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Classification and New Approaches to Analgesics
1.
2.
3. Classification of Analgesics
Analgesics can be broadly classified into:
Centrally acting(narcotic) and
Peripherally acting (non-narcotic) analgesics
11. New Approaches to Analgesics
• Enkephalinase inhibitors such as thiorphan and experimental drug
RB 120 act by inhibiting metabolic degradation of endogenous
opioid peptides. It has morphine-like effects without causing
dependence.
• Various neuropeptides, such as somatostatin and calcitonin
produce powerful analgesia when applied intrathecally.
• Non-peptide antagonist of substance P, have recently been
developed and may prove to be useful analgesic drug.
• Adenosine analogues and adenosine kinase inhibitors,
• Agonist at nicotinic acetylcholine based on epibatidine.
• Transplantation of enkephalin-secreting adrenal medulla into
spinal canal.
12. Antibiotic Therapy for children
• No aspect of pharmacology is more widely
misunderstood or improperly applied than
the antibiotic therapy for children. The
following review should improve the art
and science of drug therapy in situations
of infections in children.
• The rationale for choice and use of
antibiotics begins with review of likely
microorganisms responsible for common
orofacial infections
13. Development of oral Microflora
• Oral cavity is usually sterile at birth.
• Number of microorganisms increase following 6 to 8hrs after birth.
• At 12 months of age, most children have the following microorganisms in their oral cavity.
• Streptococcus
a) S. salivaris is the first oral streptococcus.
b) S. mutans ands S. sanguis are not established until teeth erupt in the oral cavity .
c) S. mutans disappears when a full mouth extraction is done and again reappears with dentures
along with following microorganisms.
Staphylococcus
Velionella
Actinomyces
Lactobacillus
Norcadia
Fusobacterium
• Preschool Age group
Oral flora resembles that of an adult except that Bacteriodes melanogenics and spirochetes are
uncommon.
14. Principles of Antibiotic Therapy
• The principles of antibiotic therapy ensure
that these agents are employed when
indicated(presence of infection confirmed
by clinical signs and symptoms and/or
laboratory tests and antibiotic prophylaxis
in a well-defined situation) and at optional
usage(proper choice, dose and duration
with a minimum attendant harm to the
patient).
15. • Antibiotics do not cure the patient, but function to
provide time for the normal host defenses, initially
overwhelmed by microbes, to gain control and eliminate
the infectious process.
a) Antibiotics are not a substitute for surgical drainage:
the drainage of pus thus established, increases the
efficacy of antibiotics in a particular case.
Antibiotic dosages for children are similar to those in
adults(as adjusted by body weight).The exceptions,
however, are the neonates who have reduced gastric acid,
plasma protein binding ,blood flow to muscles ,renal and
hepatic activity and body fat and increased extracellular
fluid compared to older infants and adults. Hence, a
lower antibiotic dosing is required in neonates.
16. Dose calculation by weight
• Manufacturer recommended doses are based on
extensions trials and are usually indicated for
the average, healthy adult makes of average
weight and age. Thus age, sex, weight and
chronic disease of the major organs of
metabolism(liver) and excretions(kidney) may
affect the usual safe and effective FDA approved
dose recommendations. Creatinine clearance,
peak and trough and symptomatic patient
response are often used to titrate doses for a
given, therapeutic effect.
17. • Dentists seldom treat infant, but doses for pediatric
patient require an adjustment from usual adult
dose, as determined by body surface area for
calculating dosages:
1. CLARK’S RULE
Child’s weight in lb x adult dose = child’s dose
150
2. YOUNG’S RULE:
Age of child x adult dose = child’s dose
Age+ 12
18. • Anders in 1992
Administration of the drug used on infant’s
weight is seldom appropriate.
Dosep = dosea x wt. pd
wt. ad
But the surface rule is better which is
Dosep = dosea x wt. pd
wt. ad
o.7
19. Dosep = dose of child
Dosea = dose of adult
Wt. pd = weight of child
Wt. ad = weight of adult
20. Antibiotic Resistance
• Sooner or later the
microorganisms may develop
resistance to any antimicrobial
agent. This could be attributed
to either improper dose or
duration. Thus, only practical
method to delay or restrict
microbial resistance would be
limit the antibiotic use to
proper indication, dosages and
duration. Following the
manufacturer’s instructions
and/or physician’s instructions
would reduce the chances of
misuse and prolong or prevent
antibiotic resistance
21. Antibiotic Prophylaxis
• It is the administration of antibiotics to
the patients without the evidence of
infection to prevent bacterial colonization,
to reduce subsequent postoperative
complications, e.g., antibiotic prophylaxis
to prevent infective endocarditis. It is also
required in case of immunosupressed
patients with blood disorders, cancer
chemotherapy and graft recipients.
27. Recent Advances in Antibiotics
• Fourth generation Cephalosporins
Cephime
Developed in 199o.
Antibacterial spectrum similar to 3rd generation.
Resistant to β-lacatamases
Cepirome
Recently marketed in India
Used for treatment of serious hospital-based infections
Better penetration through gram-negative bacteris
Resistant to β-lactamases
28. Newer Macrolides
Roxithromycin
• Semi-synthetic, long-acting ,acid-stable
with antimicrobial spectrum resembling
erythromycin.
Indication
• Respiratory infections
• ENT infections
• Skin and soft tissue infections
• Genital tract infections
29. • Dosage
• Adult- 150 mg BD
• Children-2.5 to 5 mg/kg BD
• Commercial Forms
• ROXID
• ROXEM
• ROXIBID
• 150mg and 50 mg kid tablets
30. • Clarithromycin
Antimicrobial spectrum erythromycin
• Indications
First line drug in Mycobacterium avium complex in AIDS
patients.
• Dosage
250 mg BD for 7 days
Severe cases 500mg BD for 14 days
• Commercial Forms
CLARIBID
CELEX
CLARMAC
31. Antibacterial spectrum expanded as compared to
erythromycin
Active against H.influenzae
High activity on respiratory pathogens
Good activity against Mycobacterium avium complex in
AIDS patients
• Indications
Pharyngitis
Tonsillitis
Sinusitis
Staphylococcus and streptococcal skin and soft tissue
infections
32. • Dosage
500 mg OD
Child above 6 months 10mg/kg for 3 days
• Commercial names
ZITHROMAC
AZITHRAL
Available as 100mg kids tablet .Should be
given 2 hours before meal.
