Dental Drugs Flashcards
What are the general principles of antimicrobial use?
- Prophylactic therapy
- Empirical therapy - use when benefits are substantial, narrowest spectrum, sufficient dose
- Directed therapy - use a single drug unless combination therapy is proven superior, keep duration as short as possible and do exceed 7 days. For odontogenic infections 5 days is enough.
What are the most common antibiotics used in dentistry?
- Beta Lactams (Pen V, Amoxycillin)
Active against gram-positive bacteria. Pen V should be the first drug of choice in odontogenic infections due to narrower spectrum and less sfx. - Nitromidazoles (Metronidazole)
effective against gram negative anaerobic bacteria. - Lincosamides (Clindamycin)
often used for people with allergies to Penicillin. Effective against gram positive aerobes and most anaerobes
Most commonly used antifungal drugs?
Azoles - fluconazole, miconazole
Polyenes - amphotericin, nystatin
Most common antivirals used?
Guanine Analogues - aciclovir, famciclovir, penciclovir
What are the most common Sfx to antibiotics?
Antimicrobial hypersensitivity (allergy)
- IgE immediate hypersensitivity: anaphylaxis - urticaria, angioedema, bronchospasms within 1-2 hours. 1-4/10,000 cases
- Delayed reactions: macular, papular rashes forming several days after start of tx. More common than anaphylactic reactions. T-cell mediated instead of IgE.
Antibiotic Associated Diarrhoea
- Clostridium Difficile is response in most cases. More common with broad spectrum AB such as cephalosporins, lincosamides
Antimicrobial drug interactions
- oral contraceptives and antibiotics
What analgesics can be prescribed to patients?
- NSAIDs, Paracetamol and Opioids
What are the general considerations for NSAIDs?
- most commonly used drug for pain relief
- relieve nociceptive pain and also have anti-inflammatory function through inhibiting COX.
- Work in both peripheral sites and centrally
- Low doses 400mg for anti-inflammatory
What are the contraindications for NSAID use?
- patients with definitive history of NSAID allegry
- active peptic ulcer disease or GI bleeding
- Pregnant or breastfeeding
What are the general considerations for paracetamol?
- paracetamol (acetaminophen) - has analgesic and antipyretic action by inhibiting prostaglandin in the CNS
- Can be used when NSAID contraindicated or used together with NSAIDs to lower their dose required and reduce risk factors
- paracetamol dose for avg adult is 0.5-1g per 4-6 hours up to 4g/day
Contraindications of paracetamol?
- acute liver failure
- serious kidney problems
- acitaminophen allergy
What are the general considerations and contraindications for opioids
General Considerations
- for severe pain - post severe trauma etc.
- most commonly used in dent is Codeine
- other opioids: morphine, oxycodone, tramadol
Contraindications
- allergies to opioids
- patients with history of opioid addiction
- drug interactions with: CNS depressants such as sedatives, hypnotics, antipsychotics and antidepressants
What are the most commonly used topical corticosteroids in dentistry and what are the prescribed for?
1% hydrocortisone acetate - minor mucosal inflammation
- 02% triamcinolone acetonide - inflammatory mucosal conditions
- 05% betamethasone dipropionate - inflammatory mucosal conditions (apthtous ulceration, lichen planus)
What are some anxiolytic and sedative drugs that we can give to anxious patients?
Benzodiazepines
- most commonly used anxiolytic and sedative drug and are GABA agonists resulting in neuronal inhibition
- taken orally - peak is 0.5-2 hours after administration
Diazepam and temazepam
- widely used anxiolytics and sedatives
For what purposes may you prescribe mouthwash to patients?
- antiseptic: CHX
- fluoride treatment
- anti-inflammatory: oral mucosal disease
- analgesic: oral mucositis
