medications with interactions

Question 1

What type of drug is nifedipine?

Answer 1

Calcium channel blocker which can be used as an antihypertensive agent.

Question 2

What are calcium channel blockers used for?

Answer 2

To treat conditions of the heart and blood vessels (e.g: hypertension, angina, arrhythmias and Raynaud’s).

Question 3

What are the oral manifestations of calcium channel blockers?

Answer 3

Gingival hyperplasia.

Question 4

What type of drug is amitriptyline?

Answer 4

A tricyclic antidepressant.

Question 5

What is amitriptyline used for?

Answer 5

1. antidepressants
2. muscle relaxant when used in low doses for cases of TMJ or back pain.

Question 6

What type of oral manifestation do tricyclic antidepressants cause?

Answer 6

Xerostomia

Question 7

What oral complications can be caused by amoxicillin?

Answer 7

1. Candidiasis due to being a broad-spectrum antibiotic (disrupts the microbiome, favouring the fungal pathogens in the mouth).
2. Antibiotic sore mouth.
3. GI upset.

Question 8

What type of drug is penicillamine?

Answer 8

An anti-rheumatic drug.

Question 9

What kind of reaction does penicillamine cause?

Answer 9

Lichenoid Reaction

Question 10

What type of drug is carbamezapine?

Answer 10

Anticonvulsant

(anti-epileptic drug)

Question 11

What potential complications arise due to long term carbamazepine use?

Answer 11

Liver dysfunction (long term use pts should have regular liver function tests as it can cause drug-induced liver failure).

Question 12

What type of drug is phenytoin?

Answer 12

Anticonvulsant

Question 13

What oral complication can arise due to phenytoin use?

Answer 13

Gingival Hyperplasia and drowsiness.

Question 14

What rare complication can be caused by phenytoin and is especially seen in children?

Answer 14

Steven-Johnson Syndrome (flu-like symptoms).

Question 15

What type of medications cause gingival hyperplasia?

Answer 15

1. Calcium Channel Blockers (e.g: nifedipine, amlodipine)
2. Immunosuppressants (e.g: cyclosporine for transplant pts)
3. Anticonvulsants (e.g: phenytoin and sodium valproate)

Question 16

What types of medications can cause xerostomia?

Answer 16

Selective Serotonin Reuptake Inhibitors
&
Tricyclic Antidepressants

Question 17

What is the main type of medication that can cause candidiasis?

Answer 17

Corticosteroids

Question 18

What type of chemical should be avoided in patients with asthma?

Answer 18

Colophony (found in fluoride varnish).

Question 19

What type of medication should be avoided in patients who are taking statins?

Answer 19

Azole antifungals (e.g: miconazole, fluconazole)

Question 20

Explain the interactions between statins and azole fungals.

Answer 20

Azoles are CYP3A4 inhibitors which interacts with the mechanism of action (pharmacokinetics) for statins which are CYP3A dependent.

The interaction produces toxicity (e.g: rhabdomyolysis - destruction of striated muscle cells).

Question 21

How might bisphosphinate use interfere with treatment (e.g: extractions)?

Answer 21

Potential to cause medication-related osteonecrosis of the jaw.

Prevents successful healing after XLA - sequestra comes off (fragments of bone) which delays the socket from healing.

Question 22

When would a patient be prescribed bisphosphinates?

Answer 22

1. Multiple Fractures (on older pts).
2. Cancer treatment - to strengthen bone.
3. Paget’s Disease (bone enlargement causing weakness, skull most commonly affected so can show on OPGs)
4. Osteoporosis

Question 23

When are bisphosphinates given?

Answer 23

For osteoporosis - reduce bone resorption by stopping the formation, recruitment and function of osteoclasts.

Question 24

Where do bisphosphinates accumulate?

Answer 24

At sites of high bone turnover (e.g: the jaw).

Question 25

What effect do bisphosphinates have on bone?

Answer 25

Reduced blood supply which can lead to death of the bone (osteonecrosis).

Question 26

What kind of treatment should be avoided if a patient is on bisphosphinates?

Answer 26

Extractions or any treatment that has an impact on bone.