Table 2: The Drugs Commonly Used in Dentistry Antibiotics/ Antifungals Anti-inflammatory Agents and Analgesics
Emergency Medications
Local Anesthetics
Sedatives
• Albuterol. • Aspirin. • Diphenhydramine. • Epinephrine. • Flumazenil. • Glucose. • Naloxone. • Nitroglycerine. • Oxygen.
• Benzodiazepines (alprazolam, diazepam, lorazepam, midazolam, and triazolam).
• Articaine. • Benzocaine (topical). • Bupivacaine. • Dyclonine (topical). • Lidocaine (with or without epinephrine). • Lidocaine (topical). • Mepivacaine
• Acetaminophen. • Aspirin. • Codeine. • Glucocorticoids (dexamethasone and prednisone). • Hydrocodone. • Ibuprofen. • Oxycodone.
• Amoxicillin. • Azithromycin. • Cephalexin. • Chlorhexidine • Clarithromycin. • Clindamycin. • Clotrimazole (topical). • Doxycycline. • Erythromycin. • Fluconazole. • Metronidazole. • Nystatin. • Penicillin. • Tetracycline.
(topical; antiseptic).
• Zaleplon. • Zolpidem.
(with or without levonordefrin).
• Prilocaine. • Tetracaine (topical).
Note. Adapted from “Pregnancy, Breast-Feeding and Drugs Used in Dentistry,” by M. Donaldson and J. H. Goodchild, 2012, Journal of the American Dental Association, 143 (11), 858-871. EVALUATING HERBAL-DRUG INTERACTIONS
Clinical decision support tools and databases are available to help OHCPs stratify herbal-drug interactions according to the level of risk they pose to patients. Two databases employed to evaluate interactions – Lexicomp (Hudson, OH) and the Natural Medicines Comprehensive Database (Stockton, CA) – were selected for the purposes of this course to determine the risks associated with CAM supplementation and particular drugs prescribed most commonly by dentists (Lexicomp, n.d.; Natural Medicines Comprehensive Database, n.d.a). Lexicomp assigns grades to interactions as shown in Table 3. Table 3: Lexicomp’s Risk Rating Definitions for Drug Interactions Risk Rating Action Description
Table 3: Lexicomp’s Risk Rating Definitions for Drug Interactions Risk Rating Action Description
Consider therapy modification.
Data demonstrate that the two medications may interact with one another in a clinically significant manner. A patient-specific assessment must be conducted to determine whether the benefits of concomitant therapy outweigh the risks. Specific actions must be taken to realize the benefits and/ or minimize the toxicity resulting from concomitant use of the agents. These actions may include aggressive monitoring, empiric dosage changes, and choice of alternative agents. Data demonstrate that the specified agents may interact with each other in a clinically significant manner. The risks associated with concomitant use of these agents usually outweigh the benefits. Use of these agents in combination are generally contraindicated.
D
No known interaction.
Data have not demonstrated either pharmacodynamic or pharmacokinetic interactions between the specified agents. Data demonstrate that the specified agents may interact with one another, but there is little to no evidence of clinical concern related to their concomitant use. Data demonstrate that the specified agents may interact with one another in a clinically significant manner. The benefits of concomitant use of these two medications usually outweigh the risks. An appropriate monitoring plan should be implemented to identify potential negative effects. Dosage adjustments of one or both agents may be needed in a minority of patients.
A
Avoid combination.
No action needed.
B
X
Monitor therapy.
Note. Adapted from “Lexicomp Online for Dentistry,” by Wolters Kluwer, n.d., Retrieved from http://webstore.lexi.com/ONLINE- Software-for-Dentists
C
EliteLearning.com/Dental
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