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



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Potassium Chloride (Klotrix, K-Dur, Klor-Con)

Nitrates

Action: Reduces cardiac oxygen demand by decreasing systemic vascular resistance and left ventricular pressure. Dilates coronary arteries and improves collateral flow to ischemic regions.

Use: Treat angina pectoris, congestive heart failure (especially if due to MI), pulmonary hypertension and hypertensive emergencies perioperatively.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, oral burning sensation, postural hypotension, and headache.

Dental Drug Interactions: Increased hypotensive effects with alcohol, opiods, aspirin in 1 gram single doses, benzodiazepines and other drugs used in conscious sedation.

Nitroglycerin (Nitrostat, Nitro-Dur, Transderm-Nitro)

Isosorbide Mononitrate (Imdur)

Isosorbide Dinitrate (Isordil)




Cardiac Glycoside

Action: Increases myocardial contractility by inhibiting sodium/potassium ATPase pump, which makes more calcium available for contractile proteins. Also suppresses AV node conduction.

Use: Congestive Heart Failure (CHF), atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia and cardiogenic shock.

Dental Considerations:

Use local anesthesia with vasoconstrictor with caution, risk cardiac arrhythmias. Have increased gag reflex (difficulty taking impressions), headache, neuralgia and photophobia.

Dental Drug Interaction: Medication effect decreased by Antacids increased by barbituarates and erythromycin. Use with corticosteroids causes hypokalemia.

Digoxin (Lanoxin, Digitek)




Antiarrhythmic Agents

Propafenone (Rythmol)

Action: Local anesthetic properties, slows conduction velocity, reduces cardiac muscle responsiveness, inhibits automaticity, increases refractory period and has beta blockade activity.

Use: Treat life threatening ventricular arrhythmias, supraventricular arrhythmias (Wolf-Parkinson-White syndrome).

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, altered taste, stomatitis, tinnitus, headache, paresthesias and blood dyscrasias.

Dental Drug Interactions: Increases levels of warfarin and local anesthetics.



Flecainide (Tambocor)

Action: Local anesthetic properties, slows conduction velocity, increases refractory

period, moderate negative ionotropic effects.



Use: Life threatening ventricular arrhythmias, sustained supraventricular tachycardia.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, altered

taste, headache, blood dyscrasias, tinnitus, paresthesia, photophobia, swelling lips,

tongue, mouth, arthralgia, myalgia.

Dental Drug Interactions: None.

Disopyramide (Norpace)

Action: Decreases myocardial excitability and conduction velocity. Reduces refractory disparity between normal and infarcted myocardium.

Possesses anticholinergic, peripheral vasoconstrictive and negative inotropic effects.

Use: Treat premature ventricular complexes, ventricular tachycardia. Conversion of atrial fibrillation, atrial flutter and paroxysmal atrial tachycardia to normal sinus rhythm and prevention of reoccurrence of these arrhythmias after conversation by other methods.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, paresthesia, headache and blood dyscrasias.

Dental Drug Interactions: Toxicity of medication increased by Erythromycin. Increased side effects with anticholinergics, alcohol. Decreased effects with barbiturates and corticosteroids.




Amiodarone (Cordarone, Pacerone)


Action: Inhibits adrenergic stimulation, prolongs the action potential and refractory

period in myocardial tissue, decreases A-V conduction and sinus node function.



Use: Management of life threatening ventricular arrhythmias or supraventricular

arrhythmias unresponsive to conventional therapy with less toxic agents.



Dental Considerations: Local anesthesia with vasoconstrictor can cause bradycardia and

hypotension. Bitter taste, dry mouth, headache, paresthesia, alveolitis, abnormal

salivation, blood dyscrasias and photophobia.

Dental Drug Interactions: Increases photosensitivity of tetracyclines. Bradycardia and

hypotension with inhalation anesthetics, lidocaine and anticholinergics.



Oral Anticoagulant

Warfarin (Coumadin)

Action: Interferes with hepatic synthesis of vitamin K dependent coagulation factors (II, VII, IX and X).

Use: Prophylaxis and treatment of venous thrombosis, pulmonary embolism and thromboembolic disorders, atrial fibrillation with risk of embolism and to prophylaxis against systemic embolism after myocardial infarction.

Dental Considerations: Gingival bleeding may indicate overdose, mouth ulcers, salivary gland pain and or swelling, fever, blood dyscrasias.

Dental Considerations: Delay surgical procedures until INR is below 2.5 either by having patient lower dose of medication taken or temporarily not take medication. Dose adjustment should be with physician consultation.

Dental Drug Interactions: Cephalosporins, erythromycin, tetracycline, parental penicillin, NSAIDs, indomethacin, salicylates, acetaminophen, propoxyphene, diflunisal, metronidazole, ketoconazole, corticosteroids, chloral hydrate increase anticoagulant activity.

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