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

Expectorant + Combined with Antitussive

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Expectorant +

  • Combined with Antitussive

Guaifenesin and Dextromethorphan (Robitussin DM)

Action: Expectorant and *chemical relative of morphine lacking narcotic properties at dose used. Antitussive through medullary cough center depression.

Use: Temporary control of cough due to minor throat and bronchial irritation.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headaches.

Dental Drug Interactions: None

  • Combined with Decongestant

*Guaifenesin and **Phenylephrine (Deconsal, Sinupan)

*Guaifenesin and **Pseudoephedrine (Entex)

Action: * Phlegm volume increased, viscosity decreased. **Decreases blood flow to respiratory mucosa.

Use: Cold preparation.

Dental Considerations: Don’t use local anesthesia with vasoconstrictor. Dry mouth, headache.

Dental Drug Interactions: Hypertensive crisis with MAO inhibitors, sympathomimetics. Sedation with CNS depressants and alcohol. Arrhythmias with inhalation anesthetics.

  • Combined with Decongestant

Guaifenesin and Phenylpropanolamine (Triaminic Expectorant)

Use: Relief of respiratory conditions with tenacious mucous plugs and congestion. Used in sinusitis, pharyngitis, bronchitis, asthma. Adjunctive therapy in serous otitis media.

Action, Dental Considerations, Dental Drug Interactions: Same as individual components.

Insulin Preparations

Action: Pancreatic hormone causing glucose to enter cells. Promotes conservation of energy as glucose is converted to glycogen (in muscle and liver cells) and triglycerides (in fat cells). Fat mobilization and gluconeogenisis is inhibited, protein synthesis is stimulated.

Use: Treat insulin dependent diabetes mellitus, IDDM, (juvenile onset, type I). Also for noninsulin dependent diabetes mellitus, NIDDM, (insulin independent, maturity onset, type II) unresponsive to diet and or oral hypoglycemics. With glucose to treat hyperkalemia. Also to reduce glycosuria in patients getting hyperalimentation.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Dry mouth, numbness of mouth, headache and hypothermia. If IDDM consider antibiotic prophylaxis with surgery, more prone to infection. Patient should monitor blood sugar and vary

insulin dosage accordingly following dental procedures which alter oral intake. May have delayed or poor healing.

Insulin Preparations (continued)

Dental Drug Interactions: Salicylates and NSAIDs (large doses, chronic use), alcohol and tetracyclines increase hypoglycemic effect. Steroids and smoking decrease hypoglycemic effect.

  • Rapid onset (1/2 - 1 hour), short duration (10 - 24 hours).

Regular Insulin (Novolin R, Humulin R)

Prompt Insulin Zinc Suspension, Semilente

Isophane Insulin and Regular Insulin (Novolin 70/30)

  • Intermediate Acting, onset (1 - 2 1/2 hours), duration (18 - 24 hours)

Insulin Zinc Suspension, NPH, (Novolin N, Humulin N)

Isophane Insulin Suspension, Lente

  • Long Acting, onset (4 - 8 hours), duration (36 hours or more)

Protamine Zinc Insulin Suspension, PZI

Extended Insulin Zinc Suspension, Ultralente (Humulin U)

Oral Anti-Diabetic Agent

  • Sulfonylurea

Action: Stimulates release of insulin from pancreatic beta cells. Increases insulin sensitivity at peripheral target sites. Reduces liver output of glucose.

Use: Control blood sugar in adult onset, noninsulin dependent diabetes (type II). Also treat neurogenic diabetes insipidus.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headaches, tinnitus, blood dyscrasias.

Dental Drug Interactions: Salicylates increase hypoglycemic response. Can act like antabuse with alcohol.

Chlorpropamide (Diabinese) 1st generation

Glimepiride (Amaryl) 2nd generation

Glipizide (Glucotrol) 2nd generation

Glyburide (Diabeta, Glynase, Micronase) 2nd generation, joint pain

  • Biguanides

Action: Decreases hepatic glucose production decreases intestinal absorption of glucose and improves peripheral insulin sensitivity (increases glucose uptake and utilization).

Use: Management of noninsulin dependent diabetes mellitus type II, either alone or concomitantly with a sulfonylurea.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Unpleasant metallic taste, blood dyscrasias.

Dental Drug Interactions: Corticosteroids decreases effect, can cause hyperglycemia. Morphine and vancomycin increases effect can cause hypoglycemia.

Oral Anti-Diabetic Agent

  • Biguanides (continued)

Metformin (Glucophage)

  • Sulfonylurea and Biguanides

Glyburide and Metformin (Glucovance)

Action, Use, Dental Considerations an d Dental Drug Interactions: See individual drugs.

  • Meglitinide

Repaglinide (Prandin)

Nateglinide (Starlix)

Action: Stimulates insulin secretion by beta cells of pancreas.

Use: Adjunct to diet and exercise to lower blood glucose in non-insulin dependent, Type II diabetes mellitus.

Dental Considerations: Local anesthesia with vasoconstrictor ok..

Dental Drug Interactions: None.

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