displaced by ibuprofen leading to hypoglycaemia.
Ibuprofen can increase the risk of gastrointestinal haemorrhage if
given to patients taking antiplatelet drugs such as clopidogrel. Ibuprofen
should be avoided in patients taking beta-adrenoceptor blockers
as there will be an antagonism of their hypotensive effect. Ibuprofen
may exacerbate heart failure, reduce glomerular filtration rate and
increase plasma concentration of digoxin. Both ibuprofen and corticosteroids
(systemic) cause peptic ulceration, therefore avoid the combination.
The excretion of methotrexate is reduced by ibuprofen
which can lead to increased toxicity. Ibuprofen reduces the excretion
of the muscle relaxant baclofen. The excretion of lithium is reduced
by ibuprofen, thus increasing the risk of lithium toxicity.

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Acebutolol (Sectral)

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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 exceedmore than 3 cartridges of epinephrine containing local anaesthetic
solution per adult patient.

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سيف الطويري كتب:

يفضل استعمال مضادات الفطريات بأقل فترة علاجيه ممكن وافضل كورس لهدا الدواء هوا 3 مرات يوميا لمدة اسبوع ودالك راجع الى ترسب الدواء داخل الكوبيبه فى الكليه مما يصعب على الكليه اخراجه ويسبب اطرابات فى الكليه مما يؤدى الى فشل كلوى في حالات استعمال الدواء لفترة طويله
وعموما ادا استعمل الدواء بالطريقه الصحيحه فهو امن ولن يلاحظ الطبيب على مريضه شي من الاعراض الجانبيه الا اضرابات الجهاز الهضمى وهو شائع مع متل هده المجموعه الدوائيه



شكرا د.انصاف

أهلا .. سيف ..


شُكرًا لـ إضافتك

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Ranitidine (Zantac)


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Description

A histamine H2-receptor antagonist.

Indications

Used in the treatment of gastrointestinal ulceration and reflux.

Effects on oral and dental structures

This drug occasionally causes erythema multiforme. The underlying
condition of reflux can lead to erosion of the teeth, especially the
palatal surfaces. H2-receptor antagonists may cause pain and swelling
of the salivary glands.

Effects on patient management

Non-steroidal anti-inflammatory drugs should be avoided due to
gastrointestinal irritation. Similarly, high dose systemic steroids
should not be prescribed in patients with gastrointestinal ulceration.
The patient may prefer to avoid the supine position due to their
underlying gastrointestinal problem. High doses of the long-acting
local anaesthetic bupivacaine should be avoided (see below). This
drug occasionally causes a pancytopenia which can affect postoperative
healing and haemorrhage control.

Drug interactions

Ranitidine may decrease the absorption of the antifungals itraconazole
and ketoconazole. It may also increase the plasma levels of the
long-acting local anaesthetic bupivacaine.

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السلام عليكم ورحمة الله وبركاته

شكرا لهذه المعلومات لكنى سأضيف عليها بعض المعلومات للفائدة فقط رغم أن مجال الأسنان لا يحتاج للتعمق في بحور مادة الفارم.
تفضلوا بزيارة هدا الموقع وأعرفوا أكثر عن
tranexamic acid


[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]

Diclofenac sodium (Diclogestic, Voltarol)

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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 pain.

Effects on oral and dental structures


Patients on long-term NSAIDs such as diclofenac sodium 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 periodontal breakdown.

Effects on patient management


Rare unwanted effects of diclofenac sodium include angioedema and
thrombocytopenia. The latter may cause an increased bleeding tendency
following any dental surgical procedure. If the platelet count is
low (
100,000) then the socket should be packed and sutured. Persistent
bleeding may require a platelet transfusion.

Drug interactions

Ibuprofen, aspirin and diflunisal should be avoided in patients taking
diclofenac sodium due to an increase in unwanted effects, especially
gastrointestinal ulceration, renal and liver damage. Systemic
corticosteroids increase the risk of peptic ulceration and gastrointestinal
bleeding.

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Ofloxacin (Tarivid)

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Description

A quinolone antibiotic.

Indications

Used to treat urinary tract infections and gonorrhoea.

Effects on oral and dental structures

This drug can cause candidiasis, xerostomia, taste disturbance and
Stevens–Johnson syndrome.

Effects on patient management

Antifungal therapy may be required if oral candidiasis occurs. As the
drug is only used short term xerostomia should not produce significant
problems, however a preventive regimen may be considered. This drugmay cause thrombocytopenia, leucopenia, and anaemia. Thrombocytopenia
may cause postoperative bleeding. If the platelet count is low
(
100,000) then the socket should be packed and sutured. Persistent
bleeding may require platelet transfusion. Leucopenia and anaemia
may result in poor healing. Any anaemia will need correction prior to
elective general anaesthesia and sedation.

Drug interactions

This drug increases the anticoagulant effect of warfarin and nicoumalone.
Combined therapy with non-steroidal anti inflammatory
drugs increases the risk of convulsions.

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Digoxin (Lanoxin)

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Description

A cardiac glycoside that was originally obtained from the leaves of
the foxglove (Digitalis).

Indications

In the treatment of cardiac failure in association with atrial fibrillation.
Effects on oral and dental structures
Has been known to cause pain similar to trigeminal neuralgia in the
lower third of the face.

Effects on patient management

Digoxin is a drug with a low therapeutic index and a slight increase in
plasma concentrations can cause digoxin toxicity. Hypokalaemia predisposes
to digoxin toxicity and epinephrine containing local anaesthetic
solutions can cause hypokalaemia. No more than 3 cartridges
should be used at any one time on adult patients taking digoxin.

Drug interactions

NSAIDs, such as ibuprofen, may exacerbate heart failure, reduce GFR
and increase plasma concentrations of digoxin. Erythromycin
enhances the action of digoxin. Systemic amphotericin can cause a
hypokalaemia which enhances digoxin toxicity. Non-steroidal antiinflammatory
drugs (e.g. ibuprofen) may exacerbate heart failure andincrease plasma concentrations of digoxin leading to toxicity. Systemic
amphotericin will exacerbate a digoxin-induced hypokalaemia.


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Desmopressin (DDAVP, Desmotabs)


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Description

A synthetic posterior pituitary hormone.

Indications

Diabetes insipidus, primary nocturnal enuresis.

Effects on oral and dental structures

Can cause xerostomia leading to an increased risk of root caries,
candidal infections and poor denture retention. If the xerostomia is
severe, dentate patients should receive topical fluoride and be offered
an artificial saliva.

Effects on patient management

Nothing of significance.

Drug interactions

None of any dental significance.


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Procaine

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Description

An ester local anaesthetic.

Indications

Used to provide local anaesthesia by injection. When used intraorally
the addition of epinephrine is advised. The only indication as a
dental local anaesthetic is for those extremely rare individuals who
are allergic to the amide group of anaesthetics but not hypersensitive
to the ester group. Another use for procaine other than for local
anaesthesia is as an intra-arterial injection to counter arteriospasm
produced by inadvertent intra-arterial injection (procaine is an
excellent vasodilator).

Presentations

2 mL ampoules of 2% solution.

Dose

The maximum recommended dose of procaine is 6.0 mg/kg with an
absolute ceiling of 400 mg.

Contraindications

Allergy to the ester group of local anaesthetics and allergy to parabens.

Unwanted effects

Allergic reactions to the ester anaesthetics is more common than to
the amides such as lidocaine, consequently procaine is seldom used
in dentistry.

Drug interactions

Procaine can antagonize the activity of the sulfonamide antibacterials.


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Rifampicin (Rifadin, Rimactane, Rifater,
Rifinah 150, Rifinah 300, Rimactazid 150,
Rimactazid 300)

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Description

A rifamycin antituberculous drug.

Indications

Treatment of tuberculosis, brucellosis, Legionnaire’s disease, and
serious staphylococcal infections.

Effects on oral and dental structures

This drug causes stomatitis, candidiasis, thrombocytopenic purpura
and an orange-red discolouration of saliva. Stevens–Johnson syndrome
may occur with this drug.

Effects on patient management

Only emergency dental treatment should be performed during active
tuberculosis and care must be exercised to eliminate spread of tuberculosis
between the patient and dental personnel, e.g. masks and
glasses should be worn and where possible treatment should be
performed under a rubber dam to reduce aerosol spread. This drugmay cause thrombocytopenia, leucopenia, and anaemia. Thrombocytopenia
may cause postoperative bleeding. If the platelet count is
low (
100,000) then the socket should be packed and sutured.
Persistent bleeding may require platelet transfusion. Leucopenia and
anaemia may affect healing adversely. Any anaemia will need correction
prior to elective general anaesthesia and sedation.

Drug interactions

Rifamycins decrease the anticoagulant effect of warfarin and nicoumalone.
The effects of phenytoin are reduced during combined
therapy. The efficacy of the antifungals fluconazole, ketoconazole,
and itraconazole is reduced by rifampicin. Similarly, the effectiveness
of rifampicin is reduced by ketoconazole. Rifamycins accelerate the
metabolism of diazepam and corticosteroids, thus reducing the
effectiveness of these drugs.


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Glipizide (Glibenese)


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Description

A sulphonylurea oral anti-diabetic.

Indications

Diabetes mellitus.

Effects on oral and dental structures

Glipizide has been cited as causing oral lichenoid eruptions, erythema
multiforme and orofacial neuropathy. The latter can manifest
as tingling or burning in the lips and tongue. The drug is a rare cause
of blood disorders including thrombocytopenia, agranulocytosis,
and aplastic anaemia. The blood disorders could cause oral ulceration,
an exacerbation of periodontal disease and spontaneous bleeding
from the gingival tissues. If the platelet count is low (
100,000)
then the socket should be packed and sutured. Persistent bleeding
may require a platelet transfusion.

Effects on patient management

The development of hypoglycaemia is the main problem associated
with glipizide. This problem is more common in the elderly. Before
commencing dental treatment, it is important to check that the
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 the patient can eat
after dental treatment. If a patient on glipizide requires a general
anaesthetic then refer to hospital.

Drug interactions

Aspirin and other NSAIDs enhance the hypoglycaemic actions of
glipizide. Antifungal agents such as fluconazole and miconazole
increase plasma concentrations of glipizide. Systemic corticosteroids
will antagonize the hypoglycaemic properties of glipizide. If these drugs
are required, then consult the patient’s physician before prescribing.


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Ketoprofen (Orudis)

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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 ketoprofen 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 periodontal breakdown.

Effects on patient management

Rare unwanted effects of ketoprofen include angioedema and thrombocytopenia.
The latter may cause an increased bleeding tendency
following any dental surgical procedure.

Drug interactions

Ibuprofen, aspirin, and diflunisal should be avoided in patients taking
ketoprofen due to an increase in unwanted effects, especially gastrointestinal
ulceration, renal, and liver damage. Systemic corticosteroids
increase the risk of peptic ulceration and gastrointestinal bleeding.

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