3. Drug Use in Dentistry

Question 1

Hazards of drug use and explanations (2)

Answer 1

Death - allergy to drug/toxicity of drug

Drug interactions - effect on absorption/metabolism of other essential medicines

Question 2

Classes of drugs used in dentistry (5)

Answer 2

LAs
Antimicrobials
Drugs in pain and inflammation
Drugs used in sedation
Emergency medical drugs

Question 3

Function of LA

Answer 3

Reduce awareness of pain

Question 4

Action of LA

Answer 4

Act on nerve channels to block propagation/nerve transmission

Question 5

Examples of LA (5)

Answer 5

Lignocaine/lidocaine
Articaine
Bupivicaine
Prilocaine
Mepivicaine

Question 6

Classes of antimicrobials (3)

Answer 6

Antibiotics
Antivirals
Antifungals

Question 7

Examples of antibiotics (4)

Answer 7

Amoxicillin
Metronidazole
Doxycycline
Clindamycin

Question 8

Example of antiviral

Answer 8

Acyclovir

Question 9

Examples of antifungals (2)

Answer 9

Nystatin (topical)

Fluconazole (systemic)

Question 10

Drugs used to reduce inflammatory mediators

Answer 10

NSAIDs

Question 11

Drugs used to reduce inflammation process

Answer 11

Corticosteroids

Question 12

Drugs involved with immunosuppresion

Answer 12

Steroids

Question 13

Action of NSAIDs (2)

Answer 13

Inhibit prostaglandin synthesis
Change balance of PGE1 and PGE2 (anti-inflammatory).
COX (COX1/2 inhibitors)

Question 14

Types of NSAIDs and examples (3)

Answer 14

Salicylates - aspirin
Propionic acid derivatives - ibuprofein
Phenylacetic acid derivatives - diclofenac )POM)

Question 15

Aspirin dosage

Answer 15

300-600mg up to 4 times daily

Question 16

Aspirin benefit

Answer 16

Reduces MI/bowel cancer risk

Question 17

Aspirin pharmacokinetics (4)

Answer 17

Rapidly absorbed from GIT
Eliminated by first order kinetics
COX1 inhibitor, anti-pyrexic
Can be taken pre-emptively

Question 18

Aspirin overdose cause/effects (2)

Answer 18

Enzyme saturation

Can lead to toxic effects including acidosis

Question 19

Aspirin side effects (5)

Answer 19

Gastric irritation (erosions, ulcerations - worse with alcohol)
Platelet function inhibition (enhanced bleeding)
Bronchospasm (exacerbates asthma)
Allergic reaction (rash)
Drug interactions - significant protein binding

Question 20

Ibuprofen dosage

Answer 20

200-600mg three times daily

Question 21

Ibuprofen side effects (6)

Answer 21

Same as aspirin, but less problematic
Gastric irritation (erosions, ulcerations - worse with alcohol)
Platelet function inhibition (enhanced bleeding)
Bronchospasm (exacerbates asthma)
Allergic reaction (rash)
Drug interactions - significant protein binding

Question 22

Diclofenac dosage and potency (2)

Answer 22

50mg three times daily

More potent than ibuprofen, therefore more effective anti-inflammatory

Question 23

COX2 inhibitors vs COX1 inhibitors (2)

Answer 23

COX2 - reduced gastric side effects

Better for long-term use (arthritis) but can lead to cardiac death

Question 24

COX2 inhibitor example

Answer 24

Arcoxia

Question 25

Corticosteroids reduce inflammation by (4)

Answer 25

``` Inhibiting capillary permeability Inhibiting bradykinin formation Inhibiting WBC migration Reducing eiconsanoid synthesis Corticosteroids suppress the features of inflammation but do not address the underlying cause ```

Question 26

Examples of topical corticosteroids and uses (4)

Answer 26

Steroid inhalers (asthma) Hydrocortisone cream (eczema) Steroid treatment for mouth ulcers (beclomethasone inhalers, hydrocortisone adhesive tablets, betamethasone solution) Triamcinolone

Question 27

Examples of systemic corticosteroids and uses (2)

Answer 27

Prednisolone tablets - prevent transplant rejection, treat immunological diseases Dexamethasone injection - reduce post-ope swelling

Question 28

Side effects of systemic corticosteroids (7)

Answer 28

``` High blood pressure Weight gain (fluid) Fat distribution change (centripetal obesity and buffalo hump) Gastric ulceration Adrenal suppression Osteoporosis Diabetes ```

Question 29

Prednisolone dosage

Answer 29

1-100mg (varies with desired level of immune suppression) | POM

Question 30

Paracetamol action (3)

Answer 30

Anti-pyretic Analgesic Few side effects

Question 31

Paracetamol dosage

Answer 31

1g (1000mg) four times daily

Question 32

Paracetamol combined drugs (2)

Answer 32

Co-codamol - with codeine | Co-drydamol - with dihydrocodeine

Question 33

Anxiolytic classes and examples (2)

Answer 33

Benzodiazepines - diazepam and midazolam | Gas - nitrous oxide