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

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Contraindications: Don’t use within 14 days of taking MAO inhibitors. Don’t give if hyperthyroid, CHF, arrhythmias, immediately post MI, child <12 yrs. Use with caution if urinary hesitancy or angle-closure glaucoma.

Drug Interactions: Increased CNS depression with alcohol, narcotics, barbiturates, sedatives, hypnotics. Increased effects of anticholinergics.

Increased toxicity with TCAs. Increased effect of direct acting sympathomimetics (epinephrine and levonordefrin).

  • Orphenadrine (Norflex)

Action: Acts central to depress synaptic pathways. Has atropine like effects as well as euphorgenic and analgesic properties.

Use: Treat muscle spasm associated with acute painful musculoskeletal conditions, tetanus, TMJ.

Dental Considerations: Local anesthesia with vasoconstrictor OK. Dry mouth, facial flushing, headache and blood dyscrasias. Avoid pregnancy, caution lactation.

Medical Considerations: >10%; drowsiness, dizziness, blurred vision. 1-10%; tachycardia, syncope, skin rash, vomiting and constipation.

Medical Considerations: 1-10%; decreased urination, weakness, nystagmus, increased intraocular pressure and nasal congestion.

Medical Considerations: Other possible reactions; hallucinations and blood dyscrasias.

Contraindications: Hypersensitivity, narrow-angle glaucoma, GI obstruction, myasthenia gravis, stenosing peptic ulcer, bladder neck obstruction and cardiospasm.

Dental Drug Interactions: Increased CNS depression with CNS depressants. Increased anticholinergic effect with anticholinergics.

  • Metaxalone (Skelaxin)

Action: Acts in central nervous system to cause skeletal muscle relaxation.

Use: Relief discomfort from acute, painful musculoskeletal conditions.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache and

blood dyscrasias.

Dental Drug Interactions: Increases action of CNS depressants.

Anti-Neoplastic Agent

  • Quinine (Legatrin, Quinaglute)

Action: Disrupts malaria parasites replication and transcription, affects calcium distribution within muscle fibers, decreases excitability of motor end plate region.

Use: Treatment of malaria and nocturnal leg cramps.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Lichenoid drug reaction, headache, fever, blood dyscrasias, tinnitus, photophobia, facial edema

Dental Drug Interactions: Increases effect of coumadin.

  • Tizanidine (Zanaflex)

Action: An alpha-2 adrenergic agonist, decreases excitatory input to alpha motor

neurons, also a central acting muscle relaxant and acts on the spinal cord.

Use: Intermittent management of increased muscle tone associated with spasticity due to

multiple sclerosis and spinal cord injury.

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

orthostatic hypotension, candidiasis.

Dental Drug Interactions: Additive sedation with other CNS sedatives.

Iron Salt

Ferrous Sulfate (Feosol, Feratab)

Action: Replaces iron found in hemoglobin, myoglobin and other enzymes. Needed for red blood cell development, energy and oxygen transport.

Use: Prevention and treatment of iron deficient anemia, prophylaxis for iron deficiency in pregnancy.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Extrinsic stain on teeth (liquid form).

Dental Drug Interactions: If take tetracycline at same time absorption of both drugs is decreased.

Iron Salt +

Ferrous Sulfate, Ascorbic Acid, Vitamin B-Complex and Folic Acid (Iberet-Folic-500)

Only difference from iron salt alone is to prevent concomitant folic acid deficiency where there is an associated deficient intake or increased need for B complex vitamins.

RBC Formation Stimulant

Epoetin (Epogen)

Action: Induces erythropoiesis by stimulating division and differentiation of erythroid progenitor cells. Also induces release of reticulocytes from the bone marrow into the blood stream where they mature to erythrocytes.

Use: Anemia associated with the following; end stage renal disease, AZT therapy for AIDs, chemotherapy for cancer and prematurity.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Headache and arthralgias.

Dental Drug Interactions: None

Anti-Neoplastic Agent


Action: Inhibits DNA synthesis, no effect on synthesis of protein or RNA.

Use: Treat chronic myelocytic leukemia, melanoma, ovarian carcinoma, head and neck cancer, adjunct in management of sickle cell anemia.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Stomatitis, erythema of face, headache and significant blood dyscrasias. If surgical procedure make sure WBCs adequate to prevent infection, platelets adequate for hemostasis, RBCs adequate for oxygen if sedation or GA.

Dental Drug Interactions: Hepatotoxicity with alcohol and hepatotoxic drugs.


Action: Inhibits enzyme that reduces folic acid, which is needed for nucleic acid synthesis in all cells.

Use: Treat trophoblastic neoplasms, leukemias, psoriasis, rheumatoid arthritis and hydatidiform mole. Carcinomas of the breast, head, lung, esophagus, stomach, and testes. Osteosarcomas and sarcomas. Gestational choriocarcinoma.

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