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Basic Principles of Pharmacology
with Dental Hygiene Applications
i
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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
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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.
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iv
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Todentalhygienestudentswhorequiretextbookinformationtobeclinicallyrelevant.
Fordentalhygienefacultywhoappreciateaclearlywordedpresentationofbasic
informationandmaterialstoassistintheeducationalprocess.
F.A.P.
G.T.T.
v
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vi
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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
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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:
