Drug prescription with understanding of physiology and health condition of an individual, substitutes.

1. Drugs and conditions
altering its
prescription.
Dr.Rohit A. Mistry

2. Contents
• Introduction.
• An overview of the drugs used in dentistry.
• Various health conditions.
• Contraindicated drugs in these conditions.
• Indicated safe drugs in these conditions.
• References.
• Conclusion.

3. Introduction
• CNN-11th sept’12
Emily jason (name changed) died after taking a single pill of
oxycodone . She was an asthma patient. Unaware of the
condition she took a single pill at night and slept and did not
wake up the next morning. Emily died of respiratory depression.
• A newborn baby suffered from haemolytic anaemia due to
the administration of the antibiotic nalidixic acid

4. Most commonly used drugs in Dentistry
• Analgesics.
• Anti-microbial drugs.
• Anti-inflammatory Drugs.
• Anti-fugal drugs.
• Anti-viral drugs.
• Corticosteroid.

5. Most commonly used Antibiotics.
Drug Indications
Tetracycline Aggressive periodontitis
Chronic periodontal disease
Gingivitis.
Metronidazole Ulcerative gingivitis
Aggressive Periodontitis
ANUG
Quinolone
Ciprofloxacin
Osteomyelitis
ANUG
Aggressive periodontitis
Penicillin
Amoxicillin
Ampicillin
Aggressive periodontitis
Cephalosporin
Cefotaxime
Cefactor
Against gram negative microbial infection
Clindamycin Anaerobic streptococci
Clostridium infection
Aggressive periodontitis
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

6. Most commonly used analgesics and
anti-inflammatory drugs(NSAIDs)
DRUGS INDICATIONS
Aspirin Dental pain
Acetaminophen Pain and fever
Indomethacin Dental pain, rheumatoid arthritis,
ankylosing spondylitis
Ibuprofen,naproxen,ketoprofen Post extraction pain, soft tissue injuries
Oxicam Post operative pain
Nimesulide Dental pain
Dicofenac sodium Pain
Mephenamic acid Pain, arthritis, as antipyretic
Ketorolac Short term management of
postoperative pain
Acetaminophen+ ibuprofen Anti-inflammatory and analgesic action
Clinical pharmacology 8th edition-Laurence, Bennett,M.J.Brown

7. Anti-fungal
DRUGS INDICATIONS
Amphoterecin B Oral cutaneous candidiasis
Nystatin Moniliasis, oral candidiasis
Griseofulvin Fungal infection of skin nail and scalp
Ketoconazole Systemic candidiasis and dermatomycosis
Fluconazole Mucosal candidiasis
Itraconazole Oropharangeal candidiasis
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

8. Anti viral
DRUGS INDICATIONS
Idoxuridine Keratoconjuctivitis
Acyclovir Mucocutaneous herpes simplex,herpes
zoster
Zidovudin AIDS
Retrovir AIDS
Amantadine Prophylaxis of influenza
Ribavarin Hepatitis virus infections
Interferon Chronic hepatitis, papilloma viral
infection.
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

9. Corticosteroids
DRUGS IDICATIONS
Hydrocortisone Lichen planus, erythema
multiforme,pemphigus, recurrent apthae,
desquamative gingivitis.
Prednisolone Lichen planus, erythema
multiforme,pemphigus, recurrent apthae,
desquamative gingivitis, thrombocytopenia
Triamcinolone Lichen planus, erythema
multiforme,pemphigus, recurrent apthae,
desquamative gingivitis, chelitis
Betamethasone Lichen planus, mucus membrane
pemphigoid.
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

10. Most Commonly Encountered Health
conditions
The prescription is advised according to the health status of
an individual. The doctor has to be sure about the
probabilities of action of a drug in the patient. If the patient
is in a condition which brings on undesirable effects in
relation to drugs then it has to be changed with an equally
effective less harmful substitute.

11. Various
conditions
Physiological Pregnancy, lactation.
Pathogical
Systemic
Diabetes,hypertension,
anaemia, asthama
Non systemic
Hypersensitivity,
localised irritations

12. PREGNANCY

13. • Fertilization.
• Crucial period for the
womb.
• Stage of growth and
implantation.
1st
trimester
• Organogenesis.
• And high Vascularity.
2nd
trimester
• Growth and
development of
foetus along with
brain.
3rd
trimester
Pregnancy.
• Three trimesters
• In each trimester there are the stages at which the drug can
affects the foetus
Pharmacokinetics in pregnancy
Drug absorption-slower
Drug metabolism-rapid metabolism
Drug excretion-increased due to increased glomerular filtration
by 70%.

14. Drugs contraindicated in pregnancy
TYPES DRUGS 1st
trimester
2nd and 3rd
trimester
SUGGESTONS
Analgesics Codein Limited
Dose
Limited
dose
Causes respiratory
distress.
Aspirin No No Premature closure of
ductus arteriosus
Ketorolac Yes No
Naproxen no No
Antibiotic Tetracyclin No No Stains teeth affect bone
Clindamycin No No ---------
Ofloxacin no No ---------
Antifungal Clotrimazole No No Liver function affected
Ketoconazole No No Embryotoxic
Sedative Benzodazepines No No TeratogenClinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

15. Safe drugs in PREGNANCY
DRUGS TPES 1st trimester 2nd and 3rd
trimester
COMMENTS
Analgesic Acetaminophen Yes Yes Teratogenic if
overdose
Ibuprofen Yes(cautiously) No Same as aspirin
Antibiotic Penicillin yes Yes Safe
Erythromycin Yes Yes Safe except
estolate form
Cephalosporin yes Yes Safe only if used
as indicated
Anti fungal Nystatin yes Yes Safe
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

16. Teratogenic drugs
(teratos-monster)
• Teratogen- it is defined as substances which cause anatomical
and non anatomical abnormalities in foetus and embryo.
• The foetal and maternal bloodstream is separated by a lipid
membrane which only allows lipid soluble substance diffusion.
Drug effect
NSAIDs Premature closure of ductus
arteriosus
Tetracyclin Anomalies of teeth and bones
Valproic acid Neural tube defect
Alcohol Growth retardation
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

17. LACTATION

18. Lactation
• All the drugs which are taken during the period of lactation have been
found to be present in mothers milk. The extent is less and so is not a
way to excrete drug, but poses a threat to the suckling child whose
drug metbolism and elimination mechanism are immature.
• Pharmacokinetics during lactation.
 Drug absorption-Normal
 Drug metabolism-Normal
 Drug elimination- 1% eliminated in breast milk of the mother.
 Drugs having short half life should be preferred and those having
sustained release formula should be avoided.

19. Drugs contraindicated in nursing mothers
Type Drug Acceptabiliy Watch infants for the sign of
Analgesics Aspirin No Associated with Reye’s syndrome
Opioids No Sedation and poor feeding
Antibiotics Tetracycline No Affects growth and stains teeth
yellowish
Clindamycin No Pseudomembranous colitis and
diarrhea
Metronidazole No Have radiosensitising property.
Potential carcinogen
Nalidixic acid No Haemolytic anaemia
Nitrofurantoin No Immunological reactions
Sulfonamides No -----
Chloramphenicol No Gray baby syndrome
Antifungal Ketoconazole No Antiandrogenic effect and
hepatotoxicity
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

20. Drugs Safe in Nursing
Type Drug Acceptability Watch infants for the sign of
Analgesics Acetaminophen Yes Overdose is toxic
Antibiotics Penicillin Yes Allergic symptoms, diarrhea
Erythromycin Yes Diarrhoea
Cephalosporin Yes Allergic reaction
Antifungal Nystatin Yes No contraindications
Clotrimazole Yes Use with cautious
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

21. Diabetes mellitus
(diabetes=siphon mellitus=sugar)
• The relation of drug metabolism and excretion with
diabetes.
• Poor glycemic control.
• Micro vascularity.
• Distribution-by non enzymatic glycation of albumin
• Excretion due to nephropathies and associated fatty
liver(if present).

23. Drugs Contraindicated In DIABETICS
Type Drug Acceptabiliy Watch infants for the sign of
Analgesics Aspirin and all
other salicylates
No Causes hyperglycemia
Nephritis
Antiplatelet aggregatory action.
Antibiotics Aminoglycosides No Nephrotoxicity
Metronidazole No Peripheral neuropathy
Gatifloxacin and
other
Fluroquinolones
No Fatal hypoglycemia
Clindamycin No Nephrotoxic
Vancomycin No Nephrotoxic
Tetracycline No Damage to kidney and induces
diabetes insipidus.
Drug Interactions of Medications
Commonly Used in Diabetes-Curtis Triplitt,
Phar.D., CDE. volume 19 (2004)

24. Drugs Safe In DIABETICS
Type Drug Acceptabiliy Comment
Analgesics Acetaminophen Yes Safest of all the others
Diclofenac
sodium
Yes See for bioaccumulation in liver
Ibuprofen Yes Look out for aspirin like effects
Antibiotics Penicillin Yes
Semisynthetic
Penicillins like-
Amoxicillin
Carbenicillin
Safe
With
caution
Extended spectrum makes it more
convenient
Cephalosporin With
caution
Low grade nephrotoxicity
Drug Interactions of Medications
Commonly Used in Diabetes-Curtis Triplitt,
Phar.D., CDE

25. Hemorrhagic disorder
• Classified as-
 Coagulation disorder.
 Thrombocytopenia purpura.
 Non-thrombocytopenia purpura.
• These patients are susceptible to bleeding and
hemorrhage on interaction with drugs which have
effect on blood clotting mechanism in any manner.
• Special care shoud be taken when surgical
interventions are needed.

26. Drug consideration
• Aspirin is one of the most highlighted drug which
has to be avoided in bleeding disorder
• Antiplatelet aggregatory action
• NSAIDs having platelet aggregatory action
• Antibiotics are safe
• Acetominophen can be prescribed safely for dental
related pain.
• Cephalosporins, as they cause bleeding.
Clinical pharmacology 8th edition-
Laurence, Bennett,M.J.Brown

27. Asthma
• Asthmatic patients are majorly on drugs which
reduce inflammatory cytokines or are
bronchodilators which stimulate β-2 receptors.
• Many people have sensitivity to certain drugs which
can precipitate an asthmatic attack.
• The drugs having effect such as depression of the
respiratory system.

29. Drugs Contraindicated In ASTHMA
Type drug comment
Analgesics Ibuprofen
Aspirin (samter’s triad)
Naproxen
Antibiotic Tetracycline Use cautiously
Erythromycin
Ciprofloxacin
Cephalosporin trigger respiratory distress
in rare cases.
Anrig C. The antibiotic dilemma. Dynamic
Chiropractic Oct. 2002;20 (21):18,32-33.

30. Drugs safe In ASTHMA
type drug Comment
Analgesic Acetemoinophen Safest
Diclofenac sodium
Antibiotics Penicillin Safe
Amoxicillin Broad spectrum
Erythromycin Safe

31. Conclusion
• The prescription of drug is in the favor of the
patient only when all the possible odds are
measured
• The goal is not just to rule out the harmful
drug but also to find an alternative solution.
• The assessment of patients health is the
foremost tool in treating the problem
• Of several remedies the physician should
chose the least sensational- Hippocrates

32. References
• An update on analgesics for management of postoperative dental pain-
Daniel A. Haas, BSc, DDS, BScD, PhD, FRCD(C)
• Antibiotic and asthama-Claudia Anrig
• Drug Interactions of Medications Commonly Used in Diabetes-Curtis
Triplitt, Phar.D., CDE
• Essentials of pharmacology in dentistry 2nd edition-KD Tripathi
• Clinical pharmacology 8th edition-Laurence, Bennett,M.J.Brown
• Clinical periodontology 11th edition- Carranza
• Textbook of oral medicine - Ghom
• Pharmacology and pharmacotherapeutics- R.S Satoskar
• Essential pathology for dentistry 4th edition-Harsh mohan
• Principles and practice of medicine-Davidson’s