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Troglitazone (Rezulin) Withdrawn from market March 2000
Action: Improves target cell sensitivity to insulin, mainly peripherally, skeletal muscle and adipose tissue, not as effective on liver. No effect on pancreas. Use: Manage type II diabetics currently on insulin whose hyperglycemia is not controlled. Also can be used as monotherapy or in combination with sulfonylureas and Metformin. Dental Considerations: Local anesthesia with vasoconstrictors ok. Headache, neck pain, pharyngitis, infection and sinusitis. Dental Drug Interactions:
Ketaconazole and itraconazole increase effect of this medication.
Alpha Glucosidase-Inhibitor Acrobase (Procase)Rosiglitazone (Avandia) Action: Competitive, reversible inhibition of pancreatic enzyme alpha-amylase and intestinal membrane bound alpha gluosidase hydrolase enzyme, delays glucose absorption and lowers blood glucose. Use: Manage type II diabetics currently on insulin whose hyperglycemia is not controlled. Also can be used as monotherapy or in combination with sulfonylureas and Metformin. Dental Considerations: Local anesthesia with vasoconstrictors ok. Dental Drug Interactions: Increased hypoglycemia with corticosteroids. Calcium Salt Action: Needed for nerve and muscle performance via action potential excitation threshold regulation. Also deposited in bone formation. Neutralizes gastric acidity. Use: Prevent postmenopausal osteoporosis. Treat and prevent calcium depletion. Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache. Dental Drug Interactions: Decreases absorption of tetracyclines. Calcium Citrate (Citracal)
Action: Inhibits osteoclastic mediated bone resorption. Use: Treatment and prevention of osteoporosis in postmenopausal women. Also treat Paget’s disease of bone, osteolytic bone metastases. Dental Considerations: Local anesthesia with vasoconstrictor ok. Taste alteration, headache, dysphagia, tinnitus, paresthesia and muscle pain. Dental Drug Interaction: Increases risk of GI side effects with NSAIDs and ASA. Alendronate (Fosamax) Risedronate (Actonal) Calcitonin Product Action: Hormone, which inhibits osteoclastic bone resorption. Promotes renal excretion of calcium, phosphate, sodium, magnesium and potassium by decreasing tubular reabsorption. Increases jejunal secretion of water, sodium, potassium and chloride. Use: Treat Postmenopausal osteoporosis, as adjunct for hypercalcemia, for Pagets disease of bone and intractable bone pain. Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, metallic taste, facial flushing, headache, paresthesia, chills, myalgia and arthrosis. Dental Drug Interactions: None Calcitonin (Miacalcin Nasal Spray) Uric Acid Lowering Agents Allopurinol (Zyloprim) Action: Inhibits the enzyme xanthine oxidase reducing uric acid synthesis. Use: Treat chronic gout, hyperuricemia associated with malignancies, recurrent calcium oxalate calculi. Dental Considerations: Local anesthesia with vasoconstrictor ok. Metallic taste, stomatitis, salivary gland swelling, Stevens-Johnson syndrome, paresthesia, headache, arthralgia, blood dyscrasias, chills and fever. Dental Drug Interactions: May increase incidence of skin rash with ampicillin and amoxicillin. Increases activity of oral anticoagulants. Colchicine Action: Decreases leukocyte motility, phagocytosis in joints, lactic acid production, reduces uric acid crystals. Use: Treat gout, manage familial Mediterranean fever. Dental Considerations: Local anesthesia with vasoconstrictor ok. Dental Drug Interactions:
Additive effect with CNS depressants.
Antiglaucoma Agent Noncardioselective Beta Blocker Action: Blocks both beta-1 and beta-2 adrenergic receptors. Reduces intraocular pressure by reducing aqueous humor production or possibly outflow. Use: Treat elevated intraocular pressure such as glaucoma or ocular hypertension. Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache. Dental Drug Interactions: None Timolol (Timoptic)
Eye drops. Levobunolol (Betagan)
Action: Reduces production of aqueous humor and thus reduces intraocular pressure. Use: Treat chronic open angle glaucoma and ocular hypertension. Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache. Dental Drug Interactions: None Betaxolol (Betoptic)
Antiglaucoma Agent Diuretic, Carbonic Anhydrase Inhibitor Action: Inhibits this enzyme, which results in less hydrogen ion secretion at renal tubule and increased renal excretion of sodium, potassium, bicarbonate and water. Action: Decreases production of aqueous humor. In CNS retards abnormal and excessive neuron discharge. Use: Open angle and narrow angle glaucoma, epilepsy, edema in CHF, drug-induced edema and acute altitude sickness.
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