P1:SFL Printer:R.R.DonnelleyChina LWBK088-FM Pickett-3870G LWBK088-Pickett.cls July1,2008 13:27 ii P1:SFL Printer:R.R.DonnelleyChina LWBK088-FM Pickett-3870G LWBK088-Pickett.cls July1,2008 13:27 Basic Principles of Pharmacology with Dental Hygiene Applications i LWBK942-FM.qxd 6/25/11 8:45 AM Page x P1:SFL Printer:R.R.DonnelleyChina LWBK088-FM Pickett-3870G LWBK088-Pickett.cls July1,2008 13:27 Basic Principles of Pharmacology with Dental Hygiene Applications Frieda Atherton Pickett, RDH, MS DentalHygieneEducator,Author,Lecturer FormerAssociateProfessor,CaruthSchoolofDentalHygiene TexasA&MBaylorCollegeofDentistry Dallas,Texas Ge´za T. Tere´zhalmy, DDS, MA EndowedProfessorinClinicalDentistry DentalSchoolProfessor,DepartmentofPharmacology GraduateSchoolofBiomedicalSciences TheUniversityofTexasHealthScienceCenteratSanAntonio SanAntonio,Texas ProfessorandDeanEmeritus SchoolofDentalMedicine CaseWesternReserveUniversity Cleveland,Ohio iii P1:SFL Printer:R.R.DonnelleyChina LWBK088-FM Pickett-3870G LWBK088-Pickett.cls July1,2008 13:27 AcquisitionsEditor:JohnGoucher ManagingEditor:JenniferWalshandJessicaSchultheis MarketingManager:ZhanCaplan ProductionEditor:PaulaC.Williams Designer:StephenDruding (cid:2)r ProductionServices:Aptara Copyright(cid:2)c 2009byLippincottWilliams&Wilkins,aWoltersKluwerbusiness. 351WestCamdenStreet 530WalnutStreet Baltimore,MD21201 Philadelphia,PA19106 PrintedinChina Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedor transmittedinanyformorbyanymeans,includingasphotocopiesorscanned-inorotherelectronic copies,orutilizedbyanyinformationstorageandretrievalsystemwithoutwrittenpermissionfrom thecopyrightowner,exceptforbriefquotationsembodiedincriticalarticlesandreviews.Materials appearinginthisbookpreparedbyindividualsaspartoftheirofficialdutiesasU.S.government employeesarenotcoveredbytheabove-mentionedcopyright.Torequestpermission,pleasecontact LippincottWilliams&Wilkinsat530WalnutStreet,Philadelphia,PA19106,viaemailat [email protected],orviawebsiteatlww.com(productsandservices). 987654321 LibraryofCongressCataloging-in-PublicationData Pickett,FriedaAtherton. Basicprinciplesofpharmacologywithdentalhygieneapplications/FriedaAthertonPickett, Ge´zaT.Tere´zhalmy.—1sted. p.;cm. Includesbibliographicalreferencesandindex. ISBN978-0-7817-6536-7 1.Dentalpharmacology. 2.Pharmacology. 3.Dentalhygiene. I.Tere´zhalmy,G.T.(Ge´zaT.) II.Title. [DNLM:1.PharmaceuticalPreparations. 2.DentalHygiene. 3.DrugTherapy. QV55 P597b2009] RK701.P622009 617.6(cid:2)01–dc22 2008024240 DISCLAIMER Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentandtodescribegenerally acceptedpractices.However,theauthors,editors,andpublisherarenotresponsibleforerrorsor omissionsorforanyconsequencesfromapplicationoftheinformationinthisbookandmakeno warranty,expressedorimplied,withrespecttothecurrency,completeness,oraccuracyofthe contentsofthepublication.Applicationofthisinformationinaparticularsituationremainsthe professionalresponsibilityofthepractitioner;theclinicaltreatmentsdescribedandrecommended maynotbeconsideredabsoluteanduniversalrecommendations. Theauthors,editors,andpublisherhaveexertedeveryefforttoensurethatdrugselectionand dosagesetforthinthistextareinaccordancewiththecurrentrecommendationsandpracticeatthe timeofpublication.However,inviewofongoingresearch,changesingovernmentregulations,and theconstantflowofinformationrelatingtodrugtherapyanddrugreactions,thereaderisurgedto checkthepackageinsertforeachdrugforanychangeinindicationsanddosageandforadded warningsandprecautions.Thisisparticularlyimportantwhentherecommendedagentisanewor infrequentlyemployeddrug. SomedrugsandmedicaldevicespresentedinthispublicationhaveFoodandDrug Administration(FDA)clearanceforlimiteduseinrestrictedresearchsettings.Itistheresponsibility ofthehealthcareprovidertoascertaintheFDAstatusofeachdrugordeviceplannedforuseintheir clinicalpractice. Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat(800)638-3030 orfaxordersto(301)223-2320.Internationalcustomersshouldcall(301)223-2300. VisitLippincottWilliams&WilkinsontheInternet:http://www.lww.com.LippincottWilliams& Wilkinscustomerservicerepresentativesareavailablefrom8:30amto6:00pm,EST. iv P1:SFL Printer:R.R.DonnelleyChina LWBK088-FM Pickett-3870G LWBK088-Pickett.cls July1,2008 13:27 Todentalhygienestudentswhorequiretextbookinformationtobeclinicallyrelevant. Fordentalhygienefacultywhoappreciateaclearlywordedpresentationofbasic informationandmaterialstoassistintheeducationalprocess. F.A.P. G.T.T. v P1:SFL Printer:R.R.DonnelleyChina LWBK088-FM Pickett-3870G LWBK088-Pickett.cls July1,2008 13:27 vi P1:SFL Printer:R.R.DonnelleyChina LWBK088-FM Pickett-3870G LWBK088-Pickett.cls July1,2008 13:27 PREFACE The primary goals of this textbook are to present up-to- tothemafteradministration,rulesforprescribingdrugsand date pharmacologic principles in an easy-to-read language informationonprescriptionlabelsrelevanttothedentalhy- while identifying applications of the information to every- gienist,autonomicpharmacology,andadversedrugeffects. (cid:2) daylifeofdentalhygienepractice.Theuniqueauthorteam Drugs Used in the Provision of Oral Healthcare ofFriedaPickett,RDH,MS,adentalhygieneeducator,and includes pharmacologic properties of local anesthetics, Ge´zaTere´zhalmy,DDS,MA,ProfessorofOralMedicineand various topical products used or recommended by the Pharmacology, have developed a text that coordinates prin- dental hygienist, analgesic agents recommended or ciplesofpharmacologywithpathophysiologyandidentifies prescribed for oral pain, antibacterial agents and the applications to the oral health treatment plan and treatment relevance to dentistry, antifungal and antiviral drugs recordinformation. and the relevance to dentistry, drugs used for conscious Previoustextsonthistopichavenotbeendirectlyrelevant sedation and general anesthesia, emergency drugs, and to clinical uses of pharmacologic information in dental hy- pharmacologic management of common oral conditions. gienepractice,whereasthistextbookincludesseveraluseful Clinical application activities in these chapters focus on subjectsthatarenotfoundinotherpharmacologytextbooks productselectionandusesfordentalhygieneprocedures. (cid:2) fordentalhygienestudents.Thisinformationincludes: Drugs Used to Control Systemic Disorders describes (cid:2) thediseaseconditionandagentsusedtomanagesignsand a chapter dealing specifically with adverse drug effects symptoms. Clinical implications are highlighted as each (Chapter5) (cid:2) chapterendswithadiscussionofdentalhygieneapplica- a chapter dealing with substance abuse, which includes tionsrelevanttothemedicalconditionordrugeffects. sources for assisting the oral health professional with a (cid:2) DrugsUsedbySpecialPopulationsincludessignificant substanceabuseproblem(Chapter23) (cid:2) information relevant to clinical considerations of clients a chapter discussing herbal products used in oral care inthesecategorieswhentheypresentfororalhealthcare. (Chapter20) (cid:2) Agentsusedindentistryarehighlightedinthechapteron an eight-page color insert containing clinical images of herbal supplements, and sources for helping individuals adversedrugeffects (cid:2) seektreatmentforsubstanceabuseisdiscussedinChapter informationonCanadianregulatoryagencies 23. Special considerations for the pregnant client are Thetextemphasisisondrugproductsthatarelikelytobe highlightedinthissection. administeredbydentalhygienistsortakenbydentalpatients. Detailedinformationonproductselectionisdiscussedinthe chaptersdealingwithlocalandtopicalanesthetics,fluorides, FEATURES anddesensitizingagents.Attentionispaidtotheuseofdental drugs in special populations, such as during pregnancy and lactation,orinclientstakingmedicationstocontroltheeffects BasicPharmacologywithDentalHygieneApplicationscon- of common chronic diseases. Because dental hygienists do tainsthefollowingelementsthataregearedtowardpracticing notwriteprescriptions(otherthaninoneprovinceofCanada), dentalhygienistsandthedentalhygienestudent: less emphasis is given to pharmacokinetics of various drug (cid:2) Key terms are bolded throughout the textbook, and the classificationsthanisfoundinothertextbooks. definitionsofthesetermsaresummarizedoneachchapter’s This textbook can be used in conjunction with the same openingpageandintheglossary. authorteam’sDentalDrugReferencewithClinicalImplica- (cid:2) Self-study review questions follow each major division tions,publishedin2008,whichincludesdetailedinformation withinthechapterstoidentifyandreinforcemainconcepts onclinicalconsiderationsforthedentalprofessional. beforecontinuingwiththereading.Thissectionalsopro- videsaguidelinefortestpreparationasfacultytestitems aredevelopedfromtheself-studyitems. ORGANIZATIONAL PHILOSOPHY (cid:2) Boxessummarizedentalhygieneapplicationsofthechap- terinformation. (cid:2) Clinical application exercises at the end of each chap- Thetextisorganizedintofourparts: terarerelatedtodentalhygieneservices,includingissues (cid:2) GeneralPrinciplesofPharmacologyincludesgeneralin- that would be addressed by the dental hygienist as part formationaboutdrugs,howdrugsworkandwhathappens ofthedrughistoryreviewanddeterminationoftreatment vii P1:SFL Printer:R.R.DonnelleyChina LWBK088-FM Pickett-3870G LWBK088-Pickett.cls July1,2008 13:27 viii Preface (cid:2) planmodifications.Theseexerciseslinkwhatthestudent Aglossaryofkeytermsfoundthroughoutthetextandtheir islearningtowhatactuallyhappensinpractice.Whenap- definitions. (cid:2) propriate,Web-basedactivitiesareincluded.Fordrugcard Anappendixwithanswerstotheclinicalapplicationex- information,authorsdirectthereadertouseadentaldrug ercises referencetextfordruginvestigation. Instructor Resources Inadditiontothestudentresources,anInstructor’sResource ART Center at http://thePoint.lww.com/pickett includes the fol- lowing: (cid:2) Figuresassistinunderstandingofconceptsareincluded. (cid:2) ATestGeneratorwith770multiple-choicequestions (cid:2) Coloredclinicalimagesareprovidedtoillustratetheap- (cid:2) PowerPointpresentationsintheformoflectureoutlines pearanceofadversedrugeffectswithintheoralcavity. (cid:2) AnImageBankcontainingallfiguresandtablesfoundin thetextbook STUDENT AND INSTRUCTOR RESOURCES Student Resources A Student Resource Center at http://thePoint.lww.com/ pickettincludesthefollowingmaterialsfromthetext: