Oral healthcare providers treat an ever increasing number of medically and pharmacologically compromised patients. Consequently, clinicians can expect to face situations in the perioperative period that may threaten not only the physical well-being of their patients; but at times, even their own safety (e.g., the transmission of healthcare-associated infections). Potential risk factors are predicated on procedure-specific and patient- and provider-specific variables.
A patient’s overall health status determines the patient’s ability to undergo dental care. Patient-specific problems that may impact upon a patient’s quality of life and/or the clinical process must be identified. Past and present illnesses, major hospitalizations, review of organ systems, drug allergies and other adverse drug reactions (ADRs), dietary supplements and special diets, and medications taken by a patient must be considered in determining perioperative risk.1
In the United States, there are approximately 500 active ingredients (drugs) in several thousand different formulations. ClinCalc DrugStats provides prescription drug utilization data estimates based on the Medical Expenditure Panel Survey (MEPS) conducted annually.2 The data are invaluable in identifying patient-specific risks factors. The list of Top Prescription Drugs of 2017 is based on more than 3 billion out-patient prescriptions and reflects data collected in 2014.2
The Top 200 Prescription Drugs dispensed by U.S. community pharmacies represent 40% of the available 500 active ingredients and comprise 90% of all drugs taken by ambulatory patients.2 The Top 300 Prescription Drugs represent 60% of the available 500 active ingredients and comprise 97% of all drugs taken by ambulatory patients.2 It is axiomatic that the remaining 200 or 40% of all available active ingredients are taken by < 3% of ambulatory patients.
The Top 300 Prescription Drugs of 2017 include the antifungal agents fluconazole (#172), nystatin (#199) ketoconazole (#218), and the antiviral agents oseltamivir phosphate (#219); and acyclovir (#157) and valacyclovir (#192). Clearly, the volume of antifungal and antiviral agents dispensed by U.S. community pharmacies is very low.2 It is also of note that while the largest numbers of available antiviral agents are anti-HIV drugs, not a single one is found in the top 300.
It is practical to think of drugs as falling into two categories: those prescribed by oral healthcare providers and those prescribed by other clinicians. Of those agents prescribed by oral healthcare providers minimum competency assumes knowledge in the following seven areas: (1) drug name (brand/generic), (2) mechanisms of action, (3) drug kinetics, (4) indication, (5) dosing, (6) familiarity with potential ADRs and monitoring parameters, and (7) contraindications.
In relation to those drugs prescribed by other clinicians, minimum competency by oral healthcare providers assumes knowledge in the following five areas: (1) recognition of those drugs most commonly taken by patients by name (brand/generic); (2) indications for their use, i.e., why a patient is taking the drug; (3) in some instances therapeutic dosages, e.g., corticosteroids and thyroids; (4) recognition of ADRs; and, importantly, (5) the use of informational resources.
Antifungal and antiviral agents are prescribed primarily by physicians. However, the treatment of oropharyngeal candidiasis and orolabial herpetic infections is, for the most part, the responsibility of oral healthcare providers. Consequently, the depth of information presented on selected antifungal and antiviral agents will reflect the expanded knowledge-base required by oral health care providers for minimum competency in prescribing such agents.
DailyMed is the official repository for FDA-approved package inserts, i.e., for individual drug-related knowledge base.3 The information on this website is the most recent submitted to the FDA by manufacturers and may include strengthened warnings undergoing FDA review. The labeling information is accurate; whenever possible it is based on human experience, and does not contain promotional or misleading information such as implied claims for the use of a drug.