Delmar's Dental Drug Reference is intended to be a quick reference to obtain useful information on drugs. An important objective is also to provide information on the proper monitoring of drug therapy and to assist practitioners in teaching clients and family members about important aspects of dental drug therapy.
Chapter 2 includes general information on important therapeutic or chemical classes of drugs. The classes of drugs are listed alphabetically. Specific drugs in therapeutic or chemical classes are found in Chapter 3 (alphabetical listing of drugs). The information on each therapeutic or chemical class in Chapter 2 begins with a list of the drugs addressed in that drug class. Information on the specific drugs is provided under that drug name in Chapter 3. Chapter 3 also includes information on many other drugs.
The format for information on individual drugs (and for drug classes when appropriate) is presented as follows:
Drug Names: The generic name for the drug is presented first; this is followed by the phonetic pronunciation of the generic name. The FDA pregnancy category A, B, C, D, or X (see Appendix 3 for definitions) to which the drug is assigned is also listed in this section. All trade names follow this; if the trade name is available only in Canada, the name is followed by a maple leaf ( M). If the drug is controlled by the U.S. Federal Controlled Substances Act, the schedule in which the drug is placed follows the trade name (e.g., C-II, C-
III, C-IV or I, II, III, IV, V). See Appendix 1 for a listing of controlled substances in both the United States and Canada. A combination drug heading indicates that two or more drugs are combined in the same product. Classification: This section defines the type of drug or the class under which the drug is listed. This information is most useful in learning to categorize drugs. To minimize the need to repeat general information, a cross reference to Chapter 2 is often made for drugs listed in Chapter 3. This information should also be consulted.
General Statement: Information about the drug class and/or what might be specific or unusual about a particular group of drugs is presented. In addition, brief information may be presented about the dis-ease(s) for which the drugs are indicated.
Action/Kinetics: The action portion describes the proposed mecha-nism(s) by which a drug achieves its therapeutic effect. Not all mechanisms of action are known, and some are self-evident, as when a hormone is administered as a replacement. The kinetics portion lists pertinent pharmacologic properties, if known, about rate of drug absorption, distribution, time for peak plasma levels or peak effect, minimum effective serum or plasma level, biologic half-life, duration of action, metabolism, and excretion. Metabolism and excretion routes may be important for clients with systemic liver disease, kidney disease, or both. Again, information is not available for all therapeutic agents.
The time it takes for half the drug to be excreted or removed from the blood, t1/2 (half-life), is important in determining how often a drug is to be administered and how long to assess for side effects. Therapeutic levels indicate the desired concentration, in serum or plasma, for the drug to exert its beneficial effect and are helpful in predicting the onset of side effects or the lack of effect. Drug therapy is often monitored in this fashion (e.g., antibiotics, theophy-lline, phenytoin, amiodarone). Uses: Approved therapeutic use(s) for the particular drug are presented. Some investigational uses are also listed for selected drugs. Contraindications: Disease states or conditions in which the drug should not be used are noted. The safe use of many of the newer phar-macologic agents during pregnancy, lactation, or childhood has not been established. As a general rule, the use of drugs during pregnancy is contraindicated unless specified by the provider where the benefits of drug therapy far outweigh the potential risks.
Special Concerns: This section covers considerations for use with pediatric, geriatric, pregnant, or lactat-ing clients. Situations and disease states when the drug should be used with caution are also listed. Side Effects: Undesired or bothersome effects the client may experience while taking a particular agent are described. Side effects are listed by the body organ or system affected and are usually presented with the most common side effects in descending order of incidence. It is important to note that nearly all of the potential side effects are listed; in any given clinical situation, however, a client may show no side effects, or one or more side effects. If potentially life threatening, the side effect is indicated by boldface italic print. Drug Interactions: This is an alphabetical listing of drugs that may interact with one another. This section focuses on those drug interactions which are of particular concern to dental health and dental practitioners. The study of drug interactions is an important area of pharmacology and is changing constantly as a result of the influx of new drugs, clinical feedback, and increased client usage. The compilation of such interactions is far from complete; therefore, listings in this handbook are to be considered only as general cautionary guidelines.
Drug interactions may result from a number of different mechanisms (e.g., additive or inhibitory effects, interference with degradation of drug, increased rate of elimination, decreased absorption from the GI tract, and competition for or displacement from receptor sites or plasma protein binding sites). Such interactions may manifest themselves in a variety of ways; however, an attempt has been made throughout the text to describe these interactions whenever possible as an increase (T ) or a decrease ( -i ) in the effect of the drug, and a reason for the change.
It is important to realize that any side effects that accompany the administration of a particular agent also may be increased as a result of a drug interaction.
The reader should be aware that drug interactions are often listed for classes of drugs. Thus, the drug interaction is likely to occur for all drugs in a particular class. Consult this information in Chapter 2. How Supplied: The various dosage form(s) available for the drug and amounts of the drug in each of the dosage forms is presented. Such information is important as one dosage form may be more appropriate for a client than another. This information also allows the user to ensure the appropriate dosage form and strength is being administered. Dosage: The dosage form and route of administration is followed by the disease state or condition (in italics) for which the dosage is recommended. This is followed by the adult and pediatric doses, when available. The listed dosage is to be considered as a general guideline; the exact amount of the drug to be given is determined by the provider. However, one should question orders when dosages differ markedly from the accepted norm. Dental Concerns: The dental concerns section was developed to assist the practitioner to apply the assessment process to pharmacotherapeu-tics. Guidelines for assessing the client before, during, and after drug therapy are identified as are interventions for the prescribed therapy.
The practitioner must also assess the client for the Side Effects which must be documented and reported to the provider. Severe side effects generally are cause for dosage modification or discontinuation of the drug.
Client/Family Teaching: Specific information for the client is provided for each drug. Client/family teaching emphasizes specifics to help the client/family recognize side effects, avoid potentially dangerous situations, and to alleviate anxiety that may result from taking a particular drug. Side effects that require medical intervention are included as well as specifics on how to minimize side effects for certain medications (i.e., take medication with food to decrease GI upset or take at bedtime to minimize daytime sedative effects).
The proper education of clients is one of the most challenging aspects of dental care. The instructions must be tailored to the needs, awareness, and sophistication of each client. For example, clients who take medication to lower BP should assume responsibility for taking their own BP or having it taken and recorded. Clients should carry identification listing the drugs currently prescribed. They should know what they are taking and why, and develop a mechanism to remind themselves to take their medication as prescribed. Clients should carry this drug list with them whenever they go for a check-up or seek medical care. The drug list should be shared with the pharmacist if there is a question concerning drugs prescribed, if the client is considering taking an over-the-counter medication, or if the client has to change pharmacies. The records, especially BP recordings, should be shared with the health care provider to ensure accurate evaluation of the response to the prescribed drug therapy. This may also alert the provider to any medication consumption by the client that they did not prescribe, were not aware of, or that may interfere with (i.e., potentiate, antagonize) the current pharmaco-logic regimen. The provider may also encourage the client to call with any questions or concerns about their therapy.
Finally, when taking the dental history, emphasis should be placed on the client's ability to read and to follow directions. Clients with language barriers should be identified, and appropriate written translations should be provided. In addition, client life-style, cultural factors, and income as well as the availability of health insurance and transportation are important factors that may affect adherence with therapy and followup care. The potential for a client being/becoming pregnant, and whether a mother is breast feeding her infant should be included in assessments. The age and orientation level, whether learned from personal observation or from discussion with close friends or family members, can be critical in determining potential relationships between drug therapy and/or drug interactions. Including these factors in the dental health assessment will assist all on the dental care team to determine the type of therapy and drug delivery system best suited to a particular client and promotes the highest level of adherence.
Information that requires emphasis or is relevant to a particular drug is listed under appropriate headings, such as Additional Contraindications or Additional Side Effects. These are in addition to and not instead ofthe regular entry, which is ref erenced and must also be consulted.
The scope of drugs covered in this reference includes traditional dental drugs used in the treatment of perio-dontal disease, antibiotic prophylaxis, and pain management with amide local anesthetics, NSAIDs, and opioid analgesics. Also, coverage is provided for other dental related drugs that are given systemically for the treatment of anxiety and other general infections. Coverage also includes cardiovascular drugs, opi-oid analgesics, opioid antagonists, drugs used for smoking cessation programs, and certain other drugs of special interest to dental practitioners.
Additional information to assist in monitoring drug therapy is also included. A list of sound-alike drug names is included in the front portion of the book to alert the provider to these similarities in an effort to prevent a potential lethal error. Also helpful are the Elements of a Pre scription (Appendix 2), Drugs Causing Dry Mouth by Class (Appendix 4), Commonly Used Abbreviations and Symbols (front portion of book).
The Index has been designed for maximum efficiency in finding a drug. Generic drug names are presented in boldface, trade names in regular type, therapeutic drug classes in italics, and combination drugs in all capital letters. In addition, each generic name is followed, in parentheses, by the most common trade name; and, each trade name is followed, in parentheses, by the generic name.
You are now ready to use Del-mar's Dental Drug Reference. We hope that the text will be useful and assist you in your education, profession, and practice. The safe administration of drugs, assessment of potential interactions and adverse effects, as well as outcome evaluation are crucial parts of the dental health process.
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