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Explain the MOI b/w non-cardioselective beta-blockers and epi
- Alpha 1 ag: vasocon
- Beta 1 ag: cardiac +
- Beta 2 ag: vasodil
- *w/non-selective beta-blocker, beta-ag is blocked leaving unopposed alpha-1 reflex inc. in vagal tone, HTN
- *Limit epi to .04mg/2hr visit
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Discuss the MOI b/w oral contraceptives and systemic antibiotics
- Estrogens from BCP's are conjugated in liver and secreted into intestine where normally intestinal bacteria cleave the conjugate so that free estrogen can be reabsorbed
- Antibiotics dec. the # of intestinal bacteria and therefore dec. plasma estrogen concentrations
- *Note: progesterone does not interact with dental antibiotics
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List significant interactions w/NSAIDS
- Anticoagulants (Warfarin = 2 AVOID, coumadin)- inc. risk of bleeding disorders in anticoag. pt
- Antihypertensives (ACE -,etc)- dec. anti-HTN effect, monitor BP
- Lithium carbonate- inc. lithium levels, use sulindac
- Methotrexate- toxicity may be inc., monitor
- Salicylates- dec NSAID levels w/inc GI effecs, AVOID CONCURRENT USE
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List significant interactions w/epi
- TCA (high dose only) -inc sympathomimetic effects, limit epi to 0.04mg
- Non-cardioselective beta-blockers (3)- HTN and cardiac rxn possible
- Alpha-1 blocking antipsychotics
- MAOI- slight possibility of HTN rxn
- COMT - (for parkinson's disease)- slight possibility of HTN rxn
- *Epi+alpha-1, beta-1, beta-2 agonist = min change in MAP & mild inc in HR
- *Epi+beta-blocker = HTN, inc vagal tone
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Explain why macrolides and azole antifungals have so many drug interactions
- They are potent INHIBITORS of CYP3A4 which is responsible for probably the highest number of biotransformation rxns
- Ex: Fluconozole/OC - can dec OC effectiveness due to dec in estrogen
- Metronidazole/alcohol -can lead to food poisoning type effects
- Clarithromycin/CCBs -QT interval elongation-->sudden death
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Clinical screening for drug interactions in dentistry
- Category 1: avoid concomitant use
- Category 2: avoid if alternative is available and if used, close monitoring
- Category 3: avoid if alternative is available and if used, some monitoring
- Category 4: potential for harm is low so drug combo CAN be used
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