The document discusses drugs used in coagulation disorders and bleeding. It describes two major groups of drugs - those that decrease clotting like anticoagulants and thrombolytics, and those that increase clotting for deficiencies. Anticoagulants discussed include heparins, warfarin, and direct thrombin/factor Xa inhibitors. Antiplatelets to inhibit platelet aggregation are also covered. Drugs to arrest bleeding include local haemostatics applied topically and systemic agents like vitamin K and antifibrinolytics. Key points for dentists on managing patients taking these drugs emphasize safer options and monitoring coagulation levels before procedures.
Obtudent, mummifying agents and disclosing agentbibi umeza
overview of obtudent, mummifying agents and disclosing agent with detailed information on their pharmacological action, mechanism, uses and adverse effect for both medical and dental 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
Obtudent, mummifying agents and disclosing agentbibi umeza
overview of obtudent, mummifying agents and disclosing agent with detailed information on their pharmacological action, mechanism, uses and adverse effect for both medical and dental 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 anaesthesia is defined as a loss of sensation in a circumscribed area of the body caused by a depression of excitation in nerve endings
Or an inhibition of the conduction process in peripheral nerves; no loss of consciousness occurs
Local anesthetics interfere with the excitation process in the nerve membrane in one or more of the following ways:
1) Altering the basic resting potential of the nerve membrane
2) Altering the threshold potential (firing level)
3) Decreasing the rate of depolarization*
4) Prolonging the rate of repolarization
Antibiotics used in dentistry
Terminologies
History
Classification of antibiotics
Principles of antibiotics use
Commonly used antibiotics
Drug interaction
Drug combination
Antibiotic resistance
Summary
Coagulant & AntiCoagulant Haemostasis (arrest of blood loss) and blood coagulation involve complex interaction between the injury vessel wall, platelets and coagulation factors
Individualized Webcam facilitated and e-Classroom USMLE Step 1 Tutorials with Dr. Cray. Starting at $50.00/hr., depending on pre-assessment. 1 BMS Unit is 4 hr. General Principles and some Organ System require multiple units to complete in preparation for the USMLE Step 1 A HIGH YIELD FOCUS IN Biochemistry / Cell Biology, Microbiology / Immunology and the 4 P’s-Phiso, Pathophys, Path and Pharm. Webcam Facilitated USMLE Step 2 Clinical Knowledge and Clinical Skills diadactic tutorials /1 Unit is 4 hours, individualized one-on-one and group sessions, Including all Internal Medicine sub-sub-specitialities. For questions or more information.. drcray@imhotepvirtualmedsch.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
local anaesthesia is defined as a loss of sensation in a circumscribed area of the body caused by a depression of excitation in nerve endings
Or an inhibition of the conduction process in peripheral nerves; no loss of consciousness occurs
Local anesthetics interfere with the excitation process in the nerve membrane in one or more of the following ways:
1) Altering the basic resting potential of the nerve membrane
2) Altering the threshold potential (firing level)
3) Decreasing the rate of depolarization*
4) Prolonging the rate of repolarization
Antibiotics used in dentistry
Terminologies
History
Classification of antibiotics
Principles of antibiotics use
Commonly used antibiotics
Drug interaction
Drug combination
Antibiotic resistance
Summary
Coagulant & AntiCoagulant Haemostasis (arrest of blood loss) and blood coagulation involve complex interaction between the injury vessel wall, platelets and coagulation factors
Individualized Webcam facilitated and e-Classroom USMLE Step 1 Tutorials with Dr. Cray. Starting at $50.00/hr., depending on pre-assessment. 1 BMS Unit is 4 hr. General Principles and some Organ System require multiple units to complete in preparation for the USMLE Step 1 A HIGH YIELD FOCUS IN Biochemistry / Cell Biology, Microbiology / Immunology and the 4 P’s-Phiso, Pathophys, Path and Pharm. Webcam Facilitated USMLE Step 2 Clinical Knowledge and Clinical Skills diadactic tutorials /1 Unit is 4 hours, individualized one-on-one and group sessions, Including all Internal Medicine sub-sub-specitialities. For questions or more information.. drcray@imhotepvirtualmedsch.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Anticoagulants are used to treat and prevent blood clots that may occur in your blood vessels. Blood clots can block blood vessels (an artery or a vein). A blocked artery stops blood and oxygen from getting to a part of your body (for example, to a part of the heart, brain or lungs).
Anticoagulants have been thoroughly covered in this SlideShare, including an overview with typical examples, their function in the human body and how they operate (MOA), side effects, contraindications, and uses.
Since they are known to regulate blood clotting, it is crucial to keep an eye on their blood levels lest they have a fatal impact on a patient on anticoagulant treatment.
also we have added novel anticoagulants which got approval in just few years.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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!
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
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.
7. The drugs used in clotting and bleeding
disorders fall into 2 major groups:
(1) drugs used to decrease
clotting or dissolve clots
already present in patients
at risk for vascular occlusion
and
(2) drugs used to increase
clotting in patients with
clotting deficiencies.
9. 1. ANTICOAGULANTS
• Anticoagulants inhibit the formation of fibrin
clots.
• 3 major type are available:
1. Heparin and related compounds which
must be used parenterally;
2. the orally active coumarin derivatives
(warfarin)
3. direct thrombin inhibitors also used
parenterally; and
10.
11. A. Heparin and related compounds
1. Unfractionated heparin (UFH)
– has a molecular weight range of 5000–30,000 (HMW)
– Heparin is given intravenously or subcutaneously
2. Low-molecular-weight (LMW)
– have molecular weights of 2000–6000.
– (eg, enoxaparin ,dalteparin)
– LMW heparins have greater bioavailability and
longer durations of action than unfractionated
heparin;
– thus, doses can be given less frequently (eg, once or
twice a day).
– They are given subcutaneously.
3. Fondaparinux - once-daily s.c
12. Mechanism and effects
• Unfractionated heparin binds to endogenous
antithrombin III (ATIII)
• The heparin–ATIII complex combines with and
irreversibly inactivates thrombin and factor Xa
13. Clinical use
—Because of its rapid effect, heparin is used when
anticoagulation is needed immediately (eg, when
starting therapy).
Common uses include:
• Treatment of Deep Vein Thrombosis,
• Pulmonary embolism,
• Acute myocardial infarction.
• In pregnancy heparin is the drug of choice . Because
it does not cross the placental barrier.
LMW heparins and fondaparinux have similar clinical
applications.
14. Adverse Effects
• The major adverse effect of heparin is
bleeding
• Allergy
• Long-term therapy has been associated with
osteoporosis
• Reversible alopecia has been reported
• Thrombocytopenia
15. Contraindications
• Heparin is contraindicated in patients with
– Thrombocytopenia,
– allergy to the drug,
– active bleeding,
– advanced hepatic or renal disease
• Should be avoided in patients who had a
recent surgery .
16. Warfarin
Mechanism of action:
• Factors II, VII, IX, and X (1972) require vitamin K
as a cofactor for their synthesis by the liver.
• Inhibits vitamin K epoxide reductase and thereby
interferes with production of functional vitamin K-
dependent clotting and anticlotting factors
Clinical use:
• Warfarin is used for chronic anticoagulation in all
of the clinical situations described previously for
heparin.
17. Warfarin
• The action of warfarin can be reversed with
vitamin K, but recovery requires the synthesis
of new normal clotting factor and is,
therefore, slow (6-24hr) .
18. Toxicity
• Hemorrhage is the main hazard
• Warfarin crosses the placenta
– abnormal bone formation of fetus
• Cutaneous necrosis
19. Management of the Dental Patient
Taking Warfarin
• Avoid aspirin and aspirin-containing
compounds;
– Paracetamol and opioids analgesic (eg:
tramadol) can be used.
• Oral hygiene with sub-gingival calculus
removal can produce bleeding
– use local pressure.
• Check with patient to ensure healing.
20. Mechanism of Action :
• Binds to thrombin’s active site and inhibits its
enzymatic action in the circulation and within
clots.
Clinical use :
• Anticoagulation in patients with heparin-
induced thrombocytopenia (HIT)
• Lepirudin: IV administration
• Dabigatran: oral administration
B. Direct Thrombin Inhibitors
Lepirudin, & Dabigatran
21. C. Direct factor X inhibitors
Rivaroxaban and Apixaban
Mechanism of Action :
• Binds to the active site of factor Xa and inhibits its
enzymatic action thereby preventing its ability to
convert prothrombin to thrombin.
Clinical use :
• Venous thrombosis,
• pulmonary embolism,
• prevention of stroke
• in patients with atrial fibrillation
Adverse effects:
• Bleeding is the most serious adverse effect.
22. Concerns in a Patient Taking Factor Xa
or a Direct Thrombin Inhibitor
• Anticoagulant effects, which can last up to 24
hours, cannot be reversed.
– No antidote is available
• Patient should avoid aspirin and non-steroidal
anti-inflammatory drugs (NSAIDs).
– Risk of bleeding is increased.
24. Uses
• Acute MI: Low-dose aspirin is most commonly
used in high-risk individuals to reduce the
incidence of MI and in post-MI patients to
prevent recurrent attacks.
• Clopidogrel - prevention of re-stenosis after PCI
• Dipyridamole
– Adjuvent with warfarin to Prevention of
thromboembolic complications of cardiac valve
replacement .
– combined with aspirin for secondary prevention of
ischemic stroke
26. 3. THROMBOLYTIC AGENTS
• Plasmin is an endogenous fibrinolytic enzyme that
degrades clots by splitting fibrin into fragments.
• promote the conversion of plasminogen to plasmin.
• Plasmin degrades fibrin into fibrin degradation
products and thus rapidly dissolves the blood clot
• Reteplase, alteplase, Streptokinase, Urokinase.
27. 3. THROMBOLYTIC AGENTS
Clinical use :
• Coronary artery thrombosis,
• Ischemic stroke,
• pulmonary embolism
Adverse effects :
• Bleeding, especially cerebral hemorrhage
• Contraindications
• These include recent trauma, recent surgery,
recent stroke, severe hypertension, severe liver
damage, peptic ulcer and bleeding disorders.
29. Haemostatic Agents
• They arrest bleeding either by vasoconstriction
or by promoting coagulation of blood.
30. Local Haemostatics
• These drugs are commonly used to control
bleeding from capillaries
– e.g. bleeding following tooth extraction,abrasions,
epistaxis, etc.
1. Astringents: They precipitate proteins locally
in the bleeding site and control capillary
oozing
– e.g. tannic acid, ferric chloride, ferric sulfate,
aluminum chloride, aluminum sulfate, etc.
31. Local Haemostatics
2. Adrenaline: It causes vasoconstriction (α1) and
arrests bleeding.
– A cotton pad soaked in 0.1% adrenaline solution is
applied on the bleeding site to control capillary oozing
– e.g., epistaxis, bleeding after tooth extraction etc.
– Adrenaline should be avoided in patients with
cardiovascular disease and uncontrolled
hyperthyroidism as it may precipitate myocardial
infarction (MI) or aggravate the existing condition.
32. Local Haemostatics
3. Thrombin: It converts fibrinogen to fibrin, thus
facilitating the last step in the coagulation
cascade and promoting haemostasis.
– Bovine plasma-derived thrombin, human plasma-
derived thrombin.
– Hypersensitivity reactions can occur to bovine
thrombin.
– Human plasma-derived thrombin carries the risk of
virus transmission.
– Thrombin is placed in the tooth socket to arrest
bleeding.
33. Local Haemostatics
4. Fibrin glue: It consists of fibrinogen, factor
XIII, thrombin, Ca2+ and other clotting
components.
– It is used to control bleeding during surgical
procedures or as a spray on the bleeding surface.
– Fibrin sealant in combination with tranexamic
acid mouthwash helps to reduce bleeding during
dental extraction in haemophilic patients.
– Fibrin sealants made from human plasma carry
the risk of transmitting viral infections.
34.
35. Local Haemostatics
5. Collagen: It controls bleeding by promoting
aggregation of platelets and accelerating
coagulation.
– Collagen sponges are placed in tooth socket
following extraction to arrest bleeding.
36. Local Haemostatics (Styptics)
6. Gelatin: It is a protein. It produces haemostasis
by providing a physical meshwork on which
clotting can occur.
– It is an absorbable haemostatic and is available as a
sponge or a film.
– Adverse effects are infection, granuloma formation
and fibrosis.
37. Local Haemostatics
7.Oxidized Cellulose: It is an absorbable
haemostatic. It should be applied dry so that
it swells up and form a clot.
• It is used to control bleeding from capillaries
and arterioles where ligation is not possible.
• It may cause tissue necrosis, nerve damage or
vascular stenosis.
38. Local Haemostatics
9. Calcium alginate: It is obtained from sea
weeds.
• It is an absorbable haemostatic and
• is used to promote wound healing.
39. Local Haemostatics
10. Haemocoagulase: Haemocoagulase enzyme
complex is isolated from the venom of Bothrops
atrox (viper).
Mechanism of action
It has a powerful haemostatic effect. It promotes
coagulation by two enzymes:
– one that has thrombin- like action
– another that has thromboplastin-like action.
– It can also shorten the bleeding and clotting time;
– thereby it controls capillary bleeding.
40. Local Haemostatics
10. Haemocoagulase:
Pharmacokinetics
• It is available for topical, intravenous, intramuscular
and subcutaneous administration.
• It has a rapid onset of action—within 5–10 min of i.v.;
20–30 min after i.m. administration and within a
minute of topical application (spray/soaked swab).
Indications
– To control bleeding following tooth extraction or any other
dental procedure.
Adverse effects are rare; they may cause anaphylactic
reaction on intravenous administration.
41. Systemic Agents
• Vitamin K
– Vitamin K, a fat-soluble vitamin, is required for the
synthesis of clotting factors.
– In vitamin K deficiency, there is an increased tendency to
bleed—epistaxis, haematuria, gastrointestinal bleeding
and post-operative bleeding.
• Uses
– For prevention and treatment of bleeding associated with
vitamin K deficiency.
– To control bleeding due to oral anticoagulant therapy
– in salicylate poisoning with haemorrhagic complications.
42. Systemic Agents
• Adverse effects:
– Oral vitamin K is safe.
– Intravenous injection may cause flushing,
sweating, dyspnea, hypotension, cyanosis, and
anaphylactic reaction.
– intramuscular and s.c. routes may cause severe
pain and bleeding at the site of injection
43. Systemic Agents
Antiplasmin drugs (Aminocaproic acid & Tranexamic acid)
• Competitively inhibits plasminogen activation in
Excessive fibrinolysis used.
• Tranexamic acid-It is available for oral, i.v. and
topical administration. It is more potent.
– In dentistry, tranexamic acid soaked gauze or
mouthwash can be used to reduce bleeding
postoperatively in haemophiliacs and in patients on
anticoagulant therapy.
• Adverse effcts : Thrombosis, hypotension,
nausea, vomiting, diarrhoea, headache.
46. Key Points for Dentists
• Low molecular-weight heparins are safer than
unfractionated heparin.
• Patient on anticoagulants should be instructed to
report signs of bleeding.
• NSAIDs should be avoided in patients on
anticoagulants and antiplatelet agents. Paracetamol
and selective COX-2 inhibitors are safer as they have
no antiplatelet action.
• Avoid intramuscular injections in patients on
anticoagulants.
• Oral anticoagulants are contraindicated in pregnancy.
• INR and aPTT should be monitored in patients on
warfarin and heparin, respectively, before a dental
procedure.