Comprehensive Pharmacology
for Clinical Dentistry
by
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COMPREHENSIVE PHARMACOLOGY for Clinical Dentistry Patrons: Iram Abbas BDS, MCPS, FCPS Professor and Head of Oral and Maxillofacial Surgery Department of Dentistry Ayub Medical College, Abbottabad Waqar ur Rehman Qureshi BDS, MSc (UK) Associate Professor Oral Dental and Maxillofacial Surgery Department of Dentistry Ayub Medical College, Abbottabad Sumbal Tariq MBBS, MCPS, FCPS (Med.) Assistant Professor Department of Pharmacology & Therapeutics Ayub Medical College, Abbottabad Wisal Mahmood Khan MBBS, MRCS (UK) Surgical Specialist Emergency Hospital Scheme, FATA Pakistan Table of Contents Chapter # Description Pg # Preface I About the Book II Abbreviations III Part I Chapter 1 Introduction to Pharmacology 02 Chapter 2 Pharmacokinetics 06 Chapter 3 Interaction of Drugs with Receptors 12 Part II Chapter 4 Sympathomimetics 17 Chapter 5 Nasal Decongestants 24 Chapter 6 Alpha-Adrenergic Blocking agents 28 Chapter 7 Beta-Adrenergic Blocking agents 31 Chapter 8 Cholinergic Blocking agents 35 Chapter 9 Calcium channel Blocking agents 39 Chapter 10 Cardiac Glycosides 42 Chapter 11 ACE-Inhibitors 45 Chapter 12 Angiotensin II Receptor Blockers 48 Chapter 13 Diuretics 50 Chapter 14 Nitrates/ Nitrites 55 Chapter 15 Platelet Aggregation Inhibitors 59 Chapter 16 Anti-Coagulants 62 Chapter 17 Drugs for Treatment of Bleeding 66 Chapter 18 NSAIDs 70 Chapter 19 Acetaminophen 74 Chapter 20 Opioids 76 Chapter 21 Anti-Convulsants 81 Chapter 22 Anxiolytics & Hypnotics 85 Chapter 23 Anti-Depressants 88 Chapter 24 Skeletal-Muscle Relaxants 91 Chapter 25 Corticosteroids 95 Chapter 26 Anti-Diabetics 101 Chapter 27 Anti-Histamines 109 Chapter 28 Penicillins 116 Chapter 29 Cephalosporins 119 Chapter 30 Tetracyclines 122 Chapter 31 Macrolides 125 Chapter 32 Clindamycin 128 Chapter 33 Amoebicidal Drugs 130 Chapter 34 Anti-Fungal Drugs 134 Chapter 35 Anti-Viral Drugs 142 Chapter 36 Local Anaesthetics 148 Part III Chapter 37 Drugs for Oral Lesions 159 Chapter 38 Drugs for Oro-facial pain 167 Chapter 39 Emergency Drugs in Dental office 171 Key to References 179 ABOUT THE BOOK: COMPREHENSIVE PHARMACOLOGY for Clinical Dentistry is a unique collection of therapeutic drugs relevant to dentistry. It has the following salient features. It consists of three parts. • Part I is an “Introduction to pharmacology” that contains necessary information regarding General Pharmacology important for dental students. • Part II is a “Therapeutic Drugs Classification” that contains Classes of Drugs, which are important for dental students and dental practitioners. Special feature of ‘Dental consideration’ has been added at the end of most chapters so, that dental students must know how to deal with a patient using that particular drug, during dental procedures in his office. Mechanism and mode of actions have been kept short and simple for dental students. In some chapters, ‘Dental uses’ have been highlighted separately under the heading of ‘Indications’ in addition to medical uses. In the side effects, only those side effects are mentioned that are most significant and important from dental point of view. In the ‘Individual drugs’, only those drugs are mentioned, which are commonly used in clinical practice in our region and important form dental point of view. • Part III is “Pharmacology in Dental Practice”, contains information regarding Drugs that are directly used by Dentist in his office. Chapter 7 Beta-adrenergic blocking Agents: They fall into first category “receptor blocking drugs”. They are drugs, which prevent stimulation of beta-adrenergic receptors at the nerve endings of sympathetic nervous system. CLASSIFICATION: Selective beta-1 blockers: Acebutalol Atenolol Esmolol Metaprolol Bisoprolol Non-selective beta-1 and beta-2 blockers: Propanolol Sotalol Timolol Both alpha and beta blockers: Labetalol Carvedilol MODE OF ACTION: They block beta-receptors reversibly. By blocking beta-1 receptors, they affect heart by decreasing cardiac output, heart rate and AV conduction resulting in overall decrease in blood pressure. They block the vasodilating effect of catecholomines on peripheral blood vessels leading to vasoconstriction. They block beta-2 receptors in lungs leading to bronchoconstriction and spasm of bronchioles. They also decrease production of aqueous humour in eye making it useful for glaucoma patients. INDICATIONS: • Use for hypertensive patients alone or in combination with alpha-1 blockers or diuretics. • Use for angina pectoris, prevention of MI, cardiac arrhythmias and prevention of migraine. • It is also use more for acute angle glaucoma. 2 ADVERSE EFFECTS: Oral: dry mouth (may lead to xerostomia) CVS: bradycardia, dysarrhythmia, postural hypotension Respiratory: bronchospasm, dyspnea & wheezing (Contraindicated in asthmatic patients) GI: diarrhoea, ischemic colitis, mesenteric arteries thromboses Hematologic: blood dyscrasias, (fever, sore throat and bleeding from gums), thrombocytopenia (petechia, prura, bleeding) Allergy: skin rashes, laryngospasm, stridors and anaphylaxis Sexual dysfunction, (decrease in libido in males) INDIVIDUAL DRUGS: 1. Acebutalol: Dosages: 400 mg/day (200 mg b.i.d) may increase upto 800 mg per day. In renal dysfunction, decrease the dose by 50% if creatinine clearance is 50 mL/min/1.73m.square. Decrease dose by 75% if creatinine clearance is 25mL/min/1.73 m.square. 2. Atenolol: For hypertension, angina, alcohol withdrawal syndrome, prophylaxis of migraine, ventricular arrhythmias. Dosages: 50mg dose per day along with other diuretics (thiazide). Dose may increase upto 100 mg/ day. 3. Propanolol: Dosages: For hypertension, 40 mg b.i.d. or 80 mg for sustained release. For angina, 80 -320 mg b.i.d, t.i.d or .q.i.d For arrhythmias, 10-30 mg t.i.d or q.i.d after meal time and at bed time. For migraine, 80 mg/day, then increase to 160-240 mg /day. 10 DENTAL CONSIDERATION: • If patient is with cardiac problem, consult primary care physician. • For cardiac patient schedule early morning appointment in order to reduce anxiety of the patient and waiting room time. • Keep counselling with the patient constantly in order to reduce anxiety. • While giving local anaesthesia use of epinephrine-free local anaesthetic is beneficial. • Give local anaesthesia in fully supine position to avoid syncope, then upright the patient slowly to avoid postural hypotension. Ask the patient to keep sitting for at least 2 minutes after supine position. • Manage dry mouth with tart, sugar free gums, frequent sip of water and/or saliva substitute. • Advocate fluoride home treatment for caries susceptible patients. • Manage periodontal diseases with caution. • Avoid use of epinephrine containing gingival retraction cord. • Prevent use of alcohol containing mouth rinse. • Avoid directly dental unit light into eye of glaucoma patient and advise him to wear black glasses during dental treatment. INDICATIONS: Medical uses: • For the diagnosis of Addison’s disease; Short ACTH stimulation test, a tetracosactide (ACTH analogue) is given intramuscularly or intravenously. After 30 minutes of administration plasma cortisol level is measured. In normal individual cortisol, level is more than 600 n
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About the Book
COMPREHENSIVE PHARMACOLOGY for Clinical Dentistry is a unique collection of therapeutic drugs relevant to Dentistry. Salient features include: • An “Introduction to pharmacology” that contains necessary information regarding General Pharmacology important for Dental students. • A “Therapeutic Drugs Classification” that contains Classes of Drugs, which are important for Dental Students and Dental Practitioners. Special feature of ‘Dental consideration’ has been added at the end of most chapters so, that Dental Students must know how to deal with a patient using that particular Drug, during dental procedures in his office. • And “Pharmacology in Dental Practice”, contains information regarding Drugs that are directly used by Dentist in his office.