ABs, LAs, and Analgesics in Paeds Flashcards
7:30
7:30
chapters to read from the ADA therapeutic guidelines:
Dental prescriptions and prescription writing
Practical information on using drugs in dentistry
Acute odontogenic infections
What are the commonly used antibiotics?
Phenoxymethylpenicillin (Penicillin V)
Amoxycillin
Cephalexin
Clindamycin
Metronidazole (to be used in addition to one of the above antibiotics for spreading odontogenic infections)
What are the commonly used antibiotics?
Phenoxymethylpenicillin (Penicillin V) • Amoxycillin • Cephalexin • Clindamycin • Metronidazole (to be used in addition to one of the above antibiotics for spreading odontogenic infections)
What is phenoxymethylpenicillin?
Narrow spectrum beta lactam antibiotic
What dosage of phenoxymethyl peniciilin should be used?
12.5mg/kg up to 500mg orally
1 hour before meals or 2 hours after. 6 hourly for 5 days.
What are the available suspensions for phenoxymethylpenicillin?
125/5 mg/g
150/5
250/5
Can be known via PBS
Why is amoxycillin used?
Moderate spectrum penicillin
• not affected by food and requires fewer oral doses per day
What dose of amoxycillin is used?
12.5mg/kg up to 500mg orally
Taken 8 hourly for 5 days
Available as 100mg/ml; 125mg/5mL; 250mg/5mL; 500mg/5mL
Is there need for clavulanic acid with amoxicillin?
Not a good idea because amoxicillin is already quite broad spectrum
When should cephalexin be used?
Maybe an alternative when patients are sensitive to penicillin (excluding immediate hypersensitivity)
What dose of cephalexin should be prescribed?
12.5mg/kg up to 500mg orally, 8 hourly for 5 days.
Available as 125/5; 250mg/5 suspensions for kids
When should clindamycin be used?
First choice to people allergic to penicillin
What dose of clindamycin should be used?
7.5mg/kg up to 300mg orally taken 8 hourly for 5 days
• 150mg capsules
Does a childhood rash in response to penicillin mean that a patient is allergic?
Not necessarily, can be caused by viral infections or drug-virus interaction. Patients can be rechallenged under specialist guidance for definitive assessment.
What are the types of allergic reactions to penicillin?
Immediate (IgE mediated) or delayed (t-cell mediated)
What causes penicillin allergies in the molecule?
The R1 structure which is found on both penicillins and cephalosporins
Which antibiotics are contraindicated in penicillin allergies?
Ampicillin
Amoxycillin
Amoxycillin/clavulanic acid (e.g. Augmentin®)
Benzathine penicillin
Benzylpenicillin (e.g. penicillin G)
Phenoxymethylpenicillin (e.g. penicillin V)
Dicloxacillin
Flucloxacillin
Piperacillin/tazobactam (e.g. Tazocin®)
Ticarcillin/clavulanic acid (e.g. Timentin®)
Which antibiotics should be used with caution in penicillin allergies?
Cefaclor Cefepime Cefotaxime Cefoxitin Ceftazidime Ceftriaxone Cefuroxime Cephalexin Cephazolin Doripenem, ertapenem, imipenem, meropenem
Which antibiotics are safe for people with penicillin allergies?
Aztreonam Azithromycin, erythromycin, roxithromycin, clarithromycin Ciprofloxacin, norfloxacin, moxifloxacin Clindamycin, lincomycin Doxycycline, minocycline, tigecycline Gentamicin, tobramycin, amikacin Linezolid Metronidazole Trimethoprim/sulfamethoxazole Vancomycin
When is metronidazole prescribed?
Supplement to penicillin or clindamycin in the case of unresponsive or severe infection.
Active against most anaerobic bacteria P.gingivalis, P. oxalis
How much metronidazole should be used?
10mg/kg up to 400mg orally taken 12 hourly for 5 days
Available as 200mg/5mL suspensions
What are the side effects of metronidazole?
Nausea
Vomiting
Flushing
Headaches
What interactions does metronidazole have?
Warfarin
Patients should not drink any alcohol until 24 hours after metronidazole use
Which analgesics are used for children?
Paracetamol
Ibuprofen
How much paracetamol should be prescribed by clinicians to child patients?
15mg/kg orally
4 to 6 hourly
Available as 120mg/5ml suspensions
When is paracetamol contraindicated?
impaired renal or hepatic function
What dose should ibuprofen be prescribed?
5 - 10mg/kg orally
6 to 8 hourly
Available as 100mg/5ml suspensions
When is ibuprofen contraindicated?
Hypersensitivity (asthma, rhinitis, urticaria)
Renal or cardiac impairment,
Gastroenterological pathology,
Anticoagulants/corticosteroids
Use lowest dose possible
Why is codeine and aspirin contraindicated in children?
Avoid codeine prescription due to variability in metabolism in children causing lethal effects in some kids
Reyes syndrome in aspirin
What are the types of local anaesthetic used in dentistry?
Ester types (Benzocaine, 2-chloroprocaine, procaine, tetracaine)
Amide types (Articaine, bupivacaine, dibucaine, etidocaine, lidocaine, mepivacaine, prilocaine, S-ropivacaine)
What are the types of LA?
Topical
Injectable
Which injectable LA agents have low potency and short duration?
Procaine and 2-chloroprocaine
Which injectable LA agents have moderate potency and duration?
Articaine
Lidocaine
Mepivacaine
Prilocaine
Which injectable LA agents have high potency and duration?
Tetracaine
Bupivacaine
Etidocaine
S-ropivacaine
What are the types of single agent topical anaesthetics?
Benzocaine
Lidocaine
Tetracaine
What combination mixtures are used for topical anaesthetic?
Lidocaine + prilocaine
Lidocaine + tetracaine
Lidocaine + prilocaine + dibucaine
What are the most common LA mixtures used in dentistry?
2% lignocaine with 1:80000 adrenaline.
4% articaine with adrenaline 1:100000
0.5% bupivacaine with 1:200000 adrenaline
What is the maximum dose of lignocaine?
7mg/kg
What is the maximum dose of articaine?
7mg/kg
What is the maximum dose of bupivacaine?
2mg/kg
How much lignocaine is in each carpule?
44mg per carpule
What must be documented when using LA?
Type and dosage of LA
Dosage of vasoconstrictors if any.
If the max dosage is a concern in a patient, weight should be documented preoperatively
What must be documented when using LA?
Type and dosage of LA
Dosage of vasoconstrictors if any.
If the max dosage is a concern in a patient, weight should be documented preoperatively
Patient’s reaction to the injection is important to note.
How is the inferior alveolar nerve block different in children?
ramus shorter vertically
Narrower anteroposteriorly
Consider using a short needle
Gauge 27 to 30
What are the important things to consider when performing an inferior alveolar nerve block?
Use precise technique
Practice aspiration technique
Use vasoconstrictors
Adhere to maximum dose
Use half a carpule initially and then re-inject if inadequate or block is missed
Post-operative care
Why should vasoconstrictors be used in children?
High cardiac output
Greater tissue perfusion rate
Higher BMR
Liver enzymes less mature than adults
Immature CNS and CVS so more susceptible to toxicity at low concentrations
What are the symptoms of a high dose of LA?
CNS: Depression, sleepy
CVS: Decreased contractile force, decreased cardiac output
Pulmonary system: resp. arrest - death
IV administration: Analgesia, anxiety, restlessness, GA
What are the symptoms of a high dose of LA? What about due to IV administration?
CNS: Depression, sleepy
CVS: Decreased contractile force, decreased cardiac output
Pulmonary system: resp. arrest - death
IV administration: Analgesia, anxiety, restlessness, GA
