Drug Prescription in Dentistry

Drug Prescription in Dentistry

1. Drug Prescription in oral surgery Dr. Hadi Munib Oral and Maxillofacial Surgery Resident

2. outline Indications for Drugs prescription Prescription example Common Drugs prescribed in dental clinics Drug Precautions References

3. Indications for drug prescription Pain Killer Treat Infections Prevent Infections Treat Diseases Palliative treatment

4. Prescription example A proper drug prescription should include: Name Age Date Drug name Drug Dose Drug Frequency Drug Route of intake Physician’s name and signature

5. Abbreviations Rx PO PR IV IM OD , BID , TID QID PRN, Q SR, QN, QOD ABD EOD

6. Drug Prescription Patient’s name, age and date of prescription Amoxicillin 500mg PO 1 * 3 * 7 Paracetamol 500mg PO Q4 hours Chlorhexidine 0.2% I 1 * 2 Close remaining space Name and signature

7. Common classes of drugs Analgesics Antimicrobials drugs Anti-Hypertensive drugs Anti-Diabetic drugs Narcotics

8. Paracetamol / Acetaminophen Analgesic (Mild to Moderate pain) Anti-Pyretic Little to no anti-inflammatory action. Thought selectively inhibit  COX  activities in the brain Dose 500mg – 1 g Q4 hours Common Drugs in oral surgery

9. Common Drugs in oral surgery NSAIDs Anti-Pyretic Anti-Inflammatory Analgesic Types Mechanism: Inhibiting COX enzymes preventing the formation of Prostaglandins and Leukotrienes Examples: Aspirin, Ibuprofen, Naproxen …etc. Dose: 400-600 mg Q 4-6 hours

10. NSAIDs precautions Children < 12 years old  Reye’s Syndrome Anticoagulants Bleeding Disorders Peptic Ulcers  Reduced PGs, Mucus secretions and Bicarbonates and increased acid secretions Pregnancy  Prolonged Labor, Excess Bleeding and Early Closure of Ductus Arteriosus Renal or Hepatic Failures Asthmatics Lithium

11. opioids Bind to Opioids receptors in the central, peripheral and GI systems Alcoholics?  Side effects:  sedation ,  respiratory depression ,  constipation , Tolerance and dependence . Codeine: Anti- Tussive , might be mixed with Paracetamol as Revacod 500 mg 1-2 tablets * 3 Tramadol: Moderate to Moderately Severe Pain. 50-100 mg 1 * 3 PRN

12. Antimicrobials Include: Antibiotics, Antivirals, Antiprotozoal and Antifungals Principles of Antimicrobial therapy: Identification of Microorganisms Empirical Therapy? Patients factors Route Of Administration

13. Surgical site infection

14. Prosthetic joints

15. Antibiotics Cell-Wall Inhibitors: Penicillin Mechanism of Action Amoxicillin 500 mg 1* 3 * 7 MRSA Amoxicillin with Clavulanic acid  Curam ® and Augmentin® 625 mg 1 * 3 or 1 g 1 * 2 Ampicillin PO: 250-500 mg Q6hr Flucloxacillin  250 mg 1 * 4 for Staph. Adverse effects: Hypersensitivity (5%) and Diarrhea

16. Cephalosporin: Cell-Wall Inhibitors First Generation: G+ Bacteria ( cephalexin 500mg 1*3 ) Second Generation: effect on G – Bacteria ( cefuroxime 1gm IV/IM ) Third Generation: Greater effect on G – Bacteria ( cefotaxime 1gm IV/IM ) Fourth Generation: Greatest Against G – Bacteria ( ceftriaxone 1 gm IV/IM) Hypersensitivity: 10% of Penicillin Hypersensitivity patients have Hypersensitivity to Cephalosporin Vancomycin: Cell-Wall Inhibitor Metronidazole: Flagyl ® 250 – 500 mg 1 * 3 Antibiotics

17. antibiotics Protein Synthesis Inhibitors: Tetracycline, Aminoglycosides, Macrolides and Lincosamides . Inhibit Ribosomes (30S and 50S) Safe? Broad-Spectrum Erythromycin, Clindamycin, Clarithromycin and Azithromycin. Clindamycin Dose Strength: 150 mg, 300 mg and 600 mg [Maximum Dose] 150 mg 1 * 4, 300 mg 1 *2 and 600 mg 1*1

18. Antifungals Nystatin  usually used for Oral thrush, 400,000 to 600,000 units of the oral suspension orally 4 times a day . Miconazole  Oral thrush and Angular Cheilitis, Dose: Oral gel 25mg/ml 2-5 ml 1*4, Cream 2%  1*3 Fluconazole  100 mg: Dispense 15 tablets, take 2 tablets on day 1, followed by 1 tablet a day for the remainder of the14-day treatment period. Clotrimazole troches 10 mg: Dispense 70, dissolve 1 troche in mouth 5 times a day for 14 days. [Benefit?]

19. Antifungals

20. Antivirals Acyclovir  Herpes virus infections, Dosage: Prodromal Symptoms 5% Topical Cream 1 * 4 200 mg to 800 mg daily for 10 days [Usage]

21. mouthwash CHLORHEXIDINE: 0.12% to 0.2% Concentration 1 * 2 SE: Staining POVIDINE – IODINE: C/I: Thyroid Diseases

22. Drug precautions Groups at risk: Children, Elderly and Pregnant Women Children: Dose reduction Weight: Clarke’s Rule Age:

23. Elderly Up to 75% have one or more chronic diseases (30% have more than three). Mucosal lesions may be present in up to 40% of older people (Malignancy risk?) GI Disorders are very common in this group of patients Polypharmacy

24. Pregnancy Up to 10% of late Pregnancy may become hypotensive if laid supine Use safe categories of drugs Deficiency Anemias in 20% of pregnant women are suspected Teratogenic effects are most likely in the first trimester. Second and third trimester effects are mainly on growth. Breast Feeding Liver Diseases Kidney Diseases

25. References Lippincott’s Pharmacology – Sixth Edition; Chapters: 37, 38, 39, 42 and 45 https://www.iasusa.org/sites/default/files/tam/13-5-143.pdf Scully’s Medical Problems in Dentistry; Chapters 25, 27 and 29

26. Thank you