Tooth Center » CHLORAL HYDRATE

CHLORAL HYDRATE

January 25th, 2009 by admin

M = Available in Canada bold italic = life-threatening side effect

g/m2) at bedtime (up to 1 g may be

given as a single dose).

Daytime sedative.

Pediatric: 8.3 mg/kg (250 mg/m2)

up to a maximum of 500 mg t.i.d. after

meals.

Premedication prior to EEG procedures.

Pediatric: 20–25 mg/kg.

• Suppositories, Rectal

Daytime sedative.

Adults: 325 mg t.i.d. Pediatric: 8.3

mg/kg (250 mg/m2) t.i.d.

Hypnotic.

Adults: 0.5–1 g at bedtime. Pediatric:

50 mg/kg (1.5 g/m2) at bedtime (up

to 1 g as a single dose).

DENTAL CONCERNS

General

1. A semisupine position for the

dental chair may be necessary to

help minimize or avoid adverse GI effects.

2. Mix the liquid in fruit juice or

punch in order to mask the unpleasant

taste and minimize adverse GI

effects.

3. This drug is contraindicated in

patients with peptic ulcer disease.

4. There is a risk for physical and

psychological dependence with

chronic use.

Client/Family Teaching

1. Avoid activities that require mental

alertness. Have someone drive

you to and from your appointment.

Chlorhexidine gluconate

C[hlokrhexlidoine grluc-onHate EX i-deen]

Pregnancy Category: B

PerioGard

Classification: Anti-infective oral rinse

Action/Kinetics: Chorhexidine is

absorbed onto the tooth surface,

dental plaque, and oral mucosa allowing

for a sustained reduction of

plaque organisms. Poorly absorbed

orally, 30% retained in the oral cavity

and slowly released.

Uses: Treatment of gingivitis between

dental visits. Non-FDA Approved

Uses: Acute aphthous ulcers,

denture stomatitis.

Contraindications: Hypersensitivity.

Special Concerns: Efficacy not established

in children < 18 years of age,

lactation, not intended for periodontitis.

Side Effects: Oral: Altered sense of

taste, increased calculus formation,

staining of teeth, tongue, and restorations,

mucosal desquamation and irritation,

transient parotitis.

Drug Interactions

Alcohol / ↑ Chance of disulfiramlike

reaction

Disfulfiram / ↑ Chance of disulfiram-

like reaction

Metronidazole / ↑ Chance of disulfiram-

like reaction

How Supplied: Oral rinse: 0.12%

Dosage –––––––––––––––––––––––––––––––

• Oral rinse

Gingivitis.

Adults: Rinse with 15 mL for 30 seconds

b.i.d. after brushing and flossing

teeth, then expectorate.

Denture stomatitis.

Soak dentures for 1 to 2 min b.i.d.

Have the patient follow the oral

rinse instructions.

DENTAL CONCERNS

General

1. Patients require dental examination

and prophylaxis/scaling/root

planing prior to the rinse.

2. Patients require frequent visits

due to oral side effects.

3. The medication may not be appropriate

for patients with anterior

facial restorations with rough surfaces

or margins.

Client/Family Teaching

1. Patients should be instructed to

eat, brush, and floss prior to using the

rinse.

2. Do not rinse with water after using

the rinse.

3. Inform patients of the oral side

effects of this drug.

Chlorpheniramine maleate

C[hlokrphelnoiraminre -mafleeate n-EAR-ah-meen]

Pregnancy Category: B

Syrup, Tablets, Chewable Tablets:

Aller-Chlor, Allergy, Chlo-Amine,

156 CHLORAL HYDRATE

Chlor-Trimeton Allergy 4 Hour, Chlor-

Tripolon M [OTC], Extended-release

Tablets: Chlor-Trimeton 8 Hour and 12

Hour [OTC], Injectable: Chlorpheniramine

maleate [Rx]

Classification: Antihistamine, alkylamine

type

See also Anti-Infectives.

Action/Kinetics: Related chemically

to nalidixic acid. Acts by inhibiting

DNA replication, resulting in a bactericidal

action. Rapidly absorbed after

PO administration; a 500-mg dose

results in a urine concentration of

300 mcg/mL during the first 4-hr period

and 100 mcg/mL during the

second 4-hr period. Within 24 hr,

97% is excreted in the urine, 60%

unchanged. Mean serum t1/2: 1.5 hr.

Food decreases peak serum levels

by approximately 30% but not the

total amount absorbed.

Uses: Initial and recurrent UTIs

caused by Escherichia coli, Proteus

mirabilis, P. vulgaris, Klebsiella, and

Enterobacter species. Prevents UTIs

for up to 5 months in women with a

history of UTIs. NOTE: Cinoxacin is ineffective

against Pseudomonas,

staphylococci, and enterococci infections.

Prophylaxis of UTIs.

Contraindications: Hypersensitivity

to cinoxacin or other quinolones.

Infants and prepubertal children.

Anuric clients. Lactation.

Special Concerns: Use with caution

in clients with hepatic or kidney

disease. Safety and efficacy in children

less than 18 years of age have not

been determined.

Side Effects: GI: N&V, anorexia, abdominal

cramps and pain, diarrhea, altered

sensation of taste. CNS: Headache,

dizziness, insomnia, drowsiness,

confusion, nervousness.

Hypersensitivity: Rash, pruritus, urticaria,

edema, angioedema, eosinophilia,

anaphylaxis (rare), toxic epidermal

necrolysis (rare), erythema multiforme,

Stevens-Johnson syndrome.

Other: Tingling sensation, photophobia,

perineal burning, tinnitus,

thrombocytopenia.

Drug Interactions: Probenecid / ↓

Excretion of cinoxacin → ↓ concentration

in the urine.

How Supplied: Capsule: 250 mg,

500 mg

Dosage –––––––––––––––––––––––––––––––

• Capsules

UTIs.

Adults: 1 g/day in two to four divided

doses for 7–14 days. In clients

with impaired renal function: Initial,

500 mg; then, dosage schedule

based on creatinine clearance (see

package insert).

Prophylaxis of UTIs in women.

250 mg at bedtime for up to 5

months.

DENTAL CONCERNS

See also Anti-Infectives.

168 CISAPRIDE

Action/Kinetics: Clarithromycin is

a macrolide antibiotic that acts by

binding to the 50S ribosomal subunit

of susceptible organisms, thus interfering

with or inhibiting microbial protein

synthesis. Rapidly absorbed

from the GI tract although food

slightly delays the onset of absorption

and the formation of the active metabolite

but does not affect the extent of

the bioavailability. Peak serum levels:

When fasting, 2 hr for the tablet

and 3 hr for the suspension. Steadystate

peak serum levels: 1 mcg/mL

within 2–3 days after 250 mg q 12 hr

and 2–3 mcg/mL after 500 mg q 12 hr.

Clarithromycin and 14-OH clarithromycin

(active metabolite) are

readily distributed to body tissues

and fluids. t1/2, elimination: 3–7 hr

(depending on the dose) for clarithromycin

and 5–6 hr for 14-OH clarithromycin.

Up to 30% of a dose is excreted

unchanged in the urine.

Uses: Mild to moderate infections

caused by susceptible strains of the

following. Adults. Pharyngitis/tonsillitis

due to Streptococcus pyogenes.

Acute maxillary sinusitis or acute

bacterial exacerbaton of chronic

bronchitis due to Sreptococcus pneumoniae,

Haemophilus influenzae,

and Moraxella catarrhalis. The active

metabolite, 14-OH clarithromycin,

has significant activity (twice the

parent compound) against H. influenzae.

Pneumonia due to Mycoplasma

pneumoniae, S. pneumoniae,

or Chlamydia pneumoniae. Uncomplicated

skin and skin structure

infections due to Staphylococcus aureus

or S. pyogenes. Treatment of

disseminated mycobacterial infections

due to Mycobacterium avium

(commonly seen in AIDS clients)

and M. intracellulare. Prevention of

disseminated M. avium complex in individuals

with advanced HIV.

Used with omeprazole or ranitidine

bismuth citrate (Tritec) for the

eradication of Helicobacter pylori infection

in clients with active duodenal

ulcers associated with H. pylori infection

also with amoxicillin and

lansoprazole for the same purpose.

Children. Pharyngitis or tonsillitis

due to S. pyogenes. Acute maxillary sinusitis

or acute otitis media due to S.

pneumoniae, H. influenzae, and M.

catarrhalis. Uncomplicated skin and

skin structure infections due to S.

aureus or S. pyogenes. Disseminated

mycobacterial infections due to M.

avium or M. intracellulare. Prevention

of disseminated M. avium complex

disease in clients with advanced

HIV infection. Community-acquired

pneumonia caused by M. pneumoniae,

Chlamydia pneumoniae, and S.

pneumoniae.

Contraindications: Hypersensitivity

to clarithromycin, other macrolide

antibiotics, or erythromycin. Clients

taking astemizole, terfenadine,

cisapride, or pimozide.

Special Concerns: Use with caution

in severe renal impairment with

or without concomitant hepatic impairment

and during lactation. Safety

and effectiveness in children less

than 6 months of age have not been

determined. Safety has not been determined

in MAC clients less than 20

months of age.

Side Effects: Oral: Abnormal taste,

glossitis, stomatitis, oral candidiasis.

GI: Diarrhea, nausea, dyspepsia, abdominal

discomfort or pain, pseudomembranous

colitis, vomiting. CNS:

Headache, dizziness, behavioral

changes, confusion, depersonalization,

disorientation, hallucinations,

insomnia, nightmares, vertigo. Allergic:

Urticaria, mild skin eruptions

and, rarely, anaphylaxis and Stevens-

Johnson syndrome. Hepatic: Hepatocellular

cholestatic hepatitis with or

without jaundice, increased liver enzymes,

hepatic failure. Miscellaneous:

Hearing loss (usually reversible),

alteration of sense of smell

(usually with taste perversion).

In children, the most common

side effects are diarrhea, vomiting,

abdominal pain, rash, and headache.

CLARITHROMYCIN 169

M = Available in Canada bold italic = life-threatening side effect

Drug Interactions

See also Drug Interactions for Erythromycins.

Anticholinergic drugs / ↓ Effects of

anticholinergic drugs

Astemizole / Combination not to be

used in clients who have preexisting

cardiac abnormalities or electrolyte

disturbances

Carbamazepine / ↑ Blood levels of

carbamazepine

Cisapride / Possibility of serious

cardiac arrhythmias, including ventricular

tachycardia, ventricular fibrillation,

torsade de pointes, and QT

prolongation

Oral contraceptives / ↓ Effectiveness

of oral contraceptives

Pimozide / ↑ Risk of sudden death;

do not use together

Terfenadine / ↑ Plasma levels of the

active acid metabolite of terfenadine;

↑ risk of cardiac arrhythmias,

including QT interval prolongation

Triazolam / ↑ Risk of somnolence

and confusion

How Supplied: Granule for reconstitution:

125 mg/5 mL, 250 mg/5 mL;

Tablet: 250 mg, 500 mg

Dosage –––––––––––––––––––––––––––––––

• Tablets, Oral Suspension

Pharyngitis, tonsillitis.

250 mg q 12 hr for 10 days.

Acute exacerbation of chronic

bronchitis due to S. pneumoniae or M.

catarrhalis; pneumonia due to S.

pneumoniae or M. pneumoniae;

skin and skin structure infections.

250 mg q 12 hr for 7–14 days.

Acute maxillary sinusitis, acute

exacerbation of chronic bronchitis

due to H. influenzae.

500 mg q 12 hr for 7–14 days.

Disseminated M. avium complex

or prophylaxis of M. avium complex.

Adults: 500 mg b.i.d.; children: 7.5

mg/kg b.i.d. up to 500 mg b.i.d.

NOTE: The usual daily dose for

children is 15 mg/kg q 12 hr for 10

days.

Community-acquired pneumonia

in children.

15 mg/kg/day of the suspension, divided

and given q 12 hr for 10 days.

Active duodenal ulcers associated

with H. pylori infection.

Clarithromycin, 500 mg t.i.d., with

omeprazole, 40 mg, each morning

for 2 weeks. Then, omeprazole is

given alone at a dose of 20 mg/day for

2 more weeks. Or, clarithromycin,

500 mg t.i.d., with ranitidine bismuth

citrate, 400 mg b.i.d., for 2 weeks.

Then, ranitidine bismuth citrate is

given alone at a dose of 400 mg

b.i.d. for 2 more weeks or, clarithromycin

500 mg, plus lansoprazole, 30

mg, and amoxicillin, 1 g b.i.d. for 2

weeks.

DENTAL CONCERNS

See also Dental Concerns for Anti-Infectives

and Erythromycins.

Client/Family Teaching

1. May take with or without meals;

food delays onset of absorption.

Drug may cause a bitter taste.

2. Report any persistent diarrhea; an

antibiotic-associated colitis may be

precipitated by C. difficile and require

alternative management.

3. Report if no symptom improvement

after 48–72 hr.

4. Use an additional nonhormonal

form of birth control if taking oral

contraceptives because their effectiveness

may be diminished.

5. Review the importance of good

oral hygiene in order to prevent soft

tissue inflammation.

Clindamycin

hydrochloride hydrate

C[linkdamlyciinn-dah-MY-sin]

Cleocin Hydrochloride, Dalacin C M

[Rx]

Clindamycin palmitate

hydrochloride

C[linkdamlyciinn-dah-MY-sin]

Cleocin Pediatric, Dalacin C Palmitate

M [Rx]

Clindamycin phosphate

C[linkdamlyciinn-dah-MY-sin]

Pregnancy Category: B (vaginal

cream, topical gel, lotion, solution)

170 CLARITHROMYCIN

Cleocin Vaginal Cream, Cleocin

Phosphate, Cleocin T, Clinda-Derm,

C/T/S, Dalacin C Phosphate M, Dalacin

T Topical M, Dalacin Vaginal

Cream M [Rx]

Classification: Antibiotic, clindamycin

and lincomycin

See also Anti-Infectives.

Action/Kinetics: A semisynthetic

antibiotic that suppresses protein

synthesis by microorganism by binding

to ribosomes (50S subunit) and

preventing peptide bond formation. Is

both bacteriostatic and bactericidal.

Peak serum concentration: PO, 4

mcg/mL after 300 mg; IM, 4.9

mcg/mL after 300 mg; IV, 14.7

mcg/mL after 300 mg. t1/2: 2.4–3 hr. In

serious infections the rate of IV administration

is adjusted to maintain appropriate

serum drug concentrations:

4–6 mcg/mL.

Uses: Should not be used for trivial infections.

Systemic. Serious respiratory

tract infections (e.g., empyema,

lung abscess, pneumonia) caused by

staphylococci, streptococci, and

pneumococci. Serious skin and soft

tissue infections, septicemia, intraabdominal

infections, pelvic inflammatory

disease, female genital tract infections.

May be the drug of choice for

Bacteroides fragilis. In combination

with aminoglycosides for mixed

aerobic and anaerobic bacterial infections.

Staphylococci-induced

acute hematogenous osteomyelitis.

Adjunct to surgery for chronic

bone/joint infections. Bacterial endocarditis

prophylaxis. Non-FDA Approved

Uses: Alternative to sulfonamides

in combination with pyrimethamine

in the acute treatment of

CNS toxoplasmosis in AIDS clients. In

combination with primaquine to

treat Pneumocystis carinii pneumonia.

Chlamydial infections in women.

Bacterial vaginosis due to Gardnerella

vaginalis. Topical Use. Used

topically for inflammatory acne vulgaris.

Vaginally to treat bacterial vaginosis.

Non-FDA Approved Uses: Treatment

of rosacea (lotion used).

Contraindications: Hypersensitivity

to either clindamycin or lincomycin.

Use in treating viral and minor

bacterial infections or in clients with

a history of regional enteritis, ulcerative

colitis, or antibiotic-associated

colitis. Lactation.

Special Concerns: Use with caution

in infants up to 1 month of age,

in clients with GI disease, liver or renal

disease, or a history of allergy or

asthma. Safety and efficacy of topical

products have not been established in

children less than 12 years of age.

Side Effects: Oral: Candidiasis. GI:

N&V, diarrhea, bloody diarrhea, abdominal

pain, GI disturbances, tenesmus,

flatulence, bloating, anorexia,

weight loss, esophagitis. Nonspecific

colitis, pseudomembranous

colitis (may be severe). Allergic:

Morbilliform rash (most common).

Also, maculopapular rash, urticaria,

pruritus, fever, hypotension. Rarely,

polyarteritis, anaphylaxis, erythema

multiforme. Hematologic: Leukopenia,

neutropenia, eosinophilia,

thrombocytopenia, agranulocytosis.

Miscellaneous: Superinfection. Also

sore throat, fatigue, urinary frequency,

headache.

Following IV use: Thrombophlebitis,

erythema, pain, swelling. Following

IM use: Pain, induration, sterile

abscesses.

Following topical use: Erythema,

irritation, dryness, peeling, itching,

burning, oiliness of skin.

Following vaginal use: Cervicitis,

vaginitis, vulvar irritation, urticaria,

rash.

NOTE: The injection contains benzyl

alcohol, which has been associated

with a fatal “gasping syndrome”

in infants.

Drug Interactions

Antiperistaltic antidiarrheals (opiates,

Lomotil) / ↑ Diarrhea due to ↓

removal of toxins from colon

Ciprofloxacin HCl / Additive antibacterial

activity

Erythromycin / Cross-interference

→ ↓ effect of both drugs

CLINDAMYCIN 171

M = Available in Canada bold italic = life-threatening side effect

Inhaled hydrocarbon anesthetics / ↑

Effect of inhaled hydrocarbon anesthetics

Kaolin (e.g., Kaopectate) / ↓ Effect

due to ↓ absorption from GI tract

Neuromuscular blocking agents / ↑

Effect of blocking agents

How Supplied: Clindamycin hydrochloride

hydrate: Capsule: 75 mg,

150 mg, 300 mg. Clindamycin palmitate

hydrochloride: Granule for reconstitution:

75 mg/5 mL. Clindamycin

phosphate: Vaginal cream: 2%;

Gel: 1%; Injection: 150 mg/mL, 300

mg/50 mL, 600 mg/50 mL, 900

mg/50 mL; Lotion: 1%; Solution: 1%;

Swab: 1%

Dosage –––––––––––––––––––––––––––––––

• PO only: Capsules, Oral Solution

Adults: Clindamycin HCl, Clindamycin

palmitate HCl: 150–450

mg q 6 hr, depending on severity of

infection. Pediatric: Clindamycin

HCl hydrate: 8–20 mg/kg/day divided

into three to four equal doses;

clindamycin palmitate HCl: 8–25

mg/kg/day divided into three to four

equal doses. Children less than 10

kg: Minimum recommended dose is

37.5 mg t.i.d.

• IV

Clindamycin phosphate. Adults:

0.6–2.7 g/day in two to four equal

doses depending on severity of infection.

Life-threatening infections.

4.8 g. Pediatric over 1 month:

15–40 mg/kg/day in three to four

equal doses depending on severity

of infections.

Severe infections.

No less than 300 mg/day, regardless

of body weight.

Acute pelvic inflammatory disease.

IV: 600 mg q.i.d. plus gentamicin, 2

mg/kg IV; then, gentamicin, 1.5

mg/kg t.i.d. IV. IV therapy should be

continued for 2 days after client improves.

The 10–14-day treatment cycle

should be completed using clindamycin,

PO: 450 mg q.i.d.

• Topical Gel, Lotion, or Solution

Apply thin film b.i.d. to affected areas.

One or more pledgets may also be

used.

• Vaginal Cream (2%)

One applicatorful (containing about

100 mg clindamycin phosphate),

preferably at bedtime, for 7 consecutive

days.

Bacterial endocarditis prophylaxis.

Adult: 600 mg 1 hr prior to procedure.

Children: 20 mg/kg of body

weight 1 hr prior to procedure not to

exceed adult dose. IV dose form for

patients who cannot take oral medications.

DENTAL CONCERNS

See also Anti-Infectives.

Action/Kinetics: Depending on

concentration, may be fungistatic or

fungicidal. Acts by inhibiting the biosynthesis

of sterols, resulting in

damage to the cell wall and subsequent

loss of essential intracellular

elements due to altered permeability.

May also inhibit oxidative and

peroxidative enzyme activity and inhibit

the biosynthesis of triglycerides

and phospholipids by fungi. When

used for Candida albicans, the drug

inhibits transformation of blastophores

into the invasive mycelial

form. Poorly absorbed from the GI

tract and metabolized in the liver to

inactive compounds that are excreted

through the feces. Duration: up to 3

hr.

Uses: Broad-spectrum antifungal effective

against Malassezia furfur,

Trichophyton rubrum, Trichophyton

mentagrophytes, Epidermophyton

floccosum, Microsporum canis, C.

albicans. Oral troche: Oropharyngeal

candidiasis. Reduce incidence

of oropharyngeal candidiasis in clients

who are immunocompromised due

to chemotherapy, radiotherapy, or

steroid therapy used for leukemia,

solid tumors, or kidney transplant.

Topical OTC products: Topically to

treat tinea pedis, tinea cruris, and

tinea corporis. Topical prescription

products: Same as OTC plus candidiasis

and tinea versicolor. Vaginal

products: Vulvovaginal candidiasis.

Contraindications: Hypersensitivity.

First trimester of pregnancy.

Special Concerns: Use with caution

during lactation. Safety and effectiveness

for PO use in children less

than 3 years of age has not been determined.

Side Effects: Skin: Irritation including

rash, stinging, pruritus, urticaria, erythema,

peeling, blistering, edema.

Vaginal: Lower abdominal cramps;

urinary frequency; bloating; vaginal irritation,

itching or burning; dyspareunia.

Hepatic: Abnormal liver

178 CLOPIDOGREL BISULFATE

function tests. GI: N&V following

use of troche.

Drug Interactions

Astemizole / Serious CV side effects,

including torsades de pointes and

other ventricular arrhythmias (including

QT interval prolongation),

cardiac arrest, and death

Terfenadine / Serious CV side effects,

including torsades de pointes

and other ventricular arrhythmias

(including QT interval prolongation),

cardiac arrest, and death

How Supplied: Kit; Lotion: 1%; Lozenge/

Troche: 10 mg; Solution: 1%;

Topical cream: 1%; Vaginal cream:

1%; Vaginal tablet: 100 mg, 500 mg

Dosage –––––––––––––––––––––––––––––––

• Troche

Treatment of oropharyngeal candidiasis.

One troche (10 mg) 5 times/day for 14

consecutive days.

Prophylaxis of oropharyngeal

candidiasis.

One troche t.i.d. for duration of chemotherapy

or until maintenance

doses of steroids are instituted.

• Topical Cream, Lotion, Solution

(each 1%)

Massage into affected skin and surrounding

areas b.i.d. in morning and

evening for 7 consecutive days. Diagnosis

should be reevaluated if no

improvement occurs in 4 weeks.

• Vaginal Tablets

One 100-mg tablet/day at bedtime

for 7 days. One 500-mg tablet can be

inserted once at bedtime.

• Vaginal Cream (1%)

5 g (one full applicator)/day at bedtime

for 7 consecutive days.

• Vaginal Inserts and Clotrimazole,

Vaginal yeast infections.

Insert daily for 3 consecutive days.

DENTAL CONCERNS