Professional Documents
Culture Documents
Dr Mohamed Rabie
BDS, MSc, PhD
Learning objectives
▪ 1- Identify the cases in need for therapeutic treatment in dentistry.
▪ 2- Determine drugs employed for treatment of anxiety.
▪ 3- Determine the therapeutic treatment of pain.
▪ 4- Determine non-steroidal anti-infalmmatory agents.
▪ 5- Differentiate non-narcotic from narcotic analgesics.
▪ 6- Describe mechanism of antibiotic action.
▪ 7- Describe mechanism of bacterial resistance to antibiotics.
▪ 8- Recognize antibiotic toxic and allergic effect.
▪ 9- Identify different types of antibiotics.
▪ 10- Recognize different types of penicillin.
▪ 11- Illustrate the structure, spectrum, effects, adverse effects,
administration and does of cephalosporin, erythromycin, clindamycin,
tetracycline, and metronidazole.
Cases requiring therapeutic
treatment in endodontics:
▪ 1. Benzodiazepines (Tranquilizers).
▪ 2. Sedative – Hypnotics.
▪ 3. Antihistamines.
✓Pharmacologic effects
– Antianxiety
– Anticonvulsant
– Sedative-nonhypnotic
– Skeletal muscle relaxant
– Amnesic
✓Properties
• Well absorbed from GIT
• Peak blood levels after 1-2 hours
Adverse effects
▪ Drowsiness and Ataxia
▪ Motor impairments
▪ CNS depression
▪ Chronic drug dependence
Contraindications
▪ Allergy to the drug
▪ Glaucoma
▪ Porphyria
▪ 1st trimester of pregnancy
▪ Dosage
2-10 mg (adult oral dose)
Examples ;
– Diazepam (Valium)
– Chlordiazepoxide (Librium)
– Lorazepam (Ativan)
Sedative - Hypnotics
▪1. Barbiturates
▪2. Non barbiturates
Barbiturates
▪ Pharmacological effects
– Sedation
– Hypnosis
– Anesthesia, or
– Death >> according to the dose because of
respiratory depression
– Normal hypnotic dose >>> slight fall in heart rate & blood
pressure
Barbiturates
▪ Adverse effects
– Respiratory depression
– CNS ,,
– Psychological and physical dependence
▪ Routes of administration
– Orally
– Rectally
– IM or IV.
▪ metabolized In liver
Barbiturates
▪Contraindications
– Liver impairment
– Respiratory distress
– Allergy to the drug
– Porphyria
Dosage (adult)
▪ 100 mg Pentobarbital (Nembutal) 1 hour preoperative
▪ 100 – 200 mg of Secobarbital (Seconal) 1 hour preoperative
Nonbarbiturates (antihistamines)
Reception
• A specialized nerve cell called a nociceptor will be sensitized by the
stimulus and the chemicals released from injured tissues.
Transmission
• The nociceptor sends signals to the brain through several neurons
within the central nervous system.
• The signals travel up the spinal cord to the brain through a "neural
freeway" called the spinothalamic tract.
Pain center reception
• Within the brain, a relay station called the thalamus distributes the
signals to various parts of the brain; there is no single pain center.
• Areas like the somatosensory cortex process the information and you
feel pain.
– 2. Narcotics
NSAIDS
▪Group of drugs differ in chemical structure and sharing the
pharmacological & toxicological properties known as non-
narcotic analgesics.
Advantages
Disadvantages
▪ May mask fever
▪ Not effective for sever pain
▪ GIT irritation
▪ Damage of platelets
Mechanism Of Action of NSAIDs
Mechanism of NSAIDs
❖Most NSAIDs inhibit COX-1 and COX-2
nonselectively .
❖But some newer NSAIDs; like: celecoxib and
rofecoxib are selective inhibitors of COX-2.
Ibuprofen
Non selective NSAIDS Naproxen
Diclofenac
ketoprofen
▪ 1. Salicylic Acids
– Acetylsalicylic acid (aspirin).
– Non-acetylated salicylates (Diflunisal).
▪ 2. Propionic Acids
– Ibuprofen, 200-800 mg / 4-6hrs.
– Ketoprofen, 75 mg / 4-6hrs.
▪ 3. Acetic Acids
– Indomethacin, 50 mg / 8hrs.
– Diclofenac, 50-75 mg / 12hrs.
Aspirin
▪ Properties:
▪ Long-term duration ( 8-12 hr. ), however has a slow onset of
action ( 3 hrs. ).
▪ Contraindicated in patients with aspirin intolerance , in the
last trimester of pregnancy.
Propionic Acids ( Ibuprofen )
▪ Pharmacological properties:
▪ - Analgesic -antipyretic
▪ - Anti-inflammatory - anti-rheumatic
▪ well absorbed orally , excreted in kidney.
▪ Adverse effect:
▪ - G I T irritation - epigastric pain - Anorexia - nausea
▪ - vomiting - dizziness - vertigo
▪ Contraindications:
▪ - Allergy - peptic ulcer
Drug interactions
• Antihypertensive medications
• Aspirin
• Lithium
• Warfarin
Acetic Acids Diclofinac ( voltaren, cataflam )
▪ e.g. Acetaminophen
▪ A substitute drug of choice for aspirin allergic patients, with only analgesic
and antipyretic effect
▪ Pharmacological properties:
Dose :
Adults : 0.5-1 g every 4-6 hours
6-12 year..250-500 mg every 4-6 h
1-5 years .. 120-250 mg every 4-6 hours
• Tablets
• Suppositories
• Syrups
• Soluble tablets
• Capsules
Acetaminophen
• Adverse Effects
– Hepatotoxicity
• Can occur after the ingestion of a single toxic dose (20-25
gm) or after long term use of therapeutic doses.
▪ Dose: 15-60 mg
Tramadol
• E.g.
• Ibuprofen 400 mg and codeine 60 mg
• Ibuprofen 400 mg and oxycodone 10 mg.
• Tramadol and Ibuprofen
Antibiotics
▪
▪ Drugs used for treatment of established infections and as a prophylactic
agent in medically compromised patient.
▪ 1-Uncontrolled diabetes
▪ 2- Rheumatic or congenital heart disease
▪ 3- Prosthetic cardiac valves
▪ 4- Mitral valve prolapse with regurgitation
▪ 5- SBE
▪ 6- Immunosuppressive drugs ( chemotherapy, prolonged corticosteroids.
▪ 7- Immunological diseases that reduce the patient defensive mechanism
e. g. H I V , AIDS infections
Antibiotics in Endodontics
▪Penicillin
▪ A generic name for closely related A. B. that differ in:
▪ * antibacterial spectrum.
▪ * resistance to gastric acidity .
▪ * destruction by beta-lactamase enzyme.
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