Pharmacology and the dental patient Flashcards
Name some commonly used analgesics
- Ibuprofen
- Paracetamol
- Aspirin
- Corticosteroids
- Codine
What is an con of ibuprofen
- Occasionally causes xerostomia (dry mouth) which can increase oral plaque and dental caries (cavities)
What is the use of Corticosteroids
Anti-inflammatory medications that are used to relieve discomfort and soreness of the mouth
What may be given if pain is more severe
Narcotic analgesics - codeine, hydrocodone
What is the role of CYP2D6
The conversion of codeine to its active metabolite morphine occurs in the liver, and is catalysed by CYP2D6
What’s the effect of being a poor metaboliser of CYP2D6 in relation to taking codeine
- As codeine is a prodrug, poor metabolisers of CYP2D6 will experiences little to no analgesia from the medication
- This is because they lack the enzyme to metabolise the drug
What’s the issue with being a Poor Metaboliser (PM)
PM have inadequate pain control due to very minimal conversion of codeine (prodrug) to morphine
What’s the issue with being an Ultrarapid Metaboliser (UM)
- Likely to have more side effects from higher morphine concentrations
- Can be life-threatening
What is Pharmacogenetics
The identifications of genetic variants that affect the responses to medications in patients
Name some drugs for sedation
- Nitrous oxide
- Midazolam
Describe Nitrous Oxide
- Main use is usually as a mild sedative + analgesic
- Helps to alleviate patient anxiety
What are the 4 levels of sedation with Nitrous Oxide
- A tingling sensation
- Warm sensations
- A feeling of well-being/euphoria
- Sleepiness
Describe Midazolam
- IV sedation, recommended for adults
- Has a fast onset (1-2 mins)
- Drug slows heart rate and rate of breathing
- Patient can leave the surgery 1-1.5 hours after
- Can become addictive
What are the 2 phases of sedation with Midazolam
- Recovery from sedation
- Recovery from psychomotor impairment
What are some localised oral lesions that are indicated for antibiotic use
- Periodontal abscess
- Acute necrotising ulcerative gingivitis
What does short-course antibiotic therapy require in terms of characteristics
- Rapid onset of action
- Bactericidal activity
- Easy penetrability
- Administration at an optimal dose
What may prolonged courses of antibiotics result in
- Normal resident oral flora being destroyed
- Selection of resistant strains
- Colonisation by harmful micro-organisms that aren’t normal residents
What is Metronidazole and what can it be indicated for
- Used particularly for anaerobic bacteria + protozoa
- Can be indicated for treatment of a bacterial dental infection (often used with Amoxicillin)
When should you not take Metronidazole whilst consuming alcohol
Effects include:
- Nausea
- Vomiting
- Flushing of skin
- Shortness of breath
Describe antihypertensives and postural hypotension
- Postural hypotension is an excessive fall in blood pressure when an upright position is assumed
- Symptoms: faintness, light-headedness, dizziness, confusion
Describe opioids and addiction-related behaviour
- Opioid analgesics are sometimes used for some forms of chronic orofacial pain
- With long-term opioid therapy for chronic pain, there’s the potential risk of developing opioid tolerance, dependance or addiction
Describe insulin and oral hypoglycaemics
- Most common complication of diabetes therapy that can occur in the dental surgery is a hypoglycaemic episode (drop in blood glucose levels)
- Oral infections or dental procedures can affect food intake in diabetics
Describe steroids
- Chronic usage of steroid inhalers make the patient susceptible to oral yeast infection + blood blisters
Describe beta blockers
- Patients medicated with non-selective beta blockers have heightened sensitivity to the systemic effects of vasopressors
- Beta blockers can decrease hepatic blood flow and/or inhibit hepatic enzymes, resulting in the reduced metabolism of lidocaine
Describe warfarin and antiplatelet drugs
- Warfarin is an anticoagulant which inhibits synthesis of the vitamin K-dependant coagulation factors
- A normal coagulation profile has an INR of 1.0, the risk of bleeding increases exponentially as the INR rises
- INR should be measures within 72 hours prior to the operative procedure - allows time for any dose adjustment so the INR is less than 4.0 on the day of procedure
Describe bisphosphonates
- Bisphosphonates are used to prevent bone resorption in osteoporosis and bone cancer
- Bisphosphonate usage is associated with exposure of dead bone in jaws
- By surpressing bone resorption, any damaged bone will be left in situ instead of being resorbed
