Pharmacology reference by Michael L. Iczkovitz, D. D. S



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PHARMACOLOGY REFERENCE



By Michael L. Iczkovitz, D.D.S.

Midwest Oral & Maxillofacial Surgery

Fort Wayne, IN



American Dental Association Sponsored Speaker



Diuretics

  • Thiazide

Action: Inhibits Na reabsorption in distal renal tubule. Results in increased excretion of water, sodium, chloride, potassium and hydrogen ions.

Use: Treat mild to moderate hypertension, edema in congestive heart failure and nephrotic syndrome.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, paresthesia, headache and orthostatic hypotension. Blood dyscrasias can increase risk infection, bleeding and poor healing.

Dental Drug Interactions: Tetracycline increases photosensitization. Nonsteroidal anti-inflammatory drugs (NSAIDs), especially indomethacin, decreases hypotensive response.

Hydrochlorothiazide (HydroDiuril)

Metolazone (Zaroxolyn)


Chlorthalidone (Hygroton, Thalitone)

Methyclothiazide (Aquatensin, Enduron)

Indapamide (Lozol)




  • Loop

Action: Inhibits Na and Cl reabsorption in loop of Henle and distal renal tubule. Increases excretion of water, sodium, chloride, magnesium and calcium.

Use: Manage edema of congestive heart failure, hepatic, renal disease and hypertension. Also pulmonary edema.

Dental considerations: Local anesthesia with vasoconstrictor ok. Watch patients for orthostatic hypotension. Headache, blood dyscrasias, Stevens-Johnson syndrome.

Dental Drug Interactions: NSAIDs, especially indomethacine, decrease antihypertensive effect of loop diuretics. Corticosteroids increase electrolyte imbalance.

Furosemide (Lasix)

Torsemide (Demadex)

Bumetanide (Bumex)

Bumetanide (Bumex)

  • Potassium Sparing

Action: Competes with aldosterone receptors at distal renal tubules. Increases sodium chloride and water excretion, conserves potassium and hydrogen ions.

Use: Treat edema of cirrhosis of liver, hyperaldosteronism, hypokalemia and hypertension. Treat hirsutism.

Dental considerations: Local anesthesia with vasoconstrictor ok. Gingival bleeding dry mouth, blood dyscrasias, headache.

Diuretics

  • Potassium Sparing (Continued)

Dental Drug Interactions: Indomethacin and possibly other NSAIDs may cause nephrotoxicity and decrease hypertensive response.

Spironolactone (Aldactone)

Triamterine (Dyrenium)




  • Potassium Sparing* Combinations (Thiazide)**

Action: Competes with aldosterone distal renal tubule and inhibits sodium reabsorption at distal tubule, loose water, retain potassium.

Use: Treat mild to moderate hypertension, edema of congestive heart failure and nephrotic syndrome.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Can cause bright orange tongue, burning of tongue, cracked corners of mouth, blood dyscrasias.

Dental Drug Interactions: Tetracycline increases photosensitization. Nonsteroidal anti-inflammatory drugs (NSAIDs), especially indomethacin, decreases hypotensive response and may cause nephrotoxicity

Triamterene* and Hydrochlorothiazide** (Maxzide, Dyazide)

Adrenergic Inhibitors

  • Noncardioselective Beta-Blockers

Action: Blocks beta 1 & 2 stimulation. Results in decreased heart rate, myocardial contractility, blood pressure and myocardial oxygen demand.

Use: Treat hypertension, angina pectoris, pheochromocytoma, essential tremor, cyanosis in tetralogy of Fallot, arrhythmias (atrial, A-V nodal reentry, catecholamine induced) prevention of myocardial infarction, migraine headache, symptoms of hypertrophic subaortic stenosis. Treat Parkinson’s disease tremor, alcohol withdrawal, aggressive behavior, antipsychotic induced akathisia, bleeding esophageal varices, anxiety, schizophrenia, acute panic and gastric bleeding in portal hypertension.

Dental Considerations: Use local anesthesia with vasoconstrictors with caution, may cause hypertension followed by bradycardia. Dry mouth, paresthesias, blood dyscrasias, facial swelling and arthralgia.

Dental Drug Interaction: Hypotensive effect decreased by NSAIDs (use ok less than 3 days), penicillin, barbiturates and salicylates. Beta-blockers increase the effect of acetaminophen and anticoagulants.

Propranolol (Inderal)

Pindolol (Visken) Muscle pain

Nadolol (Corgard) Taste disturbance

Carvedilol (Coreg) Muscle pain, tinnitus, vertigo


Sotalol (Betapace) Life threatening arrhythmia treatment

Adrenergic Inhibitors

  • Cardioselective Beta-Blockers

Action: Blocks beta 1, reduces cardiac output by slowing heart rate and strength of contractility and thus reduces myocardial oxygen demand. Also may inhibit renin release by renal juxtaglomerular apparatus. Reduces spontaneous pacemaker firing and slows AV nodal conduction.

Use: Treat hypertension, angina pectoris, postmyocardial infarction, acute alcohol withdrawal, supraventricular and ventricular arrhythmias, and migraine headache prophylaxis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, blood dyscrasias, headache and sore throat.

Dental Drug Interaction: Decreased antihypertensive effect with long term NSAID (can give safely for three days) and barbiturates. May slow metabolism of lidocaine.

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