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



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Thiazolidinedione Derivative

Pioglitazone (Actos)


Rosiglitazone (Avandia)

Troglitazone (Rezulin) Withdrawn from market March 2000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)




Biphosphonate Derivative

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) Eye drops.



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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