Dr. Hadi Munib's document outlines drugs commonly prescribed in oral surgery. It discusses indications for drug prescriptions including pain relief, infection treatment, and disease management. Examples are given for proper prescription format and common abbreviations. Frequently prescribed drug classes like analgesics, antibiotics, and antifungals are covered along with examples like paracetamol, amoxicillin, and fluconazole. Precautions for special groups like children, the elderly, and pregnant women are also reviewed.

1. DRUG PRESCRIPTION IN ORAL
SURGERY
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. OUTLINE
• Indications for Drugs prescription
• Prescription example
• Common Drugs prescribed in dental clinics
• Drug Precautions
• References

3. INDICATIONS FOR DRUG PRESCRIPTION
• Pain Killer
• Treat Infections
• Prevent Infections
• Treat Diseases
• Palliative treatment

4. PRESCRIPTION EXAMPLE
• A proper drug prescription should include:
• Name
• Age
• Date
• Drug name
• Drug Dose
• Drug Frequency
• Drug Route of intake
• Physician’s name and signature

5. ABBREVIATIONS
• Rx
• PO
• PR
• IV
• IM
• OD , BID , TID
• QID
• PRN, Q
• SR, QN, QOD
• ABD
• EOD

6. DRUG PRESCRIPTION
• Patient’s name, age and date of prescription
• Amoxicillin 500mg PO 1 * 3 * 7
• Paracetamol 500mg PO Q4 hours
• Chlorhexidine 0.2% I 1 * 2
• Close remaining space
• Name and signature

7. COMMON CLASSES OF DRUGS
• Analgesics
• Antimicrobials drugs
• Anti-Hypertensive drugs
• Anti-Diabetic drugs
• Narcotics

8. • Paracetamol / Acetaminophen
• Analgesic (Mild to Moderate pain)
• Anti-Pyretic
• Little to no anti-inflammatory action.
• Thought selectively inhibit COX activities in the brain
• Dose 500mg – 1 g Q4 hours
COMMON DRUGS IN ORAL SURGERY

9. COMMON DRUGS IN ORAL SURGERY
• NSAIDs
• Anti-Pyretic
• Anti-Inflammatory
• Analgesic
• Types
• Mechanism: Inhibiting COX enzymes preventing the formation of Prostaglandins and
Leukotrienes
• Examples: Aspirin, Ibuprofen, Naproxen …etc.
• Dose: 400-600 mg Q 4-6 hours

10. NSAIDS PRECAUTIONS
• Children < 12 years old  Reye’s Syndrome
• Anticoagulants
• Bleeding Disorders
• Peptic Ulcers  Reduced PGs, Mucus secretions and Bicarbonates and increased acid
secretions
• Pregnancy  Prolonged Labor, Excess Bleeding and Early Closure of Ductus Arteriosus
• Renal or Hepatic Failures
• Asthmatics
• Lithium

11. OPIOIDS
• Bind to Opioids receptors in the central, peripheral and GI systems
• Alcoholics?
• Side effects: sedation, respiratory depression, constipation, Tolerance and dependence.
• Codeine: Anti-Tussive, might be mixed with Paracetamol as Revacod 500 mg 1-2 tablets * 3
• Tramadol: Moderate to Moderately Severe Pain. 50-100 mg 1 * 3 PRN

12. ANTIMICROBIALS
• Include: Antibiotics, Antivirals, Antiprotozoal and Antifungals
• Principles of Antimicrobial therapy:
• Identification of Microorganisms
• Empirical Therapy?
• Patients factors
• Route Of Administration

13. SURGICAL SITE INFECTION

14. PROSTHETIC JOINTS

15. ANTIBIOTICS
• Cell-Wall Inhibitors: Penicillin
• Mechanism of Action
• Amoxicillin 500 mg 1* 3 * 7
• MRSA
• Amoxicillin with Clavulanic acid  Curam ® and Augmentin® 625 mg 1 * 3 or 1 g 1 * 2
• Ampicillin PO: 250-500 mg Q6hr
• Flucloxacillin  250 mg 1 * 4 for Staph.
• Adverse effects: Hypersensitivity (5%) and Diarrhea

16. • Cephalosporin: Cell-Wall Inhibitors
• First Generation: G+ Bacteria (cephalexin 500mg 1*3 )
• Second Generation: effect on G – Bacteria (cefuroxime 1gm IV/IM )
• Third Generation: Greater effect on G – Bacteria (cefotaxime 1gm IV/IM )
• Fourth Generation: Greatest Against G – Bacteria (ceftriaxone 1 gm IV/IM)
• Hypersensitivity: 10% of Penicillin Hypersensitivity patients have Hypersensitivity to
Cephalosporin
• Vancomycin: Cell-Wall Inhibitor
• Metronidazole: Flagyl ® 250 – 500 mg 1 * 3
ANTIBIOTICS

17. ANTIBIOTICS
• Protein Synthesis Inhibitors: Tetracycline, Aminoglycosides, Macrolides and Lincosamides.
• Inhibit Ribosomes (30S and 50S)
• Safe?
• Broad-Spectrum
• Erythromycin, Clindamycin, Clarithromycin and Azithromycin.
• Clindamycin Dose Strength: 150 mg, 300 mg and 600 mg [Maximum Dose]
• 150 mg 1 * 4, 300 mg 1 *2 and 600 mg 1*1

18. ANTIFUNGALS
• Nystatin  usually used for Oral thrush, 400,000 to 600,000 units of the oral
suspension orally 4 times a day.
• Miconazole  Oral thrush and Angular Cheilitis, Dose: Oral gel 25mg/ml 2-5 ml
1*4, Cream 2%  1*3
• Fluconazole  100 mg: Dispense 15 tablets, take 2 tablets on day 1, followed by 1
tablet a day for the remainder of the14-day treatment period.
• Clotrimazole troches 10 mg: Dispense 70, dissolve 1 troche in mouth 5 times a day
for 14 days. [Benefit?]

19. ANTIFUNGALS

20. ANTIVIRALS
• Acyclovir  Herpes virus infections, Dosage:
• Prodromal Symptoms
• 5% Topical Cream 1 * 4
• 200 mg to 800 mg daily for 10 days [Usage]

21. MOUTHWASH
• CHLORHEXIDINE:
• 0.12% to 0.2% Concentration
• 1 * 2
• SE: Staining
• POVIDINE – IODINE:
• C/I: Thyroid Diseases

22. DRUG PRECAUTIONS
• Groups at risk: Children, Elderly and Pregnant Women
• Children: Dose reduction
• Weight: Clarke’s Rule
• Age:

23. ELDERLY
• Up to 75% have one or more chronic diseases (30% have more than three).
• Mucosal lesions may be present in up to 40% of older people (Malignancy risk?)
• GI Disorders are very common in this group of patients
• Polypharmacy

24. PREGNANCY
• Up to 10% of late Pregnancy may become hypotensive if laid supine
• Use safe categories of drugs
• Deficiency Anemias in 20% of pregnant women are suspected
• Teratogenic effects are most likely in the first trimester.
• Second and third trimester effects are mainly on growth.
• Breast Feeding
• Liver Diseases
• Kidney Diseases

26. REFERENCES
• Lippincott’s Pharmacology – Sixth Edition; Chapters: 37, 38, 39, 42 and 45
• https://www.iasusa.org/sites/default/files/tam/13-5-143.pdf
• Scully’s Medical Problems in Dentistry; Chapters 25, 27 and 29

27. THANK YOU