Drugs complications

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Drugs complications

  1. 1. Drug – related emergency Aiman A. Ali DDS, PhD.
  2. 2. Outlines Metabolism of drugs  Definitions  Classification of Adverse Drug Reactions ADR  Drugs used in dentistry & their ADR  Over dose reactions in details  Management of ADR emergency 
  3. 3. Metabolism of drugs  A given drug: ………..> circulation ……….> Redistribution ……….> Biotransformed [metabolism] ……….> Excreted
  4. 4.  Toxicology: Is the study of the harmful effects of drugs on biological systems  ADRs: adverse drug reactions are the undesirable reactions when a drug is given  No drug is completely safe or completely harmful  To reduce ADR      Rout of administration (IV most effective and more serious for ADR) Dose (85% of ADR related to overdose) Patient (age, sex, weight, race, hereditary…) Time Reason
  5. 5. Rout of administration
  6. 6. +
  7. 7. Classification of ADRs   Before: 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 immune response  Allergy ...………………..III  Idiosyncrasy…………….IV Effects result from altered patient
  8. 8. Classification of ADRs Side effects Over dose Allergy Idiosyncrasy
  9. 9. I-side effects reactions Are the undesirable effects of drugs that occur when the drugs are given . desirable  Ex adrenaline………...bronchodilator undesirable ……..….palpitation desirable ex antibiotics …………antibacterial undesirable ………… GI upset 
  10. 10. II- over dose reactions  Definition: are reactions that result from toxic amounts of a drug ex:    Vitamin A normal dose usually less than 5000 IU More than 50.000 IU usually are toxic amount many drugs can cause over dose reactions leading to emergency in dentistry, ex:     Analgesic Antibiotic Anti anxiety Local anesthetics………….. commonest
  11. 11. III-Drug allergy Definition:  It is a hypersensitive response to an allergen to which the individual has been previously exposed to (already existed antibodies)  It is seen clinically as:         Fever Angioedema Urticaria Dermatitis Blood elements depression Photosensitivity Anaphylaxis
  12. 12.  many drugs can cause drug allergic reactions as Penicillin  Aspirin  Latex  Bisulfites   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
  13. 13. IV-Idiosyncrasy  A unique hypersensitivity reaction that belong to a particular drug in a specific individual and cannot be explained as any known mechanism such as allergy or over-dose reaction.  Clinically (unpredictable) a wide range of manifestations ex:   Barbiturate or antihistamine Muscle relaxant excitation or agitation hyperpyrexia
  14. 14. Drugs used in dentistry & their ADR Common drugs used in Dentistry are Local anesthetics  Antibiotics  Analgesics  Anti anxiety drugs 
  15. 15. Local anesthetics  Amide       Articaine Lidocaine Mepivacaine Prilocain Bupivacaine Ester  Benzocaine
  16. 16. Antibiotics  Penicillin       Ampicillin Amoxicillin and Augmentin Erythromycin Clindamycin Cephalosporins (1st 2nd 3rd and 4th generations)   G and V Duricef, Keflex/ Ceclor, Cefotan/ Cefizox, Spectracef/ Maxipime Azithromycin
  17. 17. Analgesics  Non opioids     Acetylsalicylic acid Acetaminophin NSAIDs /Ibuprofen, Mefinamic acid….. Opioids  Codeine  Hydrocodeine
  18. 18. Anti anxiety drugs  Benzodiazepines     Non- Benzodiazepines   Midazolam Diazepam (Valium) Oxazepam (Serax) Zaleplon (Sonata) Others   Chloral hydrate (Aquachloral) Hydroxizine (Atarax)
  19. 19. Local Anesthetics & their ADR Side effects Esters allergy Rare: Common: drowsiness Amides over dose CNS depression Tremor - seizures extreme rare Rare: Rare: Common: drowsiness With genetic disorders + topical Erythema
  20. 20. Antibiotics & their ADR Antibiotics Side effects Rare: GI upset over dose Rare allergy Common: Allergic phenomena
  21. 21. Analgesics & their ADR Side effects Nonopioids over dose allergy Common Common: Salicylism Common: Urticaria, bronchospasm (aspirin) Very common Common Opioids - nausea - Vomit - Orthostatic hypotension CNS & respiratory depression Rare
  22. 22. Anti-anxiety / Sedative drugs & their ADR Side effects over dose allergy Benzod… Drowsiness CNS depression Over sedation Uncommon Nonbenzo… Nausea Rarely vomiting CNS depression Over sedation Never reported
  23. 23. Prevention & Management
  24. 24. Prevention: Medical history  Are you being treated by physician now?  Do you have, or have you had:   Allergy to drugs, food, latex… Are you taking:    Any drugs: medications, herbal, over-counter…. Tobacco in any form Alcohol …..
  25. 25. Prevention: Important points  Complete the medical evaluation before any treatment  Recognize and manage any anxiety or fear before any treatment  Apply topical anesthesia to the site of needle penetration 1 minute before injection  Aspirating syringes must always be used  Injections should be slow; at least 60 seconds for each dental cartridge
  26. 26. Management of local anesthetic overdose Clinical manifestations Onset is rapid in 5-10 min  Confusion  Talkative  Anxiety  Muscular tremor  Increased blood pressure  Increased heart and respiratory rate  Headache  Dizziness  Loss of consciousness  Blurred vision and ringing in ears 
  27. 27. Management of local anesthetic overdose      Recognize overdose reaction Terminate dental treatment Put the chair in comfortable position ABC, basic life support as needed Definitive treatment      O2 Monitor vital signs Give anticonvulsant if needed Medical assistance Permit recovery & discharge
  28. 28. in severe overdose reactions      Recognize the overdose reaction Terminate dental treatment Position: supine with legs slightly elevated A B C …..as needed Definitive treatment:      Medical assistance O2 Monitor vital signs IV anticonvulsant (diazepam) Permit recovery & discharge
  29. 29. Epinephrine overdose  Forms:  Epinephrine or adrenalin, with local anesthesia 1:250,000 - 1: 50,000  Local hemostasis  In gingival retraction cord …
  30. 30. Epinephrine overdose  Clinical manifestations symptoms: Fear,  anxiety,  restlessness,  tremors,  palpitation  dizziness..   signs:  increased blood pressure  increased respiratory rate
  31. 31. Epinephrine overdose Management  R :recognition of the case  T : terminate dental treatment  P :position :comfortable  A B C, (BLS) as needed  D : definitive treatment  Monitoring vital signs  Summoning of medical assistance ?  O2  vasodilators such as Nitroglycerin ?  Recovery and discharge
  32. 32. CNS depressant overdose Clinical features Elevated Barbiturate Respiratory Arrest Calming Sleep Respiratory depression & Cardiovascular depression Unconsciousness
  33. 33. CNS depressant overdose Management  R: recognition of the case  T: terminate dental treatment  P: position, comfortable  A B C ….. as needed  D: definitive treatment:  O2  Monitor vital signs  In barbiturate overdose (ABC)  In benzodiazepine overdose (Flumazenil 0.2 mg)
  34. 34. ‫محطة الحجاز في دمشق‬ ‫قبل مئة عام‬ ‫اآلن‬

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