<ul><li>GOOD MORNING </li></ul>
Department Of Oral Medicine & Radiology PRESENTED BY: NEHA KAPOOR ROLL NO. 32 4th batch
SEMINAR ON ANALGESICS USED IN DENTISTRY
CONTENTS <ul><li>Introduction </li></ul><ul><li>Classification </li></ul><ul><li>NSAIDs </li></ul><ul><li>References </li>...
INTRODUCTION <ul><li>ANALGESICS </li></ul><ul><li>A drug that selectively relieves pain by acting in CNS or on peripheral ...
OROFACIAL PAIN <ul><li>NOCICEPTIVE PAIN </li></ul><ul><li>( tissue injury and inflammation) </li></ul><ul><li>Odontogenic ...
CLASSIFICATION <ul><li>Divided into 2 groups: </li></ul><ul><li>1.  Opioid Analgesics  -Narcotics/Morphine like analgesics...
OPIOID ANALGESICS <ul><li>Natural Opium alkaloids   </li></ul><ul><li>-   Morphine & Codeine. </li></ul><ul><li>Semi synth...
NON OPIOID ANALGESICS & NSAIDs <ul><li>Analgesic and Anti inflammatory </li></ul><ul><li>NON-SELECTIVE COX INHIBITORS </li...
<ul><li>B.   Prefential COX-2 inhibitors </li></ul><ul><li>-  Nimesulide </li></ul><ul><li>- Meloxicam </li></ul><ul><li>-...
<ul><li>D. Analgesics with poor Anti inflammatory action- </li></ul><ul><li>Paraminophenol derivative   </li></ul><ul><li>...
MECHANISM OF ACTION OF NSAIDS <ul><li>Prostaglandins synthesis inhibiton </li></ul><ul><li>Membrane phospholipids </li></u...
ASPIRIN <ul><li>Acetylsalicylic acid </li></ul><ul><li>Pharmacological actions </li></ul><ul><li>Analgesic, antipyretic, a...
<ul><li>ADVERSE EFFECTS :  </li></ul><ul><li>Nausea, vomiting, epigastric distress, increased blood loss in stools </li></...
<ul><li>USES : </li></ul><ul><li>Analgesic </li></ul><ul><li>Antipyretic </li></ul><ul><li>Acute rheumatic fever </li></ul...
<ul><li>Precautions & Contraindications : </li></ul><ul><li>Peptic ulcer </li></ul><ul><li>Bleeding tendencies </li></ul><...
<ul><li>Commercially available as: </li></ul><ul><li>Aspirin :   350 mg tab. </li></ul><ul><li>Disprin:  350mg tab. </li><...
Dental consideration in a patient who is on aspirin therapy   <ul><li>BT </li></ul><ul><li>CT </li></ul><ul><li>PT </li></...
INDOMETHACIN <ul><li>Indole derivative </li></ul><ul><li>Potent inhibitor of PG synthesis & suppresses neutrophil motility...
IBUPROFEN <ul><li>Propionic acid derivative </li></ul><ul><li>Adverse effects: </li></ul><ul><li>Gastric discomfort, nause...
<ul><li>USES: </li></ul><ul><li>Analgesic & Antipyretic </li></ul><ul><li>Rheumatoid arthritis, osteoarthritis, musculoske...
MEPHENAMIC ACID <ul><li>Anthranilic acid derivative </li></ul><ul><li>Adverse effect:  Diarrhoea, skin rashes, dizziness &...
DICLOFENAC SODIUM <ul><li>Aryl-acetic acid derivative </li></ul><ul><li>Well absorbed orally </li></ul><ul><li>Plasma t ½ ...
PIROXICAM <ul><li>Oxicam derivative </li></ul><ul><li>Long acting potent NSAID </li></ul><ul><li>Good analgesic-antipyreti...
KETOROLAC <ul><li>Pyrrolo-pyrrole derivative </li></ul><ul><li>Potent analgesic & modest anti inflammatory </li></ul><ul><...
<ul><li>USES: </li></ul><ul><li>Postoperative & acute musculoskeletal pain: 15-30 mg i.m or i.v every 4-6 hrs </li></ul><u...
NIMESULIDE <ul><li>Preferential COX-2 inhibitors </li></ul><ul><li>Used for short lasting painful inflammatory conditions ...
<ul><li>Adverse effects: </li></ul><ul><li>- Epigastralgia, heart burn, nausea, loose motions, rash pruritus. </li></ul><u...
ROFECOXIB <ul><li>Selective COX-2 inhibitor. </li></ul><ul><li>Effective in osteoarthritis, rheumatoid arthritis, dysmenor...
PARACETAMOL <ul><li>Para-amino phenol derivative </li></ul><ul><li>Actions:  Good & promptly acting antipyretic </li></ul>...
<ul><li>Acute paracetamol poisoning: </li></ul><ul><li>-  In small children with glucuronide conjugating ability </li></ul...
<ul><li>USES: </li></ul><ul><li>First choice analgesic for osteoarthritis </li></ul><ul><li>Best drug to be used as antipy...
<ul><li>DOSE:   </li></ul><ul><li>0.5-1g TDS; </li></ul><ul><li>infants 50mg; </li></ul><ul><li>children 1-3 yrs 80-160mg ...
SYNERGISTIC EFFECT <ul><li>When the action of one drug is facilitated or increased by the other, they are said to be syner...
TOPICAL NSAIDs <ul><li>Topical formulations are available for application over painful joints and muscles. </li></ul><ul><...
INDICATIONS OF NSAIDS IN DENTISTRY <ul><li>Irreversible pulpitis </li></ul><ul><li>Apical periodontitis </li></ul><ul><li>...
GENERAL CONTRAINDICATIONS <ul><li>Ulcer </li></ul><ul><li>Asthma </li></ul><ul><li>Patient with nasal polyp </li></ul><ul>...
CONCLUSION <ul><li>Nature of problem along with consideration of risk factors in an individual patient directs the initial...
REFERENCES <ul><li>Essentials of Medical Pharmacology, </li></ul><ul><li>  K. D Tripathy, 5 th  edition </li></ul><ul><li>...
<ul><li>THANK YOU </li></ul>THANK YOU
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Analgesics

  1. 1. <ul><li>GOOD MORNING </li></ul>
  2. 2. Department Of Oral Medicine & Radiology PRESENTED BY: NEHA KAPOOR ROLL NO. 32 4th batch
  3. 3. SEMINAR ON ANALGESICS USED IN DENTISTRY
  4. 4. CONTENTS <ul><li>Introduction </li></ul><ul><li>Classification </li></ul><ul><li>NSAIDs </li></ul><ul><li>References </li></ul>
  5. 5. INTRODUCTION <ul><li>ANALGESICS </li></ul><ul><li>A drug that selectively relieves pain by acting in CNS or on peripheral pain mechanism, without significantly altering consciousness. </li></ul><ul><li>ANAESTHESIA </li></ul><ul><li>Anaesthesia means loss of sensation. Anaesthetic agent is one which bring about loss of all modalities of sensation, particularly pain, along with a reversible loss of consciousness. </li></ul><ul><li>PAIN (ALGESIA) </li></ul><ul><li>An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. </li></ul><ul><li>-IASP </li></ul>
  6. 6. OROFACIAL PAIN <ul><li>NOCICEPTIVE PAIN </li></ul><ul><li>( tissue injury and inflammation) </li></ul><ul><li>Odontogenic conditions </li></ul><ul><li>Eg. Pulpitis,apical periodontitis. </li></ul><ul><li>Mucosal conditions </li></ul><ul><li>Eg. Ulcers,lichen planus,herpes simplex </li></ul><ul><li>Musculo skeletal conditions </li></ul><ul><li>Eg. Myofacial pain,temporo mandibular joint capsulitis,arthritis. </li></ul><ul><li>NEUROPATHIC PAIN </li></ul><ul><li>( primary lesion or dysfunction of nervous system) </li></ul><ul><li>Classic cranial neuralgias </li></ul><ul><li>Eg. Trigeminal and glossopharygeal </li></ul><ul><li>Stomatodynia </li></ul><ul><li>Phantom tooth pain </li></ul><ul><li>Traumatic nerve injuries </li></ul>
  7. 7. CLASSIFICATION <ul><li>Divided into 2 groups: </li></ul><ul><li>1. Opioid Analgesics -Narcotics/Morphine like analgesics </li></ul><ul><li>2. Non Opioid Analgesics -NSAIDs/Non narcotic/aspirin like analgesics </li></ul>
  8. 8. OPIOID ANALGESICS <ul><li>Natural Opium alkaloids </li></ul><ul><li>- Morphine & Codeine. </li></ul><ul><li>Semi synthetic opiates </li></ul><ul><li>Diacetylmorphine </li></ul><ul><li>oxymorphone </li></ul><ul><li>- Pholcodeine </li></ul><ul><li>Synthetic opioids </li></ul><ul><li>Pethidine </li></ul><ul><li>Fentanyl </li></ul><ul><li>Methadone </li></ul><ul><li>Dextropropoxyphene </li></ul><ul><li>Ethoheptazine </li></ul><ul><li>Tramadol </li></ul>
  9. 9. NON OPIOID ANALGESICS & NSAIDs <ul><li>Analgesic and Anti inflammatory </li></ul><ul><li>NON-SELECTIVE COX INHIBITORS </li></ul><ul><li>Salicylates – Aspirin, Salicylamide, Benorylate, Diflunisal. </li></ul><ul><li>Pyrazolone derivatives – Phenyl butazone, Oxyphenyl-butazone. </li></ul><ul><li>Propionic acid derivatives – Ibuprofen, Naproxen, Ketoprofen, Fenoprofen, Flurbiprofen, Oxaprozin. </li></ul><ul><li>Indole derivatives – Indomethacin, Sulindac. </li></ul><ul><li>Anthranilic acid derivative – Mephanimic acid, Flufenamic acid. </li></ul><ul><li>Aryl acetic acid derivative – Diclofenac, Tolmetin.. </li></ul><ul><li>Oxicam derivative – Piroxicam, Tenoxicam. </li></ul><ul><li>Pyrrolo pyrrole derivatives – Ketorolac, Feprazone. </li></ul>
  10. 10. <ul><li>B. Prefential COX-2 inhibitors </li></ul><ul><li>- Nimesulide </li></ul><ul><li>- Meloxicam </li></ul><ul><li>- Nabumetone </li></ul><ul><li>C. Selective COX-2 inhibitors </li></ul><ul><li>- Valdecoxib </li></ul><ul><li>- Celecoxib </li></ul><ul><li>- Rofecoxib </li></ul>
  11. 11. <ul><li>D. Analgesics with poor Anti inflammatory action- </li></ul><ul><li>Paraminophenol derivative </li></ul><ul><li>- Paracetamol (Acetaminophen) </li></ul><ul><li>Pyrazolone derivative </li></ul><ul><li>- Metamizol, Propiphenazone </li></ul><ul><li>Benzoxazocine derivative </li></ul><ul><li>- Nefopam </li></ul>
  12. 12. MECHANISM OF ACTION OF NSAIDS <ul><li>Prostaglandins synthesis inhibiton </li></ul><ul><li>Membrane phospholipids </li></ul>Phospholipase A Arachidonic acid Cyclo oxygenase PG G 2 + PG H 2 Isomerases Thromboxane sythetase Prostacyclin synthetase PG E 2 , PG D 2 , PG F TX A2 TX B 2 PG I 2 PG E 2 , PG D 2 , PG F TX A 2
  13. 13. ASPIRIN <ul><li>Acetylsalicylic acid </li></ul><ul><li>Pharmacological actions </li></ul><ul><li>Analgesic, antipyretic, antiinflammatory actions </li></ul><ul><li>Metabolic effects: Blood sugar may decrease, plasma free fatty acid & cholesterol levels reduced </li></ul><ul><li>Respiration: Hyperventilation in salicylate poisoning </li></ul><ul><li>Acid base & electrolyte balance: Compensated respiratory alkalosis </li></ul><ul><li>CVS: Vasodilation, increase in cardiac output </li></ul><ul><li>GIT: Epigastric distress, nausea & vomiting </li></ul><ul><li>Blood: Prolongs bleeding time </li></ul>
  14. 14. <ul><li>ADVERSE EFFECTS : </li></ul><ul><li>Nausea, vomiting, epigastric distress, increased blood loss in stools </li></ul><ul><li>Rashes, fixed drug eruptions, urticaria, rhinorrhea, angioedema, asthma, anaphylactoid reaction </li></ul><ul><li>Salicylism – dizziness, tinnitus, vertigo, impairment of hearing & vision, excitement & mental confusion, hyperventilation & electrolyte imbalance </li></ul><ul><li>Acute salicylate poisoning: Fatal dose in adults 15-30g, lower in children </li></ul>
  15. 15. <ul><li>USES : </li></ul><ul><li>Analgesic </li></ul><ul><li>Antipyretic </li></ul><ul><li>Acute rheumatic fever </li></ul><ul><li>Rheumatoid arthritis </li></ul><ul><li>Osteoarthritis </li></ul><ul><li>Postmyocardial infarction </li></ul><ul><li>Patent Ductus Arteriosus </li></ul><ul><li>Familial colonic polyposis </li></ul><ul><li>Prevention of colon cancer </li></ul><ul><li>Treatment of Bartter’s syndrome </li></ul>
  16. 16. <ul><li>Precautions & Contraindications : </li></ul><ul><li>Peptic ulcer </li></ul><ul><li>Bleeding tendencies </li></ul><ul><li>Children with chicken pox or influenza </li></ul><ul><li>Chronic liver disease </li></ul><ul><li>Diabetics </li></ul><ul><li>Pregnancy </li></ul><ul><li>Breast feeding mothers </li></ul><ul><li>G6 PD deficient individuals : Hemolysis </li></ul><ul><li>Dose </li></ul><ul><li>- 0.3-0.6 g 4-6 hrly orally </li></ul>
  17. 17. <ul><li>Commercially available as: </li></ul><ul><li>Aspirin : 350 mg tab. </li></ul><ul><li>Disprin: 350mg tab. </li></ul><ul><li>Colsprin: 100, 325,650mg tab. </li></ul><ul><li>Ecosprin: 75, 150, 325mg tab. </li></ul>
  18. 18. Dental consideration in a patient who is on aspirin therapy <ul><li>BT </li></ul><ul><li>CT </li></ul><ul><li>PT </li></ul><ul><li>INR </li></ul>
  19. 19. INDOMETHACIN <ul><li>Indole derivative </li></ul><ul><li>Potent inhibitor of PG synthesis & suppresses neutrophil motility </li></ul><ul><li>Well absorbed orally & t ½ is 2-5 hrs </li></ul><ul><li>Adverse effects: Gastric irritation, nausea, anorexia, gastric bleeding & diarrhoea, frontal headache, dizziness, ataxia, mental confusion, depression, psychosis, leukopenia, rashes, increased risk of bleeding </li></ul><ul><li>Contraindicated in machinery operators, drivers, psychiatric patients, epileptics, kidney disease, pregnant women & children </li></ul><ul><li>Dose: 25-50mg BD-QID </li></ul><ul><li>Commercially available as- </li></ul><ul><li>Idicin, Indocap, Indoflam : 25mg, 75mg tab </li></ul>
  20. 20. IBUPROFEN <ul><li>Propionic acid derivative </li></ul><ul><li>Adverse effects: </li></ul><ul><li>Gastric discomfort, nausea & vomiting </li></ul><ul><li>Headache, dizziness, blurring of vision, tinnitus & depression </li></ul><ul><li>Avoided in pregnancy, peptic ulcer patient & asthmatic patients </li></ul>
  21. 21. <ul><li>USES: </li></ul><ul><li>Analgesic & Antipyretic </li></ul><ul><li>Rheumatoid arthritis, osteoarthritis, musculoskeletal disorders </li></ul><ul><li>Soft tissue injuries, fractures, vasectomy, tooth extraction </li></ul><ul><li>Postpartum & postoperatively : suppress swelling & inflammation </li></ul><ul><li>Dose: 400-800 mg TDS </li></ul><ul><li>Comercially available as- </li></ul><ul><li>Brufen, Emflam, Ibusynth : 200, 400, 600mg tab. </li></ul><ul><li>Ibugesic : 100mg, 400 mg tab. </li></ul>
  22. 22. MEPHENAMIC ACID <ul><li>Anthranilic acid derivative </li></ul><ul><li>Adverse effect: Diarrhoea, skin rashes, dizziness & other CNS manifestation </li></ul><ul><li>Orally absorbed & t ½ is 2-4 hrs </li></ul><ul><li>Uses: Analgesic in muscle, joint & soft tissue pain, dysmenorrhoea, rheumatoid & osteoarthritis </li></ul><ul><li>Dose: 250-500 mg TDS </li></ul><ul><li>Commercially available as: </li></ul><ul><li>Medol, Meftal - 250, 500 mg tab. </li></ul>
  23. 23. DICLOFENAC SODIUM <ul><li>Aryl-acetic acid derivative </li></ul><ul><li>Well absorbed orally </li></ul><ul><li>Plasma t ½ - 2 hrs </li></ul><ul><li>Adverse effects: Epigastric pain, nausea, headache, dizziness, rashes </li></ul><ul><li>Uses: Rheumatoid arthritis, ankylosing spondylitis, dysmenorrhea, post traumatic & post inflammatory conditions </li></ul><ul><li>Dose: 50mg TDS, then BD oral, 75mg deep i.m </li></ul><ul><li>Commercially available as: </li></ul><ul><li>Voveran, Diclonac, Movonac : 50 mg tab. </li></ul><ul><li>Diclomax : 25, 50 mg tab. </li></ul>
  24. 24. PIROXICAM <ul><li>Oxicam derivative </li></ul><ul><li>Long acting potent NSAID </li></ul><ul><li>Good analgesic-antipyretic action </li></ul><ul><li>Metabolised in liver ; excreted in urine & bile </li></ul><ul><li>Plasma t ½ is 2 days </li></ul><ul><li>Side effects : heart burn, nausea & anorexia </li></ul><ul><li>Use as short term analgesic & long term anti inflammatory drug – rheumatoid & osteo arthritis, ankylosing spondylitis, acute gout, musculoskeletal injuries,dysmenorrhoea etc </li></ul><ul><li>Dose: 20mg BD for 2 days followed by 20mg OD </li></ul><ul><li>Commercially available as- </li></ul><ul><li>Dolonex, Pirox, Piricam : 10, 20 mg cap. </li></ul>
  25. 25. KETOROLAC <ul><li>Pyrrolo-pyrrole derivative </li></ul><ul><li>Potent analgesic & modest anti inflammatory </li></ul><ul><li>Rapidly absorbed after oral & i.m administration </li></ul><ul><li>Plasma t ½ is 5-7 hrs </li></ul><ul><li>Adverse effects: Nausea, abdominal pain, dyspepsia, ulceration, loose stools, drowsiness, headache, dizziness, nervousness, pruritis, pain & fluid retention </li></ul><ul><li>Not be given to patients on anticoagulants </li></ul>
  26. 26. <ul><li>USES: </li></ul><ul><li>Postoperative & acute musculoskeletal pain: 15-30 mg i.m or i.v every 4-6 hrs </li></ul><ul><li>Used for renal colic, migraine, pain due to bony metastasis </li></ul><ul><li>Orally in a dose of 10-20 mg 6 hrly. </li></ul><ul><li>Commercially available as – </li></ul><ul><li>Ketorol, Zorovon, Ketanov, Torolac : 10mg tab. </li></ul>
  27. 27. NIMESULIDE <ul><li>Preferential COX-2 inhibitors </li></ul><ul><li>Used for short lasting painful inflammatory conditions like sports injuries, sinusitis, ear nose throat disorders, dental surgery, bursitis, low backache, dysmenorrhoea, post operative pain, osteoarthritis & for fever </li></ul><ul><li>Completely absorbed orally, excreted in urine, t ½ of 2-5 hrs </li></ul>
  28. 28. <ul><li>Adverse effects: </li></ul><ul><li>- Epigastralgia, heart burn, nausea, loose motions, rash pruritus. </li></ul><ul><li>- Hematuria & fulminant hepatic failure in few cases </li></ul><ul><li>Useful in asthmatics, bronchospasm or intolerance to aspirin & other NSAIDs </li></ul><ul><li>Dose: 100 mg BD </li></ul><ul><li>Commercially available as- </li></ul><ul><li>Nimulid, Nimegesic, Nise, Nobel, Nimodol : 100mg tab. </li></ul>
  29. 29. ROFECOXIB <ul><li>Selective COX-2 inhibitor. </li></ul><ul><li>Effective in osteoarthritis, rheumatoid arthritis, dysmenorrhoea, dental, post operative & acute musculoskeletal pain at dose of 12.5-25 mg OD daily </li></ul><ul><li>Side effects mild g.i complaints, headache & dizziness </li></ul><ul><li>Well absorbed orally & t ½ of 17 hrs </li></ul><ul><li>Avoided in presence of severe hepatic or renal disease </li></ul><ul><li>Dose: 12.5-25 mg OD </li></ul><ul><li>Commercially available as- </li></ul><ul><li>Rofact, Rofegesic, Rofibax : 12.5, 25 mg tab. </li></ul>
  30. 30. PARACETAMOL <ul><li>Para-amino phenol derivative </li></ul><ul><li>Actions: Good & promptly acting antipyretic </li></ul><ul><li>Well absorbed orally </li></ul><ul><li>Plasma t ½ is 2-3 hrs </li></ul><ul><li>Safe & well tolerated </li></ul><ul><li>Nausea & rashes occur occasionally </li></ul><ul><li>Analgesic nephropathy- years of heavy ingestion </li></ul>
  31. 31. <ul><li>Acute paracetamol poisoning: </li></ul><ul><li>- In small children with glucuronide conjugating ability </li></ul><ul><li>Nausea, vomiting, abdominal pain, liver tenderness </li></ul><ul><li>Centrilobular hepatic necrosis accompanied by renal tubular necrosis & hypoglycemia, may progress to coma </li></ul><ul><li>Jaundice after 2 days </li></ul><ul><li>Treatment: Vomiting induced, activated charcoal given, N-acetylcystein 150mg/kg infused iv over 20hrs, alternatively, 75mg/kg orally every 4-6 hrs for 2-3 days. </li></ul>
  32. 32. <ul><li>USES: </li></ul><ul><li>First choice analgesic for osteoarthritis </li></ul><ul><li>Best drug to be used as antipyretic </li></ul><ul><li>Over the counter analgesic for headache, musculoskeletal pain, dysmenorrhoea, etc </li></ul><ul><li>Much safer than aspirin </li></ul><ul><li>Does not prolong bleeding time </li></ul><ul><li>Used in all age groups, pregnant & lactating women, in other disease states & in patients in whom aspirin is contraindicated </li></ul><ul><li>No significant drug interactions </li></ul>
  33. 33. <ul><li>DOSE: </li></ul><ul><li>0.5-1g TDS; </li></ul><ul><li>infants 50mg; </li></ul><ul><li>children 1-3 yrs 80-160mg </li></ul><ul><li>4-8 yrs 240-320mg </li></ul><ul><li>9-12 yrs 300-600mg </li></ul><ul><li>Commercially available as- </li></ul><ul><li>Crocin : 0.5, 1 gm tab. </li></ul><ul><li>Ultragin, Pyrigesic, Calpol : 500mg. tab </li></ul>
  34. 34. SYNERGISTIC EFFECT <ul><li>When the action of one drug is facilitated or increased by the other, they are said to be synergistic. </li></ul><ul><li>ADDITIVE SYNERGISM </li></ul><ul><li>Combiflam : ibuprofen+ paracetamol (400 + 325mg) </li></ul><ul><li>Dolokind plus : aceclofenac + paracetamol (100 +500 mg) </li></ul><ul><li>Diclozee plus : diclofenac Na + acetoaminophen (50 + 500 mg) </li></ul><ul><li>Diclomol : diclofenac Na + acetoaminophen (50 + 500 mg) </li></ul><ul><li>Serazee plus : diclofenac K + seratiopeptidase (50 +10 mg) </li></ul><ul><li>Ibugesic plus : ibuprofen+ paracetamol (400 + 325mg) </li></ul><ul><li>Asonac-SR plus : aceclofenac + paracetamol + seratiopeptidase (100 + 500 + 15mg ) </li></ul>
  35. 35. TOPICAL NSAIDs <ul><li>Topical formulations are available for application over painful joints and muscles. </li></ul><ul><li>Osteoarthritis </li></ul><ul><li>Sprains </li></ul><ul><li>Sports injuries </li></ul><ul><li>Backache </li></ul><ul><li>Preparations </li></ul><ul><li>Diclofenac 1% gel : voveron emulgel, diclonac gel. </li></ul><ul><li>Ibuprofen 10% gel : ribufen gel. </li></ul><ul><li>Ketoprofen 2.5% gel : rhofenid gel. </li></ul><ul><li>Nimesulide 1% gel : nimulid trans gel. </li></ul><ul><li>Piroxicam 0.5% gel : dolonex gel, minicam gel. </li></ul>
  36. 36. INDICATIONS OF NSAIDS IN DENTISTRY <ul><li>Irreversible pulpitis </li></ul><ul><li>Apical periodontitis </li></ul><ul><li>Acute alveolar abscess </li></ul><ul><li>Infected cyst </li></ul><ul><li>Sinusitis </li></ul><ul><li>TMJ Arthritis </li></ul><ul><li>MPDS </li></ul><ul><li>After tooth extraction </li></ul><ul><li>Dry socket </li></ul><ul><li>Recurrent apthous ulcers </li></ul><ul><li>Lichen planus </li></ul><ul><li>Agranulocytosis </li></ul><ul><li>Cyclic neutropenia </li></ul>
  37. 37. GENERAL CONTRAINDICATIONS <ul><li>Ulcer </li></ul><ul><li>Asthma </li></ul><ul><li>Patient with nasal polyp </li></ul><ul><li>Diabetes </li></ul><ul><li>Gout </li></ul><ul><li>Influenza (Reye’s syndrome) </li></ul><ul><li>Hypo coagulation state </li></ul><ul><li>Chronic allergic disorders </li></ul><ul><li>Chronic liver disease </li></ul><ul><li>Renal failure </li></ul><ul><li>Salicylate allergy </li></ul><ul><li>Breast feeding mothers </li></ul><ul><li>Pregnancy </li></ul>
  38. 38. CONCLUSION <ul><li>Nature of problem along with consideration of risk factors in an individual patient directs the initial selection </li></ul><ul><li>Drugs differ quantitatively in producing different side effects </li></ul><ul><li>Large inter individual differences </li></ul>
  39. 39. REFERENCES <ul><li>Essentials of Medical Pharmacology, </li></ul><ul><li> K. D Tripathy, 5 th edition </li></ul><ul><li>Pharmacology & Pharmacotherapeutics, </li></ul><ul><li>R. S. Satoskar,18 th edition </li></ul><ul><li>Textbook of oral medicine, </li></ul><ul><li>Burkett’s, 11 th edition </li></ul>
  40. 40. <ul><li>THANK YOU </li></ul>THANK YOU
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