drugs and therapeutics Flashcards
what are the amide LAs
mepivacaine, articaine, etidocaine, prilocaine, bupivacaine, lignocaine
what are the ester LAs
procaine, chloroprocaine, cocaine, tetracaine, benzocaine
where are ester and amide LAs metabolised
esters are metabolised in the plasma by butyrylcholinesterases
amides are metabolised in the liver
what is the mechanism of local anaesthesia
reversible blockage of propagation of peripheral nerve impulses by binding Na channels
what are the more common adverse reactions with local anaesthesia
syncope
psychogenic reaction
CNS excitation – tremors, convulsions, dizziness, lightheadedness, localised involuntary muscle activity
CNS depression – unconsciousness, resp depression
cardiac depression
neurotoxicity
in children, you should use LA with or without adrenaline?
with
what la should you avoid in children due to high risk of overdose
3% mepivacaine
what are the types of analgesics
paracetamol simple combination opioid LA TCA anti convulsants
how are the analgesic, anti inflammatory, anti pyretic properties of paracetamol
weak analgesic
weak anti inflammatory
strong anti pyretic
what are the risks of paracetamol
hepatotoxicity
what is the dosage for paracetamol
1g QDS PRN max 4g a day
NSAIDs should be used in caution in
asthmatics elderly peptic ulcer disease bleeding liver renal heart failure takin gprednisolone taking ace inhibitor taking aspirin peripheral edema, ascities at risk of vascular events
dosage for ibuprofen
400mg tds
how is the analgesic property of ibuprofen
mild
what is the dosage for naproxen
275-550mg BD
use of arcoxia should be avoided in those with what allergy
sulfonamide
NSAID can be used in combination with what for effective acute pain relief
acetaminophen (paracetamol)
when to prescribe gastric cytoprotection with NSAIDs
patients with known risk eg reflux, history of gastritis, PUD
patients with potential risk of GI bleed eg SSRI, corticosteroids
elderly over 60 years old
what can be given for gastric protection when prescribing nsaids
antacids eg mmt
h2 antagonist eg famotidine
proton pump inhibitor eg omeprazole
possible effect of NSAID interaction with alcohol and corticosteroids
increased GI bleed, PUD
possible effect of NSAID interaction with anti hypertensives
decrease anti hypertensive response
possible effect of NSAID interaction with anti coag, anti platelets, ssri
potentiate drug, increase bleeding
interfere with anti thrombotic activity of aspirin
possible effect of NSAID interaction with oral hypoglycemics
increased hypoglycemic effect
aspirin should be avoided in children under the age of
16
side effects of tramadol
headache nausea sweating drowsiness risk of suicide respiratory depression decreased seizure threshold, hence avoid in epileptics, those on ssri, tca
what should you do for effective pain relief
profound local anaesthesia pre op anaesthesia good surgical technique strict asepsis regular post op analgesia long acting la on discharge combination NSAID/paracetamol
what drugs can be used for chronic pain management
opioids
anti neuralgics
anti depressants
benzodiazepines
in the case of dentoalveolar infections, antibiotics are only required in
cases of spreading infection eg cellulitis, lymph node involvement, swelling, systemic signs and symptoms eg fever
cases of severe infection eg trismus, extra oral swelling
immunocompromised
amoxicillin coverage
broad spectrum covers gram positive and negative aerobes
limited activity against anaerobes
side effect of amoxicillin
diarrhea
coverage for erythromycin
gram positive aerobes and anaerobes
no gram neg activity
beta lactamase producing bacteria
what are some important drug interactions with macrolides
atorvastatin: diffuse myalgia, rhabdomyolysis
carbamazepine: increased risk of ataxia, vertigo, drowsiness, confusion
cyclosporin, tacrolimus: overt immunosuppression, nephrotoxicity
diazepam, midazolam: excess prolonged sedation, increased risk of airway obstruction in pediatric dental patients
felopidine, CCB: excessive anti hypertensive effect, resulting in hypotension and oedema
warfarin: increased INR, increased bleeding
what is the coverage of metronidazole
obligate anaerobes esp gram negative anaerobes
side effects of metronidazole
metallic taste, furred tongue, gi upset, headache, peripheral neuropathy, weakness
drug interactions with metronidazole
phenytoin: increased risk of drowsiness, ataxia
lithium; lithium toxicity
alcohol
warfarin: increased bleeding
statins: increased risk of myopathy, rhabdomyolysis
what drugs are frequently associated with c diff diarrhea and colitis
fluoroquinolones
cephalosporins
clindamycin
penicillin
drug interactions with azoles
fluconazole interacts with warfarin and statins, can cause heart palpitations in susceptible patients
warfarin - increase pt
statin - rhabdo
tacro, cyclo - increase immunosuppression
clopidogrel - decrease anti platelet effect
theophylline - arrhythmia
midazolam - increase sedation
side effects of systemic corticosteroids
short course: mood change fluid retention gi upset insomnia hyperglycemia
long course: easy bruisability moon face buffalo hump weight gain
what drugs should be avoided in patients with liver disease
aspirin nsaids cox 2 inhibitors paracetamol narcotic analgesics benzodiazepines azoles clindamycin
what drugs should be avoided in patients with renal disease
aspirin nsaids cox 2 inhibitors tetracyclnes aminoglycosides sulphonamides ciprofloxacin
caution use of penicillin and cephalosporins
prescription for laop
amoxicillin 500mg tds/clindamycin 300mg bds if antibiotic cover is necessary
chx 10ml tds
ponstan (mefenamic acid) 500mg tds
famotidine 20mg bd
prescription for a patient with uncontrolled diabetes taking warfarin who just underwent dental extractions
tranexamic acid 10ml tds for 2 days
amoxicillin 500mg tds
panadiene 2 tabs tds
chx 10ml tds
medication for traumatic ulcer
triamcinolone acetonamide 0.1%
medication for neurogenic pain
gabapentin 100-300mg tds, must titrate. start with 100mg bd then monitor
others: pregabalin, carbamazepine
medication for oral lichen planus
dexamethasone
nyastatin mouthwash 5ml qds
medication for tmj pain
anarex (paracetamol + orphenadrine [muscle relaxant]) 2 tabs tds
or ?
ibuprofen 400mg tds
medication for candidiasis
nyastatin 5ml qds for 14 days
gastric irritation prescription
famotidine 20mg bd
omeprazole 40mg om
