Drug Concerns In Dentristy

Question 1

Having a patient taking non-selective beta blockers means we take caution with what?

Answer 1

Serious elevation in BP if vasoconstrictors administered

Question 2

Patient taking non-selective beta blockers, what’s a good alternative for local anesthesia?

Answer 2

Plain anesthetic like 3% Mepivacaine (Carbocaine) OR

2% Mepivacaine with 1:20,000 Levonordefrin

Question 3

Too much epinephrine may increase oxygen demand and induce angina in patients taking what types of meds?

Answer 3

ACE inhibitors OR

Calcium channel blockers

Question 4

Patient taking ACE inhibitors or Calcium channel blockers - what do we limit and why?

Answer 4

Limit epinephrine

Because can cause increased oxygen demand and induce angina

Question 5

Patient taking Tricyclic antidepressant need to limit what and for what reason?

Answer 5

Potentiates vasoconstrictors (severe hypertension)
Limit epinephrine

Question 6

What must we absolutely NOT use with patients taking tricyclic antidepressants?

Answer 6

Levonordefrin (Neo-Cobefrin)! So Carbocaine!

Question 7

Patient taking Phenothiazine class antipsychotics, what does it do?

Answer 7

Suppress vasoconstriction of epi and potentiate vasodilating effects leading to hypotension
Also potentiates LA’s so depression of BP, HR and respiratory rates

Question 8

What do opioids do to LA’s?

Answer 8

Potentiate cardiorespiratory effects

Question 9

A dentist should never prescribe what to Asthma patients?

Answer 9

Opioids especially Meperdine (Demerol)

Question 10

What do opioids do to Asthma patients?

Answer 10

Produce histamine to provoke bronchospasm

Question 11

A patient taking cocaine may undergo what when administering LA’s?

Answer 11

Disrhythmias -> ventricular fibrillation

Question 12

What is ventricular fibrillation?

Answer 12

Rapid, life-threatening heart rhythm

Question 13

Patient is taking Corticosteroid, what do we do?

Answer 13

Med consult

Question 14

Why must we get a med consult with a patient taking corticosteroids?

Answer 14

Because if apprehensive or extensive treatment planned, then may have to administer a loading dose prior to treatment.

Question 15

Patient taking antidiabetic agents, what do we do?

Answer 15

Med consult

Question 16

Administering large amounts of epi does what to patients taking antidiabetic agents?

Answer 16

Elevation of blood glucose damages the body

Question 17

Large amounts of epi administered to diabetic patients means how many cartridges of 1:100,000 epi?

Answer 17

Greater than 4 cartridges

Question 18

What must we do with patients taking benzodiazepines?

Answer 18

Caution with LA’s

Question 19

Why must we be cautious with LA’s in patients taking benzodiazepines?

Answer 19

Potentiates cardiorespiratory effects

Question 20

Patient has hypothyroid and is taking Thyroxine (Levothyroxine), what must we do?

Answer 20

Limit epi

Question 21

Why must we limit epi with patients that have hypothyroid?

Answer 21

Increases cardiac sensitivity to epi

Question 22

Say we prescribe Erythromycin or Clarithromycin antibiotic to a patient. What are they at risk for?

Answer 22

Torsades de pointes

Question 23

Say we prescribe Posaconazole (Noxafil) to a patient (antifungal). What are they at risk for?

Answer 23

Torsades de pointes

Question 24

What is torsades de pointes?

Answer 24

Ventricular tachycardia that may degenerate into ventricular fibrillation

Question 25

Prilocaine may cause what at high doses?

Answer 25

Methemoglobinemia

Question 26

Before injecting Prilocaine (citanest), make sure patient is not taking what?

Answer 26

Acetaminophen

Question 27

What is methemoglobinemia?

Answer 27

Elevated methemoglobins in blood reduce ability of red blood cells to release oxygen to tissues, resulting in hypoxia (cyanosis in tissues)

Question 28

Name two histamine 2 antagonists?

Answer 28

Cimetidine (Tagamet)

Ranitidine (Zantac)

Question 29

Patient with significant CHF (ASA III) is taking a histamine 2 antagonist (like Cimetidine or Ranitidine), what should dentists be aware of?

Answer 29

Inhibits biotransformation of amide local anesthetics (so toxicity)