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



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Fexofenadine (Allegra) Doesn’t cross blood brain barrier, little sedation.

Clemastine (Tavist)

Diphenhydramine (Benadryl) Also used to treat motion sickness, Parkinson’s disease, phenothiazine induced dystonic reactions, infant colic, nonproductive cough, used for nighttime sedation. Can also be used as local anesthetic. Blood dyscrasias.

Meclizine (Antivert) Nonspecific CNS depressant with anticholinergic and antihistamine activity blocks middle ear neural activity. Used to treat vertigo and motion sickness.

Promethazine (Phenergan) as a suppository. A phenothiazine derivative, mainly acts as antihistamine. Also used as antiemetic, to treat motion sickness and as a pre and postoperative sedative.


Azatadine (Optimine)

Chlorpheniramine (Chlor-Trimeton)

Decongestant

  • Adrenergic Agonist Agent

Action: Primarily stimulates alpha-adrenergic receptors of respiratory mucosa causing vasoconstriction. Also stimulates beta-adrenergic receptors causing bronchial relaxation, increased heart rate and contractility.

Use: Temporary symptomatic relief of nasal congestion due to common cold, upper respiratory allergies and sinusitis. Also promotes nasal and sinus drainage.

Dental Considerations: Don’t use local anesthetic with vasoconstrictor, can cause pressor response. Dry mouth, headache.

Decongestant

  • Adrenergic Agonist Agent (continued)

Dental Drug Interactions: Hypertensive crisis with MAO inhibitors, sympathomimetics. Sedation with CNS depressants and alcohol. Arrhythmias with inhalation anesthetics.

Pseudoephedrine (Sudafed, Actifed Tabs, Afrin Tabs, Triaminic)

Oxymetazoline (Afrin) Treat middle ear infections, redness of eye. Rebound congestion with prolonged use.

Ephedrine Also treat bronchial asthma and bronchospasm, orthostatic hypotension. Releases tissue stores of epinephrine. Longer acting but less potent than epinephrine. Use with atropine will increase blood pressure

.

Anti-Histamine +

  • Combined with Decongestant

Action: Antihistamine decreases allergic reaction. Adrenergic agonist causes vasoconstriction of respiratory mucosa.

Use: Treat nasal and sinus congestion.

Dental Considerations: No local anesthetic with vasoconstrictor. Rest same as antihistamines and decongestants.

Dental Drug Interactions: Same as antihistamines and decongestants. Most important, don’t use erythromycin with these medications.

Loratadine and Pseudoephedrine (Claritan D)

Brompheniramine and Phenylpropanolamine (Dimetapp)

  • Combined with Antitussive

Promethazine and Codeine (Phenergan with Codeine)

Action: Promethazine, which is also a Phenothiazine derivative, primarily functions as a antihistamine. Codeine, an opium alkaloid, is also a narcotic analgesic. At the smaller doses, used here, it primarily exerts an antitussive effect by suppressing the CNS medullary cough center.

Use: Temporary relief of cough and upper respiratory symptoms associated with allergy or common cold.

Dental Considerations: Local anesthesia with vasoconstrictor ok. In dosages used no problems reported.

Dental Drug Interactions: In dosages used none reported.


+ Decongestant

  • Analgesic and Decongestant

Acetaminophen* and Pseudoephedrine (Tylenol Sinus, Allerest, Dristan, Sinarest)

Action: Acetaminophen is analgesic and antipyretic, not anti-inflammatory. Pseudoephedrine is adrenergic agonist decongestant.

Use: Relief of congestion with mild to moderate pain.

Dental Considerations: No local anesthesia with vasoconstrictor. *Dry mouth, headache, blood dyscrasias, don’t use with G6PD deficiency.

Dental Drug Interactions: *Can cause hepatic toxicity in therapeutic doses with alcoholics and with INH. Large doses cause hepatitic toxicity with barbiturates and Dilantin. Rest same as decongestants.

+ Anti-Histamine +

Acetaminophen, Chlorpheniramine and Pseudoephedrine (Sinutab)

Action: Analgesic, antihistamine and decongestant.

Use: Temporary relief of sinus symptoms.

Important Dental Considerations: Say no to local anesthesia with vasoconstrictors. Say no to alcoholics, if taking INH, erythromycin and antifungal medications.

Expectorant

Guaifenesin (Robitussin)

Action: Irritates gastric mucosa and stimulates respiratory tract secretions thus increasing respiratory fluid volumes and decreasing phlegm viscosity.

Use: Temporary control of cough due to minor throat and bronchial irritation.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache.

Dental Drug Interactions: None



Iodinated Glycerol (Organidin)

Action: Increases respiratory tract secretions by decreasing surface tension and thereby

decreases mucous viscosity, which aids in removal of mucous.



Use: Adjunctive treatment of bronchitis, bronchial asthma, pulmonary emphysema,

cystic fibrosis and chronic sinusitis.



Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache.

Dental Drug Interactions: Increases toxicity of Flagyl, CNS depressants.
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