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



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Anorexiant

Phentermine (Fastin, Adipex)

Action: An amphetamine, stimulates hypothalamus which results in decreased appetite.

Use: Short term adjunct to exogenous obesity.

Dental Considerations: Local anesthetic with vasoconstrictor may result in enhanced sympathomimetic response resulting in hypertension and cardiotoxicity.

Dental Considerations: Dry mouth, unpleasant taste, blood dyscrasias and myalgias.

Dental Drug Interactions: Counteract sedative effects of antihistamines. Potentiates analgesic effects of meperidine.




Fenfluramine (Pondimin) Removed from market in 1997

Dexfenfluramine (Redux)

Any patients with history of taking these drugs are in danger of cardiac valvulopathy. They need medical exam and also echocardiograph if undergoing invasive procedure. Removed from market in 1997.

Dexfenfluramine & Fenfluramine (Redux Fen)


Fenfluramine & Phentermine (Fen Phen)

If emergency give AHA antibiotic prophylaxis. Fenfluramine was combined with Phentermine to form the popular Fen Phen combination. There are no valvular problems with phenteramine. Your history should ask if these meds ever were taken by patient.



Sibutramine (Meridia)

Action: Mixed reuptake inhibitor, CNS, of norepinephrine, and to lesser extent serotonin

and dopamine.



Use: Management of obesity.

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

mouth, taste alteration, TMJ-arthralgia, pharyngitis, sinusitis.



Dental Drug Interactions: Erythromycin, ketoconazole, itraconazole, increase

sibutramine levels, serotonin syndrome with demerol, tramadole.


Anti-Alcoholic Agent

Disulfiram (Antabuse)

Action: Blocks oxidation of alcohol at the acetaldehyde stage. Increase in serum acetaldehyde results in flushing, nausea, thirst, palpitations, chest pain, vertigo and hypotension. Disulfiram-alcohol reaction can also include throbbing, respiratory difficulty, vomiting, sweating, dyspnea, hyperventilation, tachycardia, confusion, CV collapse, MI, CHF, convulsions and death.

Use: Management of chronic alcoholism.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache and metallic or garlic-like aftertaste.

Dental Drug Interactions: Increased CNS depression with long acting benzodiazepines. Alcohol reaction. Do not use with metronidazole, causes psychosis.




Smoking Deterrent

Nicotine (Nicoderm, Nicorette)

Action: Potent autonomic ganglionic and central nervous system stimulant. Larger doses result in biphasic effect, stimulation followed by blockage of transmission of ganglia and adrenal medulla. CNS stimulation characterized by tremors, respiratory excitation. Larger doses may cause convulsions and respiratory failure.

Use: Aid to smoking cessation with behavior modification.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Burning oral mucosa and unpleasant taste.

Dental Considerations: Increased salivation, dry mouth (rare), sore throat, numbness, tinnitus, arthralgia and headache and jaw muscle ache.

Medical Considerations: Tachycardia, atrial fibrillation, nausea, vomiting, indigestion, belching, increased appetite, hiccups, insomnia, depression, euphoria, dizziness, vertigo, nervousness, dysmenorrhea, diarrhea, dyspepsia, constipation, abdominal pain, vomiting, eructation, myalgia, hoarseness, cough, sneezing, wheezing, erythema, itching and pruritis.

Contraindications: Pregnancy or nursing, life-threatening arrhythmias, immediate post myocardial infarction period, severe or unstable angina pectoris.

Precautions: Esophagitis, peptic ulcer, CAD, hypertension, pheochromocytoma, hyperthyroidism, diabetes, renal and hepatic dysfunction, and skin disease.

Dental Drug Interactions: Increased blood levels at cessation of smoking of propoxyphene. Decreases effect of caffeine and pentazocine.

Medical Drug Interactions: Decreases effect of Imipramine, Oxazepam, Propranolol, theophylline, Glutethimide and lithium patch. Increases effects of furosemide, insulin and circulating cortisol and catecholamines.

Anti-Malarial Agent

Hydroxychloroquine (Plaquenil)

Action: Inhibits parasite replications, transcription of DNA to RNA by forming complexes with DNA of parasite. Also interferes with digestive vacuole function in malarial parasite. Inhibits PMN locomotion, chemotaxis of eosinophils and impairs complement dependent antigen-antibody reactions.

Use: Suppress and treat acute attacks of malaria. Treat systemic lupus erythematosus and rheumatoid arthritis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Discoloration of oral mucosa and lichenoid lesions, headache, blood dyscrasias, tinnitus and photophobia.

Dental Drug Interactions: Hepatotoxicity with alcohol and hepatotoxic drugs.



Chelating Agent

Penicillamine (Cuprimine, Depen)

Action: Chelates with lead, copper, mercury and other heavy metals to form stable,

soluble complexes that are excreted in urine, combines with cystine to form more

soluble compound to prevent cystine calculi, depresses circulating IgM rheumatoid

factor, depresses T-cell but not B-cell activity.



Use: Treat Wilson’s disease, cystinuria, adjunct in treatment of severe rheumatoid

arthritis, lead poisoning, primary biliary cirrhosis.



Dental Considerations: Local anesthesia with vasoconstrictor ok. Fever, arthralgia,

edema of face, chills, sore throat, blood dyscrasias, white spots on lips or mouth,

tinnitus.

Dental Drug Interactions: None.
Multiple Sclerosis Agents

Giltiramer (Copaxone)

Action: Mixture of polymers of amino acids antigenically similar to myelin sheath of

nerves, interferes with T-lymphocytes specific for attacking myelin sheath.



Use: Treat multiple sclerosis, most effective with minimal disability.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Pain, TMJ-arthralgia,

fever, chills, headache, facial edema, lupus erythematosus, blood dyscrasias.



Dental Drug Interactions: None

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