drugs use in dentistry

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drugs used in endodontics

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drugs use in dentistry

  1. 1. SUBMITTED BY: ARTI BDS – INTERN BATCH – 2008 – 2013
  2. 2. Rx Antiboitics NSAIDS GI relife eg. H2 blokers, proton pump inhibitors
  3. 3.  Cardinal Rules: 1) Use the right drug. 2) Use the right dose. 3) Use the correct dosing schedule. 4) Correct duration.  Avoid combinations of bacteriostatic and bacteriocidal drugs.
  4. 4. Gram Positive? Gram Negative? Mixed Infection? Anaerobes?
  5. 5. Narrow Spectrum? Broad Spectrum? Anaerobes? Consider if the infection is present > 3days or if no improvement.
  6. 6. Specific for the pathogen. Fewer disturbances of non-pathogenic bacteria. Fewer side effects. Rapid response for sensitive organisms. Ex: Pen VK, Pen G, Erythromycin
  7. 7. Affects both Gram + and Gram – bacteria, better for mixed infections. May give up some effectiveness for Gram + to gain effectiveness for Gram -. Examples: Amoxicillin, Ampicillin
  8. 8. Necrotic pulp and apical abscesses 1. Obligate anaerobic bacteria a. Gram negative rods Prevotella & porphyomonas spp. Fusobacterium spp. Campylobacter rectus b. Gram positive rods Eubacterium spp. Actinomycetes spp. c. Gram positive cocci Peptostreptococcus spp. 2. Facultative anaerobic bacteria Gram positive cocci Strep and Entercoccus spp.
  9. 9. 1. ß-Lactams 2. Cephalosporins 3. Lincosamides 4. Macrolides 5. Nitroimidazoles 6. Fluoroquinolones
  10. 10. Natural penicillins (Pen VK and Pen G) MOA: Inhibit cell wall synthesis Dose: 250-500 mg qid x 7-10 days Contraindications: Allergies Poor renal fxn  Adverse events: GI upset Drug interactions: oral contraceptives Pregnancy category B
  11. 11.  Bactericidal  Spectrum:  Strep, staph, enterococcus, neiseria, treponema, listeria  Resistance:  Mostly staph (>80%)
  12. 12. Amino-penicillins Amoxicillin, ampicillin MOA: Inhibit cell wall synthesis Dose: 250-500 mg q 8 h x 7-10 days Contraindications: Allergies Poor renal fxn  Adverse events: GI upset Drug interactions: oral contraceptives Amoxicillin and clavulanic acid (Augmentin)
  13. 13. . Bactericidal Spectrum:  Strep, staph, enterococcus, neiseria, treponema, listeria, E. coli, proteus, H. Flu, shigella, salmonella Resistance:  Entero, citro, serratia, proteus vulagris, provedincia, morganella, pseudomonas aeriginosa, acinetobacter
  14. 14. Cephalexin (Keflex) MOA: Inhibit cell wall synthesis Dose: 250-1000mg q 6 h x 7-10 days Contraindications: Allergies Poor renal fxn Adverse events: mild GI Drug interactions: probenecid Pregnancy category B
  15. 15.  Cephalexin (Keflex)  Bactericidal  Spectrum:  Gram +  Resistance:  Methicillin resistant gram +
  16. 16. Clindamycin (Cleocin) MOA: binds to the 50S ribosomal subunit and inhibits protein synthesis Dose: 100-450mg q 6 h x 7-10 days Precautions: Poor hepatic fxn Adverse events: GI upset, pseudomembraneous colitis Drug interactions: neuromuscular blocking agents Pregnancy category B
  17. 17. Bactericidal or static depending on concentration  Spectrum: Gram +, anaerobes, parasites Resistance Enteroccocus *Clostridium diff. pseudomembranous colitis!!
  18. 18. Azithromycin (Zithromax), clarithromycin (Biaxin) MOA: bind to the 23S rRNA in the 50S subunit ribosome Dose: 250-500 mg/day x 5-10 days Precautions : Poor hepatic fxn Adverse effects: GI Drug interactions: Cytochrome P-450 (Remember Seldane?) Pregnancy category B
  19. 19.  Bactericidal  Spectrum:  Gram +, gram -, anaerobes  Resistance:  B. fragilis, and strep pneumo
  20. 20. Doxycycline (Vibramycin) MOA: inhibit protein synthesis by preventing aminoacyl transfer RNA from entering the acceptor sites on the ribosome Dose: 100mg qd-bid x 7-14 days Contraindications: pregnancy Adverse events: GI Drug interactions: anti-epileptics Pregnancy category D
  21. 21. Doxycycline Bacteriostatic Spectrum: Broad, Gram +, -, anaerobes, aerobes, and spirochetes Resistance: Widespread, cross resistance PHOTO SENSITIVITY!!!
  22. 22. Metronidazole (Flagyl) MOA: reduced intermediate interacts and breaks the bacterial or parasitic DNA Dose: 250-1000 mg q 6-8 h x 7-10 days Precautions : poor hepatic fxn Adverse events: HA, N/V/D Drug interactions: EtOH, warfarin, Li+ Pregnancy category D
  23. 23.  Bactericidal  Spectrum:  Gram - anaerobes  Resistance:  Rare, H. Pylori?  Unpleasant metallic taste
  24. 24. Ciprofloxacin (Cipro) MOA: Inhibition of DNA gyrase, and Topo II Dose: 250-500 mg qd x 7-10 days Contraindications: <18 yrs old, pregnancy Adverse events: spontaneous tendon rupture Drug interactions: probenacid, warfarin Pregnancy category C
  25. 25. Ciprofloxacin Bactericidal Spectrum: Very broad except B. frag Resistance: MRSA, MRSE
  26. 26. Should be given to patients with a history of: • Prosthetic cardiac valve • Previous infective endocarditis • Cardiac transplantation recipients, who develop cardiac valvulopathy • Congenital heart disease ( CHD)* including
  27. 27. Should not be given to patients with history of: • Heart murmur (not as listed in 1.1) • ‘Floppy valve’ • Hypertrophic cardiomyopathy • Previous Rheumatic Fever • Angina, Coronary disease, Previous MI • Cardiac Failure The following procedures and events do not need prophylaxis: • Taking dental radiographs • Dental impressions • Routine dental anaesthetic injections through non-infected tissue • Fissure sealants • Supragingival restorations • adjustment of orthodontic appliances • root canal treatment, if not penetrating the apex
  28. 28. COX-2 (induced by inflammatory stimu
  29. 29. Ibuprofen Naproxen Fenoprofen Ketoprofen oxzprozin
  30. 30. Celecoxib Valdecoxib Rofecoxib Naproxen, ibuprofen and diclofenac are frequently used as comparators in RCTs on the safety and efficacy of COX-2 inhibitors. BUT… Different comparator doses may influence the results of RCTs. It has been hypothesized that RCTs of COX-2 inhibitors where different doses were administered resulted in different conclusions about the cardiovascular safety of COX-2 inhibitors. High comparator doses may let COX-2 inhibitors look better in terms of safety, while low comparator doses may result in the opposite.
  31. 31. Dental Infection Acute—Rapid growth < 3 days Chronic > 3 days Pen VK 500mg q6h or Amox 500mg q8h or Cephalosporin Allergic to PCN Clindamycin 300mg q8h or Cephalosporin (check allergic Rxn) or Azith or Clarithromycin Think Anaerobes Add Metronidazole 250-500mg To PCN, Amox, or Ceph Clindamycin 300mg q8h

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