C104A/C104B AVOID LIABILITY: KNOW YOUR PATIENT HAROLD CROSSLEY, DDS, MS, PHD THURSDAY, FEBRUARY 20

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1 C104A/C104B AVOID LIABILITY: KNOW YOUR PATIENT HAROLD CROSSLEY, DDS, MS, PHD THURSDAY, FEBRUARY 20 DISCLAIMER: This work, audio recordings and the accompanying handout, are the intellectual property of the clinician, and permission has been granted to the Chicago Dental Society, its members, successors and assigns, for the unrestricted, absolute, perpetual, worldwide right to distribute solely as an educational material at the scientific program being presented at the 2011 Midwinter Meeting. Permission has been granted for this work to be shared for non-commercial education purposes only. No other use, including reproduction, retransmission in any form or by any means or editing of the information may be made without the written permission of the author. The Chicago Dental Society does not assume any responsibility or liability for the content, accuracy, or compliance with applicable laws, and the Chicago Dental Society shall not be sued for any claim involving the distribution of this work.

2 Chicago Dental Society MWM & REGIONAL MEETING COURSE EVALUATION Speaker: Subject: Date: Number of attendees: PLEASE RATE YOUR SPEAKER AS TO: Excellent Good Fair Poor N/A Subject selected Timeliness of subject Comprehensiveness Meeting your expectations Content level Delivery Voice quality Holding your interest Appropriate audiovisuals Effective audiovisuals Overall evaluation of speaker Overall evaluation of program Should this speaker be invited for future meetings? Yes q No q What topics of interest would you like to see covered in the future? Comments (use reverse if you need additional space): Name (requested but not required please print): RETURN EVALUATION CARD TO: Chicago Dental Society Aloysius F. Kleszynski, DDS 401 N. Michigan Ave., Suite 200, Chicago, IL DO NOT FOLD CARD. FOR CDS PERMANENT FILES.

3 AVOID LIABILITY: KNOW YOUR PATIENTS MEDICATIONS AND THEIR IMPACT ON DENTAL TREATMENT Hosted by Chicago Dental Society 2014 Midwinter Meeting Chicago, Illinois February 20, 2014 No. 1 ********************************************* HYDROCODONE WITH ACETAMINOPHEN (generic) - opiate & non-opiate analgesic - addictive, second most abused drug by general dentists - Schedule III (soon to be Schedule II?) - common side effects: - constipation - urinary retention - xerostomia - opiate metabolism-cyp2d6 - More efficacious than codeine, less nausea & vomiting - Nausea/vomiting begins in CNS - APAP and paracetamol-names for acetaminophen - Maximum daily dose of acetaminophen is 3000 mg - Maximum effective dose of acetaminophen is 1000 mg No. 2 No. 3 LEVOTHYROXINE (generic) - replacement therapy (hypothyroidism) - local anesthetic with vasoconstrictor is NOT contraindicated AZITHROMYCIN (generic) - extended spectrum antibiotic - SBE prophylaxis alternative - Z-Pak (five days)- Zithromax, Tri-Pak (three days) 1

4 Rx Azithromycin tablets 250 mg Disp: 2 tablets Sig: Take two tablets by mouth minutes before dental appointment No. 4 No. 5 No. 6 No. 7 No. 8 No. 9 LISINOPRIL (generic) - ACE (Angiotensin Converting Enzyme) inhibitor - Zestril - Dental Implications - Scalded mouth syndrome - Non-productive cough - NSAID interaction with long-term use - Tekturna (aliskiren)-direct renin inhibitor SIMVASTATIN (generic) - HMG-CoA reductase inhibitor - Decrease serum total and LDL cholesterol - grapefruit juice interaction? - Zocor PROAIR HFA (albuterol) - albuterol - Beta 2 receptor agonist - bronchodilator - asthma, COPD - prevention of exercise-induced bronchospasm CRESTOR (rosuvastatin) - HMG-CoA reductase Inhibitor - Decrease serum total and LDL cholesterol - grapefruit juice interaction? SYNTHROID (levothyroxine) - replacement therapy (hypothyroidism) - local anesthetic with vasoconstrictor is NOT contraindicated NEXIUM (esomeprazole) - hydrogen ion pump inhibitor - GastroEsophageal Reflux Disease (GERD) - Side effects 2

5 No. 10 No. 11 ATORVASTATIN (generic) - HMG-CoA reductase Inhibitor - Decrease serum total and LDL cholesterol - grapefruit juice interactions - Lipitor IBUPROFEN (generic) - NonSteroidal Anti-Inflammatory Drug (NSAID) - COX 1 & COX 2 inhibitor - Maximum daily dose is 3200 mg for acute pain - Motrin, Motrin-IB, Advil (OTC) Rx Ibuprofen Tablets 400 mg Disp. 16 tablets Sig: Take 1-2 tablets 3-4 times per day as needed for the relief of pain Do not exceed eight tablets within 24 hours No. 12 No. 13 No. 14 TRAZADONE (generic) - Desyrel - Antidepressant - SSRI vilazodone (Viibryd ) METOPROLOL TARTRATE (generic) - Selective Beta Blocking Agent (Beta 1 blocking agent) - DO NOT DISCONTINUE ABRUPTLY - Long-term use of NSAIDs (~ 3 weeks) may diminish hypotensive effectiveness of beta blockers - Antihypertensive - Toprol WARFARIN (generic) - Coumadin - produces hypoprothrombinemia (Vitamin K antagonist) - INR is used to measure effectiveness - dabigatrin (Pradaxa ) - rivaroxaban (Xarelto ) - apixaban (Eliquis ) 3

6 No. 15 No. 16 No. 17 No. 18 No. 19 No. 20 No CYMBALTA (duloxetine) - Serotonin/Norepinephrine Reuptake Inhibitor (SNRI) - depressive episodes - chronic fatigue sydrome - chronic pain (neuropathic) - adjunctive therapy for attention deficit hyperactivity disorder (ADHD) FLUTICASONE NASAL (generic) - corticosteroid - management of seasonal and perennial allergic rhinitis - Flonase SINGULAIR (montelukast) - leukotriene receptor antagonist - treatment of asthma - no aspirin/nsaids with these patients HYDROCHLORTHIAZIDE (generic) - HCTZ - diuretic/antihypertensive - depletes potassium - eat lots of bananas and drink lots of orange juice VENTOLIN HFA (albuterol) - Beta 2 receptor agonist - bronchodilator - asthma, COPD - prevention of exercise-induced bronchospasm ADVAIR DISCUS - fluticasone and salmeterol - maintenance treatment of asthma - no problems with vasoconstrictor - oral candidiasis? PRAVASTATIN (generic) - HMG-CoA reductase Inhibitor - Decrease serum total and LDL cholesterol - grapefruit juice interaction? - Pravachol

7 No. 22 AMOXICILLIN (generic) - Broad spectrum antibiotic - SBE prophylaxis Rx Amoxicillin tablets 500 mg Disp: 4 tablets Sig: Take four tablets by mouth minutes before dental appointment - Cardiac Conditions Associated With the Highest Risk of Adverse Outcome from Endocarditis for Which Prophylaxis With Dental Procedures is Recommended 1. Artificial heart valves 2. A history of infective endocarditis 3. Certain specific, serious congenital (present from birth) heart conditions, including a. Unrepaired or incompletely repaired cyanotic congenital heart disease, including palliative shunts and conduits b. A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention during the first six months after the procedure c. Any repaired congenital heart defect with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device 4. A cardiac transplant that develops a problem in a heart valve - Prophylaxis for Patients with Orthopedic Prostheses - December 18, The ADA and the American Academy of Orthopaedic Surgeons have found that the evidence does not support routine prescription of antibiotic prophylaxis for joint replacement patients undergoing dental procedures. This finding is based on a collaborative systemic review of the scientific literature. - No. 23 AMLODIPINE BESYLATE (generic) - calcium channel blocker - antihypertensive - gingival hyperplasia - Norvasc 5

8 No. 24 No. 25 No. 26 No. 27 No. 28 OMEPRAZOLE (generic) - hydrogen ion pump inhibitor - GastroEsophageal Reflux Disease (GERD) - Prilosec METOPROLOL SUCCINATE (generic) - Selective Beta Blocking Agent (Blocks Beta 1 receptor) - Antihypertensive - DO NOT DISCONTINUE ABRUPTLY - Long-term use of NSAIDs (~ 3 weeks) may diminish hypotensive effectiveness - Toprol XL OXYCODONE WITH ACETAMINOPHEN (generic) - More efficacious than codeine, but less nausea and vomiting - Schedule II - Percocet,Tylox - Oxecta -Pfizer/Acura Pharmaceuticals SERTRALINE (generic) - Selective Serotonin Reuptake Inhibitor (SSRI) - depressive episodes - chronic fatigue sydrome - chronic pain - adjunctive therapy for attention deficit hyperactivity disorder (ADHD) - Zoloft DIOVAN (valsarten) - ARB (Angiotensin Receptor Blocker) - Dental Implications - Scalded mouth syndrome - Non-productive cough - NSAID interaction with long-term use - Tekturna (aliskiren)-direct renin inhibitor 6

9 No. 29 No. 30 No. 31 No. 32 No. 33 No. 34 No ALPRAZOLAM (generic) - antianxiety agent - Xanax - Xerostomia - most common drug found in dirty urine of methadone patients - combination of Xanax and Ecstacy is called Parachuting METFORMIN (generic) - type II diabetes mellitus - appoint in the morning - Glucophage FLUCONAZOLE (generic) - oral antifungal mg BID first day and 100 mg/day for 13 days - Diflucan TRIMETHOPRIM/SULFA (generic) - trimethoprim and sulfamethoxazole (SMX/TMP) - antibacterial combination - urinary tract infections, middle ear infections, bronchitis - stomatitis - Bactrim, Septra DS, Sulfatrim LORAZEPAM (generic) - benzodiazepine antianxiety agent - xerostomia - Ativan MELOXICAM (generic) - Mobic - NSAID-COX1 and COX2 inhibition mg/day - Maximum 15 mg/day PREDNISONE ORAL (generic) - corticosteroid - asthma - arthritis - inflammation - cancer

10 No. 36 No. 37 No. 38 No. 39 No. 40 CLONAZEPAM (generic) - benzodiazepine antianxiety agent - xerostomia - Klonopin TRAMADOL (generic) - Ultram -50/100 mg every 4 to 6 hours - tramadol with acetaminophen (Ultracet ) - Contraindications - seizure disorders - allergy to codeine - medications that lower seizure threshold - Black Box Warnings FUROSEMIDE ORAL (generic) - loop diuretic - antihypertensive - Lasix PLAVIX (clopidogrel) - prodrug - platelet aggregation inhibitor- blocks ADP receptor - prasugrel (Effient ) - ticagrelor (Brilinta ) GABAPENTIN (generic) - anticonvulsant - chronic pain - mood stabilizer - Neurontin Harold L. Crossley, DDS., M S., Ph.D. 8