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Drugs in dentistry (2)
- 1. بسم الله الرحمنالرحيم
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- 4. Antibiotic Use onlywhen there is an indication : Choose the narrowest spectrum drug that will be effective Consider the risk/benefit equation Prescribe an adequate dose Adequate frequency Adequate duration
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- 7. Reasons for Failureof antibiotic Wrong drug or dose Bacterial resistance Host defenses depressed Poor compliance
- 8. Antibiotic actions Bactericidal Penicillins Metronidazole Cephalosporins Aminoglycosides* Vancomycin* Bacteriostatic Clindamycin Erythromycin Tetracyclines
- 9. Penicillin Oral penicillinare penicillin V and amoxicillin Pen V is narrow-spectrum against gram-positive Strep and others Drug of choice for orofacial infections Dose = 300-600 mg q6h Amoxicillin is broad-spectrum and better absorbed orally Dose = 250-500 mg q8h Dental uses dental abscesses, infections around wisdom teeth and infections after surgery
- 10. Adverse reactions ofpenicillin Allergy Diarrhea Nausea and vomiting Pseudo membranous colitis Candidacies Allergy rate is 1-10% of the population Penicillins responsible for 75% of anaphylaxis deaths Combine B_lactamase inhibitor:augmentin Extended specterum:ampicillin|amoxicillin_ Penicillin: Contraindication (None except hypersensitivity to penicillin)
- 11. amoxicillin Indications Usedto treat bacterial infection such as a dental abscess. Used prophylactically in the prevention of infective endocarditis Contraindications Hypersensitivity. Precautions Renal disease. Glandular fever
- 12. Side effect Glossitisand tongue discolouration. Candidiasis. Hypersensitivity. Gastrointestinal upset. Pseudomembranous colitis. Hypokalaemia
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- 14. *Cephalosporins are bactericidalagents (which means that they kill bacteria) Side Effects mild stomach cramps or upset, nausea, vomiting, and diarrhea. Cephalosporins can also cause overgrowth of fungus normally present in the body. Cross allergy with penicillins Because the cephalosporins are structurally similar to the penicillins, some patients allergic to penicillins may be allergic to a cephalosporin antibiotic.
- 15. Vancomycin antibiotic usefulfor the treatment of a number of bacterial infections. It is of the glycopeptide antibiotic class and is effective mostly against Gram-positive bacteria. * treatment of penicillin-resistant Staphylococcus aureus Vancomycin should be reserved for a condition that does not respond to metronidazole Side effects IV vancomycin include: local pain nephrotoxic and ototoxic drug Vancomycin should be reserved for a condition that does not respond to metronidazole
- 16. Tetracycline Group includestetracycline, doxycycline (Vibramycin, Periostat) and minocycline (Minocin) Broad-spectrum, bacteriostatic Useful in treatment of periodontal disease Widespread resistance Host of adverse effects including: tooth staining, photosensitivity, blood dyscrasias, GI effects
- 17. Tetracycline Contraindications: Renallyimpaired patients should not be treated with any of the tetracyclines except doxycycline. Accumulation of tetracyclines may aggravate preexisting azotemia (a higher-than-normal level of urea or other nitrogen-containing compounds in the blood)by interfering with protein synthesis, thus promoting amino acid degradation. The tetracyclines should not be employed in pregnant or breast-feeding women or in children less than 8 years of age.
- 18. Aminoglycoside Aminoglycosides area group of bactericidal antibiotics, which act by inhibiting bacterial protein synthesis. Their use is restricted because of potential side effects, as they can cause ear and kidney damage. All the aminoglycosides resemble each other in antibacterial activity, pharmacokinetics and toxicity.
- 19. Macrolides Group includeserythromycin, clarithromycin and azithromycin Erythromycin was the former drug of choice for penicillin-allergic/ penicillin-resistant patients Numerous GI adverse effects Active against gram-positive aerobic/facultative staph and strep and gram-negative anaerobes Contraindications: Patients with hepatic dysfunction should be treated cautiously with erythromycin, telithromycin, or azithromycin, because these drugs accumulate in the liver. severe hepatotoxicity
- 20. Clindamycin An alternativefor penicillin-allergic or penicillin-resistant patients *Active against gram-positive and gram-negative anaerobes and facultative/aerobic bacteria *Dose = 150-300 mg q6h
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- 23. Antibiotic adverse reaction Overall incidence is 6-7% Possible reactions include: GI tract complications Colonization of resistant or fungal strains Cross reactions with other medications Pseudomembranous colitis Development of resistant bacteria and superinfection Little concern about short-term use
- 24. Antibiotic prophylaxis Indicatedfor patients with: Prosthetic heart valves History of infective endocarditis Cardiac transplant with subsequent heart valve problem Some congenital heart conditions Unrepaired cyanotic disease (incl. shunts and conduits) Repaired defect (<6 months) with prosthetic material or device Repaired defect with residual defect at or adjacent to the site of repair Antibiotic Prophylaxis
- 25. Indicated for thefollowing procedures: Implant placement Extractions Periodontal procedures Reimplantation of avulsed teeth Endodontics beyond the apex of the tooth Intraligamentary injections Subgingival placement of fibres or strips Placement of orthodontic bands Polishing of teeth or implants where bleeding is expected
- 26. May be indicatedfor patients at increased risk including: < 2 years post-surgery Inflammatory joint disease Immunosuppressant (incl. drug-induced, radiation-induced, HIV) Previous joint infections Type I diabetes mellitus Hemophilia Malignancy
- 27. Antibiotics & ImplantSurgery Two randomized controlled studies were subjected to meta-analysis Showed a statistically significant higher number of implant failures in the group that did not receive antibiotics “It might be recommendable to suggest the use of one dose of prophylactic antibiotics prior to dental implant placement
- 32. Indication of antifungaldrugs -Stop spread of infection -Treat oral thrush -Denture stomatitis -Used in combination with antibiotic in case of abscess
- 33. Amphotericin B Description A polyene antifungal Indications Used to treat candidal infections
- 34. Side effect -Gastrointestinaldisturbances. -Renal damage. -Hypokalaemia. -Myopathy and neuropathy -Dependence. -Respiratory depression
- 35. Amphotericin B Precautions Respiratory disease. Pregnancy and breastfeed Drug and alcohol abuse. Psychoses. Porphyria.
- 36. Nystatin(nystan) Indications Usedin the treatment of candidal infections Contraindications Hypersensitivity. Side effects Hypersensitivity. Gastrointestinal upset
- 37. Fluconazole (diflucan) Description Diazole antifungal agent. Indications Used to treat oral fungal infections
- 38. Fluconazole Contraindications Previoushypersensitivity Best avoided during pregnancy and when breastfeeding. Precautions Use with caution in patients with renal and hepatic disease. Side effects Hypersensitivity reactions. Gastrointestinal problems
- 39. ketoconazole Mechanism Inhibitsynthesis of ergosterol Used for the treatment of a. systemic infections b. mucocutaneous candida infections c. cryptococcal meningitis Avoid use in patients with kidney problems
- 40. Clotrimazole Indicated forthe local treatment of oropharyngeal candidiasis Usual adult dose is one lozenge five
- 41. Antiviral drugs Treatmentof viral infections has posed the greatest problem of all infectious organisms Viruses are obligate intracellular organisms The herpes virus is of the most interest to the dental health care worker
- 42. Acyclovir (Zovirax) Indication Used in topical , IV, oral formulations Herpes simplex virus 1,2 (HSV) Varicella zoster virus And used in treatment of herpes simplex
- 43. Herpes Simplex Herpesviruses are associated with “cold sores” Most antiviral agents are either purine or pyramiding analogues that inhibit deoxyribonucleic acid (DNA) synthesis
- 44. Adverse reactions Topicaladministration: produces burning, stinging, or mild pain in about one third of patients Oral administration: headache (13%) is one of the most common; other central nervous system (CNS) and GI effects Parenteral administration: local reactions at the injection site are the most common
- 45. Side effect ofacyclovir -Stinging sensation at site of application, altered taste, gastrointestinal upset, renal failure, bone marrow depression, tremors and convulsions, lichenoid reactions, rash and urticaria
- 46. Penciclovir Available topically Shown to reduce both the duration of the lesion and the pain of the lesions on the lips and face associated with both primary and recurrent herpes
- 47. Docosanol 10% Availabletopically and without a prescription Has been shown to decrease healing time by about a half day in patient with recurrent orolabial herpes when started within 12 hours of the appearance of prodromal symptoms
- 48. Famciclovir Indications Usedin the treatment of herpes zoster and genital herpetic infections Contraindications Hypersensitivity, children. Precautions Renal and liver disease, pregnancy and breastfeeding. Side effect Maitenance of adequate fluid intake is required with high doses. Fever, gastrointestinal upset, dizziness, confusion, and hallucinations, headache and sinusitis, rash.
- 49. Valaciclovir (Valtrex) Description An antiviral drug. It is a pro-drug for aciclovir. Indications Used to treat herpes simplex and varicella-zoster infections.. Contraindications Hypersensitivity, children. Precautions Renal disease, pregnancy and breastfeeding. Side effects Glossitis, altered taste, gastrointestinal upset, renal failure, bone marrow depression, tremors and convulsions, rash, and urticaria.
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- 52. diazepam)Valium) Description Abenzodiazepine sedative and anxiolytic drug with anticonvulsant properties. Indications Used in dental sedation and preoperative anxiolysis (although it has now been superseded by midazolam when intravenous techniques are employed: for oral sedation temazepam is the drug of choice). Also indicated in the emergency treatment of epilepsy in the dental surgery.
- 53. Contraindication Severe respiratorydisease. Severe liver disease. Porphyria (although should be used in emergency management of status epilepticus). Precautions History of drug abuse. Severe liver disease. Severe muscle weakness (myasthenia gravis). Pregnancy and breastfeeding. Unwanted effects Xerostomia. Respiratory depression. Hypotension. Visual disturbances
- 54. Oxazepam Description Abenzodiazepine anxiolytic. Indications Used in the short term treatment of anxiety. Effects on oral and dental structures Xerostomia may occur. Effects on patient management As the drug is only used short term xerostomia should not produce significant problems, however a preventive regimen may be considered. The main interaction in the management of patients receiving any benzodiazepine therapy is the use of benzodiazepine sedation.
- 55. Temazepam Description Abenzodiazepine anxiolytic drug. Indications Used as an oral sedative for dental treatment (also used short term to treat insomnia). Contraindications Severe respiratory disease. Severe liver disease. Myasthenia gravis. Precautions Respiratory disease. Pregnancy and breastfeeding.
- 56. Chlordiazepoxide (Librium) Description A benzodiazepine anxiolytic. Indications Used in the short term management of anxiety and in alcohol withdrawal. Effects on oral and dental structures Xerostomia can occur. Effects on patient management Avoid concurrent prescription of CNS depressant agents.
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- 60. Mechanism of action Paracetamol inhibits prostaglandin biosynthesis under some circumstances (e.g. fever), but not others. The difference from other NSAIDs is still under investigation Adverse effects The most important toxic effect is hepatic necrosis leading to liver failure after overdose, but renal failure in the absence of liver failure has also been reported after overdose. There is no convincing evidence that paracetamol causes chronic liver disease when used regularly in therapeutic doses (4 g/24 hours). Paracetamol is structurally closely related to phenacetin
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- 65. Celebrex Description Aselective COX-2 inhibitor. Indications Pain and inflammation in osteoarthritis or rheumatoid arthritis Effects on oral and dental structures Stomatitis, sinusitis and taste disturbances can occur. Effects on patient management If patient develops celecoxib-induced stomatitis then the drug should be stopped and a full blood count carried out
- 66. Acetaminophen Indications Painand inflammation associated with musculoskeletal disorders, e.g. rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Postoperative analgesia. Effects on oral and dental Patients on long-term NSAIDs such as acemetacin may be afforded some degree of protection against periodontal breakdown. This arises from the drug’s inhibitory action on prostaglandin synthesis. l
- 67. NSAID contraindications Gastriculcers Bleeding dyscrasias or concerns Significant renal disease asa (or other NSAID) hypersensitivity Combination of severe asthma, nasal polyps and multiple allergies Can lead to ARDS Pregnancy Especially in the 3rd trimester Children asa only Elderly Concurrent use of certain other drugs
- 68. NSAID Adverse Effects Increased bleeding Gastric mucosal damage Dyspepsia Renotoxicity Anaphylactoid reactions
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- 71. Opioid Usually usedfor analgesia for moderate to severe pain in dentistry Other opioid effects: Sedation Mood alteration Antitussive Respiratory depression Nausea and vomiting Constipation
- 72. NALOXONE It isN-allyl analogue of oxymorphone have a high affinity for mu receptor ,and lower affinity at delta and kappa sites. It selectively antagonizes the respiratory depression produced by opioids. NALTREXONE It is a pure antagonist and chemically related to naloxone. It is more potent than naloxone and because of its longer duration of action, it can be used as maintenance drug for morphine addicts.
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