Emergency drugs used in dentistry

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Emergency drugs used in dentistry

  1. 1. EMERGENCY DRUGS USED IN DENTISTRY
  2. 2. Introduction <ul><li>In dental practice different types of emergecy can occur which the dentist has to treat his own if no physician is available at that time. </li></ul><ul><li>The emergencies which can occur are syncope,hypoglycemia,diabetic coma,convulsions,asthamatic attack,anaphylactic shock,angina pectoris,acute myocardial infarction,cardia arrest,acute adrenal cortical insufficiency and drug related emergency. </li></ul>
  3. 3. CATEGORY OF EMERGENCY DRUGS <ul><li>Injectable drugs </li></ul><ul><ul><li>Primary or essential </li></ul></ul><ul><ul><li>1.Epinephrine </li></ul></ul><ul><ul><li>2.Antihistamine </li></ul></ul><ul><ul><li>3.Narcotic antagonist </li></ul></ul><ul><ul><li>4. Anticonvulsant </li></ul></ul><ul><ul><li>Secondary or non essential </li></ul></ul><ul><ul><li>1.Analgesic </li></ul></ul><ul><ul><li>2.Vassopressor </li></ul></ul><ul><ul><li>3.Corticosteroid </li></ul></ul><ul><ul><li>4. Antihypoglycemic </li></ul></ul><ul><ul><li>Drugs for advanced cardiac life support </li></ul></ul><ul><ul><li>1.Sodium bicarbonate </li></ul></ul><ul><ul><li>2.Lidocaine </li></ul></ul><ul><ul><li>3.Atropine </li></ul></ul>
  4. 4. <ul><li>B. Non-injectable drugs </li></ul><ul><li>1.Oxygen </li></ul><ul><li>2.Vasodialating agents </li></ul><ul><li>3.Respiratory stimulant </li></ul><ul><li>4.Antihypoglycemic agents </li></ul><ul><li>5.Bronchodialating agents </li></ul>
  5. 5. INJECTABLE DRUGS <ul><li>PRIMARY INJECTABLES DRUGS </li></ul><ul><li>1. EPINEPHRINE </li></ul><ul><li>a)Properties-it has got rapid onset of action,potent action as a bronchial smooth muscle dialator,anti-histaminic properties and vassopressor properties </li></ul><ul><li>b)Side effects-tendency to predispose the heart to arrhythmias and relatively short duration of action. </li></ul><ul><li>c)Indication –cardiac arrest,anaphylaxis or an acute asthmatic attack </li></ul><ul><li>d)Prfecaution-it should not be used in treatment of shock because it can decrese the venous return with increased ischemia and it can also precipitate ventricular fibrillation. </li></ul><ul><li>-it should be used with caution in pregnency as it decreses the placental blood flow and may induce pre-mature labor. </li></ul>
  6. 6. <ul><li>e)The rationale for the use of epinephrine for cardiac arrest is the beta-stimulation of the myocarium </li></ul><ul><li>f)Availability-For parentral administration supplied in 1:1000 concentration each ml will contain 1mg of agent </li></ul><ul><li>g)Administration- it can be administarted by I.V or Intra cardiac route.Dental personnel may give it into the frenulum under the tongue.Dose is 0.32-0.5mg of solution Sub-cutaneously or Intramuscularly </li></ul>
  7. 7. <ul><li>2 .Antihistamine </li></ul><ul><li>a)Drugs of choice- Chlorpheniramine,diphenhydramine,pheniramine malate(Avil). </li></ul><ul><li>b)Indication-It is usually used in delayed allergic reaction in which onset of symptoms is more than 1 hour after administration of allergens. </li></ul><ul><li>c)Precaution-It is contraindicated in management of acute asthmatic episode,as thickening of bronchial secretion results from the drug drying action. </li></ul>
  8. 8. <ul><li>d)Availability-Chlorpheniramine(10 mg/ml I.V),Diphenhydramine(10 mg/ml) and pheniramine maleate(amp 1-2ml I.M) </li></ul><ul><li>3.ANTICONVULSANT </li></ul><ul><li>a)Drug of choice-Diazepam and alternative drug is Barbiturate. </li></ul><ul><li>b)Action-Diazepam or Barbiturate will terminate seizure activity without pronounced depression of respiratory and cardiovascular system. </li></ul><ul><li>c)Side effects-Respiratory depression. </li></ul>
  9. 9. <ul><li>d)Availabitity and doses-Valium 5mg /ml </li></ul><ul><li>e)Administration-It should be administrated I.V or I.M </li></ul><ul><li>4.NARCOTIC ANTAGONIST </li></ul><ul><li>a)Drug of choice-Naloxone </li></ul><ul><li>b)Indication- It is pure opioid antagonist and it is the drug of choice for opioid induced apnea. </li></ul><ul><li>c)Action-More than one admionistration may be needed because of its short duration of action. </li></ul><ul><li>d)Administration-It is given I.V but can be given sub-cutaneously or I.M </li></ul>
  10. 10. <ul><li>e)Dose-0.4mg/dl </li></ul><ul><li>SECONDRY INJECTABLE DRUGS </li></ul><ul><li>1.ANALGESIC DRUGS </li></ul><ul><li>a)Drug of choice-Morphine sulphate or Mepiridine. </li></ul><ul><li>b)Indication-Acute myocardial infarction,congestive heart failure,intense prolonged pain and anxiety </li></ul><ul><li>c)Side effects-CNS and Respiratory depression </li></ul>
  11. 11. <ul><li>d)Precaution-It is contra-indicated in head injuries and multiple trauma.It is also used with care in patient with compromised respiration. </li></ul><ul><li>e)Availability-Morphine sulphate 10mg/ml and Mepiridine 50mg/ml </li></ul><ul><li>2.Vassopressor </li></ul><ul><li>a) drug of choice – methoxamine and phenyl ephrine </li></ul><ul><li>b) action – adrenergic agonist. It produces mild increase in blood pressure due to peripheral vasoconstriction </li></ul>
  12. 12. <ul><li>c) Indication – acute adrenal insufficiency, drug overdose,hypotension and allergic reaction </li></ul><ul><li>d)Precaution – used in caution with hyperthyroidism, bradycadia,partial heart block,myocardial disease and atherosclerosis. </li></ul><ul><li>e)Dose – methoxamine 10mg/ml , phenyl ephrine 10 mg/ ml IV or IM </li></ul><ul><li>3.CORTICOSTEROID: </li></ul><ul><li>a)Drug of choice – hydrocortisone sodium succinate </li></ul>
  13. 13. <ul><li>b) Indication – allergic reaction ,anaphylaxis and adrenal crisis. </li></ul><ul><li>c) Action – slow onset of action. </li></ul><ul><li>4.ANTIHYPOGLYCEMIC: </li></ul><ul><li>Drug of choice – 50% dextrose solution. </li></ul><ul><li>B) indication – to manage hypoglycemic episodes </li></ul><ul><li>Administration - IV or IM </li></ul>
  14. 14. INJECTABLE DRUG FOR ADVANCED CARDIAC LIFE SUPPORTS <ul><li>1.SODIUM BICARBONATE : </li></ul><ul><li>It is effective in management of metabolic acidosis </li></ul><ul><li>It elevates the pH of blood by combining with hydrogen in blood. </li></ul><ul><li>Dose – 300-500ml of 5% sodium bicarbonate IV </li></ul><ul><li>2.ATROPINE SULPHATE: </li></ul><ul><li>It is a parasympathetic drug that decrease vagal tone. </li></ul><ul><li>Indication – sinus bradycardia accompanied symptomatic hypotension. </li></ul><ul><li>Precaution – not indicated in patient with MI. </li></ul>
  15. 15. <ul><li>3.LIDOCAINE: </li></ul><ul><li>Used in cardiac arrhythmias especially those of ventricular orgin. </li></ul><ul><li>NON INJECTABLE DRUGS: </li></ul><ul><li>1.OXYGEN: </li></ul><ul><li>Most important drug in emergency </li></ul><ul><li>Patient with chronic obstructive pulmonary disease should be given with caution because apnoea may result. </li></ul>
  16. 16. <ul><li>2.VASODIALATOR: </li></ul><ul><li>Drug of choice – nitroglycerine or amyl nitrate </li></ul><ul><li>Indication – to manage acute anginal attack and MI. </li></ul><ul><li>Contraindication – not given in hypotensive patient. </li></ul><ul><li>Action – taken sublingually, it acts in 1-2 mts </li></ul><ul><li>Availability – tab nitroglycerine- 0.1,0.3,0.6 mg </li></ul><ul><li>Nitroglycerine spray – 0.4mg </li></ul><ul><li>Amyl nitrate vaporous – 0.3ml </li></ul>
  17. 17. <ul><li>3.RESPIRATORY STIMULANT: </li></ul><ul><li>Aromatic ammonia spirit – used to treat syncope </li></ul><ul><li>Action – irritating the membrane of upper respiratory tract resulting in stimulation of respiration and blood pressure. </li></ul><ul><li>Contraindication – used with caution in asthma as it may precipitate asthma. </li></ul><ul><li>Availability – silver-grey vaporole- 0.3ml </li></ul>
  18. 18. <ul><li>4.ANTIHYPOGLYCEMIC AGENTS: </li></ul><ul><li>Oral glucose or any available liquid carbohydrate is used to manage oral hypoglycemia in concious and semiconcious diabetic patients. </li></ul><ul><li>5.BRONCHODIALATING AGENTS: </li></ul><ul><li>Drug of choice – metaproterenol or epinephrine, isoproterenol </li></ul><ul><li>Indication – management of bronchoconstriction and allergic reaction. </li></ul><ul><li>Contraindication – tachy arrhythmias. </li></ul><ul><li>Dose – 1or2 inhalations every hour. </li></ul>
  19. 19. <ul><li>CONCLUSION: </li></ul><ul><li>In dental practice different type of emergencies can occur which the dentist has to treat on his own if no physician is available at that time. </li></ul><ul><li>the dental office emergency kit need not and indeed should not be complicated. </li></ul><ul><li>It ought to remain as simple as possible. </li></ul>

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