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



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Medical Considerations: Uncommon adverse reactions; stimulation, drowsiness, hepatotoxicity, nausea, vomiting, abdominal pain, angioedema, rash and urticaria.

Medical Considerations: Toxicity shown with cyanosis, anemia, neutropenia, jaundice, pancytopenia, CNS stimulation, delirium; then vascular collapse, convulsions, coma and death.

Dental Drug Interactions: Barbiturates liver toxicity of high doses of acetaminophen. Therapeutic doses with alcohol may cause severe hepatic toxicity. Nephrotoxicity with long-term consumption especially if combined with NSAIDs. Buffered acetaminophen decreases tetracycline absorption.

Medical Drug Interactions: Cholestyramine reduces effect. Hepatic toxicity possible with INH and Dilantin.

Precautions: Don’t use with G-6-PD deficiency, alcoholics and liver disease.

Acetaminophen (Tylenol, Aspirin Free Anacin, Tempra)

  • Acetaminophen Combinations

Acetaminophen and Diphenhydramine (Excedrin P.M., Midol P.M.)

Action: Acetaminophen is analgesic and antipyretic. Diphenhydramine (Benadryl) is H-1 blocker, decongestant.

Use: Treat mild to moderate pain, sinus headache.

Main side effect dry mouth. Others same as individual components.

Non-Narcotic Analgesic?

Tramadol (Ultram)

Action: Binds to Upsilon opiate receptors in CNS and inhibits reuptake of norepinephrine and serotonin. This inhibits ascending pain pathways and alters perception and response to pain.

Use: Treat moderate to severe pain.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, stomatitis and headache. Don’t use if pregnant, lactation.

Medical Considerations: >1%; dizziness, somnolence, restlessness, nausea, constipation, sweating.

Non-Narcotic Analgesic?

Tramadol (Ultram) continued

Medical Considerations: Other adverse reactions; vertigo, seizures, anxiety, confusion, vasodilatation, palpitation, vomiting, dyspepsia, diarrhea, flatulence, urinary retention, frequency, visual disturbances, pruritis, sweating, rash hypertonia and malaise.

Dental Drug Interactions: Increased risk respiratory depression with anesthetics and alcohol. Increased risk sedation with other CNS depressants and alcohol.

Medical Drug Interactions: Decreased activity with carbamazepine. Increased activity with cimetidine and quinidine. Increased risk of seizures MAO inhibitors, TCAs and serotonin reuptake inhibitors.

Precautions: Can’t use if allergic to opiods. Don’t use if acute intoxication with alcohol, hypnotics, centrally acting analgesics, psychotropic drugs or opiods. While

not a controlled substance dependence and abuse are possible. Greater risk with elderly, chronic respiratory disorders, liver and renal disease, children, myxedema, hypothyroidism and hypoadrenalism.

Narcotic Analgesic

  • Opium Alkaloid +

Hydrocodone and Acetaminophen (Anexia, Bancap, Co-Gesic, Lorcet, Lortab and Vicodin)

Action: Hydrocodone is opiate analgesic, binds to Mu and Kappa opiate receptors in cerebral cortex and blocks pain perception. In medulla suppresses cough center.

Action: Acetaminophen is prostaglandin inhibitor with analgesic and antipyretic activity.

Use: Treat moderate to severe pain. Class III narcotic.

*Hydrocodone and Acetaminophen

*Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, headache and tinnitus. Better than codeine for pregnancy, but not great. No with breast-feeding (codeine ok).

*Medical Considerations: >10%; hypotension, lightheadedness, dizziness and sedation. 1-10%; nausea.

*Medical Considerations: Other adverse reactions; convulsions, euphoria, dysphoria, weakness, hallucinations, disorientation, circulatory depression, palpitations, tachycardia, bradycardia, change in BP, syncope, anorexia, vomiting, constipation, cramps, respiratory depression, dysuria, increased urinary output, urinary retention, blurred vision, miosis, diplopia, rash, urticaria, flushing and pruritis.

*Dental Drug Interactions: Allergic cross reactions with other phenanthrene derivatives (morphine, codeine, levorphanol, oxycodone and oxymorphone). Increased CNS depression with alcohol, phenothiazines, sedative/hypnotics, skeletal muscle relaxants, general anesthetics and other opiods. Increased effects of anticholinergics, may cause paralytic ileus.

*Medical Drug Interactions: Use of antidepressants (MAO inhibitors or TCAs) and hydrocodone can increase effects of both antidepressant and hydrocodone.

Narcotic Analgesic

  • Opium Alkaloid +

Hydrocodone and Acetaminophen (Anexia, Bancap, Co-Gesic, Lorcet, Lortab and Vicodin) (Continued)

Precautions: Don’t use if G-6-PD deficiency. Use with caution if respiratory diseases (asthma, emphysema, COPD), severe liver or renal insufficiency. Many preparations contain sulfites, watch for allergic reactions.

Hydrocodone and Aspirin (Lortab ASA)

Same action, use, considerations, drug interactions, and precautions as individual components.

Acetaminophen and *Codeine (Capital and Codeine, Phenaphen with Codeine, Tylenol with Codeine) *More nausea, vomiting and constipation than with Hydrocodone. Same action and use as Hydrocodone. Similar considerations, drug interactions and precautions as individual components. Codeine acts as hydrocodone.

Acetaminophen and *Oxycodone (Percocet, Tylox)

*Class II narcotic. Same use and action as individual components with Oxycodone acting as Hydrocodone. More side effects than with Hydrocodone. Dry mouth more common. * >10%: Fatigue, drowsiness, dizziness, nausea and vomiting. 1-10%: Anorexia, stomach cramps, xerostomia, constipation and biliary spasm.

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