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

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Vitamin A Derivative

  • Isotretinoin (Accutane)

Action: Reduces sebaceous gland size and reduces sebum production. Regulates cell proliferation and differentiation.

Use: Severe recalcitrant cystic acne. Investigational for metastatic neuroblastoma and leukemia in children unresponsive to normal medication.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, cheilitis, inflammation of lips, gingival bleeding, headache, arthralgia, myalgia and photophobia.

Dental Drug Interactions: Additive photosensitivity with tetracycline. Pseudotumor cerebri with tetracyclines.

Vitamin A Derivative

  • Tretinoin, Topical (Retin-A)

Action: Keratinocytes in sebaceous follicle become less adherent allowing easier removal. Decreases microcomedone formation.

Use: Treatment of acne vulgaris, photodamaged skin, skin cancer and lichen planus.

Dental Considerations: Local anesthesia with vasoconstrictor ok.

Dental Drug Interactions: Increased photosensivity with tetracyclines. Increased toxicity salicylic acid.

Vitamin D Derivative

  • Calcitrol (Rocaltrol, Calcijex)

  • Doxercalciferol (Hectorol)

Action: Promotes absorption of calcium in intestines and retention in kidneys, thus increases calcium levels, decreases serum phosphatase levels, parathyroid levels, decreases bone resorption, increases renal tubule phosphate resorption.

Use: Treat hypocalcemia due to chronic renal dialysis, reduce elevated parathyroid hormone, treat psoriasis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache, altered taste, TMJ-myalgia, photophobia

Dental Drug Interactions: None.

Non-Narcotic Analgesic

  • Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

Action: Analgesic decreases prostaglandin formation. Prostaglandin allows bradykinin to be perceived as painful. Anti-inflammatory, prostaglandin increases capillary blood flow and permeability. There is decreased prostaglandin. Anti-pyretic, inhibits prostaglandin synthesis by hypothalamus which reduces temperature.

  • Salicylate NSAIDs

Use: Treat mild to moderate pain, fever, transient ischemic attacks, thromboembolic disorders, rheumatoid arthritis, rheumatic fever, osteoarthritis, gout (high dose), and treat and prophylaxis for myocardial infarction.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Increased oral bleeding (chronic, high doses), headache, blood dyscrasias and tinnitus. If possible avoid one week prior to surgery. Pregnancy and lactation, no.

Medical Considerations: >10%; nausea, vomiting, dyspepsia, epigastric discomfort, heartburn. 1-10%; GI ulceration. 0.2% aspirin allergy; asthmatic syndrome, wheezing, bronchiolar constriction.

Medical Considerations: Other adverse reactions; coma, convulsion, stimulation, drowsiness, dizziness, confusion, flushing, hallucinations, rapid pulse, pulmonary edema, hepatitis, diarrhea and anorexia, hyperpnea, hearing loss, rash, urticaria, bruising, hypoglycemia, hyponatremia and hypokalemia.

Non-Narcotic Analgesic
  • Salicylate NSAIDs (continued)

Dental Drug Interactions: Increased bleeding risk oral anticoagulants. May reduce effect of other NSAIDs. Avoid corticosteroids and acetaminophen.

Medical Drug Interactions: Can cause toxicity of acetazolamide (CNS) and methotrexate (hepatic). Increased GI bleeding and complaints alcohol. Increased risk

bleeding valproic acid, dipyridamole. Increased toxicity lithium and zidovudine. Decreased effects of probenecid and sulfinpyrazone.

Contradictions: Don’t use if bleeding or platelet disorder, renal and hepatic dysfunction, ulcer disease and allergic to tartazine dye. Children <16 with chickenpox or flu symptoms (Reyes Syndrome). Use with caution in asthmatics.

Acetylsalicylic Acid (Aspirin, Anacin, Bayer, Bufferin, Ecotrin, Empirin)

  • Salicylate NSAIDs +

Orphenadrine, Aspirin and Caffeine (Norgesic, Norgesic Forte)

Orphenadrine is muscle relaxant Norflex, dry mouth. Treat skeletal muscle discomfort.

Use: Mild to moderate pain, swelling, rheumatoid, gouty and osteoarthritis, primary dysmenorrhea and vascular headache.

Dental & Medical Considerations: Same as salicylates plus dry mouth, stomatitis and increased thirst.

Dental & Medical Drug Interactions: Same as salicylates. Nephrotoxic with acetaminophen. Increased photosensitivity with tetracycline. Increased toxicity diuretics. Not with methotrexate.

Ketoprofen (Orudis, Oruvail) Pregnancy B

Oxaprozin (Daypro) Pregnancy C, mainly arthritis treatment. Erythema multiforme, Stevens-Johnson syndrome.

Naproxen (Aleve, Anaprox, Naprosyn) Decreases effects of furosemide. Pregnancy B (D 3rd trimester). Also treat fever.

Ibuprofen (Advil, Motrin, Midol, Nuprin, Rufen) Juvenile rheumatoid arthritis, ankylosing spondylitis, acute migraine headache. Antiplatelet effect only lasts as long as drug in blood. Pregnancy B (D in 3rd trimester).

  • Acetic Acid derivative NSAIDs

Use: Mainly arthritis.

Dental & Medical Considerations: Same as other proprionics plus 1-10%; nervousness, itching, fluid retention. <1%; hypertension, congestive heart failure, arrhythmias, Erythema multiforme and toxic epidermal necrolysis.

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