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Dental pharmacology iii

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Dental pharmacology iii

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THIS CLASS IS IN BRIEF FOR UNDERGRADUATE UNDERSTANDING AND EXAMINATION PURPOSE

THIS CLASS IS IN BRIEF FOR UNDERGRADUATE UNDERSTANDING AND EXAMINATION PURPOSE

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Dental pharmacology iii

  1. 1. Dr. RAGHU PRASADA M S MBBS,MD ASSISTANT PROFESSOR DEPT. OF PHARMACOLOGY SSIMS & RC.
  2. 2. Tendencies for longer dental procedures Increased use of drugs Secondary diseases in geriatric populations The conditions are Anaphylaxis Uncontrolled Bleeding Unconciousness-vasovagal attack Hypoglycemia Seizures Arrhythmia Cardiac arrest
  3. 3. 1.Anaphylactic Shock 1:1000 adrenaline 0.5 ml for adults IM 0.3ml for child 6-12 years May be repeated after 10-20 minutes . Avoid I/V because fatal ventricular fibrillation may occur. Contraindications: Hyperthyroidism, HTN Arrhythmias 2. Oxygen –high flow 3. Cardiopulmonary resusitation 4. IV hydroocortisone 100-200mg 5. Chlorpheniramine IM 20 mg
  4. 4. Cotton swab dipped in 1% adrenaline solution packing Common causes patients on antiplatelet drugs patients on antico-agulation therapy hemophiliacs Long term glucocorticoid therapy
  5. 5. Premonitory stage-diazepam-10-15mg repeated once after 15 min Early status-lorazepam-0.1mg/kg repeated once after 15 min Give usual AED medications if already on treatment Established status-fosphenytoin infusion15-20mg/kg Refractory status-general anaesthesia-propofol 2- 10mg/kg/hr -midazolam-0.5mg/kg/hr -Thiopental sodium 3-5mg/kg Anaesthesia continued for12-24 hrs after last clinical or electrographic seizure 5
  6. 6. 6
  7. 7. 1. Pain and anxiety-- -GTN, morphine 2. Opioid analgesics and Antianxiety agents 3. Pethidine, Diazepam, alprazolam 4. General measures-O2 therapy, dopamine, 5. atropine, diltiazem, 6. Maintainance of blood volume-Saline , dextran 7. Correction of acidosis- sod. Bicarbonate infusion 8. Prevention of treatment of arrhythmias 9. -beta blocker 7
  8. 8. 7. Pump failure-furosemide, vasodilators, ionotropic drugs 8. Prevention of thrombus extension, venous thrombosis- aspirin, heparin, anticoagulants- dalteparin, Enoxaparin 9. Thrombolysis and reperfusion-fibrinolytic agents- streptokinase, urokinase 10. Prevention of remodeling and CHF-ACE inhibitors, ARBs- lisinopril, ramipril 11. Prevention of future attacks-platelet inhibitors- clopidogrel, β blockers, statins 8
  9. 9. Hypovolemic, Septic, Cardiogenic , Anaphylactic Neurogenic and Obstructive Hypovolemic Shock Airway Breathing Circulation Establish 2 large bore IVs or a central line Crystalloids Normal Saline or Lactate Ringers-Up to 3 liters Packed Red Blood Cells O negative or cross matched Control any bleeding Arrange definitive treatment
  10. 10. “Crystalloids” Normal saline (just NaCl). Lactated ringers Plasmalyte-balanced crystalloid solution with multiple electrolye solution Normosol-solution of balanced electrolytes in water for injection. Last 3 have K+ and other stuff (acetate, Mg++, etc.)
  11. 11. Crystalloids enter entire ECF: ISF (3/4 of ECF) and IVF (1/4 of ECF). 3 or 4:1 for replacement of blood loss with crystalloid Colloids only enter IVF (in short term– 16 hour half- time for entrance into ISF) 1:1 replacement of blood loss with colloid
  12. 12. 12 Epinephrine , β1, (β2) 2-10 µg/min Norepinephrine , β1 0 - 2-20 µg/min Dopamine β1, DR, (α ) 1 - 30 Dobutamine β1, β2 2 - 20 Phenylphrine  20-200µg/min Vasopressin Angiotensin III 5 - 20 Amrinone PDI 2 -15 Drug Receptor CO SVR Dose Range 0 - (µg/kg/min) 1 0
  13. 13. Careful replacement of fluid deficits. Correction of acidosis & hyperglycemia via Insulin administration. Correction of electrolytes imbalance. Treatment of underlying cause. Monitoring for complications of treatment.
  14. 14. Hypoglycemia-(bld glucose < 60mg) due to large dose or missed meals symptoms counter regulatory sympathetic stimulation- sweating, anxiety, palpitation and tremors Those symptoms due to deprivation- dizziness, headache, visual disturbance, hunger Treatment 20% dextrose IV 100ml or 50ml 50% dextrose IV
  15. 15. Condition precipitated by sudden withdrawal of steroids after long term administration ACTH (adrenal corticotropic hormone) regulates hormone secretion by the cortex of the adrenal glands. ACTH- stimulates –Glucocorticoids, mineralocorticoid and androgens. ACTH-stimulated by trauma and stress It presents as weakness , hypotension, dehydration Treatment Hydrocortisone hemisuccinate 100mg every 4-6hrs Correction of fluid and electrolyte balance
  16. 16. Due to hypocalcemia Presents as muscle cramps, paraesthesias, laryngospasm and convulsions Treatment Slow IV injection of 5-20 ml 10% calcium gluconate
  17. 17. Acute attach of bronchial asthma Oxygen free flow Nebulization with salbutamol and ipratropium bromide Nebulization with budesonide IV injection of deriphylline and dexamethasone
  18. 18. 19 Download slides from slideshare- raghuprasada authorstream-raghuprasada YOUTUBE-raghu prasada

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