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DMD3 > ABs, LAs, and Analgesics in Paeds > Flashcards

ABs, LAs, and Analgesics in Paeds Flashcards

1
Q

7:30

A

7:30

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2
Q

chapters to read from the ADA therapeutic guidelines:

A

Dental prescriptions and prescription writing

Practical information on using drugs in dentistry

Acute odontogenic infections

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3
Q

What are the commonly used antibiotics?

A

Phenoxymethylpenicillin (Penicillin V)

Amoxycillin

Cephalexin

Clindamycin

Metronidazole (to be used in addition to one of the above antibiotics for spreading odontogenic infections)

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4
Q

What are the commonly used antibiotics?

A 
Phenoxymethylpenicillin (Penicillin V)
• Amoxycillin
• Cephalexin
• Clindamycin
• Metronidazole (to be used in addition to one of the above antibiotics for spreading odontogenic infections)
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5
Q

What is phenoxymethylpenicillin?

A

Narrow spectrum beta lactam antibiotic

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6
Q

What dosage of phenoxymethyl peniciilin should be used?

A

12.5mg/kg up to 500mg orally

1 hour before meals or 2 hours after. 6 hourly for 5 days.

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7
Q

What are the available suspensions for phenoxymethylpenicillin?

A

125/5 mg/g
150/5
250/5

Can be known via PBS

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8
Q

Why is amoxycillin used?

A

Moderate spectrum penicillin

• not affected by food and requires fewer oral doses per day

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9
Q

What dose of amoxycillin is used?

A

12.5mg/kg up to 500mg orally

Taken 8 hourly for 5 days

Available as 100mg/ml; 125mg/5mL; 250mg/5mL; 500mg/5mL

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10
Q

Is there need for clavulanic acid with amoxicillin?

A

Not a good idea because amoxicillin is already quite broad spectrum

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11
Q

When should cephalexin be used?

A

Maybe an alternative when patients are sensitive to penicillin (excluding immediate hypersensitivity)

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12
Q

What dose of cephalexin should be prescribed?

A

12.5mg/kg up to 500mg orally, 8 hourly for 5 days.

Available as 125/5; 250mg/5 suspensions for kids

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13
Q

When should clindamycin be used?

A

First choice to people allergic to penicillin

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14
Q

What dose of clindamycin should be used?

A

7.5mg/kg up to 300mg orally taken 8 hourly for 5 days

• 150mg capsules

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15
Q

Does a childhood rash in response to penicillin mean that a patient is allergic?

A

Not necessarily, can be caused by viral infections or drug-virus interaction. Patients can be rechallenged under specialist guidance for definitive assessment.

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16
Q

What are the types of allergic reactions to penicillin?

A

Immediate (IgE mediated) or delayed (t-cell mediated)

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17
Q

What causes penicillin allergies in the molecule?

A

The R1 structure which is found on both penicillins and cephalosporins

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18
Q

Which antibiotics are contraindicated in penicillin allergies?

A

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®)

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19
Q

Which antibiotics should be used with caution in penicillin allergies?

A 
Cefaclor
Cefepime
Cefotaxime
Cefoxitin
Ceftazidime
Ceftriaxone
Cefuroxime
Cephalexin
Cephazolin
Doripenem, ertapenem, imipenem, meropenem
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20
Q

Which antibiotics are safe for people with penicillin allergies?

A 
Aztreonam
Azithromycin, erythromycin, roxithromycin, clarithromycin
Ciprofloxacin, norfloxacin, moxifloxacin
Clindamycin, lincomycin
Doxycycline, minocycline, tigecycline
Gentamicin, tobramycin, amikacin
Linezolid
Metronidazole
Trimethoprim/sulfamethoxazole
Vancomycin
21
Q

When is metronidazole prescribed?

A

Supplement to penicillin or clindamycin in the case of unresponsive or severe infection.

Active against most anaerobic bacteria P.gingivalis, P. oxalis

22
Q

How much metronidazole should be used?

A

10mg/kg up to 400mg orally taken 12 hourly for 5 days

Available as 200mg/5mL suspensions

23
Q

What are the side effects of metronidazole?

A

Nausea

Vomiting

Flushing

Headaches

24
Q

What interactions does metronidazole have?

A

Warfarin

Patients should not drink any alcohol until 24 hours after metronidazole use

25
Q

Which analgesics are used for children?

A

Paracetamol

Ibuprofen

26
Q

How much paracetamol should be prescribed by clinicians to child patients?

A

15mg/kg orally

4 to 6 hourly

Available as 120mg/5ml suspensions

27
Q

When is paracetamol contraindicated?

A

impaired renal or hepatic function

28
Q

What dose should ibuprofen be prescribed?

A

5 - 10mg/kg orally

6 to 8 hourly

Available as 100mg/5ml suspensions

29
Q

When is ibuprofen contraindicated?

A

Hypersensitivity (asthma, rhinitis, urticaria)

Renal or cardiac impairment,

Gastroenterological pathology,

Anticoagulants/corticosteroids

Use lowest dose possible

30
Q

Why is codeine and aspirin contraindicated in children?

A

Avoid codeine prescription due to variability in metabolism in children causing lethal effects in some kids

Reyes syndrome in aspirin

31
Q

What are the types of local anaesthetic used in dentistry?

A

Ester types (Benzocaine, 2-chloroprocaine, procaine, tetracaine)

Amide types (Articaine, bupivacaine, dibucaine, etidocaine, lidocaine, mepivacaine, prilocaine, S-ropivacaine)

32
Q

What are the types of LA?

A

Topical

Injectable

33
Q

Which injectable LA agents have low potency and short duration?

A

Procaine and 2-chloroprocaine

34
Q

Which injectable LA agents have moderate potency and duration?

A

Articaine

Lidocaine

Mepivacaine

Prilocaine

35
Q

Which injectable LA agents have high potency and duration?

A

Tetracaine

Bupivacaine

Etidocaine

S-ropivacaine

36
Q

What are the types of single agent topical anaesthetics?

A

Benzocaine

Lidocaine

Tetracaine

37
Q

What combination mixtures are used for topical anaesthetic?

A

Lidocaine + prilocaine

Lidocaine + tetracaine

Lidocaine + prilocaine + dibucaine

38
Q

What are the most common LA mixtures used in dentistry?

A

2% lignocaine with 1:80000 adrenaline.

4% articaine with adrenaline 1:100000

0.5% bupivacaine with 1:200000 adrenaline

39
Q

What is the maximum dose of lignocaine?

A

7mg/kg

40
Q

What is the maximum dose of articaine?

A

7mg/kg

41
Q

What is the maximum dose of bupivacaine?

A

2mg/kg

42
Q

How much lignocaine is in each carpule?

A

44mg per carpule

43
Q

What must be documented when using LA?

A

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

44
Q

What must be documented when using LA?

A

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.

45
Q

How is the inferior alveolar nerve block different in children?

A

ramus shorter vertically

Narrower anteroposteriorly

Consider using a short needle

Gauge 27 to 30

46
Q

What are the important things to consider when performing an inferior alveolar nerve block?

A

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

47
Q

Why should vasoconstrictors be used in children?

A

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

48
Q

What are the symptoms of a high dose of LA?

A

CNS: Depression, sleepy

CVS: Decreased contractile force, decreased cardiac output

Pulmonary system: resp. arrest - death

IV administration: Analgesia, anxiety, restlessness, GA

49
Q

What are the symptoms of a high dose of LA? What about due to IV administration?

A

CNS: Depression, sleepy

CVS: Decreased contractile force, decreased cardiac output

Pulmonary system: resp. arrest - death

IV administration: Analgesia, anxiety, restlessness, GA

DMD3 (53 decks)

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