Mito R S, Yagiela J A
University of California, Center for the Health Sciences, Los Angeles 90024.
J Am Dent Assoc. 1988 Jan;116(1):55-7. doi: 10.14219/jada.archive.1988.0155.
Propranolol is a commonly used drug; of new and refilled prescriptions, it ranked no. 1 in 1984 and no. 2 in 1985. Medical conditions for its use include angina pectoris, myocardial infarction, hypertension, cardiac dysrhythmias, hypertrophic subaortic stenosis, migraine headache, hyperthyroidism, and pheochromocytoma. Almost all dental practitioners will treat a patient receiving propranolol for one of these conditions. The following recommendations seem appropriate at this time: The patient should continue to receive propranolol during dental treatment. Sudden withdrawal of the beta-blocker will cost the patient the benefit of propranolol therapy and may lead to acute myocardial ischemia. Acute stress should be minimized, as hypertensive responses may also be caused by endogenously released epinephrine. Short appointments scheduled in the morning, possibly with conscious sedation, should be considered. The dosage of adrenergic vasoconstrictors should be limited and gingival retraction cord containing epinephrine avoided entirely. The blood pressure should be taken approximately 5 minutes after local anesthesia is administered to determine if a systemic response has occurred. In the unlikely event of a hypertensive emergency, a rapidly acting, short-duration antihypertensive drug, such as the alpha-blocker phentolamine (Regitine, 5 mg intravenously) should be administered. Sublingual nitroglycerin (Nitrostat, 0.4 mg) may be useful as a nonparenteral alternative. These recommendations apply to other nonselective beta-blockers, including nadolol (Corgard) and timolol (Blocadren). They may also apply to labetalol (Normodyne, Trandate), a nonselective beta-antagonist with some alpha-blocking activity and to pindolol (Visken), a beta-blocker with some intrinsic beta 2-agonistic activity.(ABSTRACT TRUNCATED AT 250 WORDS)
普萘洛尔是一种常用药物；在新开出的和再次配药的处方中，它在1984年排名第一，在1985年排名第二。其适用的医疗状况包括心绞痛、心肌梗死、高血压、心律失常、肥厚性主动脉瓣下狭窄、偏头痛、甲状腺功能亢进和嗜铬细胞瘤。几乎所有牙科医生都会治疗因上述某种病症而正在服用普萘洛尔的患者。目前，以下建议似乎是合适的：在牙科治疗期间，患者应继续服用普萘洛尔。突然停用β受体阻滞剂会使患者失去普萘洛尔治疗的益处，并可能导致急性心肌缺血。应尽量减少急性应激，因为内源性释放的肾上腺素也可能引起高血压反应。应考虑安排在上午进行短时间的预约，可能需要使用清醒镇静。肾上腺素能血管收缩剂的剂量应加以限制，应完全避免使用含肾上腺素的牙龈收缩线。在局部麻醉给药后约5分钟应测量血压，以确定是否发生全身反应。在极不可能发生的高血压急症情况下，应给予一种起效迅速、作用时间短的抗高血压药物，如α受体阻滞剂酚妥拉明（利其丁，静脉注射5毫克）。舌下含服硝酸甘油（硝酸甘油片，0.4毫克）作为非肠道用药的替代药物可能有用。这些建议适用于其他非选择性β受体阻滞剂，包括纳多洛尔（康加尔多）和噻吗洛尔（噻吗心安）。它们也可能适用于拉贝洛尔（柳胺苄心定），一种具有一定α受体阻滞活性的非选择性β受体拮抗剂，以及吲哚洛尔（心得静），一种具有一定内在β2激动活性的β受体阻滞剂。（摘要截短于250字）
