Clinical Drug Classifications and Dental Pharmacology Notes

Antidepressant Drugs

• Tricyclic Antidepressants (TCAs): Ending in -line or -mine
• Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine, Paroxetine, Citalopram, Fluvoxamine, Sertraline, Nefazodone
• Monoamine Oxidase Inhibitors (MAOIs): Phenelzine, Moclobemide

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

1. Salicylic Acid Derivatives: Aspirin, Diflunisal, Fosfosal (+ codeine for dentalgia)
2. Acetic Acid Derivatives: Indomethacin, Tolmetin, Ketorolac, Diclofenac
3. Propionic Acid Derivatives (Widely used in dentistry): Naproxen, Ketoprofen, Ibuprofen
4. Nicotinic Acid Derivatives: Clonixinate lysine
5. Oxicam Derivatives: Piroxicam
6. Pyrazolones: Dipyrone (Metamizole)
7. Selective COX-2 Inhibitors: Rofecoxib, Celecoxib

Glucocorticoids

• First Generation: Cortisone, Prednisone, Prednisolone
• Second Generation: Triamcinolone, Dexamethasone, Betamethasone
• Third Generation: Deflazacort
• In Odontology (ODN): Betamethasone or Dexamethasone (administered IM or IV); Intra-articular (Prednisolone or Dexamethasone); Local application (Betamethasone).

Local Anesthetics

• Amino Esters (Short duration): Cocaine, Procaine, Tetracaine, Benzocaine
• Amino Amides (Long-acting): Lidocaine, Mepivacaine, Prilocaine, Etidocaine, Bupivacaine, Ropivacaine

Antibiotics

Cell-Wall Synthesis Inhibitors

1. Beta-Lactams: Penicillins, Cephalosporins, Monobactams, Carbapenems
2. Glycopeptides: Vancomycin

Protein Synthesis Inhibitors

1. Tetracyclines: Alternative for beta-lactam allergies. Doxycycline is indicated for periodontitis and scaling/root planing. Note: Causes dental hypoplasia and permanent yellow staining in children.
2. Chloramphenicol: Used in conditions such as typhoid fever and meningitis; side effects include Gray baby syndrome.
3. Macrolides: Active against Gram-positive bacteria and Streptococcus. Alternative drug of choice in penicillin allergies. Indicated in acute pulpitis, periodontal abscess, and maxillary sinusitis.
   • Erythromycin: 14-atom lactone ring, inhibits cytochrome P450, increases digoxin levels.
   • Azithromycin: 15-atom ring, active against Gram-negative bacteria and oral anaerobes; macrolide of choice (3-day regimen).
   • Spiramycin: 14-atom lactone ring.
4. Lincosamides: Clindamycin (effective against anaerobes with high bone tissue penetration capacity).
5. Aminoglycosides: Active against Gram-negative aerobes; used for Enterobacteriaceae infections, tuberculosis, and brucellosis. Side effects include ototoxicity and nephrotoxicity.
   • Streptomycin: Tuberculosis, meningitis (IM administration)
   • Neomycin: Severe digestive tract infections
   • Spectinomycin: Gonococcal infections
   • Gentamicin: The most widely used

DNA Synthesis Inhibitors

1. Quinolones: Indicated for skin infections; not commonly used in odontology (e.g., Nalidixic acid, fluoroquinolones ending in -floxacin).
2. Nitroimidazoles: Active against anaerobes; used in periodontitis, scaling and root planing, and acute necrotizing ulcerative gingivitis (ANUG/GUNA). Examples: Metronidazole, Tinidazole, Ornidazole.
3. Rifampicin: Meningitis prophylaxis.

Folic Acid Synthesis Inhibitors

1. Sulfonamides: Used for respiratory and urinary tract infections. Can cause crystalluria and systemic digestive disorders. Examples: Sulfamethoxazole, Sulfasalazine (intestinal tract).
2. Trimethoprim