Applied Pharmacology for the Dental Hygienist by Elena Bablenis Haveles

General Principles     1
Information, Sources, and Regulatory Agencies     2
History     2
Pharmacology and the Oral Health Care Providers     3
Sources of Information     4
Explain-Discuss Format     4
Reference-List Format     5
Types of Media     5
Drug Names     7
Drug Substitution     10
Top 200 Drugs     10
Federal Regulatory Agencies     10
Harrison Narcotic Act     10
Food and Drug Administration     11
Federal Trade Commission     11
Drug Enforcement Administration     11
Omnibus Budget Reconciliation Act     11
Drug Action and Handling     12
Characterization of Drug Action     13
Log Dose Effect Curve     13
Potency     13
Efficacy     14
Chemical Signaling between Cells     15
Mechanism of Action of Drugs     15
Nerve Transmission     16
Receptors     17
Stereoisomerism     21
Routes of Administration and Dose Forms     21
Routes of Administration     21
Dose Forms     26
Pharmacokinetics     26
Passage across Body Membranes     26
Absorption     29
Distribution     30
Half-Life     31
Blood-Brain Barrier     32
Redistribution     33
Metabolism (Biotransformation)     33
Factors that Alter Drug Effects     38
Calculation of Children's Dose     39
Adverse Reactions     41
Definitions and Classifications     41
Clinical Manifestations of Adverse Reactions     42
Exaggerated Effect on Target Tissues     43
Effect on Nontarget Tissues     43
Effect on Fetal Development (Teratogenic Effect)     43
Local Effect     44
Drug Interactions     44
Hypersensitivity (Allergic Reaction)     44
Idiosyncrasy     45
Interference with Natural Defense Mechanisms     46
Toxicologic Evaluation of Drugs     46
Prescription Writing     49
Measurement     49
Metric System     49
Household Measures     50
Prescriptions     51
Format     51
Explanations Accompanying Prescriptions      54
Drug Legislation     54
Scheduled Drugs     55
Drugs Used in Dentistry     57
Autonomic Drugs     58
Autonomic Nervous System     58
Anatomy     58
Parasympathetic Autonomic Nervous System     59
Sympathetic Autonomic Nervous System     59
Functional Organization     60
Neurotransmitters     60
Drug Groups     63
Parasympathetic Autonomic Nervous System     64
Cholinergic (Parasympathomimetic) agents     66
Anticholinergic (Parasympatholytic) agents     68
Nicotinic Agonists and Antagonists     71
Sympathetic Nervous System     71
Sympathetic Nervous System Receptors     72
Adrenergic (Sympathomimetic) Agents     73
Adrenergic Blocking Agents     77
Neuromuscular Blocking Drugs     79
Nonopioid (Nonnarcotic) Analgesics     81
Pain     81
Classification     82
Salicylates     83
Acetylsalicylic Acid     83
Other Salicylates     90
Nonsteroidal Antiinflammatory Drugs     92
Chemical Classification     92
Mechanism of Action     93
Pharmacokinetics     93
Pharmacologic Effects     94
Adverse Reactions     94
Contraindications and Cautions     95
Therapeutic Uses     95
Specific Nonsteroidal Antiinflammatory Drugs     96
Acetaminophen     98
Pharmacokinetics     99
Pharmacologic Effects     99
Adverse Effects     99
Drug Interactions     100
Uses     100
Dose and Preparations     100
Drugs Used to Treat Gout     101
Colchicine     101
Allopurinol     101
Probenecid     102
Opioid (Narcotic) Analgesics and Antagonists     103
History     103
Terminology     103
Classification     104
Mechanism of Action     104
Pharmacokinetics     106
Pharmacologic Effects     107
Analgesia     107
Sedation and Euphoria     108
Cough Suppression     108
Gastrointestinal Effects     108
Adverse Reactions     108
Respiratory Depression     108
Nausea and Emesis      109
Constipation     109
Myosis     109
Urinary Retention     109
Central Nervous System Effects     109
Cardiovascular Effects     109
Biliary Tract Constriction     109
Histamine Release     109
Pregnancy and Nursing     109
Addiction     109
Treatment     110
Allergic Reactions     110
Drug Interactions     111
Specific Opioids     112
Opioid Agonists     112
Mixed Opioids     115
Tramadol     116
Dental Use of Opioids     117
Antiinfective Agents     119
Dental Infection "Evolution"     120
History     122
Definitions     122
Culture and Sensitivity     124
Culture     124
Sensitivity     124
Indications for Antimicrobial Agents     125
Therapeutic Indications     125
Prophylactic Indications     125
General Adverse Reactions Associated with Antiinfective Agents     127
Superinfection (Suprainfection)     127
Allergic Reactions     127
Drug Interactions     127
Gastrointestinal Complaints     128
Pregnancy     128
Dose Forms     128
Cost     129
Penicillins     129
Source and Chemistry     130
Pharmacokinetics     130
Mechanism of Action     131
Spectrum     131
Resistance     131
Adverse Reactions     132
Allergy and Hypersensitivity     132
Uses     133
Specific Penicillins     133
Macrolides     135
Erythromycin     136
Azithromycin and Clarithromycin     137
Tetracyclines     138
Pharmacokinetics     139
Spectrum     139
Adverse Reactions     139
Drug Interactions     140
Uses     141
Clindamycin     142
Pharmacokinetics     142
Spectrum     142
Adverse Reactions     142
Uses     143
Metronidazole     144
Pharmacokinetics     144
Spectrum     144
Adverse Reactions     144
Drug Interactions      145
Uses     145
Cephalosporins     145
Pharmacokinetics     147
Spectrum     147
Mechanism of Action     147
Adverse Reactions     147
Uses     148
Rational Use of Antiinfective Agents in Dentistry     148=970 14$lStage 1     148=970 14$lStage 2     149=970 14$lStage 3     149
Antimicrobial Agents for Nondental Use     149
Vancomycin     149
Aminoglycosides     150
Chloramphenicol     151
Sulfonamides     151
Sulfamethoxazole-trimethoprim     152
Nitrofurantoin     152
Quinolones (Fluoroquinolones)     152
Antituberculosis Agents     154
Isoniazid     154
Rifampin     156
Pyrazinamide     156
Ethambutol     157
Topical Antibiotics     157
Neomycin, Polymyxin, and Bacitracin     157
Mupirocin     157
Antibiotic Prophylaxis Used in Dentistry     158
Prevention of Infective Endocarditis     158
Prosthetic Joint Prophylaxis     161
Noncardiac Medical Conditions      161
Antifungal and Antiviral Agents     163
Antifungal Agents     163
Nystatin     165
Imidazoles     167
Other Antifungal Agents     169
Antiviral Agents     170
Herpes Simplex     171
Acquired Immunodeficiency Syndrome     173
Local Anesthetics     177
History     177
Ideal Local Anesthetic     178
Chemistry     178
Mechanism of Action     179
Action on Nerve Fibers     179
Ionization Factors     179
Pharmacokinetics     179
Absorption     179
Distribution     182
Metabolism     182
Excretion     182
Pharmacologic Effects     182
Peripheral Nerve Conduction (Blocker)     182
Antiarrhythmic     183
Adverse Reactions     183
Composition of Local Anesthetic Solutions     185
Local Anesthetic Agents     185
Amides     185
Esters     189
Other Local Anesthetics     189
Vasoconstrictors     189
Drug Interactions     192
Choice of Local Anesthetic     192
Topical Anesthetics     193
Amides     195
Esters     196
Precautions in Topical Anesthesia     197
Doses of Local Anesthetic and Vasoconstrictor     197
Antianxiety Agents     199
Definitions     201
Benzodiazepines     201
Chemistry     201
Pharmacokinetics     201
Mechanism of Action     204
Pharmacologic Effects     204
Adverse Reactions     205
Abuse and Tolerance     207
Drug Interactions     208
Uses     208
Management of the Dental Patient Taking Benzodiazepines     210
Barbiturates     211
Chemistry     211
Pharmacokinetics     211
Mechanism of Action     212
Pharmacologic Effects     212
Adverse Reactions     212
Chronic Long-Term Use     212
Contraindications     213
Drug Interactions     213
Uses     213
Nonbenzodiazepine-nonbarbiturate sedative-hypnotics     213
Chloral Hydrate     213
Buspirone      214
Meprobamate     214
Nonbenzodiazepine Benzodiazepine Receptor Agonists     215
Zolpidem     215
Zaleplon     215
Eszopiclone     215
Melatonin Receptor Agonist     216
Centrally Acting Muscle Relaxants     216
Pharmacologic Effects     216
Individual Centrally Acting Muscle Relaxants     216
Miscellaneous Agents     217
Baclofen     217
Tizanidine     217
Dantrolene     217
General Comments about Antianxiety Agents     217
Analgesic-Sedative Combinations     217
Special Considerations     218
Cautions     218
General Anesthetics     220
History     220
Mechanism of Action     221
Stages and Planes of Anesthesia     221
Adverse Reactions     223
General Anesthetics     223
Classification of Anesthetic Agents     223
Nitrous Oxide     225
Halogenated Hydrocarbons     229
Other General Anesthetics     231
Balanced General Anesthesia     233
Vitamins and Minerals     234
Measurements of Vitamin Needs     234
Recommended Dietary Allowance     234
Fallacious Reasoning about Vitamins     236
Water-Soluble Vitamins     236
Ascorbic Acid (Vitamin C)     236
B-Complex Vitamins     238
Fat-Soluble Vitamins     247
Vitamin A     247
Vitamin D     249
Vitamin E     251
Vitamin K     252
Selected Minerals     253
Iron     253
Zinc     254
Calcium     255
Drug-Induced Vitamin Deficiencies     256
Oral Conditions and Their Treatment     258
Infectious Lesions     258
Acute Necrotizing Ulcerative Gingivitis     258
Herpes Infections     259
Candidiasis (Moniliasis)     261
Angular Cheilitis/Cheilosis     261
Alveolar Osteitis     262
Immune Reactions     262
Recurrent Aphthous Stomatitis     262
Lichen Planus     263
Miscellaneous Oral Conditions     264
Geographic Tongue     264
Burning Mouth or Tongue Syndrome     264
Inflammation     265
Pericoronitis      265
Postirradiation Caries     265
Root Sensitivity     265
Actinic Lip Changes     265
Drug-Induced Oral Side Effects     265
Xerostomia     265
Sialorrhea     268
Hypersensitivity-Type Reactions     268
Oral Lesions that Resemble Autoimmune-Type Reactions     268
Stains     268
Gingival Enlargement     268
Common Agents Used to Treat Oral Lesions     269
Corticosteroids     269
Palliative Treatment     270
Drugs That May Alter Dental Treatment     271
Cardiovascular Drugs     272
Dental Implications of Cardiovascular Disease     273
Contraindications to Treatment     273
Vasoconstrictor Limit     273
Infective Endocarditis     273
Cardiac Pacemakers     274
Periodontal Disease and Cardiovascular Disease     274
Cardiac Glycosides     274
Congestive Heart Failure     274
Digitalis Glycosides     275
Antiarrhythmic Agents     277
Automaticity     277
Action Potential     279
Arrhythmias     279
Antiarrhythmic agents      279
Adverse Reactions     281
Dental Implications     281
Antianginal Drugs     281
Angina Pectoris     281
Nitroglycerin-like Compounds     282
Calcium Channel Blocking Agents     285
[Beta]-Adrenergic Blocking Agents     286
Ranolazine     286
Dental Implications     286
Antihypertensive Agents     287
Patient Evaluation     289
Treatment of Hypertension     289
Diuretic Agents     292
[Beta]-Adrenergic Blocking Agents     296
Calcium Channel Blocking Agents     297
Angiotensin-Related Agents     299
[alpha subscript 1]-Adrenergic Blocking Agents     301
Other Antihypertensive Agents     302
Management of the Dental Patient Taking Antihypertensive Agents     303
Antihyperlipidemic Agents     304
3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors     304
Niacin     305
Cholestyramine     306
Gemfibrozil     306
Dental Implications     306
Drugs that Affect Blood Coagulation     306
Anticoagulants     306
Drugs that Increase Blood Clotting     312
Anticonvulsants     314
Epilepsy     314
Generalized Seizures     314
Partial (Focal) Epilepsies     317
Drug Therapy of Patients with Epilepsy     317
General Adverse Reactions to Anticonvulsant Agents     317
Carbamazepine     319
Valproate     320
Phenobarbital     321
Phenytoin     321
Miscellaneous Anticonvulsant Agents     323
New Anticonvulsant Agents     323
Dental Treatment of the Patient with Epilepsy     323
Nonseizure Uses of Anticonvulsants     325
Neurologic Pain     325
Psychiatric Use     325
Psychotherapeutic Agents     326
Psychiatric Disorders     326
Antipsychotic Agents     328
Pharmacologic Effects     329
Adverse Reactions     330
Drug Interactions     332
Uses     332
Dental Implications     332
Antidepressant Agents     333
Tricyclic Antidepressants     333
Second-Generation Antidepressants     336
Selective Serotonin Reuptake Inhibitors      336
Bupropion     337
Other Antidepressant Agents     337
Monoamine Oxidase Inhibitors     337
Drugs for Treatment of Bipolar Depression     338
Lithium     338
Anticonvulsants     338
Autocoids and Antihistamines     339
Histamine     339
Pharmacologic Effects     339
Adverse Reactions     340
Uses     340
Antihistamines (H[subscript 1]-Receptor Antagonists)     340
Pharmacologic Effects     341
Adverse Reactions     341
Toxicity     343
Uses     344
Peripheral (Nonsedating) H[subscript 1]-Receptor Antagonists     344
Fexofenadine     344
Loratidine     345
Cetirizine     345
Other Autocoids     345
Prostaglandins and Thromboxanes     345
Leukotrienes     347
Kinins     347
Substance P     347
Adrenocorticosteroids     349
Mechanism of Release     349
Classification     350
Definitions     350
Routes of Administration     350
Mechanism of Action      351
Pharmacologic Effects     351
Adverse Reactions     352
Metabolic Changes     352
Infections     352
Central Nervous System Effects     352
Peptic Ulcer     352
Impaired Wound Healing and Osteoporosis     352
Ophthalmic Effects     352
Electrolyte and Fluid Balance     352
Adrenal Crisis     353
Dental Effects     353
Uses     353
Medical Uses     353
Dental Uses     354
Corticosteroid Products     354
Dental Implications     354
Adverse Reactions     355
Steroid Supplementation     356
Rule of Twos     357
Topical Use     357
Other Hormones     359
Pituitary Hormones     359
Anterior Pituitary     360
Posterior Pituitary     361
Thyroid Hormones     361
Iodine     361
Hypothyroidism     362
Hyperthyroidism     362
Pancreatic Hormones     363
Diabetes Mellitus     363
Female Sex Hormones     375
Estrogens      376
Progestins     377
Oral Contraceptives     378
Male Sex Hormones     380
Androgens     380
Other Agents that Affect Sex Hormone Systems     381
Clomiphene     382
Leuprolide     382
Tamoxifen     382
Danazol     382
Aromatase Inhibitors     382
Antineoplastic Drugs     384
Use of Antineoplastic Agents     385
Mechanisms of Action     385
Classification     387
Adverse Drug Effects     387
Bone Marrow Suppression     387
Osteonecrosis     389
Gastrointestinal Effects     390
Dermatologic Effects     390
Hepatotoxicity     390
Neurologic Effects     390
Nephrotoxicity     390
Immunosuppression     390
Germ Cells     390
Oral Effects     390
Combinations     390
Use in Treatment of Inflammatory Processes     391
Dental Implications     391
Respiratory and Gastrointestinal Drugs     393
Respiratory Drugs     393
Respiratory Diseases      393
Drugs Used to Treat Respiratory Diseases     395
Sympathomimetic Agents     395
Metered-Dose Inhalers     396
Corticosteroids     396
Leukotriene-Pathway Inhibitors     399
Methylxanthines     400
Anticholinergics     400
Agents Used to Manage Upper Respiratory Infections     400
Dental Implications of the Respiratory Drugs     401
Gastrointestinal Drugs     402
Gastrointestinal Diseases     402
Drugs Used to Treat Gastrointestinal Diseases     402
Histamine[subscript 2]-Blocking Agents     402
Proton Pump Inhibitors     404
Mixed Antiinfective Therapy for Ulcer Treatment     405
Antacids     405
Miscellaneous Gastrointestinal Drugs     405
Laxatives and Antidiarrheals     406
Emetics and Antiemetics     406
Agents Used to Manage Chronic Inflammatory Bowel Disease     407
Special Situations     409
Emergency Drugs     410
General Measures     410
Preparation for Treatment     411
Categories of Emergencies     411
Lost or Altered Consciousness     411
Respiratory Emergencies     412
Cardiovascular System Emergencies     413
Other Emergency Situations     414
Drug-Related Emergencies     415
Emergency Kit for the Dental Office     415
Drugs     415
Equipment     418
Pregnancy and Breast Feeding     420
General Principles     421
History     421
Pregnancy     421
Pregnancy Trimesters     421
Teratogenicity     421
Food and Drug Administration Pregnancy Categories     422
Breast Feeding     422
Dental Drugs     422
Local Anesthetic Agents     422
Analgesics     428
Antiinfective Agents     428
Antianxiety Agents     429
Drug Interactions     431
Mechanisms of Interactions     431
Pharmacokinetic     432
Pharmacodynamic     433
Dental Drug Interactions     434
Analgesics     436
Antiinfectives     438
Benzodiazepines     439
Epinephrine     439
Summary     441
Drug Abuse     443
General Considerations      444
Definitions     444
Psychologic Dependence     445
Physical Dependence     445
Tolerance     445
Addiction, Habituation, and Dependence     446
Central Nervous System Depressants     446
Ethyl Alcohol     447
Nitrous Oxide     450
Opioid Analgesics     451
Sedative-Hypnotics     453
Central Nervous System Stimulants     454
Cocaine     454
Amphetamines     455
Caffeine     455
Tobacco     455
Psychedelics (Hallucinogens)     457
Lysergic Acid Diethylamide     457
Phencyclidine     457
Marijuana     458
Identifying the Drug Abuser     458
The Impaired Dental Health Care Worker     458
Appendixes
Top 200 Drugs (2005)     460
Medical Acronyms     466
Medical Terminology     470
What If...     472
Oral Manifestations: Xerostomia and Taste Changes     480
Natural/Herbal Products     484
Glossary     489
Drug Index     510
Index     522