Mosbys Dental Drug Reference 12th Edition

MOSBY’S DENTAL DRUG REFERENCE www.ajlobby.com MOSBY’S DENTAL DRUG REFERENCE TWELFTH EDITION Editor-in-Chief Arthur H Jeske, DMD, PhD Associate Dean for Strategic Planning and Continuing Dental Education Professor Department of General Practice and Dental Public Health The University of Texas School of Dentistry at Houston Houston, Texas www.ajlobby.com 3251 Riverport Lane St Louis, Missouri 63043 MOSBY’S DENTAL DRUG REFERENCE, TWELFTH EDITION ISBN: 978-0-323-48111-3 ISSN: 2211-5625 Copyright © 2018, Elsevier Inc All rights reserved Previous editions copyrighted 2014, 2012, 2010, and 2008 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notices Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein International Standard Book Number: 978-0-323-48111-3 Executive Content Strategist: Sonya Seigafuse Content Development Manager: Billie Sharp Associate Content Development Specialist: Laurel Shea Publishing Services Manager: Deepthi Unni Senior Project Manager: Umarani Natarajan Design Direction: Ryan Cook Printed in the United States of America Last digit is the print number:  9  8  7  6  5  4  3  2  www.ajlobby.com Drug Monograph Content Contributors and Reviewers Lincoln Edwards, DDS, PhD Associate Professor School of Dentistry University of Texas Health Science Center Houston, Texas Demetra Logothetis, RDH, MS Professor Emeritus and Graduate Program Director Department of Dental Medicine University of New Mexico Albuquerque, New Mexico Meera K Shah, PharmD, AAHIVP Clinical Pharmacist University of Kansas Health System Kansas City, Kansas Ruth Fearing Tornwell, RDH, MS Associate Professor (retired) Dental Hygiene Program Lamar Institute of Technology Beaumont, Texas Thomas Viola, RPh, CCP Instructor, Writer, and Professional Speaker Burlington, New Jersey v www.ajlobby.com Preface This twelfth edition of Mosby’s Dental Drug Reference represents Elsevier’s commitment to providing comprehensive and current information on prescription drugs and recommendations for the care of the dental patients who take them As in past editions, new individual drugs as well as new drug classes are included in this concise reference book, which is designed to address the need of oral health care practitioners and educators for readily accessible and up-todate drug information and guidance for the dental management of medically compromised patients This edition incorporates many of the features of past editions, and it now contains updated information on monoclonal antibodies and other biologically targeted agents, in addition to many new monographs for 21st-century drugs used in the management of diabetes, cardiovascular disease, and cancer A DETAILED GUIDE TO MOSBY’S DENTAL DRUG REFERENCE, TWELFTH EDITION Mosby’s Dental Drug Reference provides essential drug information in a userfriendly format The bulk of this handbook contains an alphabetical listing of drug entries by generic name Drug entries include the following: Generic and Brand Names Drug entries begin with the generic drug name, followed by its pronunciation and its U.S., Canadian, and Australian brand names Category and Schedule This section lists the drug’s pregnancy risk category and, when appropriate, its controlled substance schedule or over-the-counter (OTC) status Mechanism of Action This section clearly and concisely describes the drug’s mechanism of action and therapeutic effects Pharmacokinetics Under this heading, a quick-reference chart outlines the drug’s route, onset, peak, and duration, when known This information is followed by a brief description of the drug’s absorption, distribution, metabolism, excretion, and half-life Indications and Dosages Here, you’ll find the approved indications and routes, along with age-appropriate dosage information and, for selected agents, dosage adjustments for preexisting conditions, such as liver or kidney disease Precautions/Contraindications Using a practice-oriented format and written specifically for dentistry, this section presents precautions and considerations for each drug entry Each entry lists conditions in which use of the generic drug is contraindicated Interactions For drugs, herbal supplements, and food, this section supplies vital information about adverse interactions of the medical drug with drugs prescribed in dentistry Adverse Effects Unlike other handbooks that mix more common adverse effects with rare, minor ones in a long, undifferentiated list, this book ranks side effects by frequency of occurrence, indicating expected, frequent, occasional, and rare Serious Reactions Because serious adverse reactions can be life-threatening emergencies that require prompt intervention, this section highlights them separately from other side effects for easy identification vii www.ajlobby.com viii Preface Mosby’s Dental Drug Reference, Twelfth Edition, is an easy-to-use source of current drug information for a wide spectrum of dental care providers When it comes to providing quality patient care, all members of the dental team can rely on the twelfth edition of Mosby’s Dental Drug Reference for current, dentally relevant information presented in an easy-to-use format As you use the book, please keep in mind the following: • The majority of the monographs are descriptions of drugs that are utilized on an outpatient basis and are, therefore, more likely to be encountered in dental practice Vaccines, biologicals, and medications used only intraoperatively in hospitalized patients are generally not included, and the reader is referred to other resources for this information • The Evolve website (http://evolve.elsevier.com/Jeske/dental/) can be consulted for updates and new information pertinent to this text • Several important “Dental Considerations” are relevant to all of the drugs described in the monographs, including the following: The use of a prescription medication indicates the presence of a medical condition that is being managed by one or more physicians The physical status of the patient and his or her ability to tolerate dental treatment must be determined In collaboration with the treating physician(s), the physician, not the dentist, should guide all decisions related to changes in the use of prescription drugs for medical conditions Vital signs and/or other assessments should be determined at every dental treatment visit, as appropriate and as indicated; many drugs used for systemic conditions result in adverse oral conditions, such as xerostomia Strict attention must be paid to the prevention of negative outcomes of these conditions, particularly caries and periodontal disease; education of the patient and the patient’s family about his or her medications should be reinforced by the dental team, particularly as it relates to the prevention of oral complications of medication use This text does not constitute advice about the dental management of specific patients, each of whom must be evaluated individually using all pertinent diagnostic information, and the monographs contained in this book not constitute full prescribing information for the drugs In the production of the book, we have endeavored to make it as current and relevant as possible while emphasizing the busy oral health care provider’s need for rapid access and dentally relevant information On behalf of the Editor-inChief and Elsevier, we proudly thank our reviewers, Ruth Fearing Tornwall, RDH, MS, Lamar Institute of Technology; Lincoln Edwards, DDS, PhD, University of Texas Health Science Center; and Demetra Logothetis, RDH, MS, University of New Mexico, and our monograph content contributors, Meera K Shah, PharmD, AAHIVP, and Thomas Viola, RPh, CCP, for their expertise and contributions Finally, this edition is respectfully dedicated to the teachers and practitioners of dentistry, dental hygiene, and dental assisting around the world whose application of the book for students and patients continues to inspire our work www.ajlobby.com Internet References for Additional Drug Information and Professional Guidelines ADA Center for Evidence-Based Dentistry: http://ebd.ada.org/ (library of oral health systematic reviews and critical summaries of systematic reviews of dental topics) Cochrane Library Oral Health Group: http://www.ohg.cochrane.org/ (library of systematic reviews of randomized controlled trials only) American Heart Association: http://circ.ahajournals.org/cgi/content/full/ 116/15/1736 (complete publication on antibiotic prophylaxis to prevent infective endocarditis) Global RPh: http://www.globalrph.com/corticocalc.htm (calculator to convert corticosteroid supplemental dosages to equivalents of various drugs) Food and Drug Administration: http://www.fda.gov/ (comprehensive information on drugs, drug safety, drug approvals, etc.) American Association of Oral & Maxillofacial Surgeons (AAOMS), medication-related osteonecrosis of the jaw: http://www.aaoms.org/docs/ govt_affairs/advocacy_white_papers/mronj_position_paper.pdf (AAOMS guidelines for managing medication-related osteonecrosis of the jaw) University of Washington Oral Health Fact Sheets: http://www.dental washington.edu/departments/omed/decod/special_needs_facts.php (concise information on dental care of patients with a variety of childhood and adult medical conditions) American Association of Endodontists: http://www.aae.org/colleagues/ (archives of “Colleagues for Excellence” publications, guidelines on the management of endodontic patients, including antibiotic use and local anesthesia) American Academy of Pediatric Dentistry: http://aapd.org/policies/ (guidelines on fluorides, local anesthesia, antibiotics, and more in pediatric dental patients, updated q yrs) 10 Guide to Diagnosis and Management of Common Oral Conditions: http:// www.intechopen.com/books/diagnosis-and-management-of-oral-lesions -and-conditions-a-resource-handbook-for-the-clinician/ (open-access oral medicine reference text) xi www.ajlobby.com Medication-Related Osteonecrosis of the Jaw In 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) updated its Position Paper on Medication-Related Osteonecrosis of the Jaw (MRONJ), formerly termed bisphosphonate-related osteonecrosis of the jaw (BRONJ) This update expanded the list of drugs known to increase the risk for MRONJ to include antiangiogenic drugs (e.g., denosumab, Prolia®) and corticosteroids The updated document provides estimates of risk for MRONJ, comparisons of the risks and benefits of medications related to osteonecrosis of the jaw, guidance for clinicians on the differential diagnosis of MRONJ, and prevention measures and management strategies for patients with disease-stage MRONJ The complete document can be accessed at: http://www.aaoms.org/ docs/govt_affairs/advocacy_white_papers/mronj_position_paper.pdf According to this AAOMS document, medication-related risk for MRONJ is increased in cancer patients who have been exposed to zoledronate (Zometa®, Reclast®) and antiangiogenic monoclonal antibodies (e.g., denosumab) and tyrosine kinase inhibitors (e.g., sunitinib), but it is not as frequent in osteoporotic patients exposed to the same agents Local factors for risk of MRONJ include the following: • Operative treatment (e.g., tooth extraction) • Anatomic factors (e.g., mandible, denture use) • Concomitant oral disease (e.g., inflammatory dental disease) The position paper also provides information on genetic, demographic, and systemic factors in MRONJ and a summary of the dental management strategies for patients at risk for MRONJ, including the following: • Extraction of nonrestorable teeth and those with a poor prognosis prior to initiation of antiresorptive/antiangiogenic therapy • Elimination of mucosal trauma by removable prostheses • Consultation with the patient’s physician(s) to follow osteonecrosis-prevention protocols; • Maintenance of good oral hygiene and dental care • Avoidance of dental implant placement in oncology patients receiving intravenous antiresorptive therapy or antiangiogenic medications For patients taking oral bisphosphonates (e.g., alendronate, Fosamax®), specific guidance for cases based on length of exposure to medications includes the following: • For individuals who have taken an oral bisphosphonate for less than years and have no clinical risk factors, no alteration or delay in planned oral surgery is necessary (this includes any and all procedures common to oral and maxillofacial surgeons, periodontists, and other dental providers) • For those patients who have taken an oral bisphosphonate for less than years and have also taken corticosteroids or antiangiogenic medications concomitantly, the prescribing physician should be contacted to consider discontinuation of the oral bisphosphonate (drug holiday) for at least months prior to oral surgery if systemic conditions permit • For those patients who have taken an oral bisphosphonate for more than years with or without any concomitant medical therapy, the prescribing physician should be contacted to consider discontinuation of the antiresorptive for months prior to oral surgery if systemic conditions permit The complete AAOMS position paper should be consulted for detailed patientcare information, including management of patients with established MRONJ xiii www.ajlobby.com Monoclonal Antibodies and Other Biologic Drugs Summary: Monoclonal antibodies, anti–tumor necrosis factor (anti-TNF) agents, and other preparations are now in widespread use as immune modulators in the management of autoimmune disorders and account for a very high proportion of drug sales in the United States Although limitations on their use include the need for injection of many of these agents, they have had a significant impact on the treatment of several important diseases, particularly rheumatoid arthritis, Crohn’s disease, and more severe forms of psoriasis They are generally large proteins that can be manufactured via recombinant DNA methodologies The types of agents described in this section may be recognized by the suffixes of their official (“generic”) names, (e.g., “-mab” indicates “monoclonal antibody,” “-ib” indicates “inhibitor,” etc.) Classification: T-cell modulators: e.g., abatacept (Orencia®) B-cell cytotoxic agents: e.g., rituximab (Rituxan®) IL-1 (interleukin-1) blockers: e.g., anakinra (Kineret®), rilonacept (Arcalyst®), canakinumab (Ilaris®) Anti-IL-6 (interleukin-6) receptor antibodies: e.g., tocilizumab (Actemra®) Janus kinase (JAK) inhibitors: e.g., tofacitinib (Xeljanz®) TNF-α blockers: e.g., adalimumab (Humira®), certolizumab (Cimzia®), etanercept (Enbrel®), golimumab (Simponi®), infliximab (Remicade®) DENTAL CONSIDERATIONS FOR MONOCLONAL ANTIBODIES/BIOLOGICALLY TARGETED AGENTS General: • Consult prescribing information for specific drug interactions • Patients taking biologic agents are being treated for serious systemic autoimmune disorders, which may require postponement or modification of dental care • Patients are at increased risk of infections because of the immunosuppressive effects of biologic agents; patients should be monitored accordingly • Screen for latent or active tuberculosis and opportunistic infections • Consult physician to assess disease status and ability of patient to tolerate dental procedures • Many biologic agents must be injected; injection site discomfort and acute symptoms may occur following injection (nausea, diarrhea) Monoclonal Antibodies Approved for Use in the United States Official Name Trade Name(s) Primary Indications/Uses Abciximab ReoPro Adjunct for prevention of thromboembolism Adalimumab Humira Rheumatoid arthritis Alemtuzumab Campath Chronic lymphocytic leukemia Basiliximab Simulect Anti-rejection (for renal transplantation) Bevacizumab Avastin Metastatic colorectal and other tumors Canakinumab Ilaris Cryopyrin-associated periodic syndromes (Continued) xv www.ajlobby.com e66 Complementary and Alternative Medications USES Moderate evidence from placebocontrolled and comparative randomized controlled trials (RCTs) indicates that oral SAMe can reduce symptoms of osteoarthritis, to approximately the same extent as low doses of NSAIDs Weaker RCT evidence supports efficacy in depression, fibromyalgia, and cholestasis In highly preliminary studies, SAMe has shown promise for treatment of Gilbert’s disease and other liver disorders ADMINISTRATION Oral dose forms have variable bioavailability; doses used in clinical trials were generally 1200–1600 mg/ day daily, taken in divided doses CONTRAINDICATIONS None reported; however, there is a possible risk of hypomania in patients with bipolar disorder SIDE EFFECTS GI complaints such as diarrhea, nausea, and vomiting, and CNS effects such as hypomania in bipolar disorder and anxiety DENTAL CONSIDERATIONS Determine why the patient is taking the drug DRUG INTERACTIONS SAMe might interfere with the effectiveness of l-dopa, which is used for treatment of Parkinson’s disease Based on a case report of a toxic interaction with clomipramine, combination of SAMe with standard antidepressants should be used only with caution saw palmetto (Serenoa repens, Sabal fructus) OTHER NAMES: Sabal, cabbage palm, saw palmetto berry Class:  Herbal remedy MAJOR INGREDIENTS Contains various sitosterols (phytosterols) such as β-sitosterol and other sitosterol compounds, flavonoids, polysaccharides, and free fatty acids The ripe, dried fruit of the plant is used medicinally CLAIMED ACTIONS Reported to be antiandrogenic and antiinflammatory May have some low-level estrogenic activity The antiandrogenic activity is suggested to occur by inhibition of the enzyme testosterone-5-a-reductase This action prevents the conversion of testosterone to dihydrotestosterone, the active androgenic hormone Some data support blockade of dihydrotestosterone to receptors in the cell nucleus Limited data seem to support the estrogenic effects The antiinflammatory effects remain doubtful Use of saw palmetto does not affect prostate-specific antigen levels USES This herbal product has been used for treatment of symptoms associated with BPH, particularly urinary difficulties Clinical trials show better results than placebo and apparent comparative results to finasteride (Proscar) and other pharmaceuticals for BPH Saw palmetto appears to cause some reduction in prostate gland size, www.ajlobby.com Complementary and Alternative Medications e67 ADMINISTRATION Saw palmetto is taken at a dose of 160 mg twice a day of an extract standardized to contain 85%-95% fatty acids and sterols CONTRAINDICATIONS Not recommended for use by pregnant women or by women of childbearing age because of unclear influence of saw palmetto on other androgens and possible estrogenic effects SIDE EFFECTS Use of saw palmetto in clinical trials was associated with a few, nonspecific side effects There is one case report of saw palmetto apparently causing increased bleeding during surgery; for this reason, use of saw palmetto should be discontinued 2 wk before surgery MAJOR INGREDIENTS Contains quinoids (hypericin, pseudohypericin), anthraquinones, flavonoids (hyperoside, quercitin, rutin), bioflavonoids, and a volatile oil One of the pharmacologically active components is hyperforin; another, hypericin, has photosensitizing properties Flavonoids, including amentoflavone, may contribute to the pharmacologic action of the herb The aboveground parts of the plant harvested during the flowering season are used medicinally CLAIMED ACTIONS The primary actions are antidepressant, antiinflammatory, and antimicrobial The constituent hyperforin appears to inhibit uptake of serotonin, dopamine, and norepinephrine USES OTHER NAMES: Used for treatment of mild to moderate major depression According to most of the many randomized controlled trials (RCTs) performed, it is more effective than placebo and, except in severe major depression, is as effective as tricyclics or selective serotonin reuptake inhibitors The volatile oil seems to increase the healing of burns Hypericin has shown in vitro activity against HIV, but human trials indicate that hypericin must be taken in toxic doses in order to produce any clinical effect One RCT failed to find St John’s wort helpful for polyneuropathy Topical St John’s wort has shown some promise for treatment of eczema Hypericum, kaimath weed, John ‘s wort ADMINISTRATION Class:  Herbal remedy A variety of oral preparations are available, standardized to either hypericin or hyperforin DENTAL CONSIDERATIONS Ask why the product is being used DRUG INTERACTIONS No dental drug interactions have been reported St John’s wort (Hypericum perforatum, Hypericum herba) www.ajlobby.com APPENDIX E although not to the same extent as finasteride (Note: Several effective pharmaceuticals for BPH cause no change in prostate gland size.) Use in prostatitis and baldness remains speculative e68 Complementary and Alternative Medications SIDE EFFECTS In the extensive clinical trial experience with St John’s wort, side effects have been limited and generally nonspecific Photosensitization may occur at higher doses or with topical use Like all antidepressants, St John’s wort can cause episodes of mania in people with bipolar disorder There are some reports that use of St John’s wort by individuals with Alzheimer’s disease may increase agitation Safety during pregnancy and lactation is not established DENTAL CONSIDERATIONS use with tramadol might present a similar risk Although St John’s wort does not appear to have MAOI actions at normal doses, there is one case report of an MAO-like interaction between St John’s wort and tyramine-containing foods Discontinue use 2 wk before general anesthesia Avoid dental (or other) drugs with a potential for photosensitivity stevia (Stevia rebaudiana) Ask why the product is being used OTHER NAMES: DRUG INTERACTIONS Caa’inhem, Paraguayan sweet herb, sweet herb, sweet leaf of Paraguay, sweetleaf St John’s wort affects a variety of cytochromes, as well as the transport protein P-glycoprotein, and can reduce levels and thereby activity of numerous medications to a clinically significant extent Interacting drugs include oral contraceptives (leading to unwanted pregnancy), protease inhibitors and nonnucleoside reverse transcriptase inhibitors (leading to reduced anti-HIV effectiveness), cyclosporine (leading to organ rejection), clozapine, digoxin, losartan, metronidazole, olanzapine, omeprazole, statins, warfarin, and various chemotherapy drugs Note that if blood levels of a drug are stabilized while a patient is taking St John’s wort, discontinuation of the herb may cause a dangerous rise in levels In addition, St John’s wort should be used only with caution, if at all, in patients taking other antidepressive medications, including MAOIs, tricyclic antidepressants, and selective serotonin reuptake inhibitors, because case reports suggest a risk of serotonin syndrome Combined Class:  Herbal remedy MAJOR INGREDIENTS Major active constituents include diterpene steviosides and rebaudioside Flavonoids and volatile oil are present as well The leaves of the plant are used medicinally CLAIMED ACTIONS Steviosides are sweeter than sucrose by weight, producing a taste said to be preferable to saccharine, though not entirely without aftertaste Steviosides have shown an antihypertensive effect but only at much higher doses than reasonable for intake as a sugar substitute USES Stevia enjoys wide use as a noncaloric sweetening agent in Japan and several other countries However, stevia has not received approval for use under this www.ajlobby.com designation in the United States; nonetheless, it is used widely as a sweetener without claiming it as such Concentrated steviosides at far higher doses are beginning to be used by people with hypertension; such use may be expected to increase in the future valerian (Valeriana officinalis, Valeriana radix) OTHER NAMES: Valerian root, Indian valerian Class:  Herbal remedy ADMINISTRATION Approximately 1/6 teaspoon of ground stevia (or 2–4 drops of stevia liquid extract) equals the sweetness of teaspoon of ordinary sugar This supplies approximately 30 mg steviosides For hypertension, the dose used in clinical trials was 250–500 mg concentrated steviosides times a day Maximum safe doses in pregnant or nursing women, young children, and individuals with severe hepatic or renal disease are not established SIDE EFFECTS Stevia is generally regarded as a safe herb, but animal studies suggest that high doses may have antifertility actions in both males and females The widespread use of stevia in Japan suggests reasonable safety in children and pregnant women DENTAL CONSIDERATIONS Patients may be using steviosidesweetened products to avoid caries, a use that may be reasonable DRUG INTERACTIONS No dental drug interactions have been reported MAJOR INGREDIENTS Valepotriates (isovaltrate and others), a volatile oil (bornyl isovalerenate and isovalerenic acid), sesquiterpenes, and multiple other substances Pharmacologically active components are not identified with any certainty but may be isovaleric acid and related derivatives The fresh underground parts and roots are used medicinally CLAIMED ACTIONS Sedation, reduction in nervousness, sleep promoting, and antispasmodic Laboratory data suggest valerian may increase gamma-aminobutyric acid (GABA) levels at synapses USES Evidence from several randomized controlled trials (RCTs) suggests that valerian can improve sleep, especially with continued use Other proposed uses of valerian lacking meaningful supporting evidence include treatment of restlessness, reduction in nervousness (anxiolytic), agitation associated with menstruation, colic, stomach cramps, and uterine spasticity Antispasmodic properties are not well defined It has been used externally by adding it to bath water ADMINISTRATION Available for oral use as a variety of products, including tinctures, infusions, and extracts www.ajlobby.com APPENDIX E Complementary and Alternative Medications e69 e70 Complementary and Alternative Medications SIDE EFFECTS Generally not observed in usual doses GI complaints, headache, sleeplessness, mydriasis, excitability, and cardiac disturbances may occur with long-term use DENTAL CONSIDERATIONS Ask why the product is being used DRUG INTERACTIONS Monitor patients for increased sedation when using other CNS depressants May potentiate CNS depressants xylitol protection to the child, presumably because infants receive their initial S mutans colonization from their mothers Other RCTs suggest that xylitol use by children may reduce the incidence of otitis media Xylitol has been suggested as a prophylactic for periodontal disease, but this use has not yet undergone significant study ADMINISTRATION A typical dose of xylitol used in clinical trials for caries prevention was 4.3–10 g/day Higher doses appear to be more effective than lower doses SIDE EFFECTS Class:  Nonherbal remedy MAJOR INGREDIENTS Xylitol is a polyol with the same intensity of sweetness as sucrose, but it cannot serve as a metabolic base for oral microbes CLAIMED ACTIONS Xylitol inhibits the growth of Streptococcus mutans and on this basis has been proposed as a prophylactic agent against dental caries Xylitol may also inhibit growth of Streptococcus pneumoniae and thereby reduce the risk of respiratory infections caused by this organism High consumption of xylitol can cause mild GI distress and possibly diarrhea, especially in children DENTAL CONSIDERATIONS Patients should be reminded that xylitol gum and related products should be used in addition to standard dental hygiene recommendations, not as a substitute for them DRUG INTERACTIONS No dental drug interactions have been reported yohimbe bark (Pausinystalia yohimbe) USES OTHER NAMES: In several large randomized controlled trials (RCTs), children who used gums, lozenges, syrups, toothpastes, or candies containing xylitol experienced a reduced incidence of caries compared with control groups Use of xylitol by nursing mothers may confer some Yohimbe cortex Class:  Herbal remedy MAJOR INGEDIENTS The principal alkaloid is yohimbine (quebrachine), with lesser amounts www.ajlobby.com Complementary and Alternative Medications e71 CLAIMED ACTIONS The major effects of this drug are due to yohimbine Do not confuse the prescription drug yohimbine with yohimbe Yohimbine has α2-adrenergic antagonist activity Presynaptic α2-adrenergic receptors regulate norepinephrine release In a feedback-type action, antagonism of these receptors is associated with greater norepinephrine release It may also dilate blood vessels; claims are made for a calcium channel blocking action and inhibition of MAO enzymes USES Has been used to treat erectile dysfunction, as an aphrodisiac, for exhaustion, and even for orthostatic hypotension Limited data concern yohimbine and not yohimbe Yohimbine has not been approved for this application According to the German Commission E monographs, yohimbe’s effectiveness is not documented, and it is not recommended ADMINISTRATION Limited products are available and usually in combination with other ingredients CONTRAINDICATIONS Not recommended for use by patients with hepatic or renal impairment or with psychiatric disorders SIDE EFFECTS Usual doses produce few side effects However, significant adverse effects are reported with large doses and include increased salivation, anxiety, hallucinations, exanthema, nervousness, irritability, tachycardia, and sweating Other effects also are possible Cardiac failure, possibly fatal, has been reported DENTAL CONSIDERATIONS Ask why the product is being used DRUG INTERACTIONS No specific dental drug interactions have been reported, but it may have MAOI action Avoid use of indirect-acting sympathomimetics and tricyclic antidepressants BIBLIOGRAPHY Blake S: Alternative remedies CD-ROM, St Louis, 2001, Mosby Blumenthal M, et al: The complete German Commission E monographs, Austin, 1998, American Botanical Council Miller LG: Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions, Arch Intern Med 158:2200-2211, 1998 Mosby’s handbook of herbs and supplements and their therapeutic uses, St Louis, 2003, Mosby Healthgate Natural medicines comprehensive database, Stockton, CA, 2004, Pharmacist’s Letter/Prescriber’s Letter, Therapeutic Research Faculty Nonherbal dietary supplements, Pharmacist’s Letter 98 (4), 1998 O’Hara MA, et al: A review of 12 commonly used medicinal herbs, Arch Fam Med 7:523-536, 1998 PDR for herbal medicines, ed 4, Montvale, NJ, 2007, PDR Network Stanger MJ, et al: Anticoagulant activity of select dietary supplements, Nutr Rev 70:107-117, 2012 Therapeutic use ol herbs, continuing education booklets part and part 2, Stockton, CA, 1998, Pharmacist’s Letter www.ajlobby.com APPENDIX E of stereoisomers of yohimbine along with other indole alkaloids, including corynantheidine and allo-yohimbine It also contains a variety of plant tannins The dried bark of the trunk and branches of the tree are the parts used medicinally Appendix F  Preventing Medication Errors and Improving Medication Safety Medication safety is a high priority for the health care professional Prevention of medication errors and improved safety for the patient are important, especially in today’s health care environment, when today’s patient is older and sometimes sicker and the drug therapy regimen can be more sophisticated and complex A medication error is defined by the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.” Most medication errors occur as a result of multiple compounding events as opposed to a single act by a single individual Use of the wrong medication, strength, or dose, confusion over sound-alike or look-alike drugs, administration of medications by the wrong route, miscalculations (especially when used in pediatric patients or when administering medications intravenously), and errors in prescribing and transcription can contribute to compromising the safety of the patient The potential for adverse events and medication errors is definitely a reality and is potentially tragic and costly in both human and economic terms Health care professionals must take the initiative to create and implement procedures to reduce, and hopefully prevent, medication errors The first priority in preventing medication errors is to establish a multidisciplinary team to improve medication use The goal for this team would be to assess medication safety and implement changes that would make it difficult or impossible for mistakes to reach the patient Some important criteria in making improved medication safety successful include the following: • Promote a nonpunitive approach to reducing medication errors • Increase the detection and the reporting of medication errors, near misses, and potentially hazardous situations that may result in medication errors • Determine root causes of medication errors • Educate stakeholders about the causes of medication errors and ways to prevent these errors • Make recommendations to allow organization-wide, system-based changes to prevent medication errors • Learn from errors that occur in other organizations and take measures to prevent similar errors Some common causes and ways to prevent medication errors and improve safety include the following: Communicating Prescription Information Poor handwriting can make it difficult to distinguish between two medications with similar names Also, many drug names sound similar, especially when the names are spoken over the telephone, poorly enunciated, or mispronounced • Take time to write legibly • Keep phone or verbal orders to a minimum to prevent misinterpretation • Repeat back orders taken over the telephone www.ajlobby.com • When ordering a new or rarely used medication, print the name • Always specify the drug strength, even if only one strength exists • Print generic and brand names of look-alike or sound-alike medications Zeros and Decimal Points Hastily written orders can present problems even if the name of the medication is clear • Always place a zero before a decimal point when the number is less than a whole unit (e.g., use 0.25 mg or 250 mcg, not 25 mg) • Never have a trailing zero following a decimal point (e.g., use mg, not 2.0 mg) Abbreviations Errors can occur because of a failure to standardize abbreviations Establishing a list of abbreviations that should never be used is recommended • Never abbreviate unit as “U,” spell out “unit.” • Do not abbreviate “once daily” as od or qd, or “every other day” as qod; spell it out • Do not use DC, because it may be misinterpreted as either discharge or discontinue • Do not abbreviate drug names; spell out the generic and/or brand names Ambiguous or Incomplete Orders These types of orders can cause confusion or misinterpretation of the writer’s intention Examples include situations in which the route of administration, dose, or dosage form has not been specified • Do not use slash marks—they are read as the number one (1) • When reviewing an unusual order, verify the order with the person writing the order to prevent any misunderstanding • Read over orders after writing • Encourage that the drug’s indication for use be provided on medication orders • Provide complete medication orders—do not use “resume preop” or “continue previous meds.” High-Alert Medications Medications in this category have an increased risk of causing significant patient harm when used in error Mistakes with these medications may or may not be more common but may be more devastating to the patient if an error occurs A list of high-alert medications can be obtained from the Institute for Safe Medication Practices (ISMP) at www.ismp.org Technologies available today that can be used to address and help to solve potential medication problems or errors include the following: • Electronic prescribing systems— This refers to computerized prescriber order entry systems Within these systems is the capability to incorporate medication safety alerts (e.g., maximum dose alerts, allergy screening) Additionally, these systems should be integrated or interfaced with pharmacy and laboratory systems to provide drug-drug and drug-disease interaction alerts and include clinical order screening capability • Bar codes—These systems are designed to use bar-code scanning devices to validate identity of patients, verify medications administered, document administration, and provide safety alerts • “Smart” infusion pumps—These pumps allow users to enter drug infusion protocols into a drug library along with predefined dosage limits If a dosage is outside the limits established, an alarm is sounded and drug delivery is halted, www.ajlobby.com APPENDIX F Preventing Medication Errors e73 e74 Preventing Medication Errors informing the clinician that the dose is outside the recommended range • Automated dispensing systems/ point-of-use dispensing systems— These systems should be integrated with information systems, especially pharmacy systems • Pharmacy order entry system— This should be fully integrated with an electronic prescribing system with the capability of producing medication safety alerts Additionally, the system should generate a computerized medication administration record (MAR), which would be used by a nursing staff while administering medications From Mosby’s 2006 drug consult for nurses, St Louis, 2006, Mosby www.ajlobby.com Estrogens : ethinyl estradiol, mestranol Progestins (progesterone derivatives): desogestrel, drospirenone, ethynodiol diacetate, etonorgestrel, levonorgestrel, norethindrone, norgestimate, norgestrel Many products available in the following categories: Monophasic products: Alesse, Apri, Aviane, Brevicon, Cryselle, Demulen 1/35, Demulen 1/50, Desogen, Kariva, Lessina, Levlite, Levlen, Levora, Loestrin 21, Loestrin Fe, Low-Ogestrel, Lo/ Ovral, Mircette, Modicon, MonoNessa, Necon 0.5/35, Nelova 0.5/35E, Nordette, Norethin 1/35E, Norinyl + 50, Norinyl + 35, Nortrel 1/35, Nortrel 0.5/35, Ogestrel 0.5/50, Ortho-Cept, Ortho-Cyclen, Ortho-Novum 1/35, Ortho-Novum 1/50, Ovcon 35, Ovcon-50, Ovral, Ovral-28, Portia, Sprintec, Zovia 1/35E, Zovia 1/50E, Yasmin, others Biphasic products: Necon 10/11, Ortho-Novum 10/11 Triphasic products: Cyclessa, Enpresse, Estrostep-21, Estrostep Fe, Necon 7/7/7, Ortho TriCyclen, Tri-Levlen, Tri-Norinyl, Triphasil, Trivora Progestin-only: Aygestin, Camila, Errin, Jolivette, Micronor, Nor-QD, Nora-BE, Ortho Micronor, Ovrette, Norlutate [CAN] CATEGORY AND SCHEDULE Pregnancy Risk Category: X MECHANISM OF ACTION Prevents ovulation by suppression of the hypothalamic-pituitary system, decreasing the secretion of gonadotropin-releasing hormone (GnRH) Progestins blunt luteinizing hormone (LH) release and estrogens suppress follicle-stimulating hormone (FSH), ultimately inhibiting maturation and release of the dominant ovule USES To prevent pregnancy, endometriosis, hypermenorrhea, hypogonadism; acne (Tri-Cyclen) PHARMACOKINETICS Readily absorbed from GI tract Widely distributed, variable degrees of protein binding Extensively metabolized in liver by oxidation and conjugation; excreted in breast milk, urine, and feces Estrogens undergo enterohepatic cycling via excretion in the bile Half-life varies with individual agent INDICATIONS AND DOSAGES Contraception PO Adults.  tablet per day starting on day of menstrual cycle (day is first day of period) 20/21-TABLET PACKS PO Adults.  tablet per day starting on day of menstrual cycle; then on for 20 or 21 days, off days Drug Class:  Estrogen derivative, progesterone derivatives, combination oral contraceptives www.ajlobby.com APPENDIX G Appendix G  Oral Contraceptives e76 Oral Contraceptives 28-TABLET PACKS PO Adults.  tablet per day continuously BIPHASIC PO Adults.  tablet per day for 10 days, then next color tablet for 11 days TRIPHASIC PO Adults.  tablet per day; consult package insert for detailed instructions Amenorrhea and Abnormal Uterine Bleeding PO Adults.  Follow dose for routine contraception for specifi c product Treatment for 6–12 mo may be required Endometriosis PO Adults and adolescent females.  Follow dose for routine contraception for specifi c product; alternatively, the active tablets can be given continuously Treatment for 6–9 mo may be needed to induce endometrial atrophy and reduce symptoms SIDE EFFECTS/ADVERSE REACTIONS Occasional Breast tenderness, dizziness, headache, breakthrough bleeding, amenorrhea, menstrual irregularity, nausea, weakness Rare Mental depression, fever, insomnia, rash, acne, weight gain/loss, cholestatic jaundice, increased blood pressure, thromboembolism, hypersensitivity reactions (rash, urticaria, pruritus, erythema multiforme), optic neuritis, decreased glucose tolerance, tumors of breast PRECAUTIONS AND CONTRAINDICATIONS Acute liver disease, benign or malignant liver tumors, hypersensitivity to estrogen and/or progesterone derivatives, known or suspected breast cancer, known or suspected pregnancy, undiagnosed vaginal bleeding Caution: Lactation, hypertension, asthma, blood dyscrasias, gallbladder disease, congestive circulatory failure, diabetes mellitus, bone diseases, depression, migraine, convulsive disorders, liver disease, kidney disease, family history of breast or reproductive tract cancer DRUG INTERACTIONS OF CONCERN TO DENTISTRY • Very low risk of decreased effectiveness with antibiotics (documented risk only with non-dental antibiotics, e.g., rifampin) SERIOUS REACTIONS ! Thrombophlebitis, cerebrovascular disorders, retinal thrombosis, cholestatic jaundice, and pulmonary embolism occur rarely DENTAL CONSIDERATIONS General: • Place on regular recall to evaluate gingival infl ammation, if present • Increased incidence of dry socket after tooth extraction has been confirmed by systematic review and meta-analysis (13.9% risk versus 7.5% in females who did not take oral contraceptives).1 • Monitor vital signs at each appointment because of potential cardiovascular adverse effects www.ajlobby.com Oral Contraceptives e77 REFERENCE Bienek DR, Filliben JJ Risk assessment and sensitivity metaanalysis of alveolar osteitis occurrence in oral contraceptive users J Am Dent Assoc 2016;147(6):394-404 www.ajlobby.com APPENDIX G Teach Patient/Family to: • Use effective oral hygiene to prevent periodontal infl ammation • Advise patient of potential low risk of antibiotic interference with oral contraceptive effect Weights and Equivalents Metric System Weight kilogram gram milligram microgram Volume liter milliliter kg g mg µg 1000 grams gram 0.001 gram 0.001 milligram L ml 1000 milliliters 0.001 liter Weight Conversion, Pounds to Kilograms Kilograms (kg) Pounds (lb) 2.2 10 22 15 33 20 44 40 88 60 132 80 176 Household Equivalents—Approximate Utensil Volume teaspoonful 5 ml tablespoonful 15 ml cupful 240 ml pint 480 ml www.ajlobby.com Calculations for Determining the Amount of Local Anesthetic and/or Vasoconstrictor in Dental Cartridges Typical Local Anesthetic Concentrations Concentration mg/ml Equivalent 0.5% 5 mg/ml 2.0% 20 mg/ml 3.0% 30 mg/ml 4.0% 40 mg/ml Typical Vasoconstrictor Concentrations Concentration mg/ml (µg/ml) Equivalent 1:20,000 0.05 (50) 1:50,000 0.02 (20) 1:100,000 0.01 (10) 1:200,000 0.005 (5) General Calculation Guidelines Convert % solution to mg/ml or (µg/ml) as shown above Multiply mg/ml (àg/ml) ì cartridge volume ì number of cartridges = quantity of drug Note: Volumes of dental local anesthetic cartridges may vary slightly between products Example: Two cartridges of a 2% lidocaine HCl and 1 : 100,000 epinephrine HCl solution were administered The cartridge volume was 1.7 ml for each What quantity of each drug was given? Answer: For lidocaine HCl: 20 mg/ml × 1.7 ml × cartridges = 68 mg For epinephrine HCl: 0.01 mg/ml × 1.7ml ì cartridges = 0.034mg or 10àg/ml ì 1.7ml × cartridges = 34 µg www.ajlobby.com Additional Monographs on Evolve http://evolve.elsevier.com/Jeske/dental afatinib alteplase, recombinant anthralin apixaban argatroban ascorbic acid azelaic acid benzoyl peroxide bepotastine bisacodyl calcitriol caspofungin acetate chlorhexidine gluconate chip conjugated estrogens + bazedoxifene cottonseed oil cyanocobalamin dabrafenib dapagliflozin dolutegravir droxidopa eslicarbazepine ferrous fumarate flavocoxid fluorometholone halobetasol ibrutinib ketotifen fumarate loteprednol luliconazole macitentan miltefosine naphazoline ofloxacin pemirolast potassium ramelteon riociguat silver sulfadiazine simeprevir sofosbuvir sulconazole nitrate tasimelteon trametinib trifluridine vitamin A vitamin D vitamin E zinc oxide www.ajlobby.com ...MOSBY’S DENTAL DRUG REFERENCE www.ajlobby.com MOSBY’S DENTAL DRUG REFERENCE TWELFTH EDITION Editor-in-Chief Arthur H Jeske, DMD, PhD Associate Dean for Strategic Planning and Continuing Dental. .. 21st-century drugs used in the management of diabetes, cardiovascular disease, and cancer A DETAILED GUIDE TO MOSBY’S DENTAL DRUG REFERENCE, TWELFTH EDITION Mosby’s Dental Drug Reference provides... twelfth edition of Mosby’s Dental Drug Reference represents Elsevier’s commitment to providing comprehensive and current information on prescription drugs and recommendations for the care of the dental