This document discusses analgesics used for pain control in dentistry. It covers central analgesics like opioids which affect opioid receptors in the brain and spinal cord. Morphine is a commonly used opioid analgesic derived from opium. It acts on mu, kappa, and delta receptors. NSAIDs are also discussed, which are prostaglandin antagonists that reduce inflammation, pain, and fever. Common NSAIDs used in dentistry include paracetamol, aspirin, ibuprofen, naproxen, and diclofenac. The document provides dosing information and side effects for various central analgesics and NSAIDs.
Analgesics in maxillofacial surgery by Dr. Amit Suryawanshi .Oral & Maxillo...All Good Things
Description:
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Analgesics in maxillofacial surgery by Dr. Amit Suryawanshi .Oral & Maxillo...All Good Things
Description:
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Local anesthesia has been defined as loss of sensation in a circumscribed area of the body caused by depression of excitation in nerve endings or inhibition of the conduction process in peripheral nerves.
Antiseptics, astringents and sialogoguesbibi umeza
overview of antiseptics, antringents and sialogogues with detailed information on pharmacological action, mechanism, use and adverse effect for both dental and medical students
Classification
Mechanism of action
Duration of action
Absorption and distribution
Mode of action
Theories of action of L.A
Pharmacokinetics of local anaesthetics
Routes of administration
Metabolism or biotransformation
Individual agents
Vasoconstrictors
Systemic effects
Toxicity
Advantages
Disadvantages
Maximum allowable dose
Local anaesthetics in community trust services
Local anesthesia has been defined as loss of sensation in a circumscribed area of the body caused by depression of excitation in nerve endings or inhibition of the conduction process in peripheral nerves.
Antiseptics, astringents and sialogoguesbibi umeza
overview of antiseptics, antringents and sialogogues with detailed information on pharmacological action, mechanism, use and adverse effect for both dental and medical students
Classification
Mechanism of action
Duration of action
Absorption and distribution
Mode of action
Theories of action of L.A
Pharmacokinetics of local anaesthetics
Routes of administration
Metabolism or biotransformation
Individual agents
Vasoconstrictors
Systemic effects
Toxicity
Advantages
Disadvantages
Maximum allowable dose
Local anaesthetics in community trust services
Opiod analgesics used in Dentistry by Dr. Amit T. Suryawanshi
(MDS) Facial Cosmetic Surgeon
Oral & Maxillofacial Surgeon
Dental Surgeon & Implantologist
Hair Transplant Surgeon (Germany)
Consulting Surgeon in Kolhapur, Sangli, Pune & Mumbai (India)
&
founder of
Face Art International Super speciality
at Kolhapur (India)
Brief Synopsis of Analgesics used in Dentistry for Pain Control & Management with Dosage Information & Severity Encountered during Drug Metabolism & Administration.
Paracetamol iv as a single analgesic is very safe analgesic, but only for mild and moderate pain.
It can be combined with many analgesic or adjuvan drugs to provide strong analgesic for postoperative pain.
So, it can be the basic regiment for Multimodal Analgesia.
Because of its safety it can be the choice for high risk surgical patient
These are the pharmacological agent which when administered externally relieves mild or moderate pains without degree of consciousness called as Analgesics are worked against the pain so firstly introduced the Pain sensation.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
4. Central Analgesics
Centrally acting analgesics are thought to
affect the opiate receptors in the brain and
perhaps also those in the spinal cord.
(Receptors are specialized sites with which a
drug interacts to produce its effects.)
The most widely used and effective of these
narcotic analgesics are derived from opium
alkaloids. Morphine is one typical example
5. Central Analgesics
Opiums
(Morphine, Heroine, Codeine, Fentanyl,
Meperidine, Tramadol, Alfetanil)
Increase pain threshold and decrease reaction
movements
Decreasing Respiratory Center`s sensibility for
CO2
Some of them cause addiction
6. Central Analgesics
Non-opiums
Nevopame
Not anti-inflamatory
Don`t causes sleep
Pain is reduced on the CNS level
8. Morphine receptors
Morphine is attached to special cellular
receptors in order to perform its effects
Three kind of receprors are been
identified
Mu µ
Kappa κ
Delta δ
10. Morphine receptors
Mechanism of action
Morphine is linked to theses receptors
Activating receptor activated Potassium channels
causing rapid burst of K outside the neuron cell
(hyperpolarization)
Decrease the voltage-gated calcium chanels
activity preventing calcium ions entrance (More
hyperpolarization)
Hyperplorisation prevent propagation of the
action potential (electrical signals) along the
axon.
11. Morphines
For sever and mild pain, two types
Opium derived from opium plant
Opium agonists
Natural (Endomorphine)
Synthetic (Methadon, meperidine, Alfantenyl))
12. Morphine Agonists
Classified to
1. Strong Agonists
1. Morphine 4 h
2. Meperidine 2 h
3. Methadone 24h
4. Heroine 2 h
5. Alfentanyl 5 اto 45 min
2. Mild Agonists (Hydropoxyphene, Codeine)
13. Morphine
3. mixed agonists and antagonists
1. Pentazocaine: Agonist on κ and weak antagonist on µ and
δ
2. Nalbuphine : same as Pentozocaine but stronger afonist to
µ
3. Buprenorphine : 0.4 mg from it is equal to 10 mg of
Morphene it is partial agonist to µ and antagonist to κ
14. Morphines
4. Antagonists
1. Naloxon : Rapidly emove opiums linked to the receptors µ ،
κ and δ (30 sec after inhection)
2. Naltrixone its effects are longer than naloxon (one oral
administration can block heroine effects for more than 48 h)
16. Pharmaceutical effects
Opium can affect CNS, Digestive tube,
pupil, and cardio vascular system.
CNS
1. Prevent pain reception with a dose related effect
2. Sedation but with high doses convulsion may
occur
3. Euphoria (False feeling of happiness)
4. 10 mg (IV) for mild pain
15-20 mg (IV) for severe pain (respiratory
depression is possible at this dose)
17. Pharmaceutical effects
CNS (suite)
6. Decrease the RC (Respiratory Center) sensibility
to CO2 blood level. In that case no benefit of
giving pure Oxygen (apnea may develop)
7. Nausea and vomiting (Phenothiazine is
administrated to overcome these effects)
8. cough suppressant (specially Codeine)
18. Pharmaceutical effects
Digestive system
1. Spasm of sphincters
2. Constipation
3. These effects can be reversed by the
administration of atropine (Acetylcholine
receptors antagonists)
19. Pharmaceutical effects
Other
1. Morphine pin point pupils
2. Hypotension
3. Bronchospasme
4. ischuria (urinary retention)
20. Pharmacodynamic
Can be used orally, mostly used by injection
Analgesic for the treatment of pain (except
spasmodic origin , why?)
Its effect starts
IV : 7 min
IM : 20 min
SC (subcutaneous) : 40 min
21. Pharmacodynamic
Metabolized in the liver (not to be used with
hepatic pathology)
Eliminated by kidneys as inactive metabolites
Also eliminated by sweat, bile, and maternal
milk (not to be administrated to breast
feeding woman)
22. Opium in Dentistry
1. Low to mild pain (codeine ,hydrocodone
oxycodone Propoxyphene, and tramadol)
2. For severe pain :Morphine, Pentazocaine
Butorfanol, Meperidine, and Fentanyl
23. Opium in Dentistry
In most cases dental pain is accompanied or
caused by an inflammation process, so
NSAIDs is the first choice.
Anyhow it is not uncommon to use a
combination of opium with Aspirin or other
NSAID, thus two pain control mechanisms are
combined.
24. Opium in Dentistry
Oral way is the preferred way of opium
administrations
Most opiums have their effects appears
after 2 hours, dose cant be repeated
safely after 2 hours of the first
administration if needed
Injection forms of opium can not be
administrated in dental clinics
25. Codeine
30 to 60 mg orally every 4-6 h
With this dose side effects of Codeine is
negligable
In higher dose constipation and nausee
may be noticed
Used normally in combination with
NAISD
26. Hydrocodone and oxycodone
Used orally
Hydrocodone 30 mg every 4-6 h
oxycodone 5 mg every 4 to 6 h
Pharmaceutical effects of 5 mg of
Oxycodone equal to 30-60 mg of
Codeine
27. اPropoxyphene
Some false rumors about the addiction
capacity of Codeine led to the development of
Propoxyphene
Used for mild pain
Its sedative action is lower than Codeine
Normally used in combination with
Paracetamol (60 to 100mg)
28. Morphine
For severe pain
The dose for 70 kg weight patient is 10 mg
The best sedative effect between opium
but also side effects (constipation, nausea,
respiratory depression, addiction) are most
obvious comparing to other opiums
30. NSAIDs
Have analgesic, antipyretic V, and anti-
inflammatory effects
NSAIDs are Prostaglandin Antagonist
Prostaglandin is important mediator of
inflammation, pain and fever
31. Prostaglandin and Cyclooxygenases
Prostaglandins are produced
following the sequential
oxidation of AA, DGLA or EPA
by cyclooxygenases (COX-1 and
COX-2) and terminal
prostaglandin synthases:
COX-1 is responsible for the
baseline levels of
prostaglandins.
COX-2 produces prostaglandins
through stimulation.
(GLA) Gamma-linolenic acid
(AA) Arachidonic acid
(EPA) Eicosapentaenoic acid
32. NSAIDs
COX-1 and COX-2 are both located in the blood
vessels, stomach and the kidneys,
Prostaglandin levels are increased by COX-2 in
scenarios of inflammation.
Inhibiting COX-1 is responsible of NSAIDs side
effects
A third form of COX, termed COX-3 is thought to
exist in the brain and may be associated with
relief of Headaches when on NSAID therapy.
33. NSAIDs
COX-2 selective inhibitor is an anti-inflammatory
drug (NSAID) that directly targets COX-2, with such NSAID
pharmaceutical effect are maximal while side effects are
minimal
34. NSAIDs-Pharmacodynamics
Well absorbed in the digestive tube
Metabolized in the liver
Essentially eliminated by the Kidney
35. Paracetamol
Most used NSAID especially when Aspirin is
contraindicated
Inhibit prostaglandin formation in the CNS level only
(cox-3)
Thais explains its maximal antipyretic and analgesic
effects, and minimal anti-inflammatory effects
(preferred with infection)
500 to 650 mg x4 daily
Can be increased to 1000 mg X4 daily if needed
36. Paracetamol
Side effects
No side effects with therapeutic dose
Allergy is rar
Extensive use mais
Excessive use of paracetamol can damage multiple
organs, especially the liver and kidney.
Non Tetragenic, can be administrated to pregnant
and breast feeding woman.
37. Aspirin
Aspirin also known as acetylsalicylic
acid abbreviated ASA
First choice in non-infection origin dental pain
treatment (when there is no contraindication)
Very effective in acute dental pain (650 mg of
Aspirin is more effective than 60 mg of Codeine)
The maximum effect of aspirin is not dose related
(all or none), increasing the dose more than 650
mg is useless
This dose is repeated four time daily.
38. Aspirin
Aspirin use has been shown to increase the risk
of gastrointestinal bleeding.
Although some enteric coated formulations of
aspirin are advertised as being "gentle to the
stomach", in one study enteric coating did not
seem to reduce this risk.
39. Aspirin
Combining aspirin with other NSAIDs has also
been shown to further increase this risk.
Using aspirin in combination
with clopidogrel or warfarin also increases the risk
of upper gastrointestinal bleeding.
40. Aspirin
Large doses of salicylate, a metabolite of aspirin,
have been proposed to cause tinnitus
Reye's syndrome, a severe illness characterized by
acute encephalopathy and fatty liver, can occur
when children or adolescents are given aspirin for
a fever or other illnesses or infections
Aspirin (or aspirin-containing products) should
not be given to anyone under the age of 12 who
has a fever
41. Propionic Acid derivatives
Ibuprofen, fenoprofen, ketoprofen, and
flurbuprofen.
Effective for mild pain
Used safely with children
42. Propionic Acid derivatives
Ibuprofen
400 mg X4 daily
May be administrated preoperatively to reduce
postoperative pain
Naproxen
For mild pain
500 mg then 250 mg X3 daily
43. Propionic Acid derivatives
Flurbuprofen
More effctive than Ibuprofen
50-100 mg of it equal 400 mg of Ibuprofen in
efficacity
Daily dose is 300 mg divided on 2 to 3
administration. (150 X2 or 100 X 3)
44. Etodolac
Etodolac
Efective dose for dental pain is 200 – 400
X3 daily
Analgesic effect with this dose starts after
30 min and last for 4-6 h
Daily dose shouldn`t exceed 1200 mg
45. Diclofenac
Diclofenac
Its pharmaceutics and side effects are
similar to Naproxen
Dose is 25-50 mg X3 daily
46. Nimesulide
Its side effects are minor, excellent
analgesic and anti-inflammatory effects
Analegesic effect are stronger than
Ketoprofen (most effective propionic
acid)
Given orally 100 mg X2 daily
48. Opiums + non-opiums
Good strategy (two pain control
mechanisms are involved)
Most used non-opium used is Codeine
(60 mg)
Dextropropoxyphene (65 mg) might
also be used but it is less effective than
Codeine
49. NSAIDs + Sedative
NSAIDs can be combined with sedatives
(Diphenhydramine hydrochloride)
This help to release dental origin pain
normally accompanied with insomnia
But increased possibility of Drug-drug
interaction should be considered when
administrated with other drugs