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



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Aspirin and Oxycodone (Percodan)

Same action, use and side effects as individual components.

Morphine Sulfate (MS Contin, Roxanol)

Action: Binds to opiate receptors in CNS to depress pain impulse transmission.

Use: Severe pain

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, headache, TMJ-tinnitus,


Dental Drug Interactions: Increases effect of other CNS depressants, anticholinergics
  • Synthetic

Meperidine (Demerol)

Action: Binds to mu and kappa opiate receptors in CNS, inhibiting ascending pain pathways. Alters pain perception and response. Produces generalized CNS depression.

Use: Moderate to severe pain. Alternative if allergic to codeine. Preoperatively in sedation techniques.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, headache and tinnitus. Better than codeine/hydrocodone if pregnant, ok with lactation.

Medical Considerations: >10%; Hypotension, fatigue, drowsiness, dizziness, nausea, vomiting, constipation, weakness and histamine release.

Medical Considerations: Less common; Confusion, sedation, euphoria, increased intracranial pressure, palpitation, bradycardia, change in BP, tachycardia (IV),

Narcotic Analgesic

  • Synthetic

Meperidine (Demerol) (Continued)

Medical Considerations: anorexia, cramps, respiratory depression, increased urinary output, dysuria, urinary retention, blurred vision, miosis, diplopia,

depressed corneal reflex, rash, urticaria, bruising, flushing, diaphoresis and pruritis.

Dental Drug Interactions: Increased effects with all CNS depressants, anticholinergics.

Medical Drug Interactions: Effect increased by MAO inhibitors, TCAs, phenothiazine, fluoxetine ant other serotonin uptake inhibitors.

Medical Drug Interactions: Dilantin decreases effect. Aggravates adverse effects of isoniazid. Don’t use if MAO inhibitor given in previous 14 days, not with Eldepryl.

Precautions: Use with caution with pulmonary, hepatic and renal disorders, history of seizures. Some preparations contain sulfides; watch out if allergic to sulfides.

  • Synthetic +

Meperidine and Promethazine (Mepergan)

Same action, use and effects as individual components. Main side effect is dry mouth.

  • Synthetic, Meperidine Group

Fentanyl Transdermal System (Duragesic Patches)

Action: Same as Meperidine.

Use: Management of chronic pain.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, dysesthesias. Orthostatic hypotension and laryngospasm.

Medical Considerations: >10%; Hypotension, bradycardia, CNS depression, drowsiness, sedation, nausea, vomiting, constipation and respiratory depression.

Medical Considerations: 1-10%; cardiac arrhythmias, confusion, biliary tract spasm, miosis.

Medical Considerations: <1%; Circulatory depression, convulsions, paradoxical CNS excitation or delirium, dizziness, erythema, pruritis, rash, hives, itching, cold and clammy skin, urinary tract spasm, bronchospasm and muscle rigidity.

Dental Drug Interactions: Effects increased with other CNS depressants and skeletal muscle depressants. Increased anticholinergic effect with anticholinergics. Additive hypotension with nitrous oxide and benzodiazepines.

Medical Drug Interactions: Effects increased by chlorpromazine and cimetidine. Additive hypotension with phenothiazines.

Precautions: Don’t use with myasthenia gravis. Use with caution with respiratory depression, severe liver or renal insufficiency and bradycardia.

Elderly more prone enhanced analgesia, CNS depression and constipation. Pregnancy B (D if high dose at term or for prolonged period).

Narcotic Analgesic

  • Synthetic, Methadone Group

Propoxyphene (Darvon, Darvon-N)

Action: Binds to opiod receptors in CNS, blocking pain.

Use: Treat mild to moderate pain.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, headache and tinnitus. No if pregnant, ok with lactation.

Medical Considerations: >10%; Hypotension, dizziness, lightheadedness, sedation, paradoxical excitement, insomnia, fatigue, drowsiness, GI upset, nausea, vomiting, constipation, weakness and histamine release.

Medical Considerations: 1-10%; Nervousness, restlessness, malaise, confusion, anorexia, stomach cramps, biliary spasm, decreased urination, uretal spasms and dyspnea.

Medical Considerations: <1%; Mental depression, hallucinations, paradoxical CNS stimulation, increased intracranial pressure, rash, urticaria, paralytic ileus.

Dental Drug Interactions: Decreased effect with charcoal (cigarettes). Increased toxicity with other CNS depressants and skeletal muscle relaxants. Increases effects of warfarin and anticholinergics.

Medical Drug Interactions: Increases effects of carbamazepine, barbiturates, MAO inhibitors and TCAs.

Precautions: Severe hepatic and renal disease, respiratory depression and alcoholism. Pregnancy risk factor C (D if prolonged use), Psychological and physical dependence with prolonged use.

  • Synthetic, Methadone Group+

Propoxyphene and Acetaminophen (Darvocet-N, Darvocet-N 100, Propacet, Wygesic) Effects same as individual components.




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