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



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CNS Stimulant

Methylphenidate (Ritalin)

Action: Increases release of norepinephrine and dopamine in the cerebral cortex to the reticular activating system. Stimulates cerebral cortex and subcortical structures similar to amphetamines.

Use: Treat attention deficit disorder with hyperactivity, narcolepsy.

Dental Considerations: Local anesthesia with vasoconstrictor ok unless patient is hypertensive. Dry mouth, headache, blood dyscrasias, and erythema multiforme.

Dental Drug Interactions: May increase effects of oral anticoagulants and barbiturates.

Pemoline (Cylert)



Action: Blocks reuptake of dopamine, acts at cerebral cortex and subcortical

levels.


Use: Attention deficit disorder with hyperactivity, narcolepsy.

Dental Considerations: Local anesthesia with vasoconstrictor ok..

Headache.



Dental Drug Interactions: None
Modafinil (Provigil)

Action: CNS stimulant, mechanism of action unknown.

Use: Narcolepsy

Dental Considerations: Local anesthesia with vasoconstrictor ok. Chills, fever, dry

mouth, oral ulcerations, gingivitis, blood dyscrasias, arthralgia, paresthesia, pharyngitis,

headache.

Dental Drug Interactions: May increase coumadin toxicity. Azole antifungals,

ketoconazole and itraconazole may increase toxicity of modafinil. May increase

valium toxicity.

  • Amphetamines


Dextroamphetamine and Amphetamine (Adderall)

Dextroamphetamine (Dexedrine, Dextrostat)

Action: Blocks dopamine and norepinephrine reuptake, increasing their concentration in

cerebral cortex and reticular activating system. MAO inhibitor, causes catecholamine

release.

Use: Treat narcolepsy, obesity, abnormal behavior syndrome in children, attention

deficit/hyperactivity disorder.



Dental Considerations: No local anesthetic with vasoconstrictor, potential hypertension

and cardiotoxicity. Headache, dry mouth, unpleasant taste.



Dental Drug Interactions: Arrhythmias possible with general anesthetics.


  • Antiobesity Agent

Orlistat (Xenical)

Action: Reversible inhibitor of lipases, prevents GI absorption of fats.

Use: Treat obesity.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Gingival and tooth

disorder, headache, TMJ-myalgia, TMJ-arthralgia.



Dental Drug Interactions: Decreases vitamin K absorption, makes warfarin more

effective.


Ergot Alkaloid

Ergoloid Mesylates (Germinal, Hydergine)

Action: May increase cerebral blood flow and metabolism.

Use: Treatment of cerebrovascular insufficiency in primary progressive dementia, Alzheimer’s dementia, multiinfarct dementia and senile dementia.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Sublingual irritation, orthostatic hypotension, headache.

Dental Drug Interactions: None


Ergotamine (Cafergot, Wigraine) Adrenergic blocking agent, prevent vascular headaches, such as migraine or cluster. Dry mouth, myalgia and paresthesia. Macrolide antibiotics may cause ergot toxicity.

Acetylcholinesterase Inhibitor

Donepezil (Aricept)


Action: Central acting reversible cholinesterase inhibitor, increases acetylcholine

concentration.



Use: Treat mild to moderate dementia associated with Alzheimer’s disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Toothache, dry

mouth, bad taste, gingivitis, tongue edema, coated tongue, headache, muscle

cramps, arthritis, blood dyscrasias, tinnitus.

Dental Drug Interactions: Use with NSAIDs increases risk GI bleeds. Action

decreased by anticholinergics, increases action of succinylcholine. Ketoconazole may

inhibit drugs metabolism.
Galantamine (Reminyl)

Action: Unknown, possible reversible inhibition of acetylcholinesterase.

Use: Alzheimer’s disease.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Postural

hypotension, paresthesia, dysphagia, dry mouth, blood dyscrasias.



Dental Drug Interactions: Increases activity of succinylcholine, cholinergic agonists

like bethanechol. Ketoconazole and erythromycin increases Galantamine



concentration.

Anti-Convulsant

Valproic Acid and Derivatives (Depacon, Depakene, Depakote)

Action: Increases levels of gamma aminobutyric acid, an inhibitory neurotransmitter, in the brain.

Use: Simple, complex (petit mal) absence, mixed seizures, complex partial seizures, migraine prophylaxis, tonic-clonic (grand mal) seizures and infantile spasms. Depakote for manic episodes in bipolar disorder.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Gingival enlargements, headache, erythema multiforme, blood dyscrasias with prolonged bleeding and delayed healing.

Dental Drug Interactions: Increases toxicity of barbiturates, alcohol and CNS depressants potentiates depressant effects of valproic acid. Increases bleeding with aspirin, NSAIDs and coumadin.

Carbamazepine (Tegretol)

Action: Inhibits nerve impulses by limiting influx of sodium ions across cell membrane in motor cortex. Also has anticholinergic, antineuralgic, antidiuretic, muscle relaxant and antiarrhythmic properties.

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