Drugs & Dentistry I Drugs commonly prescribed by the dentist March 2002 1. Antimicrobial Drugs a. Antibiotics Drug Amoxicillin Indications -Routine drug of choice in infection. -Prophylaxis regimen for subacute bacterial endocarditis Forms Usual dose Cap. 250-500 mg Adult: Sus. 125 mg/5ml 250-500 mg 250 mg/5ml q8h Child: 20 mg/kg/day in divided Trade &price -Amoxil 250 mg = 27 SR 500 mg = 53 SR Comments - 3% of population are allergic to the drug -Ultramox 500 mg = 25 SR -Amoxidar 250 mg = 7 SR 500 mg = 13 SR doses -Augmentin Children 40kg -Infections caused by beta- Tab. 375-625 mg Adult: 375 mg = 48 SR 625 mg = 81 SR 20-40 mg/kg/day lactamase producing 1g 375-625 mg 156 mg = 22 SR amoxicillin with 5-10mg strains. Sus. 156 mg/5ml q8h -Amoclan calvulanic acid in three -Sever dental infections 228 mg/5ml OR 375 mg =34 SR Co-Amoxiclav. divided doses. q12h -Amoclan forte with spreading cellulites. 457 mg/5ml 1 g “amoxicillin 625mg = 44 SR -Megamox with 375mg =36 SR clavulanic acid” 625mg =43 SR 1g =75 SR -Klavox 375mg = 44 SR 625 mg =76 SR -Julmentin 375 mg = 40 SR -Julmentin Forte 625 mg = 68 SR -Routine second choice to amoxicillin in infection or Erythromycin first choice if amoxicillin is allergic . Tab. Cap. Syr. Inj for tablet for capsule for syrup for injection Tab. 250-500 mg 250-500 mg Sus. 200 mg/5ml q6h 200 mg/5ml q6h -Erythrocin -50% of s.auruse is 250mg = 14 SR resistant 500mg = 27 SR -GI intolerance is Sus. = 19 SR common -Eromycin Sus. for suspension q8h = every 8 hours By Dr. KHALID AL - JOHANI KING ABDULAZIZ UNIVERSITY SCHOOL OF DENTISTRY Drug Indications Forms Usual dose Trade &price Comment Some pt. is allergic to the Tab. 250-500 mg 250-500 mg Clarithromycin -Mild to moderate infection. Sus. 125 mg/ 5ml bid -Prophylaxis regimen for 250 mg/100ml subacute bacterial endocarditis for pt. allergic to amoxicillin. -Klacid drug. -Caution when prescribed for pregnant or lactating women, hepatic, renal pt. -It increases effects of cyclosporine, warfarinn & decreases the effects of clindamycin, penicillin &anticholingergic drugs. 500 mg -Mild to moderate infection. Cap. -Prophylaxis regimen for Azithromycin subacute bacterial endocarditis for pt. allergic to qid 250 mg on day1, then -Contraindicated if the pt. is -Zithromax 250 mg qid on days 2-5 hypersensitive to the drug or to erythromycin. -Caution when prescribed for pregnant or lactating women, amoxicillin. hepatic, renal & cardiac pt. or with elderly & child < 16 y. -It decrease the effects of clindamycin & penicillin -Pt. instructed to take medication at least an hour before meal or 2 hours after the meal. Tetracycline Doxycycline -Second or third choice to amoxicillin in routine inf. Tab. 250-500 mg -Anaerobic bacterial Sus. 125 mg/5ml infections & periodontitis associated with presence of AA (Actinobacillus actino-mycetemcomitans). -ANUG -Periodontitis associated with presence of AA (Actinobacillus actinomycetemcomitans). -ANUG -Syphilis Tab. 100 mg Cap. 100 mg 250-500 mg q6h -Tetracycline -Used in bone graft. , 1 hour before 250 mg = 13 SR -Cause teeth discolora- tion, so it is not used in child 8y & in pregnant women. or 2 hours after meals -Some patients are hypersensitive to the drug. -It cause candidiasis,teeth 100 mg=26 SR & tongue discoloration & dry mouth. 100 mg q12h -Doxydar -Vibramycin -It is not prescribed for child 8y &for pregnant women. Drug Indications Forms Alternative to amoxicillin Clindamycin in prophylaxis regimen for subacute bacterial endocarditis if amoxicillin is allergic. Usual dose Trade &price Cramps & diarrhea in 20% Adult Tab. 150-300 mg 150-450 mg q6h -Dalacin-C Inj. 300-600 900 mg Comment Child 8 -25 mg/kg of patients after oral 150 mg=21 SR administration. 300 mg=37 SR -Contraindicated if pt. is in 3-4 divided doses. hypersensitive to the drug -Chronic osteomyelitis. or had developed pseudomembranous colitis. -Flagyl 250 mg =13SR 500 mg =15SR -Protozoal & anaerobic Tab. 250-500 mg 250-500 mg q8h bacterial infections. -Nidazol -Elyzol Metronidazole -Refractory adult -Flazol peridontits. Combined with penicillin in serious Odontogenic infection, especially in compromised patients. Cephalexin Cefuroxime Alternative to amoxicillin Cap. 250-500 mg Adult: 250-500 mg in the tretment of orofacial infections &in Syr. 125 mg/5ml q6h Child: the prevention of SAB 6.5-50 mg/kg/ endocarditis except if the day in 4 doses pt. had an immediate anaphylactic allergic reaction to amoxicillin. Skin, soft tissue & bone infections. complain of neutropenia, hepatic disease, active CNS disease, or if the pt. on warfarin . -Contraindicated if pt. is hypersensitive to the drug or in the first trimester. -Keflex 10-15% cross reaction 250mg = 29 SR sensitivity in pt. allergic 500mg = 42 SR to penicillin -Cefrin Tab. 125-250 mg Adult: -Zinnat 10-15% cross reaction 1-2tab q12h 250 mg =87 SR sensitivity in pt. allergic to Sus. 125 mg/5ml Child: 500 mg =95 SR 250 mg/5ml penicillin 125mg 1. -Caution when the pt. q12h The Antibiotics may decrease the activity of oral contraceptive. So the pt. should be instructed to use additional method of contraception during the antibiotic course. 2. If the infection not improved within 3days, change the drug and do sensitivity test. 3. Recommended antibiotics during pregnancy : Penicillin & Cephalosporine. 4. Recommended antibiotics for lactating mother : Cephalosporine & Erythromycin. b. Antifungal Drug Indications Forms Usual dose Adult Miconazole Trade &price Daktarin -Systemic & cutaneous Tab. fungal infections. 200 mg 200-400 mg qid -Nizoral Children 2 y 3.5-6.6 mg/kg/ day in a single dose. Nystatin Oral gel Treatment of candidal Tab. 250 mg 600-1800 mg Oral gel =17 SR Apply twice / day up to infections Oral gel. 25 mg/ml in 3 divided 1 month. doses daily for 3-20 weeks Children 1 y 20-45mg/kg/day in 3 divided doses. Adult: Ketoconazol Comment -Intestinal candidiasis. Suspention 100000 -Skin candidiasis. inter. unit " iu " for -Oral candidiasis oral use. Adult: Sus. 400000600000 iu qid Children 3 months 250000-500000 iu qid Newborn 100000 iu qid -Mycostatin -Nilstat -Nystan -Rianest -Mikostat -Contraindicated in patients with previous hypersensitivity. -Used cautiously in patients with impaired hepatic & or adrenal reserve. Contraindicated with pt. has known hypersensitivity. -Oral use can cause nausea, vomiting and diarrhea. - To prevent reinoculation of candidal infection pt. is instructed to dispose the tooth brush or other contaminated oral hygiene devices used during period of infection c. Antiviral Drug Acyclovir Indications Forms Usual dose Trade &price Comment Herpes zoter: -It is contraindicated in Tab. 400- 800 mg 800 mg q4h for -Zovirax patients with known 200 mg=149SR hypersensitivity to the Cap. 200 mg 7-10 days 400 mg=697SR drug. Cream 2g Cream =23 SR Chickenpox: -Chickenpox. -It should be used with -Clovir 20 mg/kg qid -Prevention of caution in-patient with for 5 days recurrence of the viral renal impairment. infections. -It used in the tengling stage in the management of HSV before development of the lesion “vesicles “ -It could cause glossitis. -Postpone dental treatment when oral herpetic lesions are present. -Viral infections of: -Herpes zoster. -Herpes simplex. 2. Analgesics Drug Indications Forms Usual dose Trade &price Comment -Caution with hepatic disease pt. -Contraindicated if the pt. is hypersensitive to Acetaminophen acetaminophen or complain of Glucose 6Phosphate Dehydrogenase Deficiency. -Pain Tab. 200-400 400 mg every -Brufen It is contraindicated in: 400mg=12 SR -Hypersensitivity -Fever 600 mg 4-6 hours for 600mg=20 SR -Nasal polyp -Inflammatory diseases mild-moderat Ibuprofen Ibofen -Rheumatoid disorders Syrup 100 mg/5ml pain -Angio-edema -Profinal -Gout -Bronchospastic reactivity 600 mg=13 SR to aspirin or other -Sapofen 400 mg=10 SR NSAID’s. 600 mg=10 SR -Caution if the pt. on anticoagulant. -Taken after food Adult: 500mg initially -Ponstan -Avoid prescribing for Tab. 500 mg 500 mg=13 SR dental pain in last then 250 mg Cap. 250 mg -Fendol trimester of pregnancy. -Mild to moderate pain Syrup 50 mg/5ml every 6 hours 500 mg= 7 SR with food -Caution if the pt. on Mefenamic acid -Mafepain children 6 500 mg= 9 SR anticoagulant. months : 25 mg/kg daily in divided doses -Mild to moderate pain & fever Adult 325-500 mg 0.5-l g every 4-6 hours to Syrup 120 mg/5ml max.4gm daily 125 mg/5ml Children: Tab. -Panadol -Tylenol -Fevadol -Dafalgan 1 year: 60-120mg -Panacetamol 1-5y 120-150mg syrup 6-12y 250-500mg -Tempra -Mild to moderate pain Tab. 25-50-100 mg 150-200mg/ -Pain of rhematoid Inj. 75 mg/ampoule day in 2-4 arthritis & osteoarthridivided doses. tis. Diclofenac Sodium -Gout & Ankylosing spondylitis Mild to moderate pain Paracetamol 500 mg with Caffeine 30 mg & Codeine ________ Paracetamol 250 mg -Treatment of , caffeine 50 mg headache. & propyphenazone 150 mg -Adol ________ -Voltaren 50 mg =38 SR -Olfen 50 mg =21 SR -Rofinac 50 mg = 32 SR -Diclogesic 50 mg = 17 SR -Vortex 50 mg =10 SR -Colfen 50 mg = 9 SR -It can cause dry mouth & stomatitis. -Avoid prescribing for dental pain in last trimester of pregnancy. 2 tab. Every 4 -Solpadeine -Do not give if the pt. has = 9 SR allergy to propyphenazone hours to max. -Fevadol plus -Not recommended for 8 tab. daily. = 8 SR pregnant, breast-feeding women & for children<12 years. Adult: 1-2 tab 12-16y 1 tab. Up to 3 doses / -Saridon day ________ = 5 SR 3. Miscellaneous Drug Indications -Oral and perioral lesions Triamcinolone -Aphthous ulcers. orabase Pyralvex -Treatment of oral ulcers. Lignocaine -Pain due to ulcers Hydrochloride “lidocaine” Forms Usual dose Orabase: contains 2-4 times daily triacilmone 0.1% in adhesive basis 10 ml with brush 3-4 times daily Jelly 2% When needed -Use is limited for 5 days for children ,and short =7 SR term for elderly. -Contraindicated in the presence of fungal, viral or bacterial infections. Norgine Not recommended for children under 12 years. Xylocaine 5% 35 g=11 SR Spray 80g =29 SR Tab. -Zymafluor 1 mg Comment Kenalog in Orabase Ointment 5% Spray 80 g 1mg = 18 SR Prevention of dental caries & decrease teeth Sodium fluoride hypersensitivity _____________ -Adults should be expectorate after use & not to eat, drink or rinse for 30 minutes. -Child ages 6-16y should be expectorate after use, rinse mouth thoroughly to avoid swallowing fluoride. -Must ascertain fluoride conc. In-patient’s drinking water before prescribing. -Relief of muscle spasm. Tab. 10-25 mg -Relief of muscle spasm. Tab. 250-500 mg (DSC) Baclofen Chlorzoxazone Trade &price 5 mg tid×3 days then, 10 mg tid× 3days then, 15 mg tid×3 days then 20 mg tid× 3days then triturated to response, not to exceed 80 mg/day Adult 250-750 mg tid-qid Child 20 mg/kg/day in 3-4 divided doses. Lioresal 25 mg =121 SR Parafon 500 mg=19 SR -Some pt. has hypersensitivity to the medicament. -It may cause dry mouth -The medicament has a sedative effect. -Combination of the drug with aspirin or NSAIDs will improve the response. 4. Mouthwashes Mouthwash Chlorhexidine Mouth wash Indications -Antibacterial mouth rinse -Denture stomatitis -Oral hygiene and plaque inhibition. Forms -Oral rinse 0.2% Usual dose Trade &price Comment - Contraindicated if pt. has Corsodyl Swish 15ml =12 SR hypersensitivity undiluted oral -Pt. instructed not to eat, rinse around drink or rinse mouth with in mouth for water after use for several one minute, hours. then expectorate -It my cause taste changes. -Do not swallow the medication. 2 times daily -Perform scaling before starting rinse. -It causes staining of teeth & esthetic restorations. Hexetidine -Oral hygine Mouth wash or gargle 0.1% 15ml undiluted Oraldene = 7 SR 2-3times daily ________ -Do not swallow the medication Treatment &prevention -Cleanser: skin7.5% 10ml undiluted -Betadine =15 SR -Avoid contact with eyes. of microbial infections “30 m1-118 ml” for up 30 sec. -Contraindicated in pt. with -Foam 7.5% 170 g up to 4 times -Poviderim Povidone-lodine hypersensitivity to iodine . daily -Cautions with pregnancy & breast feeding. Orasept Ingredients: Benzoic acid, Thymol, Menthol, Methyl salicylate & Eucalyptol Colgate - Plax Ingredients: Swish 15 ml -Prevention & -Mouthwash 250 ml undiluted oral Orasept 250ml =10 SR reduction of gingivitis. rinse around in mouth for -General oral hygiene one minute, then expectorate & bad breath. 2 times daily -Fight plaque -Fight caries 250-500 ml -Treatment of halitosis -Not recommended for child < 6 years. 250 ml=14 SR 500 ml=22 SR Triclosan 0.03 % Sodium fluoride 0.025 % Sensodyne 15ml undiluted -Classic /red for one minute -Soft mint / green 2 times daily ________ -Anti plaque -Relieves minor mouth 250 ml irritation -Not recommended for 15ml undiluted for 30 seconds 250 ml=16 SR child<6 years. -Not recommended if the pt. 2 times daily -Helps in the removal of tar. -Fight tobacco odor. -Fight plaque -Fight caries 15ml undiluted 400 ml=13 SR child < 6 years. for 30 seconds 2 times daily sensitive to cytylpyridinium. -Used after brushing. -Not recommended for Pearl drops Smokers 1+1 Oral-B 400 ml Fight plaque & cavities 300 ml 15ml undiluted for 30 seconds 300 ml=16 SR 2 times daily -Not recommended for child < 6 years. KING ABDULAZIZ UNIVERSITY SCHOOL OF DENTISTRY Drugs & Dentistry II Most common drugs prescribed by the dentist: Forms Drug Capsule Amoxicillin 250-500 mg Usual Dose Trade Names -Amoxil Adult: 250-500 mg q8h -Ultramox Suspension 125 mg/5ml Child: 250 mg/5ml 20 mg/kg/day -Amoxidar in divided doses Tablet Co-Amoxiclav. “Amoxicillin with Clavulanic Acid" 375-625 mg Adult: 375-625 mg q8h or 1g q12h 1g Suspension 156 mg/5ml 228 mg/5ml Acetaminophen -Amoclan Forte 20-40 mg/kg/day amoxicillin -Megamox Capsule 250-500 mg Adult: Syrup 125 mg/5ml Child: Tablet Adult: 0.5-l gm every 4-6 325-500 mg hours to max.4 gm daily Syrup Tablet Syrup -Klavox -Julmentin 250-500 mg q6h -Keflex 6.5-50 mg/kg/day -Cefrin in 4 doses -Adol -Panadol -Tylenol 120 mg/5ml Child: -Fevadol 60-120 mg/day -Dafalgan 125 mg/5ml 1 year 1 -5 y 120-150 mg/day -Panacetamol syrup 6 -12 y 250-500 mg/day -Tempra 200 – 400 mg 400 mg every 4-6 hours -Brufen & 600 mg Ibuprofen -Amoclan Children 40kg with 5-10 mg calvulanic acid 457 mg/5ml in three divided doses. Cephalexin -Augmentin for mild to moderate pain -Ibofen 100 mg/5ml -Profinal -Sapofen Tablet Diclofenac Sodium 25-50-100 mg 150-200 mg/day Injection 75 mg/ampoule in 2-4 divided doses. -Voltaren -Olfen -Rofinac -Diclogesic -Vortex -Colfen 5. The Antibiotics may decrease the activity of oral contraceptive pills, so the pt. should be instructed to use additional method of contraception during the antibiotic course. 6. If the infection not improved within 3days, change the drug and do sensitivity test. 7. Recommended antibiotics during pregnancy: Penicillin & Cephalosporine. 8. Recommended antibiotics for lactating mother : Cephalosporine & Erythromycin. By Dr. KHALID AL-JOHANI Drugs & Dentistry III Common drugs purchased from pharmacies in Jeddah city Drugs listed here are the ones commonly purchased from pharmacies in Jeddah city. Trade names, indications and dental considerations, which related to the drug & the disease, are included in an informative and concise form. For more information you are advised to refer to the product information insert. (Antimicrobial, analgesics & mouthwashes are included in D & D I ) Cardiovascular System Drug Trade Names Indications Considerations Calcium channel blockers -Adalat-Retard -Prophylaxis &treatment of Nifedipine -It cause gingival hyperplasia and dry -Adalat. angina. mouth -Cardiopine. -Hypertention. -Raynaud’s disease. -Atrial fibrillation & flutter. - It cause gingival enlargement, dry -Arrhythmias. mouth (rare)&Stevens-Johnson syndrom -Isoptin . Verapamil -Angina &hypertension. -Calan. -Congestive heart failure. -Tachycardia . -Lanoxin Treatment of congestive heart failure,atrial fibrillation & or Digoxin flutter and supra-ventricular - It could cause sensitive gag reflux. tachycardia. Diuretiecs Spironolactone Centrally acting antihypertensive Methyldopa -Aldactone. -Spiroctan. -Noractone. -Aldomet -Mild to moderate essential hypertension. -Congestive heart failure. ACE Inhibitors Captopril -Primary aldosteronism. Hypertension, Hypokalaemia -Edema in liver cirrhosis. -Nephrotic syndrom. -Congestive heart failure. -Hirutism associated with polycystic ovary syndrom . -Menstrual irregularities. -Moderate to sever hypertention. -Hypertensive crisis. -Toxemia of pregnancy. -Capoten -It may cause dry mouth & lichenoid drug reaction . - It could cause dry mouth, bleeding & lichenoid reaction. -It causes adrenal suppression &candidal infection. -It could cause dry mouth, glossitis, oral ulceration , Stevens –Johnson syndrome,bleeding , lichenoid drug reaction . By Dr. Khalid Al - Johani King Abdulaziz University School of Dentistry Cardiovascular System Drug Indications Trade Names Considerations Antiarrhythmics Amiodarone -Cordarone -Arrhythmia. -It could cause dry mouth & burning Glyceryl Trinitrate Nitroglycerin - It may cause dry mouth. NitrodermTTS10 -Treatment and prophylaxis -Angised of angina pectoris. -Glyceryl -Trinitrate -CHF associated with acute sensation. -Ensure that patient’s drug is easily available if angina occurs. MI. -Nitroderm -Tridil Drug Antiplatelets Acetylsalicylic acid Trade Names -Asprin -Rivo -Aspav -Aspico Oral anticoagulants Warfarin Sodium -Coumadin Indications -Fever & minor pain -Rheumatic arthritis -Transient Ischemic Attack -MI risk reduction -Rheumatic fever -Prophylaxis of thromboembolism . -MI & bypass surgery. -Prophylaxis & treatment of venous thrombosis & pulmonary embolism. -Decrease risk of cerebral embolism &TIA. Considerations -Aspirin inhibits platelet aggregation. -Produce gastric ulcer in long term therapy -Exacerbates bronchoconstriction in asthmatic pt. -High doses should be avoided in pregnancy -Try to avoid IM injection. -Ask for INR before any dental sugary. -Prothrombin Time should be not more than twice the normal value. -Vit. K is the antagonist of warfarin action ’10 mg will reverse the action in 24 hours ’ Respiratory System Drug Trade Names Antihistamines . Promethazine -Phenergan -Histaloc -Promantine Cough prep. Triprolidine & Pseudoephedrine - Actified -Kafosed. -Tusilar. Dextromethorphan -Contrasal. -Romilar. -Simatus. Topical Nasal Decongestants Xylometazoline Hydrochloride -Otrivine -Nasivin -Xylometazoline Pseudoephedrine -Otrinol Hydrochloride Indications -Antihistaminic. -Motion sickness. -Sedative & hypnotic. -Antiemetic. -Hay fever. - It could cause dry mouth. -Temporary relife of nasal congestion. -Decongest sinus opening. -Running nose, sneezing. -Itching of nose or throat. -Hay fever or other upper respiratory allergies. -Watery eyes due to common cold. - Dry or painful cough. -Non-productive cough. - It cause dry mouth & lichenoid reaction -Nasal congestion due to seasonal allergic rhinitis. -Chronic rhinitis and rhinitis occurring with the common cold & respiratory tract infection. -Nasal congestion. Anti T.B. Ethambutol -Myambutol -Ethanbutol -Treatment of T.B. in the first 2 months Rifampicin -Rimactan -Rifadin -Rimactazid -T.B “intial treatment”. -Eradicate nasal colonisation in meningococcal infections Isoniazid “INH” Considerations -Look for oral signs of T.B. -Avoid elective dental procedures in active infections. -Look for oral signs of T.B. -Avoid elective dental procedures in active infections. -INH - Treatment and prevention -Look for oral signs of T.B. -Avoid elective dental procedures in active -Rimifon of T.B infections. -Rimactazid “INH+ Rifampicin” Respiratory System Drug Anti asthmatics Aminophylline Trade Names -Euphylline -Aminomal -Phyllocontin Beclomethasone -Bectoide -Viorex Cromolyn Sodium -Intal -Opticrom Ketotifen Fumarate -Zaditen Salbutamol Theophylline -Ventolin -Butalin -Quibron-T/SR -Bronquim Indications -Reversible airway obstructions. -Status asthmaticus & left ventricular failure. Considerations -It increases the action of erythromycin. - Ensure that patient’s drug is easily available if attach occurs. -It causes adrenal suppression & Chronic airway obstructions candidal infection . -It could cause dry mouth & hoarseness. -Pt. Instructed to gargle and rinse with water after each dose to help in preventing candidiasis. - Ensure that patient’s drug is easily available if attach occurs. -Prophylaxis of asthma & allergic conditions. -Chronic bronchitis. -Emphysema. -Asthmatic patients. -Frequently it cause mouth dryness & burning mouth senseation . - Ensure that patient’s drug is easily available if attach occurs. -Prophylaxis of asthma. - Ensure that patient’s drug is easily available if attach occurs. -Bronchodilator for. treatment of asthma. -Reversible airway obstruction. -It may cause mouth & throat irritation. - Ensure that patient’s drug is easily available if attach occurs. -Bronchial asthma. -Chronic obstructive pulmonary disease. - It could cause dry mouth. - Ensure that patient’s drug is easily available if attach occurs. Central Nervous System Drug Trade Names Antiparkinsons Levodopa -Carbidopa -Sinemet Antidepresents Amitriptyline Clomipramine -Tryptizol -Saroten -Elavil -Anafranil Imipramine -Tofranil -Imiprex Antimigraine Ergotamine -Migril -Cafergot Sumatriptan -Imigran Indications -Used in parkinsonism Considerations - It cause dry mouth. -Depression. - It cause dry mouth, stomatitis & salivary -Analgesic for certain chronic gland pain. & neuropathic pain. -Migraine prophylaxis. -Depressive illness - It cause dry mouth & bleeding. -Phobic & obsessional states -Depressive illness -It cause dry mouth & stomatitis -Nocturnal enuresis in children &school phobia. -Sever symptoms of cocaine withdrawal. -Treatment of vascular headache “migraine”, -Cluster headache. -Treatment of migraine with - It may cause discomfort in jaw, mouth or or without aura tongue. Central Nervous System Drug Antiepileptics Carbamazepine Phenytoin Sodium Ethosuximide Sodium Valproate Sedative-Hypnotic Clonazepam Trade Names Indications -First line agent in treatment of partial seizures. -Tegretol -Trigeminal neuralgia. -Tegretol Retard -Diabetes insipidus. -Pain syndrome. -Schizophrenia. -Epanutin -Dilantin -Zarontin -Emeside -Depakine -Epilim -Convulex -Rivotril Considerations -It may cause: -Stevens –Jonson syndrom. -SLE-like syndrom. - Dry mouth & glossitis. -Anticonvulsant -Antiarrhythmic. -Prevention of seizures following head truma & neurosurgery . -It may cause: -Gingival hyperplasia. -Lupus erythematosus . -Stevens –Jonson syndrom. -Osteamalacia. -Absence seizures. - Side effects : gingival bleeding ,ulceration , swelling of tongue & gingival enlargement ( Rare) . -Indicated when both absence & generalized tonic-clonic seizures are present. -Alternative to primary anticonvulsants in generalized tonic –clonic seizures. -Status epilepticus -May used as an antipanic agent. -It cause dry mouth. -Ask about epilepsy type, seizure frequency & the onset of the last attack. Gastro-intestinal System Drug H2 receptor antagonists Trade Names Ranitidine -Zantac -Tanidina -Antagonin Cimetidine -Cimedine -Tagamet Antimuscarinic Hyoscine NButylbromid. Laxatives Bisacodyl -Buscopan -Scopinal -Spasmopan -Butacid -Spasmonore -Dulcolax. -Laxocodyle Indications Considerations -Reduction of gastric aciditiy -Benign gastric &duodenal ulcers . -Reflux oesophagitis -Long term therapy lead to vit. B12 deficiency. -Decrease absorption of diazepam & ketoconazole. -Short term treatment of benign gastric& duodenal ulcers. -Prophylaxis of duodenal ulcer. Gastric hypersecretory states. -Gastro-esophageal reflux. -Prevention of upper GI bleeding in ill pt. -Decrease absorption of ketoconazole & tetracycline. -Increase blood levels of metronidazol & lidocaine. -Adjunct in gastro- intestinal -It cause dry mouth, thirst & difficulty in disorders characterized by swallowing. smooth muscle spasm. -Constipation. -Bowel evacuation befor: Surgery, endoscopy & radiology. Musculoskeletal and joint Drug Antigout Allopurinol Trade Names Indications Considerations -Prevention of attack of gout -It could cause stomatitis, lichenoid -Zyloric -Arthritis &nephropathy reaction & salivary gland swelling. -No-Uric -Prevent calcium oxalate -Main clinical feature is arthritis that calculi. could affect TMJ. -Treatment of hyperuricemia which may occure during treatment of tumers or leukemia. Nutrients, Vitamins & Blood modifiers Drug Trade Names Indications -Megalobastic anemia due to folic acid deficiency. -Chronic alcoholism. -Pregnancy &lactation. -Sprue & ileal diseases. -Nutritional deficiency & haemolytic aneamia. -Prevention & treatment of Ascorbic acid Vitamin-c chew- scurvy. Vit. C able -Urinary acidification. -Upsa-c -Prevention & decreasing of -Calcefor cold -B-complex plus vitamin- c B-complex vitamins -Becozym used in conditions B1,B6,B12 characterized by depletation or increase demand of the water –soluble vitamins. Nutrients& Vitamins Folic Acid -Folicum Vit. B9 -Folvite Blood Modifiers Ferrous Fumarate Ferrous Sulphate - Fersamal . - Galfer . Considerations -Glossitis or atrophy of the tongue and angular cheilitis may be a symptom of folic acid deficiency. - Incidence of erosion & caries has been reported with excessive use of chewable ascorbic acid tablets. -Prevention and treatment of -Absorption of tetracyclines & iron deficiency anemias penicillamine may decrease if given together with this drug. -Oral manifestation of iron deficiency: - Atrophic glossitis. - Angular cheilitis &some times aphthous ulceration. -Prevention & treatment of iron deficiency anemias -If not diluted it may cause teeth discoloration, so rinsing mouth is indicated after taken the preparation . -It may cause dysphagia. -it may reduce the absorption of tetracyclines & penicillamine. -Oral manifestation of iron deficiency: - Atrophic glossitis. - Angular cheilitis &some times aphthous ulceration. Endocrine System Drug Trade Names Indications Antidiabetes Insulin Human Reg. -Humalin-R -Diabetes mellitus -Humalin-N -Diabetes Mellitus Insulin Human –NPH Glibenclamide -Daonil -Diatab -Euglucon -Glynase -Diabetic pt. may be more susceptible to infection & have delay wound healing. -Diabetic pt. may be more susceptible to infection & have delay wound healing. -Diabetes mellitus -Diabetic pt. may be more susceptible to infection & have delay wound healing. -Diamicron -Non insulin-dependent diabetes mellitus. -Diabetic pt. may be more susceptible to infection & have delay wound healing. -Glucophage -Glucomet -Melbin - Non insulin-dependent diabetes mellitus. -Diabetic pt. may be more susceptible to infection & have delay wound healing. Gliclazid Metformin Considerations Endocrine System Drug Trade Names Corticosteroids Prednisolone Dexamethasone Hydrocorisone -Prednisolone -Deltacortef -Gupisone -Precortisly -Decadron -Oradexo -Cortef -Solu-cortef -Cortiderm -Hydrocortone Indications -In general, it is indicated in autoimmune diseases. -Multiple sclerosis. -Adrenocortical insufficiency -Adreno-genital syndrom . -Arthritis. -Collagen diseases. -Rheumatic carditis. -Nephrotic syndrom -Skin disease. eg.pemphigus -Ulcerative coltitis. -Throbocytopenia. -Organ transplantation -Acute asthma. -Group of oral lesions eg. L.P, pemphigus vulgaris, EM &cicatrical pemphigoid -Behcet’s disease. -Prevention of post – herpetic neuralgia. -Acute exacerbation of chronic allergic disorder -Cerebral edema. -Multiple sclerosis -Antiemetic with cancer therapy. -Replacement therapy in adrenal cortical insufficiency salt-losing forms of congenital adrenal hyperplasia syndromes. -Addison’s disease Considerations -Contraindicate in viral infections. –It delays wound healing. -It causes candidal infection & dry mouth. -Symptoms of oral infection may be masked. -Assess need for supplemental doses for the dental treatment. -Prophylactic antibiotic may be indicated to prevent infection in surgery or deep scaling Forms: -Tablet: 1 mg , 5 mg 20 mg , 25 mg -Enema 20 mg/100 ml As prednisolone As prednisolone KING ABDULAZIZ UNIVERSITY SCHOOL OF DENTISTRY Drugs & Dentistry IV Prophylactic Antibiotic Regimens for Bacterial Endocarditis for Dental procedures Situation Agent Regimen Adults: Standard general Amoxicillin prophylaxis Ampicillin medication Cap. 250-500 mg -Ultramox Sus. 125 mg/5ml Orally ,one hour before procedure -Amoxidar 250 mg/5ml Children: 50 mg/kg or -Pentrexyl 250 mg/vial within 30 min. before procedure 1 g /vial 600 mg Children: 20 mg/kg -Dalacin-C Cap. 150 mg Tab. 250-500 mg Orally,one hour before procedure. Adults: 2g -Keflex or Children: 50 mg/kg -Cefrin orally, one hour before the -Ultracef Tab. 1g procedure. -Cefadrox Cap. 500 mg or Azithromycin Inj. 500 mg/vial Cephalexin Cefadroxil Allergic to penicillin 2g Children : 50 mg/kg ,IM or IV -Polycillin Adults: Clindamycin Forms -Amoxil Adults : Unable to take oral 2g Trade names Sus. 125-250mg/5ml Adults: 500 mg or Children: 15 mg/kg Clarithromycin Orally, one hour before the -Zithromax Cap. 250 mg -Klacid Tab. 250-500 mg Sus. 125 mg/5ml procedure 250mg/100 ml Clindamycin or Adults: 600 mg -Dalacin-C Inj. Children: 20 mg/kg 300-600 900 mg IV within 30 min. before Allergic to penicillin & unable to take oral medication procedure. Cefazolin Adults: 1g Children: 25 mg/kg -Cefamezin -Totacef Inj. 250-500 mg 1g IM or IV within 30 min. before procedure. 1. Total dose of the children must not exceed the adult dose. 2. Do not prescribe cephalosporins if the pt. has immediate-type hypersensitivity to penicillins due to the cross reaction between the tow drugs. 3. Reference: Dental Drug Reference 1999. By Dr. KHALID AL-JOHANI