1. Identify Medical Conditions Necessitating The Drug And Its Potential Impact On The Provision Of Dental Care د . اياد أبو ربيع

5. Potential drug related oral health/management complications. Delayed healing, mucositis, fungal infections Vincristine Chemotherapeutic agents Increase risk of bacterial and fungal infection, poor stress response Corticosteroids* Immunosuppressants for organ transplants* Immunosuppressants Excessive bleeding Aspirin, Warfarin* Anticoagulants Management Problems Example Drugs Drug Groups

6. Potential drug related oral health/management complications. Delayed bone healing, bone necrosis Pamidronate (Aredia) Alendronate (Fosmax) Bisphosphonate bone stabilizers Hypoglycemia Insulin*, sulfonylureas Hypoglycemics Respiratory suppression, fall risk Tylenol, Valium, Demerol Sedative hypnotics*, narcotics, barbiturates Management Problems Example Drugs Drug Groups

8. Natural products that may alter dental management These herbs inhibit liver enzymes so they may potentiate the liver enzyme (cytochrome P450) inhibiting the effect of erythromycin and ketokonazole. Echinacea St. John’s Wort May increase bleeding Feverfew Garlic , Ginger Ginko Biloba Bilberry Dong Quai St. John’s Wort Possible Dentally Relevant Problem Compound

9. Natural products that may alter dental management May potentiate the effects of sedative Hypnotics and anti-anxiety drugs Valerian Hepatotoxicity, especially in those taking other medications metabolized in the liver. Sedative effects. Kava-Kava May increase blood pressure and heart rate due to anxiety or if epinephrine/vasoconstrictor used. Ephedra (Ma-Huang) Bitter orange Possible Dentally Relevant Problem Compound

19. Guidelines for compromised renal or hepatic function If greater than 4 times normal, do not use drugs that are toxic to or metabolized by the liver 30-40 u/l AST, ALT, liver transaminases Acetaminophen Codeine Diazepam Erythromycin Ibuprofen Ketoconazole Lidocaine Lorazepam Prednisone Hepatic One dose q 24 hrs One dose q 8-12 hours One dose q 8 hours <10 ml/min 10-50 ml/min >50 ml/min GFR (Creatinine Clearance) Amoxicillin Cephalosporin Penicillin Tetracycline Renal Margin of safety for dental prescribing Range Lab test Examples of dental drugs eliminated Potential impairment

24. Dealing with Patients of advanced age Renal Elimination Fluconazole Antifungal Amoxicillin Cephalosporin Tetracycline Antibiotic Drug Drug class

25. Dealing with Patients of advanced age Hepatic Elimination Diazepam Lorazepam Sedative/anxiolytic Lidocaine Local anesthetic Erythromycin Antibiotic Ibuprofen Pain reliever Drug Drug class

26. Dental Toxicology HEAVY METALS AND ANTIDOTES

27. HEAVY METALS AND ANTIDOTES

32. Lead Mechanisms of toxicity