This document contains 5 clinical case summaries presented to dental students for educational purposes. The cases include: 1) A patient who loses consciousness in the dental chair due to syncope. The recommended treatment is to place the patient in a supine position with feet elevated. 2) A patient who experiences hemorrhagic shock after a tooth extraction while on aspirin and antibiotics, requiring blood transfusion and IV fluids. 3) A patient having an allergic reaction to antibiotics presenting with itching, swelling and breathing difficulties, treated with antihistamines. 4) A patient going into anaphylactic shock after antibiotics, requiring epinephrine and other emergency treatments. 5) A diabetic patient experiencing hypoglycemia from missing breakfast,

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Clincal Pharmacology cases
for dentists
Dr Sameh AM Abdelghany

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EMERGENCY CASES

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Case(1):
 Patient with vital signs are within normal limits although
slightly elevated, which you attribute to his anxiety. Pulse 88,
respirations 16, blood pressure 138/88. reviewing his personal
oral hygiene puts him at ease. You notice that he had become
quite pale, hairs on his arms are standing up, he begins to
sweat profusely, frequently yawns. You ask him if he is feeling
well and he states that he is fine, just a little nervous and a bit
dizzy. You then notice he has lost consciousness.
 What happen?
 How to treat?

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 SYNCOPE
o symptoms: pallor, diaphoresis, yawning,
piloerection, dizziness
 Treatment:
1. Supine position with feet elevated.
2. After regaining consciousness he remained in
supine position for 15 minutes.
3. Dental procedure was postponed and sedative will
be given next visit

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Case(2):
Healthy female patient, she complains of severe pain in last
molar tooth. You decided an extraction for the tooth. She has
history of taking aspirin and cefoprazone(3rd generation
cephalosporins). Once upon extraction of tooth, bleeding
occurs and not stop. Her condition get worse and pulse
become weak and thread , pale skin and blood preesure
50/70 and transmitted to ER unit for management.
 What happen?
 How to treat?

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 Hemorrhagic SHOCK
o Aspirin and cefoprazone increase bleeding
tendency and result in this condition
o symptoms: weak thready pulse, confused state,
pale skin
 Treatment:
1. Blood transfusion
2. vital signs monitored.
3. Once in the ER IV fluids where administered.

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Case(3):
Patient took premedication amoxicillin
before treatment, complains of a scratchy
throat, is beginning to itch all over,, she
requests a glass of water and is trying to catch
her breath,, her eyes and lips begin to swell
What happen?
 How to treat?

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 ALLERGIC REACTION
(Moderate allergic reaction)
Symptoms: systemic pruritus, urticarial,
angioedema of eyes, lips and larynx,
dyspnea, hypotension, bradypnea
 Treatment:
1. Administer Antihistamine IM
2. monitor vital signs.

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Case(4):
17 y male Patient complains of abcess in tooth 13. You
decide to give him amoxicillin IV for treatment. After
that, patient took the injection and complains of a
scratchy throat, beginning to itch all over, trying to
catch hir breath,, his eyes and lips begin to swell. Pukse
become so weak , Blood pressure decrease to 50/70
and skin becomes pale. Patient transmitted to hospital
for management
What happen?
 How to treat?

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 Anaphylactic Shock
o Symptoms: A severe fall in blood pressure occurs, with
bronchoconstriction, angioedema and sometimes death
 Treatment:
1. Place the patient in recumbent position and elevate lower
extremities, Apply tourniquet proximal to the site of antigen
injection; remove every 10-15 minutes.
2. Adrenaline injection 0.5-1mg should be given I.M
3. Subsequent injections 10-20 min later may be given until the
patient improves.
4. H1- receptor blocker.
5. Hydrocortisone (100mg I.V
6. In severe anaphylaxis, 1-2 L of plasma substitute should be
infused rapidly.
7. Oxygen and artificial ventilation may be necessary.

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Case(5):
Diabetic Patient comes in and states he skipped
breakfast, you notice he is salivating profusely. you
ask him where he is and he is confused and
irrational, vital signs-bounding pulse and shallow
respirations, he is conscious.
 What happen?
 How to treat?

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 SEVERE HYPOGLYCEMIA
Symptoms: Profuse salivation,
confusion, irrationality, bounding
pulse.
 Treatment:
1. 6 glucose tablets
2. monitor vital signs.

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Prescription

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Defintion
 Is a physician written order to a
pharmacist for a specific medication for
a specific

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General Pricinples
1) Try to make proper diagnosis before writing prescription
2) Don not prescribe any drug except when it is essential for
patient condition
3) Avoid adverse effects of drug-drug interaction:
i. Ask about history of drug intake
ii. Try to prescribe to avoid prescribing interacting drugs and if
mandatory restrict precautions should be considered
iii. Avoid polypharmacy: write down least number of drugs
with least possible dose
4) Instructions for pharmacist and patients should be clear

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Examination
History
Decision
Investigation

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Parts
1. Phycican’ name, professional degree, address and
telephone number
2. Name. address and age of patient
3. Date
4. Superscription: the symbol R/ at the start of prescription.
5. Inscription: the prescribed medicines and their doses.
6. Subscription: includes directions to the pharmacist.
7. Transcription: includes directions to the patient in Arabic.
8. The signature of the physician.

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Prescriptions for narcotics:
1) Narcotics should be written by licensed doctors on
special form obtained from the ministry of health.
2) The doctor’s name, address, qualifications, and 
number should be clear.
3) The patient’s name, address, age and diagnosis should
be clear.
4) The dose of the narcotic should be written in numbers
and litters.
5) Doctor’s signature.
6) Two copies are done, one for the doctor and the other
for the pharmacist.

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PRESCRIPTION FOR NARCOTICS

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Some abbreviations:
• p.o. By mouth.
• i.m. Intramuscularly.
• i.v. Intravenously.
• s.c. Subcutaneously.
• o.d. Once daily.
• b.i.d. Twice daily.
• t.d.s. Three times daily.
• q.d.s. Four times daily.
• p.r.n. When required.
• state Immediately

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Some household measures:
 One tea spoonful = 5 ml.
 One table spoonful = 15ml.
 One coffee cupful = 30ml.
 One tea cupful = 120-150ml.
 One glassful = 240mg.
 One milliliter= 15 drops.

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Examples for Prescription

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Mild toothache:
R/
Aspirin 500mg tablets
‫اللزوم‬ ‫عند‬ ‫قرص‬
Or
R/
Paracetamol 500mg tablets
‫اللزوم‬ ‫عند‬ ‫قرص‬

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Severe pain of dental origin
:
R/
Diclofenac 75 mg Ampoules
‫يوميا‬ ‫العضل‬ ‫في‬ ‫حقنه‬

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Dental abcess
:
R/
Metronidazole 500 mg tablets
‫األكل‬ ‫بعد‬ ‫قرص‬
3
‫لمدة‬ ‫يوميا‬ ‫مرات‬
10
‫أيام‬
Cephradine 500 mg capsules
‫كل‬ ‫كبسولة‬
6
‫لمدة‬ ‫ساعات‬
10
‫أيام‬

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Oral moniliasis:
R/
Miconazole 2% oral gel
‫كل‬ ‫بالفم‬ ‫موضعيا‬ ‫ملعقه‬ ‫نصف‬
6
‫لمدة‬ ‫ساعات‬
10
‫أيام‬
Or
Nystatin oral drops 100.000 unit/ml
‫كل‬ ‫بالفم‬ ‫قطارة‬ ‫مأل‬
6
‫لمدة‬ ‫ساعات‬
10
‫أيام‬

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Prevention of dental caries
:
R/
Sodium fluoride 0.25mg tablets
‫يوميا‬ ‫واحد‬ ‫قرص‬

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THANKS