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Emergency drugs used_in_o.s.___common_drug_interactions_in_o.s._practice__oral_surgery_

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Emergency drugs used_in_o.s.___common_drug_interactions_in_o.s._practice__oral_surgery_

  1. 1. EMERGENCY DRUGS USED IN ORAL SURGERY KUMAR R.ANIL 4 TH BDS
  2. 2. CONTENTS * Introduction * Classification of the emergency drugs * Individual emergency drug * Drug interactions
  3. 3. EMERGENCY DRUGS USED IN ORAL SURGERY 1. Adrenaline 11. Pancuronium bromide 2. Atropine 12. Styptochrome 3. Dopamine 13. Ethamsylate 4. Metoclopramide 5. Phenaramine maleate 14. Ketorolac 15. Aminophylline 6. Hydrocortisone 16. Succinyl choline 7. Dexamethasone 17. Dextrose 8. Diazepam 18. Sodium bicarbonate 9. Fortwin-pentazocin 19. Calcium gluconate 10. Furosemide 20. Chlorphenaramine maleate
  4. 4. CLASSIFICATION Emergency drugs Injectables Non Injectables Oxygen Vasodilators Respiratory stimulants Anti Hypoglycaemic agents Bronchodilators Primary Secondary advanced cardiac support Drug for life 1) Adrenaline 1) Analgesic 1) Lidocaine 2) Antihistamine 2) Vasopressor 2) Atropine 3) Anti convulsant 3) Corticosteroid 3) Sodium bicarbonate 4) Narcotic antagonist 4) Antihypoglycaemic
  5. 5. ADRENALINE INTRODUCTION : - It is an adrenergic drug. - It increases heart rate,force of contraction and cardiac output. - It constricts blood vessels. - It increases mean BP. - Potent bronchodilator - It causes mydriases in eye that is pupil dilatation. INDICATIONS : - Anaophylactic shock - In bronchial asthma - In cardiac arrest - With local anaesthesia - To control post extraction haemorrhage - To treat open angle glaucoma
  6. 6. CONTRAINDICATIONS - Hypersensitivity - Hyperthyroidism - Hypertension - Angina pectoris - Diabetes mellitus TRADE NAME : Adrenor, Asmotone DOSAGE : 0.2-0.5 mg s.c , 0.5 % aerosol in case of im /iv – in conc of 1:10,000 to 1:1,00,000 ADVERSE EFFECTS - Marked increase in BP - photosensitivity, skin rashes - palpitation, arrythmias -anginal pain, ventricular failure
  7. 7. ATROPINE INTRODUCTION - It is a parasympathetic drug -Anticholinergic action - Antispasmodic action - Antisecretory action - Anti muscarinic action - It causes tachycardia - Anti dote for organo phosphate poisoning. INDICATIONS - Motion sickness - Colics and dysmenorrhoea - Anti parkinsonism - Pre operatively to reduce secretions & salivation - In bronchial asthma - Severe sinus bradycardia
  8. 8. CONTRAINDICATIONS - Hypersensitivity to belladona alkaloid - Glaucoma - Prostatic hypertrophy - Cardiac failure - Thyrotoxicosis TRADE NAME : Atro, Tropine, Atropine sulphate DOSAGE : Children : oral – 0.2 mg/kg inj --0.3-0.6 mg i.m Adults : 0.6- 2 mg/ml i.m ADVERSE EFFECTS - Dry mouth, decreased salivation - Decreased sweating - Constipation - Tachycardia, palpitations, arrythmias - Mydriasis and cycloplegia
  9. 9. DOPAMINE INTRODUCTION - Potent sympathomimetic agent - Agonist for dopamine receptors in CNS,renal and other vascular beds - Agonist for beta adreno receptors in heart - At high doses it causes vasoconstriction - At low doses it causes increase in renal blood flow, GFR, and sodium excretion. INDICATIONS - Cardiogenic shock - Septic shock - Septicaemia - Congestive heart failure - Renal failure - Heart failure - In parkinsonism
  10. 10. CONTRAINDICATIONS - Atrial/venticular tachy arrythmias - Hyperthyroidism - Pheochromocytoma TRADE NAMES : Dopamine, Dopinga, Dopapins, Dopar, Dopat. DOSAGE : Children – 2-20 microgram/kg/min i.v Adults -- 2-50 micrograms/kg/min i.v ADVERSE EFFECTS - Nausea , vomitting - Tachycardia - Palpitation - Anginal pain - Atopic beats
  11. 11. METOCLOPRAMIDE INTRODUCTION - It is a pro kinetic drug -- causes forward propulsion of contents of stomach - Centrally acting dopamine antagonist - Acts on chemoreceptor trigger zone - Peripherally acts to enhance the effect of A-ch at muscarinic receptors in gut INDICATIONS - As an anti emetic – in nausea, vomitting post operative vomitting drug/disease induced vomitting radiation sickness morning/ motion sickness - Gastritis - Reflux oesophagitis - Gastroenterology
  12. 12. CONTRAINDICATIONS - Gastro intestinal perforation/ obstruction - Epilepsy - Parkinsonism - Breast cancer TRADE NAMES : Reglan, Perinorm, Metaclop, Emenil, Vominil DOSAGE : oral – 5-10 mg TDS INJ. – 2 ml TDS ADVERSE EFFECTS - Dizziness - Diarrhoea - Trismus, - Tremors - Gynaecomastia, - Galactorrhoea
  13. 13. PHENARAMINE MALEATE INTRODUCTION -It is an alkylamine derivative - Antihistaminic - Anti cholinergic property - Anti muscarinic property - Central sedative property INDICATIONS - In allergies – urticaria itching angioedema dermatitis - Common cold - Motion sickness - Insect bite - To decrease the BP
  14. 14. CONTRAINDICATIONS -Hypersensitivity -Acute porphyria TRADE NAME : Avil, Avil Retard DOSAGE : Children-- syrup ------- 1-3 yrs : 2.5 ml TDS 3-12 yrs: 5 ml TDS Inj ------- 0.6 – 2 ml i.m OD/BD Adults -- oral ---- 25 – 50 mg TDS inj ---- 1.2 ml i.m TDS ADVERSE EFFECTS - Abuse potential - Dry mouth - Blurred vision - Constipation - Retention of urine
  15. 15. HYDROCORTISONE INTRODUCTION - It is a glucocorticoid ( corticosteroid) - It causes adreno pituitary axis suppression - They maintain fluid electrolyte balance - They maintain functional status of skeletal, muscles and nervous system INDICATIONS - Acute allergic reactions - Anaphylactic shock - Status asthmaticus - Addison’s disease - Rheumatoid arthritis - Pruritis - Tubercular meningitis - Infective eczema
  16. 16. CONTRAINDICATIONS - Neonates , infants - Local/systemic infections - Herpetic/fungal keratitis - Cataract TRADE NAMES : Corts, Lycortin, Primacort, Lutisoft cream, Neosporin – H DOSAGES : Anaphylaxis – 100-150 mg/sec i.m 6 hourly Status asthmaticus – 100-200 mg i.v 6 hourly ADVERSE EFFECTS - Hyperglycaemia - Hyperkalemia - Delayed wound healing - Water and sodium retention - Osteoporosis - Calcium deposition
  17. 17. DEXAMETHASONE INTRODUCTION - Corticosteroid derivative - Long acting, very potent, highly selective glucocorticoid - It causes marked pituitary adrenal suppression - Anti-inflammatory and anti-allergic properties INDICATIONS - Allergic conditions - Overwhelming infection - Inflammation in eye disorder - Shock due to trauma - Rheumatoid arthritis - Adjuvant anti emetic - Adrenal crisis
  18. 18. CONTRAINIDICATIONS -Diabetes mellitus - Congestive heart failure - Renal failure - Tuberculosis - Pyschosis - Osteoporosis TRADE NAME : Dexona, Dexavin, Decadan DOSAGES : Children - 0.1 – 0.5 mg/kg/fay Adults - 4-20 mg/day s.c/i.m/i.v ADVERSE EFFECTS - Hyperglycaemia, glycosuria - Delayed wound healing - Osteoporosis - Cushing syndrome
  19. 19. DIAZEPAM INTRODUCTION - Prototype of benzodiazepine - Sedative hypnotic action - Skeletal muscle relaxant - Anti convulsant actiond - Potentiates the neural GABA mediated inhibition in CNS INDICATIONS - Anxiety, tension - Psychosomatic and behaviour disturbances - Status epilepticus - Tetanus -Dysmenorrhoea - Termination of prolongd seizure - Local anaesthetic seizure
  20. 20. CONTRAINDICATIONS - Hypersensitivity to benzodiazepines - Acute narrow angle glaucoma - Myasthenia gravis TRADE NAMES : Calmpose, Calmod, Placidox DOSAGES : Oral - 5-20 mg/day i.m in divided doses inj – 10mg/2ml i.v ADVERSE EFFECTS - Respiratory depression - GIT disturbance - Drug dependance and abuse
  21. 21. FORTWIN – PENTAZOCINE INTRODUCTION - Opioid analgesic - Morphine like action - It has agonist – antagonist type action that is weak antagonist and marked agonist actions INDICATIONS - Chronic , recurrent, moderate to severe pain which is assosciated with - - - surgery trauma fractures labour pains burns cancer
  22. 22. CONTRAINDICATIONS - Children below 12 years - Hypertensives - Ischaemia - Myocardial infarction TRADE NAMES : Fortwin, Fortagesic, Pentazocin, Pentawin DOSAGES : 30 – 60 mg / ml i.v 3-4 hourly ADVERSE EFFECTS - Nausea, vomitting - Euphoria - Respiratory depression - Hypertension, tachycardia, palpitation - Withdrawl syndrome (rarely)
  23. 23. FUROSEMIDE INTRODUCTION - It is a diuretic - It causes loss of Nacl, Ca, K, Mg, PO 4, Na, water loss - It causes pooling of blood in peripheral deep veins - This effect occurs before the diversion and is important for the treatment of left ventricular failure and pulmonary edema INDICATIONS - Oedema in congestive heart failure, hepatic disease, renal disease and pulmonary oedema - Hypertension - To treat hypercalcaemia - To treat drug overdose ------ by inducing forced diuresis and facilitate rapid elimination of drug
  24. 24. CONTRAINDICATIONS - Hypovolaemia - Hypotonia - Hepatic coma - Renal failure with anuria and potassium defenciency TRADE NAMES : Lasix, Frusenex, Salinex DOSAGES : Children : 20 – 40 mg / day Adults : Oral -- 40 – 100 mg Inj -- 20 mg / 2 ml inj ADVERSE EFFECTS - Fluid and electrolyte imbalance - Visual impairment - Hearing impairment, deafness - Muscle cramps - Paraesthesia
  25. 25. PANCURONIUM BROMIDE INTRODUCTION - Long acting, non depolarizing, peripherally acting skeletal muscle relaxant - Competitive antagonist of acetyl choline at neuro muscular junction INDICATIONS - Long acting skeletal muscle relaxant in surgical anaesthesia - Assisted ventilation CONTRAINDICATIONS - Hypersensitivity - Inadequate general aneasthesia - Depressed ventilation
  26. 26. TRADE NAMES : Pavulon, Fancuron DOSAGES : 2 mg/ ml i.v ADVERSE EFFECTS - Hypotension - Bronchospasm - Reduction in GI motility - Wheel and flare reactions at site of injection
  27. 27. STYPTOCHROME INTRODUCTION - It is a haemostatic agent - It is a preparation of adrenochrome mono semi carbazone - It exerts haemostatic action by reducing capillary fragility - It prevents microvessel bleeding INDICATIONS - Epistaxis - Retinal haemorrhage - Secondary haemorrhage from wounds - Haematuria - Menorrhagia CONTRAINDICATIONS - Hypersensitivity
  28. 28. TRADE NAMES : Styptochrome, Cadisper – c, Styptocid DOSAGES : Pre operatively 2-6 ml at suitable intervals Postoperatively 1-2 ml every 2 hours
  29. 29. ETHAMSYLATE INTODUCTION - It is a haemostatic agent - It decreases capillary bleeding when platelets are adequate - It inhibits PGI 2 production - It corrects abnormal platelet function INDICATIONS - Epistaxis - After tooth extraction - Hematuria - Malena - After abortion - Menorrhagia - Post surgical conditions
  30. 30. CONTRAINDICATIONS - Hypersensitivity - Porphyria - History of thrombocytopenia purpura haemophillia TRADE NAMES : Ethamsyl, Hemsyl, Stat DOSAGES : Oral -- 500 mg tab post operatively inj -- pre operatively - - 1-2 ampules 1 hour before surgery postoperatively - - 1-2 ampules 4 to 6 hourly ADVERSE EFFECTS - Nausea , headache - Skin rashes - Fall in BP after i.v injection
  31. 31. KETOROLAC INTRODUCTION - It is a non steroidal anti inflammatory drug (NSAID) - It is a pyrrolo-pyrrole derivative of non selective cox inhibitor (conventional NSAID) - It is a potent analgesic, antipyretic, and anti inflammatory agent - It relieves pain by peripheral mechanism INDICATIONS - Management of acute pain - Post operative and acute musculoskeletal pain - Renal colic - Migraine - Pain due to bony metastasis - Post operative --inflammation itching allergy
  32. 32. CONTRAINDICATIONS - Hypersensitivity - After ocular surgery - Peptic ulcer -Coagulation disorder TRADE NAMES : Ketorol, Ketotifen, Ketanov, Cadolac DOSAGES : Oral - - 20 – 40 mg/day Inj - - 4 – 6 ml i.m ADVERSE EFFECTS - Gastric disturbances - Ocular irritation - Wound healing abnormalities - Superficial keratitis
  33. 33. AMINOPHYLLINE INTRODUCTION - It is a bronchodilator - Stable mixture of theophylline and ethylene di amine - Directly relaxes smooth muscles of bronchi and lungs - Stimulates CNS - induces diuresis - Increases gastric acid secretion INDICATIONS - Reversible airway obstruction - Severe acute asthma CONTRAINDICATIONS - Hypersensitivity - Hypertension - Peptic ulcer
  34. 34. TRADE NAMES : Aminophylline, Deriphylline, Minophyl DOSAGES : Oral - - 200-300 mg 3-4 times a day Inj - - 200-500 mg slowly over 20 minutes ADVERSE EFFECTS - Tachycardia - GI disturbance - Convulsions - Severe hyperventilation
  35. 35. SUCCINYL CHOLINE INTRODUCTION - It is an ultra short actiong ,peripherally acting , neuro muscular blocking skeletal muscles relaxant INDICATIONS - During General Anaesthesia - During seizures - Respiratory arrest during tracheal intubation CONTRAINDICATION - Glaucoma - Myasthenia gravis - In case of burns - History of malignant hyperthermia
  36. 36. TRADE NAMES : Scoline, Scolax, Succinyl chloride, Succin inj DOSAGES : 20- 100 mg ADVERSE EFFECTS - Hypertension - Hyperkalemia - Hyperthermia - Raised intra cranial pressure - Muscle pain - Respiratory depression
  37. 37. DEXTROSE INTRODUCTION - It is a hyperglycemic agent - It rapidly elevates the blood glucose level by mobilizing hepatic glycogen and converting it to glucose INDICATIONS - Severe hypoglycaemia - Diagnostic tool in unconsciousness and seizures of unknown origin - Cardiogenic shock (rarely) CONTRAINDICATIONS - Chronic hypoglycaemia - Hyperglycaemia - Starvation states
  38. 38. TRADE NAMES : Glucagon DOSAGES : 1md dry powder + 1 ml diluent (50 ml bottle for emergency kit – 50 % dextrose) ADVERSE EFFECTS - Nausea, vomitting - Allergic reaction - Tissue necrosis if there is infiltration
  39. 39. SODIUM BICARBONATE INTRODUCTION - It is an antacid n used to correct acidosis assosciated with hypoxia cardiorespiratory arrest metabolic acidosis - Adequate ventilation is necessary whenever sodium bicarbonate is given because carbon di oxide is produced in this procedure INDICATIONS - Reversal of metabolic acidosis occurring during anaerobic metabolism in cardiopulmonary arrest - Calcium and vitamin D defeciency states - Pregnancy and lactation - Bladder washes - Auricular lavage - Bronchial lavage
  40. 40. CONTRAINDICATIONS - In alkalosis - Respiratory depression - Hypocalcaemia - Sodium overload TRADE NAMES : Sodium bicarbonate DOSAGES : 90 – 180 mEq / lit ADVERSE EFFECTS - Metabolic alkalosis with impairment of release of oxygen from Hb - Sodium and water overload - Local pain - Venous irritation
  41. 41. CALCIUM GLUCONATE INTRODUCTION - Essential for cardiac function muscle contraction nerve activity and blood coagulation - To maintain standard integrity of all membranes - It causes neuro transmitter release DEFENCIENCY SIGNS AND SYMPTOMS : - Osteoporosis - Pathologic fracture - Brittle nails and hair
  42. 42. INDICATIONS ORAL INJECTIONS Mild hypocalcaemia Severe hypocalcaemia Growing children Hypoparathyroidism Pregnancy Hyperkalemia Lactation Cardiac arrest Post menopausal women Rickets Osteomalacia Every fourth bottle of blood transfusion
  43. 43. CONTRAINDICATIONS - Renal calculi - Hypophosphataemia - Hypercalcemia - Hypoparathyroidism TRADE NAMES : Calciium sandoz, Calcid, Calcibom DOSAGES : Oral -- 1 gram Inj -- 10 % inj ADVERSE EFFECTS - Constipation - Abdominal discomfort - Bloating - Dyspepsia -Excess gas
  44. 44. Common drug interactions in oral surgical practice Drug Interacting Drug Drug Interaction 1)Antihistamine CNS depressants 2) Salicylates 1) Anticoagulants Increased risk of bleeding 2) Antacids Premature release of aspirin 3) Corticosteroid Increased risk of gastroitestinal bleeding 4) Methotrexate Increased risk of methotrexate toxicity 5) Oral hypoglycaemics Potentiates hypoglycaemic drugs effect 6) Phenytoin Increased drowsiness and sedation Increased effect of antiepileptics
  45. 45. 3) Atropine 1) Alcohol Impaired motor performance and increased drowsiness. 4) Carbamazepine 1) Alcohol Depressed CNS 2) Barbiturates, Depressed CNS doxy cycline oral hypoglycemics steroids 5) Corticosteroids Retarded effect of drug Increased carbamazepine isoniazid plasma level resulting in sedation 3) Erythromycin 1) Anti diabetic drugs Corticosteroids may exacerbate diabetic state by hypoglycemic action Antagonism due to fluid retention 2) Anti hypertensives 3) Oral cotraceptives Increased anti-inflammatory response to topical steroids
  46. 46. 6) Cotrimoxazole 1) Diuretics Increased risk of thrombocytopenia in elderly Potentiate action of these agents 7)Diazepam 2) Anti coagulants, anti epileptics, oral hypoglycemics CNS depressants 8) Doxy cycline 1) Penicillin Reduced effect of penicillin 2) Barbiturates, antiepileptics Possiblility of reduced plasma concentration of Doxy cycline. 1) Alcohol Antagonism, therefore alcohol should be avoided 2) Antiepileptics Incereased risk of toxicity of phenytoin 9) Metronidazole 3) Anticoagulants 4) Barbiturates Intensified sedative effects Potentiated anticoagulant effect Reduced plasma level of metronidazole
  47. 47. 10)Penicillin oral Contraceptives Increased bleeding, possibly with contraceptive failure 11)Tetracyclines Oral contraceptives Increased bleeding due to contraceptive faliure Oral hypoglycemic Increased hypoglycemic effect Methotrexate Incerased methotrexate toxicity
  48. 48. References : 1. Essentials of medical pharmacology (By K.D.Tripathi). 2. A text book of pharmacology (Satoskar). 3. A text book of Oral and Maxillofacial surgery (By B. Srinivasan). 4. Contemporary Oran and Maxillofacial Surgery (By Peterson).

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