title: Pharmacological Reversal Agents in Dental Practice: Keys to Patient Safety.
abstract: Though uncommon, medical emergencies in the dental office are harrowing occurrences that can be the result of adverse drug reactions. Pharmacological antagonists have been developed for administration as reversal agents in emergency situations in which patients may have an untoward effect, typically caused by too much medication. Dental practitioners should be familiar with these agents to keep patients safe and help mitigate drug-induced medical emergencies. This article reviews the pharmacokinetic and pharmacodynamic principles of pharmacological antagonists; it emphasizes six specific reversal agents as they relate to the clinical practice of dentistry: naloxone, flumazenil, epinephrine, diphenhydramine, phentolamine, and atropine. Outside of emergency situations, the pharmacological antagonist phentolamine has been developed to reverse the effects of the vasoconstrictor in dental local anesthesia preparations when the effects of the agonist medication are no longer required. Such newer reversal agents are being considered for more routine use once the dental procedure is complete. This article is intended to assist dental practitioners who are familiar with pharmacological antagonists to be better able to help mitigate drug-induced medical emergencies should they occur.
authors.affiliation: Director of Clinical Pharmacy, Vizient Advisory Services, Whitefish, Montana; Clinical Professor, School of Pharmacy, University of Montana, Missoula, Montana; Clinical Assistant Professor, School of Dentistry, Oregon Health and Sciences University, Portland, Oregon.
authors.forename: Mark
authors.initials: M
authors.lastname: Donaldson
authors.affiliation: Clinical Associate Professor, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania; Associate Professor and Chairman, Department of Diagnostic Sciences, Creighton University School of Dentistry, Omaha, Nebraska; Private Practice, Havertown, Pennsylvania.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Goodchild
mesh_terms: D001285:Atropine / Q000627:therapeutic use; D004155:Diphenhydramine / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions / Q000188:drug therapy*; D004632:Emergency Medical Services / Q000379:methods; D004837:Epinephrine / Q000627:therapeutic use; D005442:Flumazenil / Q000627:therapeutic use; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use; D061214:Patient Safety; D010646:Phentolamine / Q000627:therapeutic use
chemical_list: D009270:Naloxone; D005442:Flumazenil; D001285:Atropine; D004155:Diphenhydramine; D004837:Epinephrine; D010646:Phentolamine