The Dentist′s Drug and Prescription Guide

Mea Weinberg, DMD, MSD, RPh, is a practicing periodontist and licensed pharmacist, giving her a unique position in the fields of dentistry and pharmacology. She is a clinical associate professor of Periodontology and Implantology at New York University. 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 Krieser Dental Center. He maintains a Private Practice limited to Periodontics and Implant Dentistry in New York City. He has lectured nationally and internationally, has authored over 100 published research articles, and authored and contributed to five books related to periodontics and implant dentistry. He is the editor of the book Dental Implant Complications: Etiology, Prevention and Treatment . Dr. Froum is President Elect of the American Academy of Periodontology.

Preface xi Contributors 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 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 100 5 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 122 6 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 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 145 7 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 200 8 Herbal and natural remedies 205 I. Herbal drug interactions 205 II. Implications in dentistry 206 Appendix 1 209 Smoking cessation therapy 209 Appendix 2 215 Oral manifestation of drugs 215 Appendix 3 219 American Heart Association antibiotic prophylaxis guidelines 219 Appendix 4 221 List of tables 221 Appendix 5 223 Pharmacology pearls in dental practice 223 Appendix 6 225 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