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1.  Drug Allergies and Implications for Dental Practice 
Anesthesia Progress  2013;60(4):188-197.
Adverse reactions to medications prescribed or administered in dental practice can be worrying. Most of these reactions are somewhat predictable based on the pharmacodynamic properties of the drug. Others, such as allergic and pseudoallergic reactions, are generally unpredictable and unrelated to normal drug action. This article will review immune and nonimmune-mediated mechanisms that account for allergic and related reactions to the particular drug classes commonly used in dentistry. The appropriate management of these reactions will also be addressed.
doi:10.2344/0003-3006-60.4.188
PMCID: PMC3891459  PMID: 24423421
Drug allergy; Drug side effects; Dentistry
2.  Antimicrobial Drugs 
Anesthesia Progress  2013;60(3):111-123.
Antibiotics play a vital role in dental practice for managing orofacial infections. They are used to manage existing infection and they are also used as prophylaxis for certain medical conditions and surgical procedures. This article will review pharmacological and therapeutic considerations for the proper use of these agents for dental infections.
doi:10.2344/0003-3006-60.3.111
PMCID: PMC3771199  PMID: 24010989
Antibiotics; Antifungals; Dental infections; Antibiotic prophylaxis
3.  Antithrombotic Drugs: Pharmacology and Implications for Dental Practice 
Anesthesia Progress  2013;60(2):72-80.
Appropriate preoperative assessment of the dental patient should always include an analysis of the patient's medications. This article reviews the actions and indications for the various categories of antithrombotic medications and considers actual risks for postoperative bleeding and potential interactions with drugs the dental provider might administer or prescribe.
doi:10.2344/0003-3006-60.2.72
PMCID: PMC3683884  PMID: 23763563
Drug interactions; Drug side effects; Antiplatelet drugs; Anticoagulants; Postoperative bleeding; Dental treatment
4.  Basic and Clinical Pharmacology of Glucocorticosteroids 
Anesthesia Progress  2013;60(1):25-32.
Glucocorticosteroids are a product of the adrenal cortex and perform a staggering number of physiological effects essential for life. Their clinical use is largely predicated on their anti-inflammatory and immunosuppressive properties, but they also have notable efficacy in the prophylaxis of postoperative nausea and vomiting. This article reviews the basic functions of glucocorticoids and their clinical use in dental practice.
doi:10.2344/0003-3006-60.1.25
PMCID: PMC3601727  PMID: 23506281
Glucocorticosteroid; Trauma; Postoperative swelling; PONV; Dentistry; Mucosal lesions
5.  Basic and Clinical Pharmacology of Autonomic Drugs 
Anesthesia Progress  2012;59(4):159-169.
Autonomic drugs are used clinically to either imitate or inhibit the normal functions of the sympathetic and parasympathetic nervous systems. A large number of additional drug classes also interact with these systems to produce a stunning number of possible side effects. This article reviews the basic function of the autonomic nervous system and the various drug classes that act within these neural synapses.
doi:10.2344/0003-3006-59.4.159
PMCID: PMC3522494  PMID: 23241039
Autonomic drugs; Sympathomimetics; Adrenergic agonists; Adrenergic antagonists; Cholinergic drugs; Anticholinergic drugs
6.  Pharmacokinetic Considerations for Moderate and Deep Sedation 
Anesthesia Progress  2011;58(4):166-173.
Moderate and deep sedation can be provided using several routes of drug administration including oral (PO), inhalation, and parental injection. The safety and efficacy of these various techniques is largely dependent on pharmacokinetic principles. This continuing education article will highlight essential principles of absorption, distribution, and elimination of commonly used sedative agents.
doi:10.2344/0003-3006-58.4.166
PMCID: PMC3237326  PMID: 22168806
Pharmacokinetics; Drug administration; Sedation
7.  Recognition and Management of Complications During Moderate and Deep Sedation. Part 2: Cardiovascular Considerations 
Anesthesia Progress  2011;58(3):126-138.
The risk for cardiovascular complications while providing any level of sedation or general anesthesia is greatest when caring for patients already medically compromised. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, providers must be prepared to manage untoward events should they arise. This continuing education article will review cardiovascular complications and address their appropriate management.
doi:10.2344/0003-3006-58.3.126
PMCID: PMC3167157  PMID: 21882989
Medical emergencies; Sedation; Anesthesia; Complications
8.  Nausea, Vomiting, and Hiccups: A Review of Mechanisms and Treatment 
Anesthesia Progress  2010;57(4):150-157.
Nausea, vomiting, and hiccups are troubling complications associated with sedation and general anesthesia. This article will review the basic pathophysiology of these events and current recommendations for their prevention and management.
doi:10.2344/0003-3006-57.4.150
PMCID: PMC3006663  PMID: 21174569
Nausea; Vomiting; PONV; Hiccups; Anesthetic complications; Antiemetics
9.  Preoperative Medical Evaluation: Part 2: Pulmonary, Endocrine, Renal, and Miscellaneous Considerations 
Anesthesia Progress  2009;56(4):135-145.
A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to provide sedation or general anesthesia as an adjunct to dental treatment. This article, the second of a 2-part sequence on preoperative assessment, will address pulmonary and other noncardiovascular disorders.
doi:10.2344/0003-3006-56.4.135
PMCID: PMC2796383  PMID: 20020794
Preoperative assessment; Medical history; Physical evaluation
10.  Preoperative Medical Evaluation: Part 1: General Principles and Cardiovascular Considerations 
Anesthesia Progress  2009;56(3):92-103.
A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to use sedation or general anesthesia as an adjunct to dental treatment. This article is the first of a 2-part sequence and will address general principles and cardiovascular considerations. A second article will address pulmonary, metabolic, and miscellaneous disorders.
doi:10.2344/0003-3006-56.3.92
PMCID: PMC2749585  PMID: 19769423
Preoperative assessment; Medical history; Physical evaluation
11.  Nitrous Oxide and the Inhalation Anesthetics 
Anesthesia Progress  2008;55(4):124-131.
Nitrous oxide is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably, but it may be combined with other inhalation and/or intravenous agents in deep sedative/general anesthestic techniques. However, as a single agent, it has impressive safety and is excellent for providing minimal and moderate sedation for apprehensive dental patients. To gain a full appreciation of the pharmacology, physiologic influences, and proper use of nitrous oxide, one must compare it with other inhalation anesthetics. The purpose of this CE article is to provide an overview of inhalation anesthetics in general and to address nitrous oxide more specifically in comparison.
doi:10.2344/0003-3006-55.4.124
PMCID: PMC2614651  PMID: 19108597
General anesthesia; Inhalation anesthetics; Nitrous oxide; Conscious sedation; Moderate sedation
12.  Local Anesthetics: Review of Pharmacological Considerations 
Anesthesia Progress  2012;59(2):90-102.
Local anesthetics have an impressive history of efficacy and safety in medical and dental practice. Their use is so routine, and adverse effects are so infrequent, that providers may understandably overlook many of their pharmacotherapeutic principles. The purpose of this continuing education article is to provide a review and update of essential pharmacology for the various local anesthetic formulations in current use. Technical considerations will be addressed in a subsequent article.
doi:10.2344/0003-3006-59.2.90
PMCID: PMC3403589  PMID: 22822998
Local anesthetics; Pharmacology; Drug toxicity; Dentistry
13.  Pharmacodynamic Considerations for Moderate and Deep Sedation 
Anesthesia Progress  2012;59(1):28-42.
Moderate and deep sedation can be provided using various classes of drugs, each having unique mechanisms of action. While drugs within a given classification share similar mechanisms and effects, certain classes demonstrate superior efficacy but added concern regarding safety. This continuing education article will highlight essential principles of pharmacodynamics and apply these to drugs commonly used to produce moderate and deep sedation.
doi:10.2344/0003-3006-59.1.28
PMCID: PMC3309299  PMID: 22428972
Pharmacodynamics; Drug actions; Drug mechanisms; Sedation
14.  Recognition and Management of Complications During Moderate and Deep Sedation Part 1: Respiratory Considerations 
Anesthesia Progress  2011;58(2):82-92.
The risk for complications while providing any level of sedation or general anesthesia is greatest when caring for patients having significant medical compromise. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, we must be prepared to manage untoward events should they arise. This continuing education article will review respiratory considerations and will be followed by a subsequent article addressing cardiovascular considerations.
doi:10.2344/0003-3006-58.2.82
PMCID: PMC3198131  PMID: 21679044
Medical emergencies; Sedation; Anesthesia; Complications
15.  Adverse Drug Interactions 
Anesthesia Progress  2011;58(1):31-41.
The potential for interactions with current medications should always be considered when administering or prescribing any drug. Considering the staggering number of drugs patients may be taking, this task can be daunting. Fortunately, drug classes employed in dental practice are relatively few in number and therapy is generally brief in duration. While this reduces the volume of potential interactions, there are still a significant number to be considered. This article will review basic principles of drug interactions and highlight those of greatest concern in dental practice.
doi:10.2344/0003-3006-58.1.31
PMCID: PMC3265267  PMID: 21410363
Drug interactions; CYP450; Drug potentiation; Drug synergism
16.  Pain Management: Part 1: Managing Acute and Postoperative Dental Pain 
Anesthesia Progress  2010;57(2):67-79.
Abstract
Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pain will be addressed in the second part of this series.
doi:10.2344/0003-3006-57.2.67
PMCID: PMC2886920  PMID: 20553137
Pain management; Analgesics; Postoperative pain; Dental pain
17.  Thermoregulation: Physiological and Clinical Considerations during Sedation and General Anesthesia 
Anesthesia Progress  2010;57(1):25-33.
Abstract
Mild hypothermia is common during deep sedation or general anesthesia and is frequently associated with patient discomfort and shivering. Greater declines in temperature can produce an even greater number of significant detrimental effects. This article reviews principles of thermoregulation and influences of anesthetic agents. An understanding of these will provide a foundation for strategies to reduce heat loss and better manage patient discomfort when it occurs.
doi:10.2344/0003-3006-57.1.25
PMCID: PMC2844235  PMID: 20331336
Sedation; General anesthesia; Thermoregulation; Hypothermia; Shivering
18.  Cardiovascular Monitoring: Physiological and Technical Considerations 
Anesthesia Progress  2009;56(2):53-60.
The American Dental Association and several dental specialty organizations have published guidelines that detail requirements for monitoring patients during various levels of sedation and, in some cases, general anesthesia. In general, all of these are consistent with those guidelines suggested by the American Society of Anesthesiologists Task Force for Sedation and Analgesia by Non-Anesthesiologists. It is well-accepted that the principal negative impact of sedation and anesthesia pertains to the compromise of respiratory function, but attentive monitoring of cardiovascular function is also important. While monitoring per se is a technical issue, an appreciation of its purpose and the interpretation of the information provided require an understanding of basic cardiovascular anatomy and physiology. The focus of this continuing education article is to address essential physiological aspects of cardiovascular function and to understand the appropriate use of monitors, including the interpretation of the information they provide.
doi:10.2344/0003-3006-56.2.53
PMCID: PMC2699693  PMID: 19642720
Monitoring; Cardiovascular; Electrocardiography; Plethysmography; Blood pressure; Sedation
19.  Respiratory Monitoring: Physiological and Technical Considerations 
Anesthesia Progress  2009;56(1):14-22.
The American Dental Association and several dental specialty organizations have published guidelines that detail requirements for monitoring patients during various levels of sedation and, in some cases, general anesthesia. In general, all these are consistent with those guidelines suggested by the American Society of Anesthesiologists for sedation and analgesia by nonanesthesiologists. It is well accepted that the principal negative impact of sedation and anesthesia is the compromise of respiratory function. While monitoring per se is a technical issue, an appreciation of its purpose and the interpretation of the information provided require an understanding of respiratory anatomy and physiology. The focus of this continuing education article is to address the physiological aspects of respiration and to understand the appropriate use of monitors, including the interpretation of the information they provide.
doi:10.2344/0003-3006-56.1.14
PMCID: PMC2662504  PMID: 19562888
Monitoring; Sedation; Capnography; Pulse oximetry
20.  Psychotropic Drugs: Implications For Dental Practice 
Anesthesia Progress  2008;55(3):89-99.
Appropriate preoperative assessment of dental patients should always include analysis of their medications. Psychiatric illnesses including panic/anxiety disorder, depression, psychoses, and manic disorders are prevalent within our society. An impressive number of drug formulations are prescribed for these disorders, and they introduce concern regarding side effects and possible drug interactions with medications the dentist may deem necessary for dental care. This article will address essential pharmacology of these psychotropic medications.
doi:10.2344/0003-3006(2008)55[89:PDIFDP]2.0.CO;2
PMCID: PMC2533641  PMID: 18788844
Preoperative assessment; Drug interactions; Drug side effects; Drug toxicity; Psychotropic drugs
21.  Cardiovascular Drugs: Implications for Dental Practice Part 2—Antihyperlipidemics and Antithrombotics 
Anesthesia Progress  2008;55(2):49-56.
Appropriate preoperative assessment of the dental patient should always include an analysis of the patient's medications. Cardiovascular diseases are the most common group of medical disorders that dentists encounter, and the number of drugs prescribed for managing these conditions is staggering. This justifiably raises concern and probable confusion regarding side effects and possible drug interactions with medications the dentist may deem necessary for dental care. This continuing education article is the second in a series that will address essential pharmacology of medications commonly prescribed for chronic medical care. A reasonable understanding of these agents will allow the dentist to better appreciate the medical status of their patients, to appreciate the actual risks associated with antithrombotic medications, and to avoid adverse interactions with drugs the dentist might administer or prescribe.
doi:10.2344/0003-3006(2008)55[49:CDIFDP]2.0.CO;2
PMCID: PMC2424016  PMID: 18547153
Preoperative assessment; Drug interactions; Drug side effects; Drug toxicity; Anticoagulants; Postoperative bleeding
22.  Cardiovascular Drugs: Implications for Dental Practice Part 1 — Cardiotonics, Diuretics, and Vasodilators 
Anesthesia Progress  2007;54(4):178-186.
Appropriate preoperative assessment of dental patients should always include analysis of their medications. Cardiovascular diseases are the most common group of medical disorders that dentists encounter, and the number of drugs prescribed for managing these conditions is staggering. This justifiably raises concern and probable confusion regarding side effects and possible drug interactions with medications the dentist may deem necessary for dental care. This continuing education article is the first in a series that will address essential pharmacology of medications commonly prescribed for chronic medical care. A reasonable understanding of these agents will allow the dentist to better appreciate the medical status of their patients and avoid adverse interactions with drugs they might administer or prescribe.
doi:10.2344/0003-3006(2007)54[178:CDIFDP]2.0.CO;2
PMCID: PMC2213250  PMID: 18085840
Preoperative assessment; Drug interactions; Drug side effects; Drug toxicity
23.  Management of Complications During Moderate and Deep Sedation: Respiratory and Cardiovascular Considerations 
Anesthesia Progress  2007;54(2):59-69.
The risk for complications while providing moderate and deep sedation is greatest when caring for patients already medically compromised. It is reassuring that significant untoward events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, we must be prepared to manage untoward events should they arise. This continuing education article will review critical aspects of patient management of respiratory and cardiovascular complications.
doi:10.2344/0003-3006(2007)54[59:MOCDMA]2.0.CO;2
PMCID: PMC1893095  PMID: 17579505
Medical emergencies; Sedation; Anesthesia; Complications
24.  Drug Therapy in Dental Practice: General Principles 
Anesthesia Progress  2007;54(1):19-24.
The fundamental principles that govern drug therapy are often overlooked by the busy clinician. This disregard frequently results in the use of particular drugs and regimens that may be less ideal for the clinical situation being managed. By convention, these principles are categorized as pharmacokinetic and pharmacodynamic. Pharmacokinetic processes include drug absorption, distribution, biotransformation (metabolism), and elimination—essentially reflecting the influence of the body on the drug administered. These principles were addressed in the preceding issue of this journal. Pharmacodynamics deals with the actual mechanisms of action and effects a drug produces on the patient and is the topic for this continuing education article.
doi:10.2344/0003-3006(2007)54[19:DTIDPG]2.0.CO;2
PMCID: PMC1821133  PMID: 17352523
Drug therapy; Pharmacodynamics; Dental pharmacology
25.  Drug Therapy in Dental Practice: General Principles 
Anesthesia Progress  2006;53(4):140-146.
The fundamental principles that govern drug therapy are often overlooked by the busy clinician. This disregard frequently results in the use of particular drugs and regimens that may be less than ideal for the clinical situation being managed. By convention, these principles are categorized as pharmacokinetic and pharmacodynamic. Pharmacokinetic processes include drug absorption, distribution, biotransformation (metabolism), and elimination, essentially reflecting the influence of the body on the drug administered. Pharmacodynamics deals with the actual mechanisms of action and the effects a drug produces on the patient. This latter topic will be addressed in a future continuing education article.
doi:10.2344/0003-3006(2006)53[140:DTIDPG]2.0.CO;2
PMCID: PMC1705829  PMID: 17177593
Drug therapy; Pharmacokinetics; Dental pharmacology

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