OSC-4 Three Adverse Drug Reactions Every Endodontist Needs to Know
CE: 0
Course Description:
Patients with complex medical and drug histories are becoming more commonplace in dental practice. This article reviews three serious adverse drug interactions that are well supported by the literature and can impact endodontic practice. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the renal excretion of lithium and lead to lithium toxicity. Metronidazole and fluconazole inhibit the metabolism of warfarin by blocking cytochrome P-450 2C9 (CYP-2C9), the major metabolic pathway of warfarin, with the result being dramatic increases in patients’ international normalized ratios (INRs) and potentially fatal bleeding. Propranolol and other nonselective beta-adrenergic blocking agents can inhibit the vasodilatory effect of epinephrine in dental local anesthetic solutions, leading to hypertensive reactions and a concomitant reflex bradycardia. It is important for clinicians to recognize and avoid these serious drug interactions. By doing so, they will provide the safest and best treatment for their patients.
At the conclusion, participants should be able to:
- Discuss the pharmacological mechanism behind the potentially lethal metronidazole or fluconazole/warfarin interaction.
- Identify which class of anti-hypertensive drugs where high doses but therapeutic doses of local anesthetic plus epinephrine is most likely to cause a pressor reaction with a reflex bradycardia.
- Discuss the rationale of why ibuprofen (Advil®) and naproxen sodium (Aleve®) should be avoided in a bipolar disorder patient taking lithium (Eskalith®).
Key:
Complete
Next
Failed
Available
Locked
Elliot V. Hersh, D.MD, M.S., Ph.D
Dr. Elliot V. Hersh is currently a professor of pharmacology/oral surgery at the University of Pennsylvania School of Dental Medicine. He received his D.M.D. degree from New Jersey Dental School UMDNJ in 1981 and his M.S. and Ph.D. degrees from UMDNJ – Graduate School of Biomedical Sciences in 1983 and 1988 respectively. Since arriving at the University of Pennsylvania in 1988, Dr. Hersh has won the Dental School’s Excellence in the Teaching of Basic Science Award 22 different times and was also presented with a University Lindback Award in 1993, the highest teaching honor in the entire university. He has published more than 150 scientific articles, abstracts and book chapters in the areas of dental pharmacology, drug interactions, analgesics and local anesthetics. His scholarly and research contributions in the areas of local anesthesia and pain control were recognized by the International Association of Dental Research in 2007 when he was presented with the Distinguished Scientist Award in Pharmacology, Therapeutics and Toxicology. “While the research accolades are nice, the most important thing I do is sharing this knowledge with my students and other dental professionals."
Disclosure
In accordance with this policy, I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated below: Bayer Pharmaceutical (Grant/Research Support).
Elliott V.. Hersh, D.MD, M.S., Ph.D
I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated: C3 Jian (Self) : Grant/Research Support (Status: Terminated --- 11/2016); Cetylite Inc (Self) : Grant/Research Support (Status: Terminated --- 6/18); Charelston Laboratories (Self) : Grant/Research Support (Status: Terminated --- 3/2015); NIH (Self) : Grant/Research Support (Status: Ongoing); Pfizer Consumer Healthcare (Self) : Grant/Research Support (Status: Terminated --- 05/2016); Septodont Inc. (Self) : Grant/Research Support (Status: Terminated --- 6/2014); St Renatus (Self) : Grant/Research Support (Status: Terminated --- 3/2015); University of Pennsylvania Institute of Precision Medicine (Self) : Grant/Research Support (Status: Ongoing)
