Drug – related emergency

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Drug – related emergency

  1. 1. X Drug – related emergency
  2. 2. Metabolism of drugs  Definitions : Toxicology, adverse drug reactions ,  Classification of A D Rs   Drugs used in dentistry & their ADR  over dose reactions in details
  3. 3. Metabolism of drugs A given drug………..>circulation  ……. Redistribution [ ex in skeletal ms] …..biotransformed [=metabolism ,or detoxication ….in liver ]  Then excreted [….by kidney …] 
  4. 4. Toxicology:  Is the study of the harmful effects of drugs on biological systems  Whenever a drug is given two types of reactions may be noted : desirable…. & undesirable [adverse drug reactions ADR]  ADRs : adverse drug reactions …..are the undesirable reactions when a drug is given 
  5. 5. Side effects Over dose Allergy idiosyncrasy
  6. 6. Classification of A D Rs        Oldly : side effects, intolerance ,drug induced disease… Now Based on effects ADR are divided into effects as direct extension of drug action…… side effects………..I overdose reactions……….II effects result from altered patient effects result from altered immune response ex: allergy &………………………III idiosyncrasy…………………….IV
  7. 7. I-side effects reactions Are the undesirable effects of drugs that occur when the drugs are given .  Ex adrenaline……..bronchodilator  but …….palpitation 
  8. 8. II- over dose reactions        Definition are reactions that result from toxic amounts of a drug many drugs can cause ….. over dose reactions ------->emergency in dentistry as ex : Analgesic Antibiotic Anti anxiety Local anesthetics………….. commonest
  9. 9. III-Drug allergy           Definition : It is a hypersensitive response to an allergen to which the individual has been previously exposed to It is seen clinically as fever Angioedema Urticaria Dermatitis Blood elements depression Photosensitivity anaphylaxis
  10. 10. many drugs can cause ….. Drug allergic reactions as  Penicillin  Aspirin  Latex  Bisulfites 
  11. 11. NB:  allergic reaction are not related to the dose of the drug …[DD ..overdose reactions] but to the immune system  allergic reaction may appear similar for the different drugs because they are caused by the same mechanism 
  12. 12. IV-idiosyncrasy A unique strong hypersensitivity reaction that belong …. To a particular drug in a specific individual  it Can’t be explained by allergy or over dose..  Clinically a wide range of manifestations as depression…..& stimulation…….  Ex a depressant [barbiturate…..]…..>> stimulation 
  13. 13. Drugs used in dentistry & their ADR Common drugs are  Local anesthetics  Antibiotics  Analgesics  Anti anxiety drugs
  14. 14. Drugs used in dentistry & their ADR ADR Local ane inject …[AMIDE] Local ane topical vasoconst Side eff Psych dis -sedation -Vasod sy -hyperven RARE over allergic idiosyn dose r crasy - CNS extreme RARE depres RARE -seizures ++ cns sti +++++
  15. 15. ADR Antibiot Parent oral Analgesic Nonopi -aspirin Side eff -acetamin Depr opioids +++ nausea Vomit ++ over dose Salicylism +++ Depr CNS allergic r ++++ penic high allergic l++++.Urtic,b ron.sp ++++ ++ CNS depres rare
  16. 16. ADR Side eff over dose Antianxiety cns -barbitu Hange over depression -nonbarb drowsiness cns depression allergic r Uncommon uncommon
  17. 17. II- over dose reactions in details Definition  are reactions that result from toxic amounts of a drug       many drugs can cause ….. over dose reactions ------->emergency in dentistry as ex : Analgesic Antibiotic Anti anxiety Local anesthetics………….. Commonest
  18. 18. Local anesthetics Are the most common drugs used in dentistry  Types:     Chemically Local anesthesia are divided into : a- amide type like… lidocaine, mepivacaine … these produce overdose & side effects reactions but rarely produce allergic reactions b-ester type Like benzocaine ,tetracaine procaine –procainamide these are highly allergic
  19. 19. by method of administration local anesthetics are divided into  a-injectable  most injectable anesthetics are amide, less are esters  so produce more overdose reactions & less allergic 
  20. 20. b- topical anesthetics  mostly of ester type  few are amide [as lidocaine which contains preservative that produce allergy … so allergy should be considered in all topical local anesthetics 
  21. 21.  N B injectabe cartridges contain   1- local anesthetic [mostly amide ; less ester ] 2- other substances as  methylparaben [ bacteriostatic ,highly allergic more in ester cartridges]  ,,Na metabisulfite…antioxidant   
  22. 22. Predisposing factor for ADR of Local anesthetics  A- patient factors:  distribution curve  age  sex  weight  Genetics  Attitude & environment 
  23. 23. B- Drug factors  route of administration  Dose  Rate of injection  Site of injection  Presence of vasoconstrictors 
  24. 24. Causes of over dose react of local anesth Defective biotransformation &  elimination  Too large dose  Rapid absorption of local anesth administration tech 
  25. 25. NB ADR of Local anesthetics [injectable] :  Side effects : psychogenic effects as vasodepressor syncope & hyperventilation  Overdose reactions :by relative overdose not real overdose  Allergic reactions : rare  Idiosyncrasy : rare
  26. 26. S/S of overdose of local an Rapid I V -- S/S within 5-10 min  if vasoc………in 30 min  In small…moderate overdose there were:  CNS -excitation…….[no depression]  -….. confusion  -talkative  - apprehension  -excited ness………….. 
  27. 27. In high overdose  -generalized convulsions[ tonic & clonic]  - followed by depression : depressed blood pre….  -symptoms : headache, dizziness ,ringing in ears, drowsiness 
  28. 28. Adverse d r of injectable local anesthesia see also topical local anesthesia
  29. 29. SYSTEMIC EFFECTS OF Local anesthetics:  C V S ……. depress  C N S …..excit….then depress…  excitation [due to removal of cerebral cortex inhibitory effects]……talkativeness ,tremors,..  depression[ respiratory depression  cardiovascular depression….]  
  30. 30. management in Mild overdose reactions  R- recognize overdose reaction  onset is rapid in 5-10 min  talkative  anxiety  increased H R ,,BL P , resp  T- terminate dental ttt  p …..in comfortable position 
  31. 31. A B C …..as needed  D : definitive ttt  O2  monitor vital signs  give anticonvulsant if needed  medical assistance  permit recovery & discharge 
  32. 32. in severe overdose reactions  R- recognize the overdose reaction  onset is very rapid [appear during injection or in seconds]  generalized seizures……>>>  loss of consciousness  T- terminate dental ttt  p …..supine ……legs slightly elevated 
  33. 33. A B C …..as needed  D : definitive ttt  medical assistance  O2  monitor vital signs  IV anticonvulsant  post convulsive ttt [see postictus ttt]  permit recovery & discharge 
  34. 34. Epinephrine overdose Forms of Epinephrine or adrenalin …  with local anesth……..1:250,000  1: 50,000  local hemostasis……..  in gingival retraction cord … racemic epinephrine……….. 
  35. 35. Clinic  symptoms : Fear, anxiety, restlessness, tremors, palpitation ,dizziness..  signs: increased blood pressure  increased respiratory rate  Managem  R :recognition of …..  T : terminate dental ttt  P :position :comfortable 
  36. 36. A B C …..as needed  D : definitive ttt  O2  vasodilators 
  37. 37. CNS depressant overdose Management  R :recognition of …..  T : terminate dental ttt  P :position :comfortable  A B C …..as needed  D : definitive ttt O2 monitor vital signs In barbiturate overdose…… in benzodiazepine overdose…..
  38. 38.      NB In barbiturate overdose…… continue P A B C management In benzodiazepine overdose….. give the specific antagonist …..> flumazenil

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