Drug use in Dentistry Flashcards
(26 cards)
What are the hazards of drug use?
• Death o Allergy o Toxicity • Drug interactions o Effect on absorption or metabolism of other essential medicines
2 exaples of drug interactions
Warfarin (anticoagulant)
Carbamazepine (anticonvulsant)
What are the different drug classes
- Local anaesthetics
- Antimicrobials
- Drugs in pain and inflammation
- Drugs used in sedation
- Emergency medical drugs
What are local anaesthetics used for?
Used to reduce awareness of pain, act on nerve ion channels to block propagation
Name 4 local anaestheics
- Lignocaine (lidocaine)
- Prilocaine
- Bupivacaine
- Mepivicaine
Bupivacaine often requires vasoconstrictor to prolong duration of action, what are the positives and negatives of this?
Positives: stop the drugs being washed away by blood
Negatives: Makes LA more toxic, patients can have reactions e.g. heart racing
What are the 3 classes of antimicrobials
antibiotics, antivirals, antifungals
Name 4 antibiotics used in dentistry
- Amoxycillin
- Metronidazole
- Doxycycline
- Clindamycin
Name an antiviral
aciclovir
Name 2 antifungals
- Nystatin (topical)
* Fluconazole (systemic – oral)
What are the 2 types of analgesics
- Drugs used to reduce the inflammatory mediators (NSAIDs)
* Drugs used to reduce the inflammation process (corticosteroids)
What are the effects of paracetamol
- Anti-pyretic (brings temp down) and analgesic
- Little anti-inflammatory action
- Few side effects
- Often combined with other analgesics
Name 3 NSAIDs
- Salicylates (Asprin)
- Propionic acid derivatives (Ibuprofen)
- Phenylaetic acid derivative (Diclofenac)
How do NSAIDs work?
- True action unknown
- INHIBIT prostaglandin synthesis
- Change the balance of PGE1 and PGE2 (Anti-inflammatory)
- Cyclo-oxygenase (COX) enzyme inhibition (COX inhibitors, COX 2 inhibitors)
What does arachidonic acid do?
cause inflammation?
via COX and therefore prostaglandins?????
How does asprin work?
Parmacokinetics
o Rapid absorbtion from GIT
o Elimination by 1st order kinetics (Unless overdose (enzyme saturation), Toxic effects – acidosis)
Inhibits COX 1
o Reduced synthesis of prostaglandins
o Reduced production of inflammatory mediators
o Anti-pyrexic
o Can be taken BEFORE inflammatory process starts (Pre-emptive analgesia)
What are the side effects of asprin?
Gastric irritation
Erosions, ulceration
Worse with alcohol
Inhibition of platelet function
Enhanced bleeding
Bronchospasm
Exacerbate asthma
Allergic reactions (rash)
Drug interactions
Significant protein binding – WARFARIN potentiation
What drug has the same actions as aspirin but the side effects affect fewer people
ibuprofen
Can you buy diclofenac over the counter
no. prescription only
What are the effects of diclofenac
• More potent than ibuprofen o Higher incidence of gastric bleeding o Higher incidence of asthma triggering o Allergic reactions (rash) o More effective anti-inflammatory action o Dose 50mg 3 times a day
How do corticosteroids reduce inflammation?
By inhibiting: o Capillary permeability o Formation of brady kinin o Migration of white blood cells o Reduce eicosanoid synthesis
(suppresses features of inflammation, doesn’t address the cause)
What do topical corticosteroids affect
just the area applied to
what do systemic corticosteroids affect
the whole organism
examples of topical corticosteroids
• Steroid inhalers in asthma • Hydrocortisone cream – eczema • Steroid treatments for mouth ulcers o Beclomethasone inhalers o Hydrocortisone adhesive tablets o Betamethasone solutions
