The Dentist s Drug and Prescription Guide

Transcription

1 The Dentist s Drug and Prescription Guide Key Features Easy-to-follow drug tables summarize the main pharmacologic features of the different disciplines but also allow the reader to review the key drugs and theories at a quick glance Sample prescription and instructions for prescription writing Instructions and guidelines for the patient on how to take the drugs Extensive, easy-to-follow tables on drug interactions in the dental practice including management prevention of these interactions Oral manifestations of drug reactions and management strategies Guidelines for prescribing for pregnant, pediatric, and medically compromised patients About the Authors Mea Weinberg, DMD, MSD, RPh, is Diplomate of the American Board of Periodontology and a practicing periodontist and licensed pharmacist, giving her a unique position in the fields of dentistry and pharmacology. She is Clinical Associate Professor of Periodontology and Implant Dentistry at New York University College of Dentistry. Stuart J. Froum, DDS, is a Diplomate of the American Board of Periodontology; Clinical Professor and Director of Clinical Research at the Department of Periodontology and Implant Dentistry, New York University College of Dentistry; and maintains a private practice limited to periodontics and implant dentistry in New York City. He has lectured nationally and internationally, has authored close to 100 published research articles, and authored and contributed to five books related to periodontics and implant dentistry. Titles of Interest Oral Medicine and Medically Complex Patients, Sixth Edition By Peter B. Lockhart ISBN: The Dentist s Drug and Prescription Guide The Dentist s Drug and Prescription Guide is written for dental professionals seeking quick advice on prescribing medications for their patients. Using an easy-to-read question-andanswer format, the text describes evidenced-based pharmacologic therapy with current and up-to-date references regarding adjunctive pharmacologic treatment of the dental patient. Drug therapy for each dental discipline, including periodontics, implantology, oral surgery, and endodontics, is included. Recommendations for pharmacologic treatment with periodontal and implant surgery as well as treatment of periodontal diseases, dental pain, and infections are also covered. The Dentist s Drug and Prescription Guide Mea Weinberg and Stuart J. Froum Stuart L. Segelnick, Consulting Editor Weinberg and Froum Weinberg Complete Cover BC.indd 2-3 8/6/2012 7:17:32 AM

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3 The Dentist s Drug and Prescription Guide

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5 The Dentist s Drug and Prescription Guide Mea A. Weinberg, DMD, MSD, RPh Diplomate of the American Board of Periodontology Clinical Associate Professor Department of Periodontology and Implant Dentistry New York University College of Dentistry New York, New York Stuart J. Froum, DDS Diplomate of the American Board of Periodontology Clinical Professor and Director of Clinical Research Department of Periodontology and Implant Dentistry New York University College of Dentistry New York, New York Consulting Editor: Stuart L. Segelnick, DDS Diplomate of the American Board of Periodontology Clinical Associate Professor Department of Periodontology and Implant Dentistry New York University College of Dentistry New York, New York A John Wiley & Sons, Inc., Publication

6 This edition first published by John Wiley & Sons, Inc. Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley s global Scientific, Technical and Medical business with Blackwell Publishing. Editorial Offices 2121 State Avenue, Ames, Iowa , USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: /2013. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging-in-Publication Data Weinberg, Mea A. The dentist s drug and prescription guide / Mea A. Weinberg, Stuart J. Froum. p. cm. Includes bibliographical references and index. ISBN (pbk. : alk. paper) 1. Dental pharmacology Handbooks, manuals, etc. 2. Drugs Prescribing Handbooks, manuals, etc. 3. Drugs Dosage Handbooks, manuals, etc. I. Froum, Stuart J. II. Title. RK701.W dc A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover design by Buffy Clatt Set in 9/11.5 pt Times by SPi Publisher Services, Pondicherry, India Disclaimer : The prescriber should use his/her own judgment in prescribing for particular patients. The prescriptions and suggested dosages in this guide are not absolute numbers, only suggestions.

7 Dedication This book is dedicated to my family, especially to my parents Dr. Abraham and Gertrude Weinberg, because of their wonderful thought provoking ideas regarding medicine and pharmacy.

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9 Contents Preface Contributors xi xiii 1 Introduction to pharmacology 1 I. Definition of terms 1 II. Pharmacokinetics 3 III. Pharmacodynamics 6 2 The prescription and drug names 9 I. Parts of a prescription 9 II. Generic substitution 10 III. Controlled drugs 11 IV. Principles of prescription writing 13 V. How to avoid prescription errors 19 3 Drug dosing 23 I. Basic principles of drug dosing 23 II. Pediatric patient 26 a. Penicillin VK oral suspension 27 b. How is the dose calculated if the child could swallow tablets? 27 Penicillin VK tablets 27 c. If amoxicillin were to be prescribed 28 Amoxicillin oral suspension 28 Amoxicillin chewable tablets 28 Amoxicillin capsules 29 d. Azithromycin 30 Oral suspension 30 Azithromycin tablets 30 e. Clindamycin 30 Clindamycin oral solution 30 Clindamycin capsules 30 III. Pregnant and nursing patients 31 IV. Elderly patient 35 V. Renal-impaired patient 35 VI. Hepatic-impaired patient 37 vii

10 viii Contents 4 Formulary sections 41 I. Antimicrobials, systemic 41 a. General considerations 41 b. Antibiotics 45 Beta-lactam antibiotics 45 Cephalosporins 48 Erythromycins 49 Lincomycins 52 Metronidazole 53 Tetracyclines 54 Fluoroquinolones 56 c. Specific instructions for taking antibiotics 58 II. Antimicrobials, local 59 a. Chlorhexidine gluconate 59 b. Other mouthrinses and periodontal health products 63 III. Controlled-release drug delivery 64 IV. Antivirals/antifungal agents 65 a. Antiviral agents 65 b. Antifungal agents 68 V. Prescribing for pain control 72 a. General considerations 72 b. Aspirin 72 c. Nonsteroidal anti-inflammatory drugs (NSAIDs) 74 d. Acetaminophen 80 e. Narcotic (opioid) analgesics 83 f. Management plan for acute dental pain 90 VI. Moderate sedation 94 a. Benzodiazepines 95 b. Other agents 96 VII. Glucocorticosteroids 97 a. Topical glucocorticosteroids 97 b. Other nonsteroidal topical agents used in the management of oral lesions 100 c. Systemic corticosteroids How to manage potential drug interactions 105 I. Introduction to drug interactions 105 II. Antibiotic-drug interactions in dentistry 110 III. Analgesic-drug interactions in dentistry 116 IV. Sympathomimetic agents and drug interactions in dentistry 119 V. Anti-anxiety drug interactions in dentistry Evidence-based theory for drug prescribing 125 I. General considerations 125 II. Prescribing for inflammatory periodontal diseases and periodontal surgical procedures 127 a. Gingivitis 127 b. Chronic periodontitis 127 c. Ulcerative periodontal diseases 129 d. Refractory and recurrent periodontitis 130

11 Contents ix e. Aggressive periodontitis 131 f. Periodontal therapy 132 Periodontal flap surgery: pocket reduction 132 Bone/bone substitutes grafting procedures 133 Periodontal regenerative surgery: Guided tissue regeneration (GTR) 134 III. Prescribing for dental implant surgery 135 a. Prescribing for sinus floor elevation surgery 136 IV. Prescribing for oral surgery 139 V. Prescribing for odontogenic infections 139 a. Prescribing for endodontic abscess 140 b. Prescribing for periodontal abscess Management of the medically compromised dental patient 149 I. American Heart Association (AHA) guidelines for antibiotic prophylaxis 149 a. Prevention of infective endocarditis: Antibiotic prophylaxis for the dental patient 149 II. Antibiotic prophylaxis for total joint replacement 152 III. Cardiovascular diseases 155 a. Hypertension 155 b. Angina and other ischemic cardiac conditions 162 c. Congestive heart failure 163 d. Patient on low-dose aspirin and other antiplatelet drugs 163 e. Anticoagulated patient (patient taking warfarin or heparin) 168 f. Low-molecular-weight heparins (LMWHs) 171 g. Myocardial infarction 171 h. Cardiac arrhythmias 172 i. Valvular heart disease 172 IV. Pregnant and postpartum patient 174 V. Adrenal suppression and thyroid disease 175 VI. Asthma 176 VII. Diabetes mellitus 178 VIII. Psychiatric/neurological disorders 180 IX. Organ transplant 181 X. Liver disease 186 XI. Chronic kidney disease 187 XII. Recreational and illicit drugs 189 XIII. Bisphosphonates 191 XIV. Tuberculosis 197 XV. Bariatric surgery 198 XVI. Pheochromocytoma Herbal and natural remedies 205 I. Herbal drug interactions 205 II. Implications in dentistry 206 Appendix Smoking cessation therapy 209 Appendix Oral manifestation of drugs 215

12 x Contents Appendix American Heart Association antibiotic prophylaxis guidelines 219 Appendix List of tables 221 Appendix Pharmacology pearls in dental practice 223 Appendix Dental drug formulary 225 Analgesics 225 Non-narcotics 225 Narcotics 225 Antibiotics 225 Penicillins 225 Erythromycins 225 Lincomycins 226 Tetracyclines 226 Fluoroquinolones 226 Others 226 Topical antimicrobials 226 Antifungal agents 226 Antiviral agents 226 Index 227

13 Preface The Dentist s Drug and Prescription Guide is a reference book for those concerned with prescribing medications to dental patients. Pharmacology deals with many sciences and one outstanding purpose, which are to provide a scientific basis for the sensible and appropriate use of drugs in human therapeutics. Essentially, the book presents a basic rationale for understanding current drug therapy including how to write prescriptions and how to adjust dosages in the elderly, pediatric and certain medically compromised patients. How to manage potential drug interactions is reviewed with several tables explaining drug drug, drug food and drug disease interactions that are most commonly encountered in dentistry. The goal of writing this book is to explain the rationale for prescribing various medications for different dental conditions and to aid the dental practitioner in choosing the appropriate antibiotics, antifungal or antiviral drug. Understanding how drugs produce their effects allow the practitioner to better understand the different pharmacologic actions and adverse effects that drugs produce. The Dentist s Drug and Prescription Guide is intended to be a pocket book for rapid reference. The book is presented in an easy-to-follow question and answer format. Many tables are included which summarizes the information in the text and makes it easier to refer back. Included in the book is evidenced based pharmacologic therapy with current and up-to-date references regarding adjunctive pharmacologic treatment of the dental patient. The book is divided into nine sections: Introduction to Pharmacology; The Prescription and Drug Names; Drug Dosing; Formulary Sections; How to Manage Potential Drug; Evidenced Based Theory for Drug Prescribing; Management of the Medically Compromised Dental Patient Herbal; Natural Remedies; and Appendices (Smoking Cessation Therapy, Oral Manifestations of Drugs, American Heart Association Antibiotic Prophylaxis Guidelines, List of Tables, Pharmacology Pearls in Dental Practice, Dental Drug Formulary). Drug therapy for each dental discipline including periodontics, implantology, oral surgery and endodontics is presented. Features of the Dentist s Drug and Prescription Guide include: Readability: short, easy question and answer format linking pharmacy theory to clinical dental practice. Need-to-know information: The content of this book was written in regard to the many questions practitioners have about prescribing drugs to patients. Drug tables: There are many tables included in the book which not only summarizes the main pharmacologic features of the different disciplines but also allows the reader to review the key drugs and theories at a quick glance. xi

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15 Contributors The author would like to thank the following people for their assistance while writing this book : James B. Fine, DMD Assistant Dean for Postdoctoral Education Associate Professor of Clinical Dentistry and Postdoctoral Director of Periodontics College of Dental Medicine of Columbia University New York, New York Larry Gupta, RPh Clinical Pharmacist Englewood, New Jersey David Hershkowitz, DDS Clinical Assistant Professor Associate Chair Clinical Education Department of Cariology & Comprehensive Care New York University College of Dentistry New York, New York Howard D. Silverman, DDS Associate Professor Department of Endodontics New York University College of Dentistry New York, New York Surrendra M. Singh, BSc, BDS, MDS Professor Department of Periodontology New Jersey Dental School Univeristy of Medicine and Dentistry of New Jersey Newark, New Jersey xiii