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



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Estrogens, conjugated (Premarin)

Estradiol (Estrace, Estraderm, Climara)

Estropipate (Ortho-Est, Ogen)




Progestogen

Action: Hormone, which inhibits the secretion of pituitary gonadotropins. This prevents follicular maturation and ovulation. Also stimulates growth of mammary tissue.

Use: Abnormal uterine bleeding, secondary amenorrhea, endometrial cancer, metastatic renal cancer, as a contraceptive. Used with estrogens to reduce incidence of endometrial cancer.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Gingival bleeding, gingival overgrowth, fever.

Dental Drug Interactions: No problems with antibiotics, only effect estrogens.

Medroxyprogesterone (Provera, Cycrin, Depo-Provera)


Norethindrone (Aygestin, Micronor, Nor-QD, Femhrt)

Progesterone (Progestasert, Prometrium)

Estrogen +

  • Estrogen and Progestin Combination

Action: Suppress gonadotropins and thus inhibit ovulation.

Use: Treat vasomotor symptoms of menopause, atrophic vaginitis, primary ovarian failure, prophylactic for osteoporosis, prevent pregnancy.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Gingivitis, gingival bleeding, headache, fever. Increased alveolitis post tooth extraction.

Dental Drug Interactions: If give oral antibiotic must use different method of birth control until next menses. Barbiturates decrease effect of this medication, increases toxicity of Tylenol, anticoagulants, benzodiazepines, and corticosteroids.

Estrogen and Medroxyprogesterone (Prempro, Premphase)

Ethinyl Estradiol and Norethindrone (Ortho-Novum, Loestrin, Loestrin Fe, Norinyl)

Ethinyl Estradiol and Norgestrel (Lo/Ovral)

Estrogen +

  • Estrogen and Progestin Combination (continued)

Ethinyl Estradiol and Norgestimate (Ortho Tri-Cyclen)

Ethinyl Estradiol and Levonorgestrel (Triphasil, Levlen, Tri-Levlen, Levlite)

Ethinyl Estradiol and Desogestrel (Desogen, Orthocept)

Ethinyl Estradiol and Ethynodiol Diacetate (Demulen)




  • Estrogen and Androgen Combinations

Action: Estrogen is hormone for growth, development and maintenance of the female reproductive system.

Androgen is hormone which stimulates receptors in organs and tissues to promote growth and development of male sex organs and maintain secondary sex characteristics in androgen deficient males.

Use: Atrophic vaginitis, hypogonadism, primary ovarian failure, vasomotor symptoms of menopause, prostatic carcinoma and prophylaxis for osteoporosis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Increased alveolitis post tooth extraction. Gingivitis, gingival bleeding, blood dyscrasias and headache.

Dental Drug Interactions: Decreases effect of oral anticoagulants. Increases insulin requirement. Increases action of corticosteroids. Oral antibiotics may decrease estrogen effect.

Estrogen and Methyltestosterone (Estratest)




SERM

  • Selective Estrogen Receptor Modulator

Action: Effects some of the same receptors as estrogen, but not all. Acts like estrogen to prevent bone loss and improve lipid profiles but has potential to block estrogen effects such as those causing breast and uterine cancer.

Use: Prevention of osteoporosis in postmenopausal women.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Sinusitis, pharyngitis, arthralgia, myalgia.

Dental Drug Interactions: None reported yet of clinical significance.

Raloxifene (Evista)




Gonadotropin Releasing Hormone

Action: Suppresses ovarian and testicular steroidogensis due to decreased levels of LH and FSH. Decreases levels of testosterone (male) and estrogen (female) hormones.

Use: Treat precocious puberty. Palliative treatment of advanced prostate carcinoma.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, paresthesia and myalgia.

Dental Drug Interactions: None

Leuprolide (Lupron)




Anti-Histamine

Action: Competes with histamine for H-1 receptor sites in GI tract, blood vessels and respiratory tract. Net result is a decreased allergic response.

Use: Relief of nasal and non-nasal symptoms of seasonal allergic rhinitis (sneezing, rhinorrhea, lacrimation and pruritis) and chronic urticaria.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, dry mouth, altered taste, increased thickness of secretions, arthralgia, myalgia, tinnitus and paresthesias.

Dental Drug Interaction: Increased CNS depression with CNS depressants and alcohol. Increased anticholinergic effects with anticholinergics and other antihistamines.

Don’t use ketoconazole or erythromycin with this medication, can result in liver damage and cardiac arrhythmias.

Loratadine (Claritin)

Terfenadine (Seldane) No longer sold, cardiac arrhythmias and fatalities when used with erythromycin and antifungals.

Astemizole (Hismanal) Blood dyscrasias, increases photosensitivity of tetracyclines. Taken off market in June 1999 for same reasons as Seldane.

Cetirizine (Zyrtec) Tongue edema, orofacial dyskinesia, blood dyscrasias.

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