dent pharm Flashcards
1-illinois dental practice act
2-prescription must contain
3-IDPA
4-never do…
1-prescribe meds for therapeutic reasons
- need documented dx that necessitates a prescription
- if you have Illinois Controlled Substance license you can prescribe controlled substance
- prescribing medications= predicted on a valid diagnosis of problem
2-name of pt
date
name and strength of drug
quantity
direction for use
prescribers name, address, & signature
DEA number for controlled substances
3-licensed dentists write prescription w/ DENTAL RELATED AILMENTS…to write it for anything non-dental= violation of Illinois dental practice act
4-Never write a prescription for someone you haven’t seen—no clinician-patient relationship can be established if you don’t see the patient
-little legal protection if something goes wrong
1-medical history
2-initial assessment
3-getting medical history
4-good drugs
5-no good drugs
1-thorough, analyze, listen, consultations
- oral/legal implications
- update it
- record BP each time & test BG
- ommissions on med history form
- pt perception
- past medical history
- current medications
2-history, clinical exam, radiology, assessment/dx, tx plan, tx or referral, prescription
3-more info & pt rapport from interview
—pt that writes has been seen to give more errors
4-pain suppressants & antibiotics
5-oral contraceptives, antidepressants, continuous refills, habitual prescribing, large quantities, non therapeutic prescriptions
1-antibiotic
2-antibacterial agents
3-bactericidal
4-bacteriostatic
5-resistance
1-compound produced by a microorganism that inhibits another microorganism
2-substances that destroy/suppress growth of multiplying bacteria
3-ability to kill bacteria irreversibly
4-ability to inhibit or retard multiplication or growth of bacteria—work w/ immune system to get rid of organism
5-natural or acquired ability of an organism to be immune to or resist the effects of an anti-infective agent
Dental antibiotics
1-curative tx
2-prophylatic tx
3-not routinely
4-empiric therapy
5-targeted therapy
6-prophylactic therapy
1-infections that cant be treated via surgery, supplement to surgery in regard to pt general condition, spread of osteomyelitis
2-before tx—absolute indications= prosthetic, joint replacement, heart valves, previous bacterial endocarditis, congenital heart problems, certain times w/ heart transplants
3-tooth extraction, perio surgery, root resection, removal of 3 molars, endo therapy
4-antibiotics admin that have activity against the predicted or most likely pathogens—causing the pts infection based on signs and symptoms of infection
5-antibiotics used to treat established infections where site of infection, causative pathogens & antibiotic susceptibilities are known
6-antibiotics given to prevent development of infection during a procedure or immunocompromised state where there is a risk of infection
1-dental infections
2-when to use antibiotics
3-prevention of infective endocarditis
4-newish guidelines w/ endocarditis
5-dont need prophylaxis
1-via intro of extra oral pathogens
- through a change in balance of indigenous flora
- entry of bacteria into sterile vital pulp of tooth
- from caries that will then destroy enamel (dec w/ fluoride in h2o)
2-use when cant treat effectively
- compromised health
- prophylactically for certain conditions—prosthetic heart valves & joints
3—-prophylaxis recommended
prosthetic cardiac valve
previous infective endocarditis
congenital heart disease (CHD)
-during first 6 mo after procedure
cardiac transplant
anything else–prophylaxis isnt recommend
its recommended here bc endothelialization w/in 6 mo after procedure
4-all dental procedures w/ manipulation of gingiva or PA region of teeth or perforation of oral mucosa
5-anesthetic injections through non infected tissue, radiographs, placing RPD, ortho things, shedding of deciduous, & bleeding from trauma
1-pt premed
2-conditions not requiring premed
1-if has valvular heart disease or congenital cardiac defect
—standard= amoxicillin—adults= 2 g 30-60 min b4
kids= 50 mg 30-60 min b4
if allergic= clindamycin adults= 600 mg 30-60 b4
kids= 20 mg 30-60 min b4
2-coronary bypass surgery
MVP
physio heart murmur= turbulence of BF
rheumatic fever
pacemakers & implanted defib
stents
poorly controlled diabetes
pins, plates, screws
total joint replacement after 2 years
1-amoxicillin
2-amoxicillin prophylaxis
3-augmentin
4-penicillin
5-keflex
6-clindamycin
7-clindamycin prophylaxis
8-periostat-doxycycline
1-250/500/875
&&& suspension
1 capsule every 8 hours until finished
2- 500 mg 30-60 min prior
3-amoxicillin w/ clavulanate K
250/125, 500/125, 1000, 62.5 & suspensions
1 tab every 12 hours until done
4-250-500
1 tab every 6 hours until gone
5-250-500
1 capsule every 6 hours until gone
6-150, 300
1 capsule every 6 hrs until gone
7-4 capsules 30-60 min before tx
8- 20 mg—inhibits collagenase activity
- suppresses collagenase & modulates host response to inflammation as an adjunct for perio tx
- 1 tablet twice daily
1-dosing
2-tx of minors
3-preggo precautions
1-watch the dose, weight is most imp
2-minor= 18 and younger---cant get tx w/o parent or guardian exceptions= minor who is preggo, married, or has court ordered emancipation, telephone permission from guardian, or minor in dire need of tx
3-emergency dental tx can be performed at any time throughout preggo, getting whatever xrays are needed to diagnose problem
- optional dental work= postponed until after preg
- if work needs to be done= 2nd & 3rd trimester are safest but 1st trimester should be avoided
- dont use meds not safe for fetus—tetracyclines, barbiturates & benzodiazepines
- LA, acetaminophen, penicillin, erythromycin, clindamycin, cephalosporins= okay but no ibuprofen in 3rd trimester
1-prescribing antibiotics
2-antibiotics
3-dental considerations
4-antibiotic side effects
1-stick to order of antibiotic use
- know what your second choices are
- known what to use for resistant bugs that dont improve w/ antibiotic use
- know prophylactics regimens
- and new antibiotics
2-type of infection—viral or bacterial
- side effects of antibiotics
- 24 to 48 hrs to begin
- prescribing habits take years to develop
- 10 day course of tx w/ oral/systemic effects
- body weight matters
3-monitor for effect & change antibiotic or review dosage
- start w/ simple antibiotics
- consider other diseases when prescribing & tolerability
4-GI upset
fungal overgrowth
photosensitivity
allergies
glossitis & stomatitis
hairy tongue & dry mouth
—to be effect antibiotics must get to site of infection
1-amoxicillin
2-cephalosporins
3-clindamycin
1-used against most oral infections
- 1st choice for prophy antibiotic tx in non-penicillin allergic pt
- 500 mg every 8 hrs
- use w/ clavulinic acid
- 1st choice for prophy premed
2-keflec
- expensive
- 500 mg every 6 hrs —alternative prophy premed
- use in penicillin allergic pts
3-effect against most oral
1st choice in pencillin allergic pts
150 mg every 8 hrs
-2nd choice for prophy premed
1-tetracycline & doxycycline
2-doxycycline
3-metronidazole
4-quinolones
5-order for prescribing
6-order if allergic to penicillin
1-broad spec
- in saliva
- used in regractory perio infections
- in penicillin allergies
- discolors developing teeth
- photosensitivity
- dont take w/ dairy
2-submicrobial dose= 20mg—suppressed collagenase & modulates inflam
-100 mg (twice)= antibiotic dose when allergic to penicillin
3-reserved for tx of serious infections
-adjunct w/ other antibiotics (amoxicillin) in tx of perio disease
4-cpiro/levofloxacin
- 1-2 times dosing a daily
- not common
5-amoxicillin & other penicillins
cephalexin
clindamycin
azithromycin
tetracycline & doxycycline
5-clindamycin, azithromycin, tetracycline/doxycycline
1-acetaminophen
2-NSAIDS
3-nsaids disadv
4-salient points
1-acts centrally—use when peripheral acting NSAIDs arent working
- little blood thinning so use if pt uses blood thinners
- relief for mild dental pain
- less irritation to stomach= pt has GERD or other GI so use then
- no physical dependence
2-acts peripherally (at site of pain)
- anti-inflam= several doses
- effective
- no psychological or physical dependence
- good for endo, perio, post op pain & dental pains
3-not sufficient for extreme pain
- tinnitus at high doses
- stomach irritation
- watch other meds—cant take w/ blood thinners
- not good during preggo–esp 3rd trimester, affects BV formation & can lead to premature delivery
- careful w/ asthma & diabetic pts
- inc BP
4-most NSAIDs work in similar fashion—some may be more effective on individual basis
- ceiling effect for analgesis that is lower than anti-inflam effect (ibuprofen 400 mg vs 600-800 qid)
- anti-inflam effects make take longer to be realized
- acetamino (650 mg), ibuprofen (200 mg) & naproxen (220 mg) all OTC
- ibuprofen in 400, 600, 800= rx
- naproxen in 375, 500, 750 = rx
1-salient NSAIDS
2-common doses
3-opiods
4-opiates
1-acts peripherally (narcotics & acetamin dont)
- anti inflam effects
- inc GI acid production
- not used in preg
- blood thinning effect not to be used when pts on blood thinners
- effective for dental pain
2-acetamin= 650 mg 1 tab every 4-6 hrs ibuprofen= 400 mg #12 1 tab every 4 hrs naproxen= 500 mg 1 tab every 12 hours
3-include all opiates but also include chemicals that have been synthesized in same way—resemble opiates in structure
4-derived directly from opium poppy by separating and purifying the various chemicals in the poppy
1-narcotics adv
2-narcotics disadv
1-effective
no blood thinning (unless in combo w/ blood thinner (like ibuprofen))
-no stomach irritation
-central effect
2-psychological depend
- physical depend
- tolerance quickly developed
- avoid during preggo but can be used
- –short term= T3 & vicodin—category C not for nursin
- –drowsiness= caution about driving vehicles
1-narcotic compounds
2-acetaminophen
3-ibuprofen
4-naproxen
1-hydrocodone & acetaminophen—-5/300
hydrocodone & ibuprofen—7.5/200
codeine & acetaminophen—#3 30/300, #4 60/300
2-OTC—325 mg, 500 mg, 650 mg
650 mg 1 tab every 6 hrs
3-200 mg OTC—NSAID
rx—400 600 800 —–max= 2600 mg a day
400 mg, 1 tab every 4 hours
4-220 mg OTC
rx—250, 375 500
naproxen 500 #12 1 tab every 12 hrs
