Ce 329

The Importance of Pharmacology
in the Delivery of Quality Dental Care

Mary Govoni, CDA, RDA, RDH, MBA; Richard L. Wynn, PhD
Continuing Education Units: 5 hours
This course provides the dental professional with a broad overview of various categories of drugs and their
implications for dental patients and treatment.
Conflict of Interest Disclosure Statement
The authors report no conflicts of interest associated with this work.
ADAA
This course is part of the home-study library of the American Dental Assistants
Association. To learn more about the ADAA and to receive a FREE e-membership
visit www.dentalassistant.org.
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The Procter & Gamble Company is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying
quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses
or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
Concerns or complaints about a CE provider may be directed to the
provider or to ADA CERP at: http://www.ada.org/cerp
Overview
Pharmacology is the study of drugs. Drugs are defined as any chemical substance that affects biological
systems. Because many substances fit this description, the scope of pharmacology is extremely broad.
It includes such things as over-the-counter pain relievers like aspirin and acetaminophen; narcotic pain
medications such as Demerol and Vicodin; vitamin supplements; local anesthetic agents; fluorides; and
much more. This course provides dental assistants with a broad overview of various categories of drugs
and their implications for dental patients and treatment.
It is becoming more and more common for dental professionals to encounter patients who are taking
a number of medications, many of which have oral side effects or some effect on the patients dental
treatment. Since dental assistants often are the frontline health care workers who review medical histories
with patients, they should be knowledgeable about the medications that a patient may need or may already
be taking.
Crest Oral-B at dentalcare.com Continuing Education Course, Revised November 14, 2012
Although dental assistants do not prescribe drugs for patients, they should have a good understanding of the
basic categories of medications and recognize their implications for dental treatment. Dental assistants also
should be able to recognize side effects that may occur from certain medications and know contraindications
for prescribing medications. Since many dental assistants are responsible for reviewing health histories with
patients, knowledge of medications can be invaluable in alerting the treating dentist to situations that could
affect the patients overall health.
Learning Objectives
Upon the completion of this course, the dental professional will be able to:
Differentiate between over-the-counter medications, nutritional supplements and prescription drugs.
Identify the federal agencies that control distribution and prescription of drugs.
List the types of drugs used in conjunction with dental treatment.
Identify the types of drugs that are used to treat various medical conditions.
Differentiate between a generic and a brand name prescription and non-prescription drug.
Name the classes of drugs with known oral side effects.
Explain the pharmacological action of different classes of drugs.
Describe the components of a drug prescription and the purpose of each.
Recall the different schedules of drugs and the implications for prescribing and abuse.
Recognize the classes of drugs that contraindicate dental treatment.
Identify U.S. Food and Drug Administration Pregnancy Risk Categories for various drugs.
Recite the current guidelines for antibiotic prophylaxis for dental treatment.
Locate resources for obtaining information on over-the-counter and prescription drugs.
Course Contents

ADD/ADHD attention deficit disorder/attention

deficit hyperactivity disorder
Glossary
Regulation of Drugs
Classification of Drugs
Drug Classes
Nutritional Supplements
Vitamins
Mineral Supplements
Miscellaneous Nutritional Supplements
Delivery Systems
Side Effects
Drugs Commonly Administered in Conjunction
with Dental Treatment
Antibiotic Prophylaxis for Dentistry
Prescription Writing and Dispensing of
Medications
Drug References
Summary
Appendices
Course Test
References
About the Authors
adverse effect or reaction an abnormal,

unexpected and usually intolerable response to a
drug that may cause injury
allergy an abnormal biological response in
which the body creates antibodies to a drug or
other stimulus, usually resulting in an unpleasant
reaction such as skin rash or itching
analgesic a drug that is used to relieve pain
anaphylaxis a severe, possibly life threatening,
allergic reaction; extreme hypersensitivity to a
drug or other stimulus
anemia a condition in which the blood is
deficient in red blood cells, hemoglobin, or total
volume
anesthetic an agent that causes a loss of
sensation or consciousness
Glossary
ACE angiotensin enzyme inhibitors used to treat

hypertension
anorexiant a drug that suppresses appetite

2
antagonistic describes an interaction of two

drugs that results in a lesser effect than one drug
used alone
dermatitis skin irritation
anti-coagulant an agent that interferes with or

prevents blood clotting
diuretic a drug that increases the output of urine

by altering kidney function
anti-emetic an agent to prevent vomiting
dose a measured amount of a drug
anti-fungal an anti-infective agent used to treat

infections caused by a fungus
drug interaction reaction occurring when two

or more drugs are taken simultaneously; may be
helpful (that is, may improve effectiveness) or
detrimental (as in a toxic reaction)
diaphoresis excessive sweating
anti-hypertensive an agent that acts to lower

blood pressure
embolism obstruction of a blood vessel by a

blood clot or other foreign substances
anti-infective an agent that fights infections, for

example, antibiotics, anti-virals, and anti-fungals
edema swelling caused by accumulation of fluids
anti-pyretic a drug that treats fever by lowering

body temperature
expectorant an agent that promotes removal of

secretions from mucous membranes, for example,
cough syrup
anti-tussive a cough suppressing agent

anti-viral an agent that fights viral infections
FDA the U.S. Food and Drug Administration,

which is responsible for regulating drugs marketed
in the United States
arthropathy a disease of the joints

arrhythmia abnormal heart rhythm
fluorosis tooth discoloration caused by high

doses of fluoride
bacteriocidal having the ability to destroy

bacteria
gastritis inflammation of the mucous membrane

of the stomach
bacteriostatic having the ability to inhibit

bacterial growth
gastroenteritis inflammation of the mucous

membrane of the stomach and intestines
beriberi a disease caused by thiamine deficiency

and characterized by neurological symptoms,
cardiovascular abnormalities, and edema
generic name the official, common, or public

designation for a drug as assigned by the FDA
bradycardia slow heart rate
glaucoma eye disease characterized by

increased intraocular pressure
brand name the registered trade name given to

a drug by its manufacturer
hematogenous formation of blood cells
contraindication a condition or disease that

precludes the use of a particular drug
hemophilia a sex-linked hereditary blood defect

that occurs almost exclusively in males and is
marked by delayed clotting (and in turn, difficulty
controlling hemorrhage even after minor injuries)
controlled substances drugs that have a

potential for abuse, for example, stimulants,
narcotics, and sedatives
hemostasis a stopping or slowing of blood flow
cystitis inflammation of the urinary bladder
hyperglycemia high blood sugar

3
hypersensitivity allergy to a drug, an overresponsiveness
osteomalacia a disease of adults characterized

by softening of the bones; analogous to rickets in
children
hypervitaminosis an abnormal state resulting

from excessive intake of one or more vitamins
osteonecrosis of the jaw (ONJ) bones of the

jaw begin to die, and decay; associated with high
dose bisphosphonate treatment
hypnotic a drug that causes sleep

hypoglycemia low blood sugar
overdose a single drug dose that exceeds the

normal recommended range or the accumulation
of daily doses of drugs
hypoxia decreased levels of oxygen in blood or

tissues
over-the-counter describes drugs that can be

purchased without a prescription
idiosyncratic unusual or unexpected, as in a

reaction to a drug
pallor paleness of the skin
immunosuppressive an agent that suppresses

immune response, drugs used to prevent
rejection of transplanted organs
paresthesia sensation of pricking, tingling, or

creeping of the skin having no objective cause;
usually associated with injury or irritation of a
sensory nerve or nerve root
intravenous within a vein

IU abbreviation for International Unit; a unit of
dosage in vitamins
parenteral administration of a drug other than

through the intestinal canal; usually refers to
injections
laryngospasm contraction of the laryngeal

muscles
pellagra a disease marked by dermatitis,

gastrointestinal disorders, and nervous
symptoms; associated with niacin and protein
deficiency
lymphadenopathy unusually enlarged lymph

nodes, indicative of an immune response
MAO inhibitors class of drugs that inhibits
the monoamine oxidase production, which is
responsible for breaking down monoamine
neurotransmitters in the nervous system; used to
treat depression
pernicious anemia a severe blood condition

marked by a progressive decrease in number
and increase in size and hemoglobin content
of red blood cells; presents clinically as pallor,
weakness, and gastrointestinal and nervous
disturbances
myalgia muscle pain
photosensitivity a drug-induced change in the

skin that results in a rash or sunburn on exposure
to the sun or ultraviolet lights
myasthenia gravis a disease characterized by

the progressive weakening of voluntary muscles
without atrophy or sensory disturbance; caused
by an autoimmune attack
prothrombin chemical in the blood involved in

the clotting process
neuritis an inflammatory lesion of a nerve

marked by pain, sensory disturbances, and
impaired or lost reflexes
NSAID a non-steroidal anti-inflammatory drug
psychoneurosis a neurosis based on

emotional conflict in which an impulse that has
been blocked seeks expression in a disguised
response or symptom
orthostatic hypotension a drop in blood

pressure upon arising from a seated or reclining
position
psychosis a serious mental disorder

characterized by defective or lost contact with
reality, often with hallucinations or delusions
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Recommended Daily Allowance the amount of

a substance (for example a vitamin or mineral) that
is officially recommended for daily consumption by
a governmental board of nutrition experts
toxicity the capacity of a drug to impair body

function, damage tissue, or cause cell death
rheumatic relating to, characterized by, or

affected with rheumatism (inflammation of pain in
muscles, joints, or fibrous tissues)
urticaria hives
toxicology the study of adverse drug reactions
vasoconstrictor an agent that constricts or

contracts the walls of blood vessels
rhodopsin a red photosensitive pigment in the

retinal rods that contributes to vision in dim light
vasodilator an agent that relaxes the walls of

blood vessels
rickets a deficiency disease affecting the young

during skeletal growth; characterized by soft and
deformed bones
vertigo dizziness
viral load a term used in reference to HIV/
AIDS patients to describe the amount of HIV virus
present in the body at a given time
sedative an agent that calms or tranquilizes

side effect a normal, expected, and predictable
non-therapeutic response to a drug that
accompanies the intended response to the drug
xerostomia dry mouth caused by decreased

salivary flow
Regulation of Drugs
stenosis a narrowing or constriction of the

diameter of a bodily passage or orifice
The U.S. Food and Drug Administration (FDA)

is the federal agency that determines which
drugs can be sold in the United States. It
oversees the development, approval for
marketing, and ongoing control of prescription
and non-prescription (overthecounter) drugs or
medications. The FDA also sets quality standards
for drug manufacturing, safety, and effectiveness.
In addition, the FDA also regulates labeling and
advertising of drugs in the U.S. and has the
authority to remove drugs from the marketplace
that are deemed unsafe. Drug safety standards
can vary greatly from country to country, and
many drugs available in Europe and South
America are not sold in the U.S. because they do
not meet the FDA standards.
sublingual under the tongue

superinfection a secondary infection caused
by organisms that are not susceptible to the drug
used to treat the original infection
supine lying on the back
synergism interaction of two drugs causing a
greater effect than the sum of each drug acting
alone
systemic lupus erythematosus an inflammatory
connective tissue disease of unknown cause that
occurs chiefly in women
The federal Drug Enforcement Administration

(DEA) is the agency responsible for enforcing
U.S. controlled substances laws and regulations.
It regulates the manufacture and distribution of
drugs that have a potential for abuse, such as
stimulants, narcotics, and sedatives. Such drugs
are classified by Schedule, as listed in Table 1.
tachycardia fast heart rate

tetralogy of Fallot a congenital abnormality
of the heart marked by pulmonary stenosis, an
opening in the interventricular septum, malposition
of the aorta, and excessive development of the
right ventricle
Classification of Drugs
thrombosis blood clot that remains stationary
Most broadly, every drug falls into one of two

categories: overthecounter (non-prescription)
or prescription. Prescription drugs may only be
tinnitus ringing in the ears

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Table 1. Drug Classification by Schedule.8
dispensed to patients by the order or prescription

of a physician or dentist. These drugs must be
given directly to the patient by his/her health care
provider, or they must be dispensed by a licensed
pharmacist. In addition, certain restrictions apply
to prescribing substances with a potential for
abuse, for example, Schedule IV drugs. These
drugs cannot be refilled more than five times in a
six-month period.
of medications must speak to a pharmacist first

and in some states a signature may be required.
Examples of medications that are commonly kept
behind the counter are lower concentration fluoride
rinses and gels (.4%) and pseudoephedrinecontaining cold medications.
As holistic medicine becomes more popular in
this country, two other groups of medications are
becoming increasingly popular: herbal remedies
and nutritional supplements. Herbal remedies
are plant-derived medicines with claims of
health benefits. Many users prefer to use herbal
and nutritional supplements to treat various
ailments, because they regard them as safe
and natural. Users dont always recognize that
herbal remedies can be dangerous if taken in large
or mega doses. Even nutritional supplements
can be harmful at doses that exceed the FDAs
Recommended Daily Allowance (RDA). In some
cases, RDAs have not been established, and little
information is known about some supplements
affects on the body. Nonetheless, many patients
take daily doses of compounds such as St.
Johns Wort, melatonin, ginseng, and vitamins
Non-prescription drugs, such as aspirin, may be

purchased anywhere that the medications are sold
and need no order or prescription. Although these
drugs are not as strictly controlled as prescription
medications, potentially dangerous side effects
can occur from taking the drugs in higher than
recommended doses and in situations where the
drug is contraindicated.
Behindthecounter medications, are
overthecounter medications that are kept
behind the counter and must be asked for even
though they do not require a prescription. Due
to possible abuse or potential for overdose,
anyone who wishes to purchase these types
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possibly in extremely high doses that can

cause undesirable side effects. Most of these
medications are overthecounter nutritional
supplements, and they are not controlled or even
tested by the FDA for safety and efficacy.
a role in some of these processes, but no studies

have demonstrated conclusively that taking megadoses of vitamins is recommended for all children
and adults.
The FDA updates its list of RDAs for nutrients
considered essential for health every five to 10
years. Revisions are based on current research
findings. Physicians do not recommend exceeding
the RDA for vitamins, especially the fat-soluble
vitamins such as vitamin A because the buildup
of excess amounts of these substances in body
tissues can have toxic effects. The potential for
toxicity is not as great with water-soluble vitamins
(for example, vitamin C) because the kidneys
excrete excessive amounts daily. Table 2 presents
a summary of the 13 essential vitamins, their RDA,
and the action that each has on the body.
Drug Classes
In addition to prescription or overthecounter,

drugs are further classified according to their
chemical action on the body. Within these classes,
drugs are referred to by both their generic as well
as their brand names. Most dental professionals
may be more familiar with the brand names than
the generic identifiers. Appendix A charts the many
classes of drugs, their intended actions, examples
of some important drugs in the class, possible
side effects, contraindications for use, and drug
interactions. Side effects do not always occur
in every patient, and severity may vary from one
patient to another. It should be noted that although
a pre-existing condition may contraindicate the
use of a drug, the benefit of taking the drug may
outweigh the risk of the contraindication. In other
cases, drug interactions may be possible, but like
side effects, they do not always occur. Patients
should be monitored carefully for any signs of drug
interactions or side effects.
Vitamin Toxicity/Hypervitaminosis
In doses too large, vitamins can represent too
much of a good thing. The results can be toxic.
Vitamin A. More than 50,000 IU daily of vitamin A
can produce toxic effects in adults; for children, a
toxic dose is only 18, 500 IU each day. Symptoms
of vitamin A toxicity include hair loss, nausea,
vomiting, diarrhea, scaly skin, blurred vision,
rashes, bone pain, irregular menstruation, fatigue,
headaches, and liver enlargement. Overdoses of
vitamin A can be fatal.
Please note that the drug class appendix is not

all-inclusive. New medications are rapidly being
introduced. Health-care professionals should
always consult the Physicians Desk Reference
(PDR) or another drug reference when prescribing
any medication or identifying possible side effects
that a patient may be experiencing.
Vitamin D. More than 20,000 mg daily for an

extended period can have toxic effects in adults.
In children, toxic effects can be seen when more
than 1,800 mg are ingested daily. Signs of toxicity
include stunted growth, weight loss, unusual
thirst, sore eyes, itching skin, vomiting, diarrhea,
urinary urgency, and abnormal calcium deposits in
the blood vessel walls, liver, lungs, kidneys, and
stomach.
Nutritional Supplements
Vitamins
Vitamins are organic compounds that are essential
for good health; they perform various important
functions in the body. Although eating a wellbalanced diet should provide all daily vitamin
requirements, a growing number of people in the
U.S. are using vitamin supplements to compensate
for poor diets or as extra insurance for good
health. Some people even take very large megadoses of various vitamins, based on claims by
popular nutrition gurus that such doses can cure
common illnesses, prevent cancers, and delay
the aging process. Some evidence suggests that
some vitamins, such as vitamin E, do in fact play
Vitamin E. Early studies of the benefits of mega

doses of vitamin E indicated that doses greater
than the recommended daily allowance (400
IU), in some cases > 2000 IU, might prevent
certain cancers, heart disease and the onset of
Alzheimers disease. According to the National
Institutes of Health (NIH), however, recent studies
indicate that the therapeutic benefit of vitamin E
may have been overestimated, an in some cases
7
Table 2. Thirteen Essential Vitamins.
Table 2 Continued. Thirteen Essential Vitamins.
Magnesium. Large doses over extended periods

can be toxic to individuals with impaired kidney
function.
might have been linked to some deaths. The

NIH recommends that daily doses of vitamin E
do not exceed two times the recommended daily
allowance, or 800 IU.
Phosphorus. Excess amounts may interfere with

iron absorption and cause osteoporosis.
Vitamin K. Doses of vitamin K greater than 500

mcg are not recommended. Administration of
this amount may cause brain or liver damage,
jaundice, and destruction of red blood cells.
Potassium. An intake of 18g or higher can be

fatal.
Mineral Supplements
In addition to vitamins, minerals are another
essential group of nutrients that the body
requires. Minerals maintain the electrical
conductivity of the heart (sodium, calcium, and
potassium) and the production of hemoglobin
(iron), and some supplements can help prevent
diseases or conditions like osteoporosis
(calcium). Table3 lists the essential minerals,
their function, and RDAs. Taking mega-doses of
minerals, however, can have toxic effects on the
body.
Selenium. Doses of 5mg can cause toxic effects,

such as hair and nail loss, nerve damage, skin
lesions, fatigue, diarrhea, nausea, vomiting, and
abdominal cramps.
Sodium. Excess intake contributes to edema and
hypertension.
Zinc. Foods (especially acidic fruit drinks like
lemonade) stored in galvanized containers can
react with zinc. When ingested, they can cause
vomiting and diarrhea. Early evidence suggests
that excess levels of zinc may be linked to
Alzheimers disease.
Mineral toxicity
As with vitamins, mega-doses of minerals also
have been linked to toxicity.
Miscellaneous Nutritional Supplements

In addition to the essential vitamins, other
nutritional supplements have gained popularity
over the last several years. In most cases,
however, conclusive studies have yet to prove
the effectiveness of these compounds. Early
studies and anecdotal reports suggest that
further investigation is warranted. As with
essential vitamins, users can overdose on
these supplements, causing unpleasant and
sometimes irreversible side effects. Because
Calcium. Daily intake of more than 2,000 mg

may cause hypercalcemia.
Iodine. Doses of 500 mcg daily can decrease
thyroid activity.
Iron. A dose of 3g or higher can be fatal to a
child, and high doses of iron have been shown to
cause heart disease in men.
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Table 3. Essential Minerals.
10
Table 4. Popular Nutritional Supplements.
they are not considered essential dietary

elements, the FDA has no established RDAs for
these compounds. Table 4 summarizes the most
common supplements and their suggested uses.
of the patient. For example, infants and young

children may have difficulty swallowing tablets
or capsules, so many pediatric medications are
offered in elixir or liquid formulas that are easier to
administer. Table 5 describes the various routes
of administration and the general classes of drugs
typically administered by each.
Delivery Systems
The method by which drugs are delivered

into the body is an important consideration.
Administration can occur by a variety of
methods, depending on the medication and its
purpose. Some medications may be available
in several different types of delivery systems to
best complement the age and/or preferences
Side Effects
Taking any medication, whether it is over-thecounter or prescription, can cause drug-specific

side effects. Drug companies are legally required
to disclose all possible side effects for any
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Table 5. Drug Delivery Systems
medication. Side effects are noted when drugs

are being researched (that is, prior to their being
available on the market) or they may be reported
under the FDAs MedWatch Program. MedWatch
requires all health professionals to report any
adverse effects they encounter from drugs or
other medical devices. (See Appendix B.)
Drugs known to cause double vision include

(drug class or generic name) anti-depressants,
anti-diabetic drugs, antihistamines, aspirin,
barbiturates, benzodiazepines, carbamazepine,
chloroquine, chlorproxithene, ciprofloxacin,
cortisone-like drugs, digitalis, digitoxin, digoxin,
hydroxychloroquine, indomethiacin, isoniazid,
levodopa, morphine, nitrofurantin, norloxacin,
pentazocaine, phenothiazines, phenytoin,
primidone, propanolol, quinidine, and thiothixene,
tranquilizers.
Any drug reference, like the PDR or Drug

Information Handbook for Dentistry, lists the most
common side effects (for example, dry mouth,
blurring of vision, drowsiness, excitement). Not
all patients experience the listed side effects when
taking a medication, and those who do typically
experience only one or two (usually not all)
possible side effects. If the side effect of a drug
is more detrimental than its therapeutic effect, a
physician or dentist may prescribe or recommend
a different drug within the same class that does
not cause the side effect(s).
Photosensitivity is another common side

effect. Drugs that can induce this adverse
reaction include barbiturates, benzocaine,
diphenhydramine, estrogen, hexachlorophine,
ibuprofen, ketoprofen, naproxen, oral
contraceptives, tetracycline, and tretinoin.
Some drugs may cause liver damage. Reactions
can range from mild, temporary liver changes to
complete liver failure and death. Use of some of
the following drugs may require regular monitoring
with liver function tests: acetaminophen, anabolic
steroids, aspirin, anti-thyroid drugs, methotrexate,
NSAIDs, oral contraceptives, penicillins,
sulfonamides, tamoxifen, tetracyclines, tricyclic
anti-depressants, and vitamin A (in excessive
doses).
Blurred or double vision is an adverse effect

of a significant number of drugs. It may occur
shortly after starting a drug, or it may present after
long-term use of the drug. In most cases, blurred
and double vision are reversible. Other more
serious changes, which may not be reversible, are
cataract development and damage to the retina or
optic nerve. Drugs known to cause blurred vision
include anti-arthritic/anti-inflammatory drugs, antidepressants, antihistamines, atropine-like drugs,
chorthalidone, ciprofloxacin, cortisone-like drugs,
diethylstilbestrol (DES), fenfluramine, norfloxacin,
oral contraceptives, phenytoin, sulfonamides,
tetracyclines, and thiazide diuretics.
Osteoporosis is a condition where bone tissues

thin and bone density decreases over time.
Bisphosphonates are a class of drugs used to
treat osteoporosis. Common bisphosphonates are
Fosamax, Boniva, and Actonel. In recent years,
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bisphosphonates taken in high doses, for example

during cancer treatment, have been linked to
osteonecrosis of the jaw (ONJ). Additional events
such as dental infection and trauma (such as a
dental extraction) can add further complications
to the disease process. It has been suggested
that treatments including bisphosphonates should
be postponed until after any dental treatment to
reduce the possibility of ONJ.
is available to provide treatment or antidote

information. Staffed by physicians, nurses, and
pharmacists trained to resolve potentially toxic
situations that arise either in the home or in a
hospital. These centers have computerized
databases containing information on hundreds
of thousands of substances. Appendix C lists
location and contact information for the Poison
Control Centers throughout the country. Callers
in states that do not have a Poison Control Center
can contact the center closest to their location.
Some drugs may interact with alcohol, causing

excessive sedation, confusion, increased
intoxication, increased stomach irritation, and
increased liver toxicity. Such drugs include
amphetamines, anti-depressants, barbiturates,
carbamazepine, chlorprothixene, chlorzoxazone,
disulfiram, ergotamine, fenfluramine, furazolidone,
haloperidol, MAO inhibitors, meperidine,
meprobamate, methotrexate, narcotic drugs,
phenothiazines, propoxyphene, reserpine, chloral
hydrate, flurazepam, methaqualone, and tricyclic
anti-depressants.
Drugs Commonly Administered in

Conjunction with Dental Treatment
In addition to encountering patients who are taking

various medications and supplements for general
health or management of medical conditions, the
dental health-care provider also uses a number
of drugs to alleviate patient pain during or after
a dental procedure, to manage or prevent oral
infections, and to strengthen teeth to resist decay.
Drugs commonly used in conjunction with dental
treatment are summarized in Appendix D.
With other drugs, interaction with alcohol can

include increased liver toxicity, increased anticoagulant effects, excessive lowering of blood
pressure, excessive hypoglycemia, excessive
sedation, or rapid heart rate. With these drugs,
alcohol should be used only in small amounts:
acetaminophen, amantadine, anti-arthritic/antiinflammatory drugs, anti-coagulants, anti-diabetic
drugs, antihistamines, anti-hypertensives, aspirin,
benzodiazepines, diuretics, NSAIDs, nitrates, and
tranquilizers.
Antibiotic Prophylaxis for Dentistry
In 2007, the American Heart Association changed

its recommendations for short-term dental
antibiotic prophylaxis. The American Heart
Association along with the American Dental
Association established the current guidelines for
dentistry based on growing scientific evidence that
shows the risks of taking preventive antibiotics
outweighing the benefits for most dental patients.
Some of the risks included adverse reactions to
the prescribed antibiotics ranging from mild to
potentially severe and, in very rare cases, death.
Inappropriate use of antibiotics has also lead to
the development of drug-resistant bacteria, a
growing concern in the medical community.
With respect to drugs, the kidneys perform two

major functions. First, they alter the drug to help
remove it from the body. Second, they eliminate
drugs from the body in urine. The following drug
classes/generics may affect kidney processes:
beta-blockers, diuretic/NSAID combinations,
lithium/tricyclic anti-depressant combinations,
NSAIDs, aminoglycoside antibiotics, oral
contraceptives, adrenocortical steroids, aspirin,
and acetaminophen.
The new guidelines are aimed at patients who

would have the greatest danger of a bad outcome
if they developed a heart infection. Under the new
guidelines, individuals who have taken antibiotics
prior to dental treatment routinely in the past but
no longer need them are included in Table 6.
In addition to side effects, patients who consume

prescription and non-prescription drugs can
suffer accidental or intentional overdose. In such
cases, emergency treatment is needed to help
prevent permanent effects or death. In the U.S.,
a network of 24-hour Poison Control Centers
Preventive antibiotics prior to a dental procedure

are still advised for the following patients.
Endocarditis is an inflammation of the endocardial
layer of the heart. Endocarditis can occur due
13
Table 6. Antibiotic Prophylaxis Not Needed.
Table 7. Antibiotic Prophylaxis Needed
to a bacteria or virus entering the bloodstream

from places such as the mouth or intestinal
tract. Those patients susceptible to endocarditis
my carry a card to explain their physicians
recommendations. When these patients arrive for
their appointments, the dental team must verify
that they have taken their prescribed form of
premedication. Appendix E offers and example of
an endocarditis wallet card.
Inflammatory arthropathies (e.g.: rheumatoid

arthritis, systemic lupus erythematosus)
Drug-induced immunosuppression
Radiation-induced immunosuppression
Patients with co-morbidities (e.g.: diabetes,
obesity, HIV, smoking)
Previous prosthetic joint infections
Malnourishment
Hemophilia
HIV infection
Insulin-dependent (Type 1) diabetes
Malignancy
Megaprostheses
Patients receiving any artificial joint replacements

historically received antibiotic prophylaxis before
any dental treatment. When the regimens were
reviewed in 2009, the American Academy of
Orthopaedic Surgeons released the following
information:
For the emergency patient with one rheumatic

fever episode with uncertainty about residual
damage to the heart, a preventative prophylaxis
should be administered prior to performing the
procedure with a referral to the patients physician
for a consultation.
Given the potential adverse outcomes and

cost of treating an infected joint replacement,
the AAOS recommends that clinicians
consider antibiotic prophylaxis for joint
replacement patients with one or more of the
following risk factors prior to any invasive
procedure that may cause bacteremia:
Prescription Writing and Dispensing of

Medications
The following is the classical or Latin description

of the parts of a prescription:
All patients with prosthetic joint replacement

Immunocompromised/immunosuppressed
patients
Superscription Contains the patients name,

address, date (age is sometimes included),
14
Table 8. Antibiotic Regimens.
time of writing. Listing the patients age allows

the pharmacist to determine if the dosage is
correct.)
and the symbol Rx, which is Latin for recipe

or take thou.
Inscription Contains the name of the drug,
the dose form, and the amount.
Subscription Directions to the pharmacist.
Transcription Directions to the patient.
Body:
1. The Rx symbol
2. Name and dosage size or liquid
concentration of the drug
3. Amount to be dispensed
4. Directions to the patient
The more modern, practical description is:

Heading:
1. Name and address of the prescriber
(telephone number also may be included).
2. Name and address of the patient (age and
telephone number also may be included).
3. Date of the prescription.

The name of the drug being prescribed is

listed first after the Rx symbol, followed by the
size in milligrams (mg) of the tablet or capsule
prescribed. If liquids are prescribed, the name
of the drug is followed by the concentration in
milligrams per milliliter (mg/ml). The amount
or quantity of the drug to be dispensed is listed
next (that is, the number of tablets/capsules or
milliliters of liquid). Frequently the symbol #
is used in place of the word dispense. The
prescriber also should write the number to be
dispensed both in numerals and in long hand to
(Law requires the name and address of the

prescriber and the patient. It is helpful to
have the telephone numbers listed in case
the dispensing pharmacist has questions
about the prescription. The date is required
for the dispensing pharmacist to intercept
prescriptions that have not been filled at the
15
prevent patients from altering prescriptions for

narcotic and other controlled drugs (for example,
to prevent a patient from changing an amount
written as 6 to 60.)
Directions to the patient are preceded by the
abbreviation Sig., which is Latin for to write.
The prescriber uses the abbreviations listed in
Figure 1 in shorthand to save time when writing
the prescription. The pharmacist translates
them into English. Table 9 lists the common
abbreviations used on prescriptions.
Drug References
Every dental practice should have a

comprehensive drug reference on hand that lists
drugs by both their generic and brand names
and includes information on their recommended
use, dosage, contraindications, possible side
effects, and drug interactions. Every member of
the team should be able to access this reference
at any times, if questions arise about a patients
medications or writing/dispensing medications to
patients. Table 10 provides a list commonly used
drug reference materials.
Figure 1.
Table 9. Common Abbreviations for Prescriptions.
The Physicians Desk Reference and Drug

Information Handbook for Dentistry are the most
often used drug reference for dentists. The PDR
is organized into six sections (Table 11)
The electronic version of the Drug Information
Handbook for Dentistry includes a drug
identification guide and a drug interaction
compound. Its extensive cross-referencing allows
users to locate information about a particular
drug, even when little information is known. For
example, if the user only knows what a medication
looks like (for example, tablet), but not the name
or type of drug, the Product Identification Guide
displays pictures to compare to the tablet to help
identify it. Once the drug is identified, the user
then can access additional information on it in the
Product Information section.
Summary
Life expectancy continues to increase with

continuing medical advancements. Patients
are often provided with a variety of medications
to improve health and quality of life. Dental
professionals must be armed with a working
knowledge of common nutritional supplements
16
and medications and their affects on their

patients overall health. As drug reference
materials change, it is important to have
access to reputable resources for current drug
information. The dental team must know the
basic dental medications prescribed most often,

their preferred delivery system, and how these
are prescribed in written format. Having this
knowledge will aid the dental team in providing
excellent, quality patient care.
Table 10.
Table 11. Sections of the Physicians Desk Reference.
17
Course Test Preview
To receive Continuing Education credit for this course, you must complete the online test. Please go to
www.dentalcare.com and find this course in the Continuing Education section.
1.
Overthecounter drugs are generally safe to use and have no side effects.
Behindthecounter medications, are overthecounter medications that are kept behind the
counter and must be asked for due to possible abuse or potential for overdose.
a. Both statements are true.
b. The first statement is true, the second statement is false.
c. The first statement is false, the second statement is true.
d. Both statements are false.
2.
Permanent stains on a patients teeth may be the result of taking __________ as a child.
a. theophylline
b. thiopental
c. tetracycline
d. all of the above
3.
Tylenol is a brand name for __________________.

a. aspirin
b. antihistamine
c. anti-emetic
d. acetaminophen
4.
An overdose of acetaminophen may cause damage to the __________________.

a. kidneys
b. liver
c. heart
d. lungs
5.
Patients who are taking oral anti-coagulants should not be given __________________.
a. aspirin
b. antihistamines
c. aspirin and acetaminophen
d. aspirin and antihistamines
6.
_____________ is commonly used to treat angina pectoris.

a. Warfarin
b. Theophylline
c. Nitroglycerin
d. none of the above
7.
The _____________ oversees development, marketing, and safety of prescription and nonpresricption drugs in the U.S.
a. state dental board
b. state medical board
c. FDA
d. DEA
e. C and D
18
8.
Acetaminophen and aspirin both have an _____________ effect.

a. anti-inflammatory
b. analgesic
c. anti-pyretic
d. B and C
9.
A common side effect of high doses of aspirin is ________________.

a. hypotension
b. hypertension
c. tinnitus
d. diarrhea
10. Antihistamines can produce _______________.

a. dry mouth
b. hypotension
c. congestive heart failure
11. MAO inhibitors are drugs that are commonly used to treat _____________________.
a. pain
b. heart disease
c. depression
d. anxiety
12. Aspirin can cause ___________________.
a. gastrointestinal irritation
b. dizziness
c. edema
d. ulcers
e. A and D
13. Anti-anginal drugs work to relieve the pain of angina by preventing spasm of the __________.
a. coronary arteries
b. bronchioles
c. A and B
14. Anti-asthmatic drugs work by relaxing the smooth muscle of the ____________.
a. tongue
b. peripheral arteries
c. bronchioles
d. coronary arteries
15. Anti-viral drugs are used to treat _____________.
a. herpes simplex virus
b. influenza
c. HIV/AIDS
19
16. Patients with congestive heart failure who suffer from edema through increased water
retention may be prescribed a(n) ________________.
a. anti-anginal
b. diuretic
c. beta blocker
d. calcium channel blocker
17. Patients who have experienced recent heart attacks may be taking ____________ to prevent
clotting.
a. diuretics
b. beta blockers
c. calcium channel blockers
d. anti-coagulants
18. Patients who are not able to adequately metabolize proteins, fats, and carbohydrates may
be deficient in ____________ and may need to take replacement therapy.
a. vitamin C
b. thyroid
c. estrogen
d. vitamin D
19. _____________ help(s) promote healthy skin and eyes.
a. Vitamin A
b. Vitamin C
c. Niacin
d. both A and B
e. all of the above
20. Local anesthetics work by ______________________.
a. promoting CNS depression
b. stimulating nerve responses
c. providing analgesia
d. inhibiting the conduction of nerve impulses
21. When a patient with a history of a mitral valve prolaspe is receiving treatment, the patient
should _______________________.
a. receive treatment with antibiotics
b. receive treatment with the operator wearing gloves
c. receive treatment without any special precautions
d. never be placed in a supine position
e. none of the above
22. Schedule II drugs may be refilled over the telephone. Schedule IV drugs cannot be refilled
more than five times in a six-month period.
20
23. A dental assistant needs to identify an unknown medication by visual comparison. The
reference(s) used to identify the medications is/are _______________________.
Manufacturers Index of the PDR
Merck Manual
Product Identification Guide of the PDR
none of the above
24. An immunosuppressive drug might be prescribed for a patient who has ________________.
a. had an organ transplant
b. systemic lupus erythematosis
c. kidney disease
d. both A and C
e. both A and B
25. In a written prescription, the subscription contains the _____________.
a. name of the drug
b. dose form and amount
c. directions to the patient
d. directions to the pharmacist
26. If a prescription is written as take one (1) tablet TID, the patient needs to take this
medication ______ time(s) a day.
a. one
b. two
c. three
d. four
27. In 2007, the American Heart Association changed its recommendations for short-term dental
antibiotic prophylaxis. These guidelines were based on ___________________.
a. risk of antibiotics outweighed the benefits
b. adverse reactions to the antibiotics
c. inappropriate use leading to drug resistant bacteria
d. all of the above
e. there were no new guidelines recommended in 2007
28. If a patient experiences an undesirable or damaging effect from taking any medication, it
should be reported to the _____________________.
a. Consumer Protection Agency
b. Drug Enforcement Agency
c. FDA MedWatch program
d. pharmacist
29. Asthma medications are most likely to be administered by _________________.
a. injection
b. mouth
c. transdermal patch
d. inhalation
21
30. An alcoholic patient taking the drug Antabuse who consumes alcohol within 12 hours can
be expected to experience _______________.
a. anaphylaxis
b. repeated vomiting
c. pruritus
d. psychosis
31. Some analgesic medications also have an anti-pyretic effect. This is useful when treating a
patient who has a(n) ____________________.
a. infection
b. swelling
c. fever
d. all of the above
32. Muscle relaxants are used to treat patients with ____________________.
a. convulsive disorders
b. insomnia
c. post operative pain
33. Since vitamins are naturally occurring substances, it is not possible to overdose or suffer
toxic effects from taking high doses. More than 1,000 mg daily of vitamin D for an extended
period can have toxic effects in adults.
34. Examples of brand name anti-hypertensive drugs are ______________________.
a. Lotensin and Valium
b. Lotensin and Aldomet
c. Valium and Aldomet
d. All of the above
35. ______________ should be taken on an empty stomach.
a. Penicillins
b. Sulfonamides
c. Tetracyclines
d. Cephalosporins
36. A patient who is taking Rifadin and Seromycin is most likely being treated for ___________.
a. HIV/AIDS
b. tuberculosis
c. candidiasis
37. The amount of vitamins or minerals that individuals should consume each day is referred to
as the __________________.
a. required daily amount
b. dose
c. recommended daily allowance
d. FDA requirement
22
38. _______________ is integral to tooth development.

a. Vitamin A
b. Vitamin C
c. Vitamin D
d. Vitamin E
39. An overdose of _______________ can lead to bone pain, liver enlargement and death.
a. Vitamin C
b. Vitamin D
c. Vitamin E
d. Vitamin A
40. _________________ can prevent birth defects when taken by pregnant women.
a. Vitamin A
b. Iron
c. Folic acid
d. Vitamin D
References
1. Adnan S, Dajani MD, Kathryn A, et al. Prevention of Bacterial Endocarditis. JAMA.1997; 277:
1794 - 801
2. Drug Information Handbook for Dentistry, 17th edition, Wynn, RL, Meiller, TF, Crossley, HL.
Lexi-Comp, Inc, 2011-2012
3. Essential Guide to Prescription Drugs, 1998 edition, HarperCollins Books
4. No longer accessible - http://www.acpmedicine.com/sam/chapters/ch0718.htm: [Online]
December 2004
5. No longer accessible - http://www.fda.gov/medwatch/REPORT/CONSUMER/1INSTRUCT.HTM
[Online] February 3, 2005 [Online] August 9, 2005
6. No longer accessible - http://www.ohioheartsurgery.com/endocarditis.htm#2: [Online]
February 3, 2005
7. http://www.hmc.org.qa/hmc/heartviews/prev2.htm [Online] February 3, 2005
8. No longer accessible - http://www/pharmacytimes.com/articles.cfmn?ID= 1314 [Online]
February 6, 2005
9. No longer accessible - www.usoj.gov/dea/agency/mission.htm [Online] February 3, 2005
10. Merck Manual of Diagnosis and Therapy, 19th edition, 2011 Merck & Company, Inc.
11. Nutrition Bible, Anderson, Jean, B.S., M.S.; and Deskins, Barbara, PhD, R.D.; William Morrow &
Company, Inc., 1995
12. Physicians Desk Reference for Prescription Drugs, Medical Economics Company, 59th edition, 2011
13. American Heart Association Endocarditis Prophylaxis Information (April 2011). Retrieved
February 16, 2012 from http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/
TheImpactofCongenitalHeartDefects/Infective-Endocarditis_UCM_307108_Article.jsp
14. http://www.onj-net.org [Online] Accessed August 23, 2011
15. Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements. (2009) American
Academy of Orthopaedic Surgeons. http://www.aaos.org/about/papers/advistmt/1033.asp Accessed
February 15, 2012
23
About the Authors

Mary Govoni, CDA, RDA, RDH, MBA
Mary Govoni, CDA, RDA, RDH, MBA, is an internationally recognized speaker,
author and consultant on clinical efficiency, ergonomics, OSHA & HIPAA compliance,
infection control and team communication. Mary is a past president and a life member
of the American Dental Assistants Association, a member of the American Dental
Hygienists Association, a consultant to the American Dental Association Council on
Dental Practice, a member of the Organization for Safety and Asepsis Procedures, the
National Speakers Association, and the Academy of Dental Management Consultants
and the Speaking and Consulting Network. She is also a featured speaker on the ADA Continuing
Education and lifelong learning seminar series.
Richard L. Wynn, PhD
Richard L. Wynn, PhD is Professor of Pharmacology at the Dental School, University
of Maryland, Baltimore. He was awarded the BS, MS and PhD degrees all from the
University of Maryland. He chaired the Department of Pharmacology at the University
of Maryland Dental School from 1980 to 1995. Previously he chaired the Department
of Oral Biology at the University of Kentucky Dental School in Lexington. He has to
his credit over 300 publications including original research articles, textbooks, book
chapters, and monographs. He has given over 500 continuing education seminars
to dental professionals in the US, Canada, Mexico and Europe. Dr. Wynn has been a consultant to the
drug industry for 25 years and his research laboratories have contributed to the development of new
analgesics and anesthetics. He is a consultant to the Academy of General Dentistry, and is a featured
columnist for the journal General Dentistry, published by the Academy of General Dentistry. He is
the lead author and chief editor of Drug Information Handbook for Dentistry, now in its 17th edition,
published by LexiComp, Inc. His chief interest is teaching pharmacology to dental and dental hygiene
students, and in keeping dental professionals informed of current and new drug information relative to
dental practice.
24
20
Reduces pain and

inflammation
Reduces pain
Reduces fever
Reduces fever (acts on heatregulation center in the brain)
Treats narcolepsy and

Attention Deficit Disorder
Also used to treat acute

airway obstruction
(anaphylaxis) and vomiting
caused by chemotherapy
May decrease risk of death

after a heart attack
May decrease risk of
kidney problems in insulin
dependent diabetics
Previous allergic reaction to

the drug, pregnancy,
breastfeeding
Acuprin, ASA, Butalbital,

Ecotrin, Excedrin, Fiorinal,
Halfprin, Lortab ASA, Nor
gesic, Percodan, Soma
Compound, Synalgos, Talwin
Compound
Gastrointestinal irritation,
intestinal bleeding, ulcers,
tinnitus, increased
prothrombin time
* Brand Name drugs are listed in Title Case; generic names appear in lowercase.
oral contraceptives, antacids,

barbiturates (Amytal, Butisol),
carbamazepine (Tegretol), isoniazid (INH, Niconyl), loop
diuretics (Lasix/Bumex), oral
anti-coagulants (Coumadin/
Warfarin), oral anti-diabetics
(Glucatrol), phenytoin
(Dilantin), primidone (Myso
line), rifabutin (Mycobutin),
rifampin (Rifadin/Rimactane),
ritonavir (Norvir), salicylates
(aspirin), thiazide diuretics
(Diazide), vaccines (influenza)
allopurinol (Zyloprim), ant

acids ((Maalox), azathioprine
(Imuran), cyclosporine (San
dimmune), ibuprofen (Motrin,
Advil), lithium (Lithobid),
loop diuretics (Lasix/Bumex),
naloxone (Narcan), potassium
preparations (K-Lyte/Slow-K),
potassium-sparing diuretics
(Moduretic/ Dyazide), salicylates (aspirin)
oral anti-coagulants, nonsteroidal anti-inflammatory

drugs (NSAIDs)
alcohol
Previous allergic reaction to ismelin, MAO inhibitors

the drug class, glaucoma,
(Marplan/ Nardil)
Tourettes syndrome, severe
anxiety, emotional depression
Active peptic ulcer

disease; active herpes simplex
infection of the eye; systemic
fungal
infection; Candida albicans in
sputum culture; active tuberculosis; psychoneurosis or
psychosis
Heavy alcohol intake
Nervousness, insomnia,
reduced appetite, growth
suppression, psychological
dependence
Increased appetite, weight

gain, retention of salt and
water, excretion of potassium, increased susceptibility
to infection
Aspirin Free Excedrin, Datril, Allergic reaction to the

Sine-Aid, Maximum Strength drug, liver toxicity
Sine-Aid, Tylenol, Tylenol
Sinus
Adderall, Adipex-P, Adipost,

Anorex, Desoxyn, Dexatrim,
Dexedrine, Didrex,
Dexedrine, Fastin, Ionamin,
Ritalin, Tenuate, Tepanil
Aerobid, Aristocort,
Azmacort, Beclovent,
Celestone, Cortef, Cortone,
Cyclocort, Decadron, DeltaCortef, Deltasone, Elocon,
Florine-f, Flonase, Haldrone,
Halog, HMS Ophthalmic
Suspension, Medrol, Nasarel,
Pulmicort, Ultravate,
Vanceril, Vexol

the drug, pregnancy, breastfeeding, elevated potassium
level, blood cell or bone marrow disorders, other antihypertensive drugs, kidney
dialysis
Possible
Contraindications Possible
Side Effects
Interactions*
Accupril, Altace, Capoten,

Dizziness, light-headedLotensin, Mavik, Monopril, ness, fainting (from excess
Prinivil, Renormax, Univasc, drop in blood pressure)
Vasotec, Zestril
Other
Examples*
Benefits
NOTE:There are literally hundreds of non-prescription medications that contain aspirin, always check the ingredients list for aspirin/salicylate if it is contraindicated.
Aspirin and Aspirin

Combinations
(salicylates)
Analgesics
Acetaminophen
Stimulates the central

nervous system
Inhibits function of some

white blood cells, reduces
production of lymphocytes and some antibodies, suppresses the
immune system
Adrenocortical steroids
(cortisone-like drugs)
Treats skin disorders
(dermatitis, eczema,
psoriasis), asthma,
allergies, systemic lupus
erythematosis, arthritis,
and ulcerative colon
disease
Amphetamine-like drugs
Blocks an enzyme in the

blood stream to relax arterial walls and lower blood
pressure, thus decreasing
the hearts workload and
improving its performance
ACE
(angiotensinconverting enzyme)
inhibitors
Treats hypertension
Class
Action

Drug Classifications
APPENDIX A
DRUG CLASSIFICATIONS
Inhibits the reuptake of

the neurochemicals
norepinephrine,
serotonin, and dopamine;
which affect appetite
Meridia (sibutramine),
Ionamin (phentermine)
Other
Examples*
Benefits
Dry mouth, constipation,
insomnia, high blood
pressure
Risk of high blood pressure;

heart valve damage;
pulmonary hypertension
anti-hypertensive drugs
Possible
Side Effects
Interactions*
Reduces the size of

sebaceous glands and
inhibits sebum (skin oil)
production.
Treatment of other skin

conditions
Anti-acne drugs
Accutane, Azelex, Differin,

Epi-Clear, Eryderm, Klaron,
Retin-A, tetracycline
Tetracycline: Tooth discoloration if used during pregnancy or early childhood,

metallic taste, yeast infections
Accutane: Severe birth
defects if used during
pregnancy ((monthly
pregnancy testing required
for women taking the drug),
depression, dryness of nose
and mouth, inflammation of
the lips, dry skin with
itching, peeling palms and
soles, thinning hair,
conjunctivitis, intolerance
of contact lenses, decreased
night vision, myalgia,
headache, indigestion
Retin-A: Excessive redness,
edema, blistering, crusting
of the skin; photosensitivity
Accutane: Previous allergic

reaction to the drug,
pregnancy, allergy to
parabens/preservatives,
diabetes, blood donation,
cholesterol or triglyceride
disorder, wearing of contact
lenses, history of kidney or
liver disease
digoxin, lithium, oral anticoagulants, oral

contraceptives, penicillins,
tetracylines
Accutane: acromycin
NOTE:The appetite suppressants dexfenfluramine (Redux) and the combination of fenfluramine and phentermine (Pondimin/Fen-Phen) were removed from the market in 1997 by the FDA, due to
possible heart valve damage and deaths due to pulmonary hypertension. Patients who have taken these drugs may be at risk for heart valve damage, and should be monitored closely. If any of these patients
have resulting heart valve damage, they may require antibiotic prophylaxis for certain dental procedures. (See Antibiotic Prophylaxis For Dentistry). Questions about the use of these drugs should be
added to the patient health history.
Anorexiants
Appetite suppressants
Class
Action

Drug Classifications continued from previous page
APPENDiX A
21
Inhibits the replication of

the human immuno
deficiency virus (HIV)
Interferes with growth

and reproduction of HIV
particles, limiting the
severity of HIV infection
22
Slows the spread of electrical activity through the

heart and inhibits the
contraction of coronary
arteries and peripheral
arterioles, thus reducing
the workload of the heart
and helping to prevent
angina
Anti-anginal drugs
Used to treat heart
disease
Aricept, Cognex, Exelon,

Namenda
Antabuse
Crixivan, Invirase, Norvir,

Viracept (indinavir)
3TC, AZT, Crixivan, D4T,

DDC, DDI, Epivir, Fuzeon,
Hivid, Invirase, Norvir,
Rescriptor, Retrovir, Videx,
Viramune, Viracept, Zerit,
Zintevir
May treat arrhythmia

the drug, pregnancy, breastfeeding, bone marrow depression, pancreatitis, phenylketonuria, heart failure,
impaired liver or kidney function
Nausea, diarrhea,
vomiting

the drug, active liver disease,
low blood pressure (systolic
below 90), significant narrowing of the aorta
Pregnancy, breastfeeding,
previous history of ulcers,
NSAID therapy
Drowsiness, lethargy, offen- Previous allergic reaction to

sive breath and body odor the drug, use of alcohol within 12 hrs, pregnancy, history
of psychosis, taking paraldehyde, taking metronidazole
(Flagyl), coronary heart disease, heart rhythm disorder
Anemia, impaired kidney

Drug therapy with rifampin
function, abdominal pain,
or ketonconazole
nausea, diarrhea, dry
mouth, headache, dizziness,
insomnia
Decreases in red cell, white

cell and platelet counts,
headaches, dizziness,
insomnia, nausea, vomiting,
diarrhea
amiodarone (Cardarone), betablockers (Tenormin, Inderal),

calcium supplements (Cal
trate), cimetidine (Tagamet),
cyclosporine (Sandimmune),
digoxin (Lanoxin), ibuprofen
(Motrin), oral anti-diabetics
(Precose), phenytoin
(Dilantin), quinidine
(Quinaglute), rifampin
(Rifadin), theophylline
(Theo-Dur)
NSAIDs, anti-cholinergics
alcohol (cough syrup), amitrip

tyline (Elavil), bacampicillin
(Spectrobid), chlordiazepoxide
(Librium), cisplatin (Platinol),
cyclosporine (Sandimmune),
diazepam (Valium), isoniazid
(INH), oral anti-coagulants
(Warfarin, Coumadin), perphenazine (Trilafon), metronidazole (Flagyl), theophylline
(Theo-Dur)
rifampin
acetaminophen (Tylenol), acyclovir (Zovirax), amphotericin

B (Fungizone), benzodiazepines (Valium, Xanax), cimetidine (Tagamet), fluconazole
(Diflucan), ganciclovir
(Cytovene), indomethacin
(Indocin), salicylates (aspirin),
sulfonamides
Possible
Side Effects
Interactions*
Adalat, Calan, Cardene,

Low blood pressure, fluid
Cardizem, Isoptin, NitroStat, retention, headache, dizziProcardia
ness, fatigue, nausea, indiMay stop progression of
gestion
atherosclerosis and congestive
heart failure
Treatment of hypertension
and Raynauds phenomenon
Shows some promise of

increasing infectionfighting CD4 cells in AIDS
patients
Some use in treating

dermatitis caused by nickel
exposure
Some drugs also are used to

treat cancers, such as Kaposis
Sarcoma, T-cell leukemia, and
lymphomas
Other
Examples*
Benefits
Lessens cognitive degeneration by affecting neurotransmitters in the brain
Anti-Alzheimers drugs
Used to treat Alzheimers
Disease
Anti-alcoholism drugs
Blocks normal liver
Used to deter future abuse enzyme activity after conof alcohol
sumption of alcohol, causing an excessive buildup
of acetaldehyde that
makes the user violently
ill (intense flushing of the
skin, sweating, shortness
of breath, chest pains,
repeated vomiting and
weakness)
Protease Inhibitors
Anti-AIDS drugs
Anti-Retrovirals
Typically used in
combinations (a drug
cocktail) to enhance
their effectiveness
Class
Action

APPENDiX A
23
Relax the smooth muscle

of the bronchioles to prevent the bronchospasm of
an asthma attack
Anti-asthmatic drugs
Used to treat asthma
Adenocard, Betapace,
Cordarone, Corvert,
Crystodigin, Inderal, Isoptin,
Lanoxin, Mexitil, Norpace,
Procan SR, Quinaglute,
Rythmol, Sectral, Tambocor,
Tenormin, Tonocard,
Xylocaine
Ambien, Atarax, Ativan,

Buspar, Equanil, Halcion,
Miltown, Lunesta, Sonata,
Trancopal, Vistaril
Skin rash, loss of appetite,

nausea, vomiting, diarrhea,
development of infections,
bone marrow depression
Low blood pressure, fluid

retention, headache,
dizziness, fatigue, nausea,
indigestion
Sedation, respiratory
depression
Muscle relaxants, oral anticoagulants, ACE inhibitors,

Zyloprim
amiodarone (Cordarone),
nadolol (Corgard), calcium
supplements (Caltrex), carbamazepine (Tegretol), cimetidine (Tagamet), cyclosporine
(Sandimmune), digoxin
(Lanoxin), disopyramide
(Norpace), lithium
(Lithobid), ibuprofen
(Motrin), phenytoin
(Dilantin), quinidine
(Quinaglute), rifampin
(Rifadin), terazosin (Hytrin),
theophylline (Theo-Dur),
amitriptyline (Elavil)
anti-coagulants (Heparin);
caffeine, amphetamines, other
stimulants; clozapine
(Clozaril), lithium (Lithobid),
oral contraceptives (Ovral),
oxycodone (Percocet), phenytoin (Dilantin), probenecid
(Benemid), theophylline
(Theo-Dur)
Previous allergic reaction to MAO inhibitors, tricyclic

the drug, coronary disorders, anti-depressants, beta-blockcardiac arrhythmias, hyperers
tension, convulsive disorders,
hyperthyroidism, diabetes

the drug, children under age
12, adults over age 60,
pregnancy, breastfeeding

the drug, active liver disease,
low blood pressure (systolic
below 90), advanced aortic
stenosis, second- or thirddegree heart block

the drug, primary depression
or psychosis, excessively low
blood pressure, narrow-angle
glaucoma
Possible
Side Effects
Interactions*
Accolate, AeroBid, Aerolate,

Allergic reaction, paradoxiAlupent, Atrovent, Azmacort, cal bronchospasm, cardiac
Beclovent, Brethine, Bricanyl, arrest from overdose
Bronkometer Aerosol, Bronk
osol, Choledyl, Combivent,
Flovent, Gastrocom, Intal,
Isuprel, Lufyllin, Marax
Tablets, Metaprel, Metapro
terenol Sulfate, Proventil,
Phyllocontin, Quadrinal Tab
lets, Respbid Tablets, Rynatuss
Tablets, Serevent Aerosol, Slobid, Theo-Dur Tilade,
Tornalate, Uni-Dur, Uniphyl,
Vanceril, Ventolin, Volmax
Tablets, Zyflo
Prevents rejection of transAralen, Cuprimine, Imuran,

planted organs
Motrin, Naproxen, aspirin
Treats chronic active hepatitis,
ulcerative colitis, systemic
lupus erythematosis
Prevents angina
Treats hypertension
Treats insomnia
Other
Examples*
Benefits
Usually administered
through inhalers
Decreases immune reaction by impairing purine

metabolism and inhibiting cell multiplication
Controls heart rate in

chronic atrial fibrillation
and flutter and prevents
paroxysmal atrial tachycardia (PAT)
Anti-arrhythmia drugs
Anti-arthritics
(see also NSAIDS and
adrenocorticosteroids)
Treats arthritis
Inhibit activity of
nervous tissue by attaching to specific sites in the
brain
Anti-anxiety drugs
Class
Action

APPENDiX A
24
Inhibits reproduction of
cancer cells
Forms protective barrier

over lesion to decrease
irritation and promote
healing
Inhibit synthesis of
vitamin K clotting
factors. Used to prevent
thrombosis and reduce
risk of heart attack;
inhibit platelet
aggregation to prevent
blood clots
Acts on the motor cortex

of the brain to limit or
prevent seizure activity
Act on the thalamus and

hypothalamus in the
brain, producing calming
effects
Anti-cancer drugs
(chemotherapeutic
agents, anti-neoplastics)
Anti-canker sore drugs
Anti-coagulant/
Anti-platelet drugs Used
to prevent thrombosis
and reduce risk of heart
attack (they inhibit
platelet aggregation to
prevent blood clots)
Anti-convulsant drugs
Anti-depressant drugs
(minor tranquilizers)
Adderall, Catapres,
Concerta, Cylert, Ritalin,
Strattera
Increased pain threshold,

muscle relaxation (with
benzodiazepines)
Amnestic action, so that
patients may not remember
unpleasant experiences.
Relaxation of smooth muscle
and anti-convulsant activity
Drugs in the benzodiazepine

class (e.g., Valium) also used
as muscle relaxants and antianxiety drugs
Previous allergic reaction,

Nervousness, insomnia,
skin rash, anorexia,
tachycardia, angina
Dilantin: Gingival
hyperplasia
Drowsiness, interference
with Vitamin D
metabolism
Fatal or non-fatal
hemorrhage, skin necrosis
Bicyclic: Effexor, Prozac

Drowsiness, confusion,
Tricyclic: Adapin, Anafranil,
fatigue, slurred speech
Asendin, Aventyl, Elavil,
Endep, Norpramin, Pamelor,
Pertofrane, Sinequan,
Surmonil, Tofranil, Vivactil
Tetracyclic: Ludiomil, Remeron
Other: Celera, Desyrel, Luvox,
Paxil, Serzone, St. Johns Wort,
Wellbutrin, Zoloft
Benzodiazepines: Ativan,
Centrax, Dalmane, Doral,
Halcion, Klonopin, Lectopam,
Libritabs, Librium, Loftran,
Mogadon, Paxipam, Restoril,
Serax, Tranxene, Valium,
Versed, Vazepam, Xanax
Celontin, Depakene, Diamox,

Dilantin, Felbatol, Klonopin,
Lamactil, Luminal, Lyrica,
Mesantoin, Miltonin, Mysoline,
Neurontin, Paradione,
Peganone, Phenerone,
Topamax, Tranxene, Tridione,
Tegretol, Valium, Zarontin
Agrylin, Coumadin, Ecotrin,

Halfprin, Miradon,
Persantine, Ticlid, aspirin/
salicylates, warfarin
aspirin/salicylates, NSAIDs,
heparin
None reported
Undetermined; no studies
performed to substantiate
MAO inhibitors, oral anticoagulants, anti-convulsants,

tricyclic anti-depressants

the drug, acute narrow angle
glaucoma, pregnancy,
breastfeeding
CNS depressant drugs,

alcohol
Previous allergic reaction to alcohol, halothane, isoniazid,

phenothiazines, salicylates,
systemic lupus erythematosis sulfonamides

the drug, hazard of
hemorrhage that outweighs
therapeutic benefits,
pregnancy, breastfeeding,
bleeding tendencies, planned
surgery

the drug

the drug, children under age
6, anxiety, depression, hypertension
Possible
Side Effects
Interactions*
Apthasol, Debacterol,
Tissue sloughing, allergic
Kenalog, Lidex gel, OraBase, reactions
Zilactin, Debacterol
Aromasin, Cytoxan, Diflucan, Hypersensitivity reactions,

Eulexin, Femara. Hydrea,
nausea, vomiting, diarrhea,
Leukeran, Nolvadex,
anemia, xerostomia, toxicity
Perinethol, Proleukin,
Rheumatrex, Roferon, Taxol
Treats narcolepsy
Other
Examples*
Benefits
Stimulates the central

nervous system,
producing mental and
behavioral effects
Anti-attention-DeficitHyperactivity drugs
(anti-ADHD drugs)
Class
Action

APPENDiX A
25
Regulates glucose
metabolism
Stimulates the release of

insulin from the pancreas
Acts in the presence of

insulin to decrease
insulin resistance
Insulins
Rapid-, intermediate-,
or long-acting
Sulfonylureas
(oral hypoglycemics)
Thiazolidinediones
Actos, Avandia
Amaryl, DiaBeta, Diabinese,

Glucotrol, Glucotrol XL,
Glynase, Glipizide,
Micronase
May be used in combination Humulin, Iletin, Novolin,

with other anti-diabetic drugs Nordisk
to gain control of blood sugar
(they use a different
mechanism that other oral
hypoglycemic drugs)
May be used in combination Precose tablets

with other anti-diabetic drugs
to gain control of blood sugar
(they use a different
mechanism that other oral
hypoglycemic drugs)
Glucophage tablets
Other
Examples*
Benefits
Impairs sugar digestion

and keeps blood sugar
low after meals
Decreases production of
glucose in the liver,
decreases intestinal
absorption of glucose,
and increases insulin
sensitivity
Glucosidase
inhibitors
Anti-diabetic drugs
Biguanides
Class
Action

Liver toxicity
Hypoglycemia, diarrhea,
dizziness, nervousness,
tremors
Hypoglycemia,
ketoacidosis
Gas or diarrhea
Hypoglycemia, lactic
acidosis
acetaminophen, digoxin,
metformin, oral
contraceptives, warfarin
Diflucan

the drug, diabetic
ketoacidosis, kidney or liver
disease, gastrointestinal
disease
Kidney or liver disease,
hypoglycemia, pregnancy,
breastfeeding
oral hypoglycemics, salicylates, sulfa antibiotics, antidepressants, alcohol
beta blockers (Corgard,

Inderal), calcium channel
blockers (Cardizem, Isoptin),
digoxin (Lanoxin),
disopryamide (Norpace),
furosemide (Lasix), insulin
(Humulin), isoniazid (INH),
ibuprofen (Motrin),
phenytoin (Dilantin),
rifampin (Rifadin),
sulfonylureas (Diabinese,
Micronase), theophylline
(Theo-Dur), thiazide diuretics
(Hydrodiuril), thyroid
hormones (Synthroid)
digoxin, glyburide,
furosemide, nifedipine,
vancomycin
Missed or skipped meals

the drug, diabetic
ketoacidosis, tendency to
develop intestinal
obstruction, inflammatory
bowel disease, ulceration of
the colon, cirrhosis of the
liver, pregnancy,
breastfeeding
Impaired renal function,

excessive alcohol intake
Possible
Side Effects
Interactions*
APPENDiX A
Acts on the vomiting

center in the brain
Anti-emetic drugs Used

to prevent motion
sickness and nausea
26
Inhibits prostaglandin
synthesis and suppresses
inflammation
Prevents the release of

histamines in allergic
reactions
Anti-gout drugs
Antihistamines
Used to treat symptoms of

cold viruses
Anti-inflammatory,
anti-pyretic, analgesic
Reduces dehydration from

severe diarrhea
Actifed, Allegra, Antivert,

Asstelin, Atarax, Benadryl,
Bonine, Chlor-Trimeton,
Claritin, Clistin, Dimetane,
Dramamine, Hismanal,
Marezine, Norflex,
Optimine, Periactin,
Phenergan, Tavist, Teldrin,
Trinalin, Tylenol Allergy
Sinus, Vistaril, Zyrtec
Advil, Anaprox, Anturane,

Benemid, Cataflam, Clinoril,
Daypro, Feldene, Indocin,
Motrin, Nalfon, Naprosyn,
Nuprin, Orudis, Ponstel,
Rufin, Voltaren, Zyloprim
Alphagan, Betagan, Betimol,

Betoptic, Diamox, Glaucon,
Optipranolol, Pilocar,
Propine, Timoptic, Trusopt,
Xalatan
Drowsiness, fatigue, dry

mouth, insomnia,
tachycardia, dizziness
gastrointestinal irritation
and ulceration, peptic
ulcers, retinal disturbances,
renal depression, fluid
retention, peripheral
edema
Burning/stinging
immediately after
administration, dryness,
photophobia, headache,
nausea
Pregnancy, breastfeeding
Previous allergic reaction

to the drug, pregnancy,
breastfeeding, oral anticoagulants

breastfeeding
Children (these drugs may

contribute to development
of Reyes Syndrome),
pregnancy; breastfeeding,
operating machinery, driving
Antivert, Atarax, Benadryl,

Bonine, Compazine,
Dramamine, Kytril,
Marezine, Phenergan,
Reglan, Thorazine, Tigan,
Transderm Scop, Vistaril,
Zofran
Blurred vision,
convulsions, diarrhea,
disorientation, dizziness,
drowsiness, headache,
muscle cramps

breastfeeding, children under
age 2, patients with
pseudomembranous
enterocolitis or enterotoxinproducing bacteria (e.g., E.
coli)
None reported
methotrexate, NSAIDS,
salicylates, digoxin
oral anhydrase inhibitors
None reported
barbiturates, tranquilizers,
alcohol
Possible
Side Effects
Interactions*
Acro-Lase, Furoxone,
Imodium, Lomotil,
Motofen, Pepto-Bismol,
Sandostatin
Other
Examples*
Benefits
Reduces intraocular
pressure
Anti-glaucoma drugs
Anti-epileptic drugs
see Anti-convulsant drugs
Inhibits peristaltic action

in the intestines
Anti-diarrheal drugs
Class
Action

APPENDiX A
27
Inhibits the growth of

bacteria
Quinolones
Nausea, vomiting,
diarrhea, headache,
dizziness, agitation, sleep
disturbances, photo
sensitivity
Superinfection, diarrhea,
nausea
Ancef, Anspor, Ceclor,

Cedax, Cefadyl, Cefizox,
Cefobid, Cefotan, Ceftin,
Cefzil, Cephalexin, Claforan,
Duricef, Fortax, Keflin,
Keflex, Kefzol, Keftab,
Mandol, Mefoxin, Monocid,
Precef, Rocephin, Suprax,
Ultracef, Vantin, Velosef,
Zefazone, Zolicef
Inhibits growth of
bacteria
Cephalosporins
norfloxacin (Noroxin),
ciprofloxacin (Cipro),
ofloxacin (Floxin), enoxacin
(Penetrex), lomefloxacin
(Maxaquin), levofloxacin
(Levaquin), sparfloxacin
(Zagam), gatifloxacin
(Tequin), trovafloxacin
(Trovan), moxifloxacin
(Avelox)
May trigger severe attack in Previous allergic reaction to

None reported
patients with psoriasis,
breastfeeding,
impaired
liver
blood dyscrasias
function, retinal or visual field
changes
Aralen, Atabrine, Daraprim,

Fansidar, Lariam, Plaquenil,
Vibramycin
Inhibits growth of sporozoan parasites
Anti-malarials

breastfeeding

breastfeeding, kidney disease

breastfeeding
antacids containing
magnesium or aluminum;
sucralfate; calcium;
magnesium; iron; zinc;
didanosine; warfarin;
phenytoin
ciprofloxacin: caffeine,
theophylline
sparfloxacin: erythromycin,
azithromycin, tricyclic
antidepressants, phenotiazines,
some anti-arrythmics, cisapride,
terfenadine, pentamidine
trovafloxacin: morphine,
caffeine
antacids, oral anticoagulants,

probenecid
oral contraceptives, oral

hypoglycemics, oral anticoagulants, phenytoin,
cyclosporine, rifampin,
theophylline, terfenadine,
cisapride, astemizole
diuretics
Inhibits growth of fungi

the drug, breastfeeding
Anti-fungals
oral anti-coagulants, alcohol
oral anti-coagulants, diuretics,

lithium
Amikin, Garamycin,
Allergic reaction
Humatin, Kantrex,
Mycifradin, Neobiotic,
Streptomycin Sulfate, Tobicin
Abelcet, Ancobon, Diflucan,
Anaphylaxis, skin rash,
Fulvicin, Fungizone, Grifulvin, diarrhea, metallic taste
Grisactin, Lamisil, Mentax,
Monostat, Mycostatin,
Nizoral, Vagistat-1

breastfeeding, liver disease
hypotension
Inhibits bacterial protein

synthesis (especially in
gram-negative bacteria)
nausea, candidiasis of the
vagina
Fetal death (with ACE

inhibitors), anaphylactic
reactions, impaired liver
function, potassium
deficiency, hypotension,
headache, nausea,
dizziness
Aminoglycosides
Aldomet, Apresoline,
Cardura, Catapres, Hylorel,
Hytrin, Ismelin, Lexel, Lotrel,
Loniten, Lotensin, Minipres,
Procardia, Serpasil, Tenex,
Wytensin, Ziac
Possible
Side Effects
Interactions*
Aralen, Flagyl, Humatin,

Yodoxin
Reduces dehydration from

severe diarrhea
Other
Examples*
Benefits
Inhibits growth of
sporozoan parasites
Anti-infective drugs
Amebicides
Anti-hypertensive drugs Blocks activity of

see also ACE Inhibi
vasoconstrictors
tors, Beta-blockers,
Calcium Channel
Blockers, and Diuretics
Class
Action

APPENDiX A
28
Achromycin, Declomycin,
Doryx, Doxychel, Minocin,
Rondomycin, Sumycin,
Terramycin, Vibramycin
Thiosulfil, Gantanol,
Azulfidine, Gantrisin,
Renoquid
Augmentin, Amoxil,
Cloxapen, Dynapen,
Gencillin, Geopren, Larotid,
Mezlin, Nafcil, Omnipen,
Pathocil, Pen Vee K, Pentids,
Pipracil, Polycillin, Polymox,
Principen, Prostaphlin,
Pyopen, Spectrobid,
Staphcillin, Tegopen, Ticar,
Timentin, Totacillin,
Trimox, Unasyn, Unipen,
V-Cillin K, Veetids,
Veracillin
Biaxin, Dynabac, EES,

E-Mycin, Erythrocin,
Ilosone, TAO, Zithromax
acyclovir (Valtrex),
famciclovir, ribavirin,
interferons, amantadine
(Symmetrel), rimantadine
(Flumadine), oseltamivir
(Tamiflu), zanamivir
(Relenza)
Other
Examples*
Benefits
Destroys or inhibits the

growth of bacteria
Tetracyclines

growth of bacteria
Penicillins

growth of bacteria

growth of bacteria
Macrolide
Antibiotics
Sulfonamides
Acts on viral DNA/

RNAto limit viral
replication
Anti-viral Drugs
Used to treat
HIV/AIDS
Anti-infectives (contd)
Class
Action

Allergic reaction,
permanent staining of
teeth during development,
photosensitivity
allergic reactions,
hypoglycemia, tachycardia,
enterocolitis
Allergic reactions,
diarrhea, gastritis, nausea,
vomiting, enterocolitis,
black hairy tongue
allergic reaction,
enterocolitis
Bone marrow suppression,

lactic acidosis, pancreatitis

breastfeeding

breastfeeding, infants less
than 2 months old, liver or
kidney impairment

breastfeeding, liver or kidney
impairment

impairment

breastfeeding, hemophilia
oral anti-coagulants, oral

barbiturates, phenytoin,
antacids
NOTE: This medication must
be taken on an empty
stomach
oral anti-coagulants,
sulfonylureas
diuretics
cisapride, pimozide,
ranitidine, terfenadine,
theophylline
ganciclovir, phenytoin,
fluconazole
Possible
Side Effects
Interactions*
APPENDiX A
29
Relieves smooth muscle

spasm of the gastro
intestinal tract
Anti-spasmodics
Antibiotic: Controls
bacteria found to cause
ulcers
Antacid: Acts to
neutralize excess acid in
the stomach
Acts as a decongestant
Anti-emetic
Decrease in blood pressure
Phenothiazines: Allergic
reaction, diminished effect
of oral anticoagulants
Tingling, paresthesias,
chest pain, diarrhea, sweating
Antibiotics: amoxicillin,
clarithromycin,
metronidazole, tetracycline,
antacids
Benylin, Brontex, Codiclear,

Dilaudid, Hold-DM,
Hycodan, Myambutol,
MSuppress, Phenergan,
Robitussin, Tessalon,
codeine
Antibiotics: see Antiinfectives
Possible allergic reaction

(especially to those with
codeine), dry mouth,
drowsiness
Cardiovascular disease,
diabetes, hypertension,
abnormal thyroid function,
prostatic hypertrophy,
Addisons disease, chronic
ulcerative colitis, history of
drug abuse or dependence
(codeine) chronic respirator
impairment
Kidney or liver disease,

ulcerative colitis,
hyperthyroidism,
hypertension,
coronary heart disease,
congestive heart failure,
hiatal hernia
Phenothiazines: Renal or
liver disease, pregnancy,
breastfeeding
Others: pregnancy,
breastfeeding

the drug, liver or kidney
dysfunction, pregnancy,
breastfeeding
beta-blockers, MAO
inhibitors, anti-hypertensive
agents, tricyclic antidepressants, CNS
depressants, alcohol
amantidine, anti-arrhythmia
agents, anti-depressants,
antihistamines, narcotics,
MAO inhibitors
Phenothiazines: alcohol,
barbiturates, narcotics, other
CNS depressants,
cardiovascular conditions
Others: lithium, other CNS
depressants
calcium channel blockers,

tricyclic anti-depressants,
propranolol, alcohol
Possible
Side Effects
Interactions*
Acro-Lase, Banthine, Bentyl, Heat prostration, diarrhea,

Cantil, Cystospaz, Donnatal, drowsiness, blurred vision,
Levbid, Pamine, Propsychosis
Banthine, Quarzan, Robinul,
Tral, Valpin
Phenothiazines: Compazine,
Mellaril, Permitil, Prolixin,
Serentil, Sparine, Stelazine,
Thorazine, Tindal, Trilafon,
Vesprin
Others: Clozaril, Haldol,
Loxitane, Navane, Rysperdal,
Taractan, Zyprexa
Amerge, Axert, Blocadren,

Calan, Corgard, Ergostat,
Imitrex, Isoptin, Inderal,
Lopressor, Maxalt,
Procardia, Sansert,
Tenormin, Zomig
Other
Examples*
Benefits
Anti-ulcer drugs
Antibiotics and antacids
Anti-tussive drugs Cough Suppresses the cough

suppressants
reflex
Sedative
Some drugs cause

constriction of the blood
vessels in the brain,
relieving the pain of
migraine headaches;
others lower blood
pressure, relieving
symptoms of the
headache
Anti-psychotic drugs
Major tranquilizers
Anti-motion-sickness,
Anti-nausea drugs
see Anti-emetic drugs
Anti-migraine drugs
Class
Action

APPENDiX A
Act as central nervous

system depressants,
producing sedation and/
or sleep
30
Lowers blood pressure
Blocks the liver enzyme

Decreases triglycerides
that starts the production
of cholesterol
Blocks the passage of

calcium through certain
cell walls, slowing the
electrical activity of the
heart and inhibiting
contraction of coronary
arteries (This prevents
coronary artery spasm
and decreases the
workload on the heart)
Treatment of seizures
Atromid-S, Baycol,
Choloxin, Colestid, Lescol,
Lipidil, Lipitor, Lopid,
Lorelco, Mevacor, Nicobid,
Prevalite, Questran,
Sb-Niacin, Zocor
Adalat CC, Calan, Cardene,

Cardene-SR, Cardizem,
Dyna-Circ, Isoptin,
Nimotop, Norvasc, Plendil,
Posicor, Procardia XL,
Tiazac, Vascon, Verelan
Blocadren, Cartrol, Coreg,

Corgard, Inderal, Kerlone,
Levatol, Lopressor,
Normodyne, Sectral,
Tenormin, Trandate, Visken,
Zebeta, Ziac
Allergic reaction to the

drug, liver dysfunction,
diarrhea
Hypotension, fluid
retention, allergic
reactions, headache,
dizziness,
nausea, constipation,
numbness or coldness
of the extremities
Allergic reactions,
headache, dizziness,
drowsiness, indigestion,
nausea, joint and muscle
pain, fluid retention,
congestive heart failure,
masking of low blood
sugar, provocation of
bronchial asthma
Corticosteroids,
anti-coagulants, doxycycline,
MAO inhibitors

the drug, pregnancy, breastfeeding, active liver disease,
history of liver or kidney
disease, excessive alcohol
consumption

the drug, pregnancy, breastfeeding, active liver disease,
ventricular tachycardia,
second or third-degree heart
block, hypotension, recent
stroke or heart attack, poor
circulation to extremities
alcohol, antacids, azole antifungals, oral contraceptives,

cyclosporine, digoxin,
erythromycin, niacin, oral
anti-coagulants
beta blockers, aspirin,

digitoxin, amiodarone,
calcium
supplements, cyclosporine,
dentrolene, disopyramide,
lithium, NSAIDs, oral
hypoglycemics, phenytoin,
quinidine, theophylline
Previous allergic reaction to oral anhydrase inhibitors

the drug, slow heart rate,
impaired liver or kidney
function, diabetes,
myasthenia gravis, history of
hayfever, asthma, chronic
bronchitis, chronic
obstructive pulmonary
disease (COPD),
hyperthyroidism, pregnancy,
breast-feeding
Liver impairment, history of

drug dependence or abuse,
suicidal tendencies,
Possible
Side Effects
Interactions*
Severe respiratory
Amytal, Alurate, Butisol,
Gemonil, Lotusate, Luminal, depression, dependency
Mebaral, Nembutol, Seconal,
Solfoton
Other
Examples*
Benefits
Cholesterol-reducing
drugs
Cephalosporins
see Anti-infectives
Calcium blockers
(calcium-channelblocking drugs)
Used to treat angina
Bronchodilators
see Anti-asthmatics
Beta-blockers
Reduces the rate and
Beta-adrenergic-blocking contraction force of the
drugs
heart, reducing the
oxygen requirement for
the heart as it works; also
reduces blood vessel wall
contraction, lowering
blood pressure
Barbiturates
Appetite suppressants
see Anorexiants
Class
Action

APPENDiX A
31
Estrogens
Maintain female
Used to treat
reproductive system
symptoms of
menopause and postmenopause and as a
method of birth
control (in oral
contraceptives)
Hormones (female)
Heart rhythm regulators

see Anti-arrhythmic drugs
H-Blockers
Decreases gastric acid
histamine blocking drugs secretion
Fluroquinolones
see Anti-Infectives
Prevention of osteoporosis
Treatment of hypertension,
congestive heart failure
Increases elimination of
sodium and water
through increased urine
production
Diuretics
Estrogens
see Hormones
Prevents heart rhythm

disorders
Increases the force of

heart muscle contraction
by increasing calcium
levels
Allergic reaction,
hypotension, decreased
potassium levels--causing
muscle weakness and
cramping, headache,
dizziness
Allergic reaction,
headache, drowsiness,
double vision, male breast
enlargement
Alora Transdermal, Climara

Transdermal,
Diethylstilbestrol, Estraderm,
Estretab, FemPatch, Menest,
Ortho-Est, Premaril,
Permarin, Vivelle
Transdermal
Change in menstrual flow,

tenderness or
enlargement of the
breasts, fluid retention,
weight gain

the drug, known or
suspected breast cancer,
uterine cancer, or
pregnancy, history of heart
attack or stroke, sickle cell
anemia, impaired liver
function

breastfeeding

breast-feeding, history of
kidney or liver disease
Ventricular fibrillation,
previous allergic reaction
breastfeeding
alendronate, oral antidiabetics, thyroid hormones,

tricyclic anti-depressants,
vitamin C, oral anticoagulants
oral anti-coagulants
alcohol, indipimine, lithium,

NSAIDs
acarbose, calcium
(intravenous), diuretics, betablockers, quinidine,
benzodiazepines,
cyclosporine, ibuprofen,
indomethiacin, verapamil,
tetracyclines, phenytoin
Possible
Side Effects
Interactions*
Axid, Axid AR, Pepcid,

Allergic reaction,
Pepcid AC, Tagamet, Tagamet headache, constipation,
HB, Zantac, Zantac 75
diarrhea, tachycardia
Aldactone, Bumex, Diamox,

Diaulo, Dyrenium, Edecrin,
Hygroton, Lasix, Lozol,
Midamor, Zaroxolyn
Thiazide Diuretics:
Anhydron, Aquatag,
Aquatensin, Diucardin,
Diuril, Enduron,
Esidrix,Exna, Hydrodiuril,
Marazide, Metahydrin,
Naqua, Naturentin, Oretic,
Renese, Saluron
Cedilanid-D, Crystodigin,
Lanoxicaps, Lanoxin
Other
Examples*
Benefits
Digitalis preparations
Class
Action

APPENDiX A
32
used to treat bulimia, chronic
headaches, post-traumatic
stress disorder
Monoamine Oxidase
Relieves symptoms of
(MAO) Inhibitor Drugs neurosis and atypical
(Type A anti-depressants) depression
Macrolide antibiotics
see Anti-infectives
Used to treat severe

rheumatoid arthritis for
patients who do not respond
to NSAIDs.
Marplan, Nardil, Parnate
Dangerous drug
interactions (described at
far left), hypertensive crisis,
agitation, confusion,
impaired memory
driving, flying airplanes
(disqualification for piloting)
Foods to avoid: Meat and
fish, pickled herring,
sauerkraut, cheese, yogurt,
alcohol, alcohol free beer,
excessive amounts of
chocolate and caffeine, any
foods that are fermented,
pickled or smoked
severe infections, severe

Azathioprine, Cytotoxin,
Imuran, Leukeran, Plaquenil, nausea and vomiting,
diarrhea, rash, fever, malaise breastfeeding
Sandimmune
Elderly or debilitated
patients, pregnancy,
breastfeeding, depression,
consumption of grapefruit
juice
Allergic reactions,
dizziness, blurred vision,
double vision, slurred
speech, nausea, drowsiness,
lethargy,
unsteadiness
Ambien, Aquachioral,
Dalmane, Doral, Doriden,
Halcion, Largon, Lunesta,
Noctec, Noludar, Paral,
Paxarel, Placidyl, ProSom,
Restoril, Sonata, Valmid
Acts on the central

nervous system to induce
sleep or produce a
hypnotic effect
Hypnotic drugs
see also
Barbiturates
Immunosuppressants
Used to prevent rejection
of transplanted organs
Cerebrovascular or coronary
artery disease; known or
suspected breast,
endometrial, ovarian, or
cervical cancer; pregnancy
Increased risk of breast,

endometrial, ovarian, and
cervical cancers; fluid
retention; weight gain;
depression; intolerance of
contact lenses
Alesse, Brevicon, Demulen,

Desogen, Estrostep, Lo/
Ovral, Modicon, Nordette,
Norinyl, Ortho-Cept, OrthoCyclen, Ortho-Novum,
Ortho-Tri-Cyclen,
Premphase, Tri-Norinyl,
Triphasil
Nonprescription:Cold and
cough preparations, allergy
medications, nasal
decongestants, sinus
medications, asthma inhalant
medications, weight-reduction
preparations, L-tryptophan
Prescription: buspirone
(Buspar), carbamazpene
(Tegretol), fluoxetine (Prozac),
fluvozamine (Luvox),
levodopa (Dopar/Sinemet),
meperidine (Demerol),
methyldopa (Aldomet),
methylphenidate (Ritalin),
metoprolol (Lopressor), naldol
(Corgard), nefazodone
(Serzone), paroxetine (Paxil),
phenothiazines
(Compazine/Thorazine),
propoxyphene (Darvon),
sertraline (Zoloft), tricyclic
anti-depressants (Elavil,
Sinequan), venlafaxine
(Effexor)
allopurinol, ACE-inhibitors,
oral anti-coagulants
psychotropic medications,
anti-convulsants,
antihistamines, isoniazid, oral
contraceptives, ranitidine
tetracyclines
Possible
Side Effects
Interactions*
Inhibits ovulation; used

in combination with
estrogens as oral
contraceptives
Other
Examples*
Benefits
Progestins
Class
Action

Hormones (female),
contd
APPENDiX A
33
Reduces production of
prostaglandins (the
chemicals involved in pain
and inflammatory
responses)
Modifies the temperatureregulating center in the
brain, dilating blood
vessels, increasing
sweating, and thus
reducing fever.
Inhibits the formation of
blood clots
Non-steroidal
anti-inflammatory drugs
(NSAIDs)
Helps reduce hypertension
Central nervous system

depression, drowsiness,
confusion, respiratory
depression
Drowsiness
Advil, Anaprox, Cataflam,

Daypro, Dolobid, Feldene,
Indocin, Lodine, Motrin,
Nalfon, Naprosyn, Orudis,
Ponstel, Relafen, Tolectin,
Voltaren, ibuprofen
Gastrointestinal irritation
and ulceration, intestinal
bleeding, kidney toxicity

the drug, bleeding disorders
(hemophilia), active peptic
ulcer disease, pregnancy

breastfeeding
Elderly, debilitated patients;

pregnancy; breastfeeding;
operating machinery;
driving; kidney or liver
impairment
acetazolamide (Diamox), adre

nocorticosteroids (Decadron),
anticoagulants (Heparin, Cou
madin), captopril (Capoten),
cimetidine (Tagamet),
diltiazem (Cardizem),
furosemide (Lasix), insulin
(Humulin), lithium (Lithobid),
methotrexate (Rheumatrex),
para-aminobenzoic acid
(Pabalate), probenecid
(Benemid), valproic acid
(Depakene), varicella vaccine
(Varivax)
alcohol, other vasodilators,

Viagra
Other narcotics and central

bervous system depressants,
alcohol, anti-psychotics,
MAO inhibitors, tricyclic
anti-depressants
Previous allergic reaction to MAO inhibitors, tricyclic antithe drug, pregnancy, breast- depressants, alcohol, central
feeding, operating machinery, nervous system depressants
driving, patients with a
history of urinary retention,
glaucoma
Possible
Side Effects
Interactions*
Headache, severe
Amyl Nitrate Vaporole,
Cardilatec, Duotrate, Indur, hypotension
Ismo, Isordil, NitroBid,
Nitroguard, Nitrolingual,
Nitrong, Nitrostat, NitroStat,
Peritrate, Sorbitrate,
nitroglycerine
Alfenta, Astramorph,
Combunox, Darvocet,
Darvocet-N, Darvon,
Demerol, Dilaudid,
Dolophine, Duragesic,
Duramorph, Fioricet with
Codeine, Hycodan,
Hydrocet, Levo-Dromoran,
Methadone, Numorphan,
Oxycontin, Roxicodone,
Sublimaze, Sufenta, Percocet,
Percodan, Tylenol with
Codeine, Tylox, Vicodin,
Vicoprofen, codeine,
hydrocodone, morphine,
oxycodone
Diantrium, Equanil, Flexeril,

Lioresal, Maolate, Miltown,
Norflex, Paraflex, Parafon
Forte, Rela, Robaxin,
Skelaxin, Soma, Valium
Other
Examples*
Benefits
Relaxes vascular smooth

muscles, dilating
peripheral blood vessels
Inhibits pain reception
Narcotics
Opioid drugs
(natural and synthetic)
Nitrates
(vasodilators)
Used to treat angina
pectoris
Relaxes skeletal muscles,

used to relieve muscle
spasm and treat
convulsive disorders
Muscle relaxants
Class
Action

APPENDiX A
Cialis, Levitza, Viagra
Other
Examples*
Benefits
allergic reaction, large and

sudden drops in blood
pressure, blurred vision or
blue-tinged vision
Patients with existing

cardiovascular disease,
patients taking organic
nitrates (forr example,
nitroglycerin)
34
Habitrol, Nicotrol
Transdermal
Nicotine
Provides delivery of
nicotine as a substitute for
tobacco products
Zyban
Smoking cessation agents Inhibits the neuronal

update of norepinephrine,
serotonin, and dopamine.
Enhances patients
abilities to abstain from
smoking

ibuprofen, patients with
seizure disorders, bulimia,
anorexia nervosa, patients
taking MAO inhibitors
Skin rashes, delayed healing Patients who continue to use
of peptic ulcers,
tobacco products, due to
hypertension
possibility of nicotine
toxicity; pregnancy; allergic
reaction
Allergic reactions,
confusion, psychosis,
insomnia
acetaminophen, caffeine,
oxazepam, pentazocine,
propanolol, theophylline,
insulin, phenylephrine
MAO inhibitors, medications

containing bupropion
(Wellbutrin)
Organic nitrates:
nitroglycerines (Deponit,
Minitran, Nitrek, Nitro-Bid,
Nitrocine, Nitro-Derm, NitroDisc, Nitro-Dur, Nitrogard,
Nitroglyn, Nitrolan,
Nitrolingual Spray, Nitrong,
Nitropar, Nitropress,
Nitroprex, Nitro S.A.,
Nitrospan, Nitrostat, NitroTransdermal, Nitro-Time,
Transderm-Nitro, Tridil),
isosorbide mononitrate
(Imdur, ISMO, Monoket),
isosorbine nitrate (DilatrateSR, Iso-bid, Isordil, Isordil
Tembids, Isosorbide Dinitrate,
Isosorbide Dinitrate LA,
Sorbitrate, Sorbitrate SA),
pentaerythritol tetranitrate
(Pertitrate, Peritrate SA),
erythritol tetranitrate
(Cardilate), amyl nitrate or
nitrite
(poppers)
Possible
Side Effects
Interactions*
NOTE:The FDA has issued a warning in the MedWatch Bulletin for prescribers of Viagra to use caution when dispensing this drug to patients with cardiovascular disease
and those taking
medications containing organic nitrates. Several deaths have been attributed to the use of Viagra by patients with these contraindications..
Sexual dysfunction drugs Works by increasing

blood flow to the genital
area, allowing erection to
occur and be sustained.
Used to treat erectile
dysfunction in men.
Penicillins
see Anti-infectives
Class
Action

APPENDiX A
Inhibit Mycobacterium
tuberculosis growth
Tuberculosis drugs
Capastal, Lianiazid,
Myambutol, Mycobutin,
Nydrazid, Rifadin,
Rimactane, Seromycin,
Trecator-SC, streptomycin,
pyrazinamide
Synthetic T3 Cytomel,
Triostat, Synthetic T-4
Levothroid, Levothyroxine,
Synthroid
Other
Examples*
Benefits
Act to enhance oxygen

consumption of most
body tissues and
regulates basal metabolic
rate and metabolism of
fats, carbohydrates and
proteins
Thyroid hormones
Class
Action

Allergic reactions, liver

dysfunction, nausea,
vomiting, diarrhea
Hair loss (initial therapy),

nervousness, weight loss,
diarrhea, abdominal
cramping, tachycardia
(overdose)

breastfeeding, treatment of
meningococcal disease
Untreated adrenal
insufficiency
thyroid hormones
adrenocorticosteroids, oral
anti-coagulants, insulin, oral
hypoglycemics, digitalis,
theophylline, tricyclic antidepressants
Possible
Side Effects
Interactions*
APPENDiX A
35
APPENDIX B
FDA MEDWATCH REPORTING FORM (VOLUNTARY)
S
A
M
P
LE
To view the complete form, visit: http://www.fda.gov/downloads/Safety/MedWatch/HowToReport/DownloadForms/ucm082725.pdf
36
APPENDIX
FDA MEDWATCH REPORTING FORM (VOLUNTARY)
S
A
M
P
LE
To view the complete form, visit: http://www.fda.gov/downloads/Safety/MedWatch/HowToReport/DownloadForms/ucm082725.pdf
37
United States Poison Centers
No matter where you are in the U.S., you have a poison center. Some centers serve several states,
and some states have several centers, but all areas across the country are covered. No matter where you are, call
1-800-222-1222 to talk to medical experts for free, private poison help 24 hours a day, seven days a week.
Alabama: Alabama Poison Center
Regional Poison Control Center
Alaska: Served by Oregon Poison Center
Iowa: Iowa Statewide Poison

Control Center
Kansas: University of Kansas Hospital Poison
Control Center
Arizona: Arizona Poison & Drug

Information Center
Banner Poison Control Center
Arkansas: Arkansas Poison & Drug Information Center
California: California Poison Control
System in Fresno, Sacramento,
San Diego, & San Francisco
Colorado: Rocky Mountain Poison
& Drug Center
Connecticut:Connecticut Poison Center
District of Columbia: National Capital Poison
Center
Delaware: Served by The Poison
Control Center
Florida: Florida/USVI Poison
Information Center in Jacksonville, Miami &
Tampa
Georgia: Georgia Poison Center
Hawaii: Served by Rocky Mountain Poison &
Drug Center
Idaho: Served by Rocky Mountain Poison &
Drug Center
Illinois: Illinois Poison Center
Indiana: Indiana Poison Center
Kentucky: Kentucky Regional

Poison Center
Louisiana: Louisiana Poison Center
Maine: Northern New England
Poison Center
Maryland: Maryland Poison Center
Also served by National Capital
Poison Center
New Hampshire: Served by Northern New

England Poison Center
New Jersey: New Jersey Poison
Information & Education System
New Mexico: New Mexico Poison &
Drug Information Center
New York:
New York City Poison Control Center
Upstate New York Poison Center
North Carolina: Carolinas Poison Center
North Dakota: Served by Hennepin Regional
Poison Center
Ohio: Central Ohio Poison Center
Massachusetts: Regional Center for Poison

Control & Prevention
Cincinnati Drug and Poison
Michigan: Childrens Hospital

of Michigan
Information Center
Northern Ohio Poison Center
Minnesota: Hennepin Regional

Poison Center
Oklahoma: Oklahoma Poison
Tennessee: Tennessee Poison Center

Texas: Central Texas Poison Center
North Texas Poison Center
South Texas Poison Center
Southeast Texas Poison Center
Texas Panhandle Poison Center
West Texas Regional Poison Center
Utah: Utah Poison Control Center
Vermont: Served by Northern
New England Poison Center
Virginia: Blue Ridge Poison Center
Virginia Poison Center
Also served by National Capital
Poison Center
Washington: Washington Poison Center
West Virginia: West Virginia
Poison Center
Wisconsin: Wisconsin Poison Center
Control Center
Wyoming: Served by Nebraska Regional

Poison Center
Mississippi: Mississippi Poison

Control Center
Oregon: Oregon Poison Center
Territories:
Missouri: Missouri Poison Center
Pennsylvania: Pittsburgh Poison Center
Puerto Rico: Puerto Rico Poison Center
Montana: Served by Rocky Mountain Poison

& Drug Center
The Poison Control Center
American Samoa: Served by Nebraska

Regional Poison Center
Nebraska: Nebraska Regional

Poison Center
Nevada: Served by Rocky Mountain Poison &
Drug Center
Rhode Island: Served by Regional

Center for Poison Control & Prevention
Federated States of Micronesia: Served by

Nebraska Regional Poison Center
South Carolina: Palmetto Poison Center
Guam: Served by Oregon Poison Center
South Dakota: Served by Hennepin Regional

Poison Control Center
U.S. Virgin Islands: Served by

Florida/USVI Poison Information
Center, Jacksonville
For more information on poison centers, visit www.aapcc.org .

Copyright 2010 American Association of Poison Control Centers
Reduces pain and

inflammation
Reduces pain
Reduces fever
Acuprin, ASA, Butalbital,

Ecotrin, Excedrin, Fiorinal,
Halfprin, Lortab ASA, Nor
gesic, Percodan, Soma
Compound, Synalgos, Talwin
Compound
intestinal bleeding, ulcers,
tinnitus, increased
prothrombin time

breastfeeding
Heavy alcohol intake
39
Bone marrow suppression,

lactic acidosis, pancreatitis
acyclovir (Valtrex),
famciclovir, ribavirin,
interferons, amantadine
(Symmetrel), rimantadine
(Flumadine), oseltamivir
(Tamiflu), zanamivir
(Relenza)
Acts on viral DNA/

RNAto limit viral
replication
Anti-viral Drugs
Used to treat
HIV/AIDS
Anaphylaxis, skin rash,

diarrhea, metallic taste
Ancef, Anspor, Ceclor, Cedax, Superinfection, diarrhea,

Cefadyl, Cefizox, Cefobid,
nausea
Cefotan, Ceftin, Cefzil, Cepha
lexin, Claforan, Duricef,
Fortax, Keflin, Keflex, Kefzol,
Keftab, Mandol, Mefoxin,
Monocid, Precef, Rocephin,
Suprax, Ultracef, Vantin,
Velosef, Zefazone, Zolicef
Mycostatin, Nizoral
Inhibits growth of
bacteria
Inhibits growth of fungi
Cephalosporins
Anti-infective drugs
Anti-fungals

breastfeeding, hemophilia

breastfeeding, kidney disease

breastfeeding
ganciclovir, phenytoin,
fluconazole
antacids, oral anticoagulants,

probenecid
oral contraceptives, oral

hypoglycemics, oral anticoagulants, phenytoin,
cyclosporine, rifampin,
theophylline, terfenadine,
cisapride, astemizole
oral anti-coagulants, nonsteroidal anti-inflammatory

drugs (NSAIDs)
alcohol
Possible
Side Effects
Interactions*
Aspirin Free Excedrin, Datril, Allergic reaction to the

Reduces fever (acts on heatregulation center in the brain) Sine-Aid, Maximum Strength drug, liver toxicity
Sine-Aid, Tylenol, Tylenol
Sinus
Other
Examples*
Benefits
NOTE:There are literally hundreds of non-prescription medications that contain aspirin, always check the ingredients list for aspirin/salicylate if it is contraindicated.
Aspirin and Aspirin

Combinations
(salicylates)
Analgesics
Acetaminophen
Class
Action

DRUGS COMMONLY ADMINISTERED IN CONJUNCTION WITH DENTAL TREATMENT
APPENDIX D
DRUGS COMMONLY ADMINISTERED IN CONJUCTION WITH DENTAL TREATMENT
40

growth of bacteria

growth of bacteria

growth of bacteria
Penicillins
Sulfonamides
Tetracyclines
Achromycin, Declomycin,
Doryx, Doxychel, Minocin,
Rondomycin, Sumycin,
Terramycin, Vibramycin
Thiosulfil, Gantanol,
Azulfidine, Gantrisin,
Renoquid
Augmentin, Amoxil,
Cloxapen, Dynapen,
Gencillin, Geopren, Larotid,
Mezlin, Nafcil, Omnipen,
Pathocil, Pen Vee K, Pentids,
Pipracil, Polycillin, Polymox,
Principen, Prostaphlin,
Pyopen, Spectrobid,
Staphcillin, Tegopen, Ticar,
Timentin, Totacillin, Trimox,
Unasyn, Unipen, V-Cillin K,
Veetids, Veracillin
Biaxin, Dynabac, EES,

E-Mycin, Erythrocin,
Ilosone, TAO, Zithromax
Other
Examples*
Benefits

growth of bacteria
Macrolide
Antibiotics
Anti-infectives (contd)
Class
Action

Allergic reaction,
permanent staining of teeth to the drug, pregnancy,
during development,
breastfeeding
photosensitivity

breastfeeding, infants less
than 2 months old, liver or
kidney impairment

impairment
Allergic reactions, diarrhea,

gastritis, nausea, vomiting,
enterocolitis, black hairy
tongue
allergic reactions,
hypoglycemia, tachycardia,
enterocolitis

impairment
allergic reaction,
enterocolitis
oral anti-coagulants, oral

barbiturates, phenytoin,
antacids
NOTE: This medication must
be taken on an empty
stomach
oral anti-coagulants,
sulfonylureas
diuretics
cisapride, pimozide,
ranitidine, terfenadine,
theophylline
Possible
Side Effects
Interactions*
APPENDIX D
Inhibits the initiation and

conduction of nerve
impulses, thus causing a
loss of sensation
Acts on the central

nervous system to induce
sleep or produce a
hypnotic effect
Local anesthetics
Hypnotic drugs
see also
Barbiturates
(Appendx A)
Promotes mineralization Prevention of osteoporosis

and remineralization of
tooth enamel, making the
tooth less susceptible to
acids and caries
Ambien, Aquachioral,
Dalmane, Doral, Doriden,
Halcion, Largon, Lunesta,
Noctec, Noludar, Paral,
Paxarel, Placidyl, ProSom,
Restoril, Sonata, Valmid
Carbocaine, Citanest,
Duranest, Isocaine, Marcaine,
Lidocaine, Lignospan,
Octocaine, Oraqix, Polocaine,
Prilocaine, Scandonest,
Septocaine, Xylocaine,
Zorcaine
Florical, Luride Drops,

Luride Lozi-Tabs, Monocal
Other
Examples*
Benefits
Fluorides
Class
Action

Allergic reactions,
dizziness, blurred vision,
double vision, slurred
speech, nausea,
drowsiness, lethargy,
unsteadiness
Allergic reaction, liver

toxicity, tachycardia
Toxicity due to overdose,

fluorosis-staining of teeth
due to overdose, nausea,
vomiting, diarrhea,
burning mouth
Elderly or debilitated
patients, pregnancy,
breastfeeding, depression,
consumption of grapefruit
juice

the drug, impaired
cardiovascular function (for
solutions with epinephrine)
Consumption of dairy
products
psychotropic medications,
anti-convulsants,
antihistamines, isoniazid, oral
contraceptives, ranitidine
Central nervous system

depressants
Possible
Side Effects
Interactions*
APPENDIX D
41
PREVENTION OF INFECTIVE (BACTERIAL) ENDOCARDITIS

Wallet Card
This wallet card is to be given to patients (or parents) by their physician. Healthcare professionals: Please see back of card for reference
to the complete statement.
Name: _________________________________________
needs protection from
INFECTIVE (BACTERIAL) ENDOCARDITIS
because of an existing heart condition.
Diagnosis: ______________________________________
Prescribed by: __________________________________
Date: __________________________________________
You received this wallet card because you are at increased risk for
developing adverse outcomes from infective endocarditis (IE), also
known as bacterial endocarditis (BE). The guidelines for prevention
of IE shown in this card are substantially different from previously published guidelines. This card replaces the previous card that was based
on guidelines published in 1997.
The American Heart Associations Endocarditis Committee together with
national and international experts on IE extensively reviewed
published studies in order to determine whether dental, gastrointestinal
(GI), or genitourinary (GU) tract procedures are possible causes of IE.
These experts determined that there is no conclusive evidence that
links dental, GI, or GU tract procedures with the development of IE.
The current practice of giving patients antibiotics prior to a dental
procedure is no longer recommended EXCEPT for patients with the
highest risk of adverse outcomes resulting from IE (see below on this
card). The Committee cannot exclude the possibility that an exceedingly
small number of cases, if any, of IE may be prevented by antibiotic
prophylaxis prior to a dental procedure. If such benefit from prophylaxis
exists, it should be reserved ONLY for those patients listed below. The
Committee recognizes the importance of good oral and dental health
and regular visits to the dentist for patients at risk of IE.
The Committee no longer recommends administering antibiotics solely
to prevent IE in patients who undergo a GI or GU tract procedure.
Changes in these guidelines do not change the fact that your cardiac
condition puts you at increased risk for developing endocarditis. If you
develop signs or symptoms of endocarditissuch as unexplained fever
see your doctor right away. If blood cultures are necessary (to determine if endocarditis is present), it is important for your doctor to obtain
these cultures and other relevant tests BEFORE antibiotics are started.
Antibiotic prophylaxis with dental procedures is reasonable only
for patients with cardiac conditions associated with the
highest risk of adverse outcomes from endocarditis, including:
Prosthetic cardiac valve or prosthetic material used in valve repair
Previous endocarditis
Congenital heart disease only in the following categories:
Unrepaired cyanotic congenital heart disease, including those
with palliative shunts and conduits
Completely repaired congenital heart disease with prosthetic
material or device, whether placed by surgery or catheter
intervention, during the first six months after the procedure*
Repaired congenital heart disease with residual defects at the
site or adjacent to the site of a prosthetic patch or prosthetic
device (which inhibit endothelialization)
Cardiac transplantation recipients with cardiac valvular disease
*Prophylaxis is reasonable because endothelialization of prosthetic material occurs
within six months after the procedure.
Dental procedures for which prophylaxis is reasonable in

patients with cardiac conditions listed above.
All dental procedures that involve manipulation of gingival tissue or the

periapical region of teeth, or perforation of the oral mucosa*
*Antibiotic prophylaxis is NOT recommended for the following dental
procedures or events: routine anesthetic injections through noninfected
tissue; taking dental radiographs; placement of removable prosthodontic or
orthodontic appliances; adjustment of orthodontic appliances; placement
of orthodontic brackets; and shedding of deciduous teeth and bleeding
from trauma to the lips or oral mucosa.
Antibiotic Prophylactic Regimens

for Dental Procedures
Situation
Agent
Oral
Amoxicillin
Unable to
take oral
medication
Allergic to
penicillins or
ampicillin
Oral regimen
Allergic to
penicillins or
ampicillin and
unable to take
oral medication
RegimenSingle Dose
30-60 minutes
before procedure
Adults
Children
2g
50 mg/kg
Ampicillin OR
2 g IM or IV*
50 mg/kg IM
or IV
Cefazolin or
ceftriaxone
1 g IM or IV
50 mg/kg IM
or IV
Cephalexin**
2g
50 mg/kg
600 mg
20 mg/kg
Azithromycin or
clarithromycin
500 mg
15 mg/kg
Cefazolin or
ceftriaxone
1 g IM or IV
50 mg/kg IM
or IV
OR
Clindamycin
600 mg IM
or IV
20 mg/kg IM
or IV
OR
Clindamycin
OR
*IMintramuscular; IVintravenous
**Or other first or second generation oral cephalosporin in equivalent
adult or pediatric dosage.
Cephalosporins should not be used in an individual with a history of
anaphylaxis, angioedema or urticaria with penicillins or ampicillin.
Gastrointestinal/Genitourinary Procedures: Antibiotic prophylaxis
solely to prevent IE is no longer recommended for patients who undergo
a GI or GU tract procedure, including patients with the highest risk of
adverse outcomes due to IE.
Other Procedures: Procedures involving the respiratory tract or
infected skin, tissues just under the skin, or musculoskeletal tissue for
which prophylaxis is reasonable are discussed in the updated document
(reference below).
Adapted from Prevention of Infective Endocarditis: Guidelines From the American
Heart Association, by the Committee on Rheumatic Fever, Endocarditis, and
Kawasaki Disease. Circulation, 2007; 116: 1736-1754. Accessible at http://circ.
ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095.
Healthcare ProfessionalsPlease refer to these recommendations for

more complete information as to which patients and which procedures
need prophylaxis.
The Council on Scientific Affairs of the

American Dental Association has approved
this statement as it relates to dentistry.
National Center
7272 Greenville Avenue
Dallas, Texas 75231-4596
americanheart.org
2008, American Heart Association.

All Rights Reserved. Lithographed in Canada.
50-1605 0805

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The Importance of Pharmacology

in the Delivery of Quality Dental Care

Conflict of Interest Disclosure Statement

The authors report no conflicts of interest associated with this work.

The Procter & Gamble Company is an ADA CERP Recognized Provider.

ADD/ADHD attention deficit disorder/attention

adverse effect or reaction an abnormal,

ACE angiotensin enzyme inhibitors used to treat

anorexiant a drug that suppresses appetite

antagonistic describes an interaction of two

dermatitis skin irritation

anti-coagulant an agent that interferes with or

diuretic a drug that increases the output of urine

anti-emetic an agent to prevent vomiting

dose a measured amount of a drug

anti-fungal an anti-infective agent used to treat

drug interaction reaction occurring when two

diaphoresis excessive sweating

anti-hypertensive an agent that acts to lower

embolism obstruction of a blood vessel by a

anti-infective an agent that fights infections, for

edema swelling caused by accumulation of fluids

anti-pyretic a drug that treats fever by lowering

expectorant an agent that promotes removal of

anti-tussive a cough suppressing agent

FDA the U.S. Food and Drug Administration,

arthropathy a disease of the joints

fluorosis tooth discoloration caused by high

bacteriocidal having the ability to destroy

gastritis inflammation of the mucous membrane

bacteriostatic having the ability to inhibit

gastroenteritis inflammation of the mucous

beriberi a disease caused by thiamine deficiency

generic name the official, common, or public

bradycardia slow heart rate

glaucoma eye disease characterized by

brand name the registered trade name given to

hematogenous formation of blood cells

contraindication a condition or disease that

hemophilia a sex-linked hereditary blood defect

controlled substances drugs that have a

hemostasis a stopping or slowing of blood flow

cystitis inflammation of the urinary bladder

hyperglycemia high blood sugar

hypersensitivity allergy to a drug, an overresponsiveness

osteomalacia a disease of adults characterized

hypervitaminosis an abnormal state resulting

osteonecrosis of the jaw (ONJ) bones of the

hypnotic a drug that causes sleep

overdose a single drug dose that exceeds the

hypoxia decreased levels of oxygen in blood or

over-the-counter describes drugs that can be

idiosyncratic unusual or unexpected, as in a

pallor paleness of the skin

immunosuppressive an agent that suppresses

paresthesia sensation of pricking, tingling, or

intravenous within a vein

parenteral administration of a drug other than

laryngospasm contraction of the laryngeal

pellagra a disease marked by dermatitis,

lymphadenopathy unusually enlarged lymph

pernicious anemia a severe blood condition

myalgia muscle pain