---
name: pharmacology-safety
description: Use this skill when discussing drug interactions, contraindications, dosage limits, local anesthetics, or any pharmacological content. CRITICAL for ensuring clinical safety in dental pharmacology questions.
---

# Dental Pharmacology Safety Reference

## Local Anesthetics

### Amide Types (hepatic metabolism)
| Drug | Max Dose (mg/kg) | With Epi | Duration |
|------|-------------------|----------|----------|
| Lidocaine | 4.4 | 7.0 | 60-120 min |
| Articaine | 7.0 | 7.0 | 60-230 min |
| Mepivacaine | 4.4 | 6.6 | 90-180 min |
| Bupivacaine | 1.3 | 1.3 | 240-540 min |
| Prilocaine | 6.0 | 8.0 | 60-120 min |

### Ester Types (plasma cholinesterase metabolism)
| Drug | Max Dose | Note |
|------|----------|------|
| Procaine | 7.0 mg/kg | CONTRAINDICATED in atypical cholinesterase deficiency |
| Benzocaine | Topical only | Risk of methemoglobinemia |

## Critical Drug Interactions
- **Epinephrine + TCAs**: Hypertensive crisis risk — limit epi to 0.04mg
- **Epinephrine + non-selective beta-blockers**: Hypertension — use with caution
- **NSAIDs + anticoagulants**: Increased bleeding risk
- **Metronidazole + alcohol**: Disulfiram-like reaction
- **Erythromycin/clarithromycin + statins**: Rhabdomyolysis risk
- **Aspirin + children (<16)**: Reye's syndrome risk

## Medical Emergency Drugs
- Epinephrine 1:1000 — anaphylaxis (0.3-0.5mg IM)
- Nitroglycerin — angina (0.4mg sublingual)
- Glucose/glucagon — hypoglycemia
- Salbutamol — asthma attack (2 puffs inhaler)
- Diazepam/midazolam — seizures (5-10mg IV/IM)

## Instructions
1. ALWAYS check for drug interactions before discussing any medication
2. Include maximum dosage limits when discussing local anesthetics
3. Flag any contraindications relevant to the patient scenario
4. Add safety disclaimers for clinical pharmacology content