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Dental Ny Rx

Dental Ny Rx

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Published by reneez123

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Published by: reneez123 on May 20, 2013
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Common Prescription Writingfor DentistsCommonly Prescribed DrugsCommonly Prescribed Drugs
 Non steroidal anti Non steroidal anti--inflammatory agentsinflammatory agentsAnalgesic agentsAnalgesic agentsAntimicrobial agentsAntimicrobial agents
(antibiotics, antifungal, antiviral)(antibiotics, antifungal, antiviral)
CorticosteroidsCorticosteroidsAntianxietyAntianxiety/sedative agents (requires special/sedative agents (requires special permit in NYS for dentists) permit in NYS for dentists)
PHARMACOLOGICALPHARMACOLOGICALTHERAPYTHERAPY
Select the appropriate drugSelect the appropriate drugPrescribe the appropriate dosePrescribe the appropriate doseAdminister by the appropriate routeAdminister by the appropriate routeSchedule the appropriate dosing intervalSchedule the appropriate dosing intervalAnticipate, prevent and manage side effectsAnticipate, prevent and manage side effects
PAINPAIN
an unpleasant sensory and emotionalan unpleasant sensory and emotionalexperience associated with actual orexperience associated with actual orpotential tissue damage or described inpotential tissue damage or described interms of such damageterms of such damage
*IASP, 1986*IASP, 1986
PAINPAIN
 Noxious Stimulus (Nociception) Noxious Stimulus (Nociception)Central ModulationCentral ModulationPerception & InterpretationPerception & InterpretationEmotional State (Suffering)Emotional State (Suffering)Reaction or pain behavior Reaction or pain behavior 
ACUTE vs. CHRONICACUTE vs. CHRONICPAIN DISORDERSPAIN DISORDERS
 Need to differentiate in order to provide appropriate treatment
 
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Acute PainAcute Pain
Identifiable injury or disease focusIdentifiable injury or disease focusUsually self Usually self --limited, resolving over hours to dayslimited, resolving over hours to daysassociated with a reasonable period for healingassociated with a reasonable period for healingObjective autonomic phenomenonObjective autonomic phenomenonResponds to treatmentResponds to treatment –  –  NSAIDs NSAIDs,,opioidsopioids,,corticosteroids, benzodiazepinescorticosteroids, benzodiazepines
Chronic PainChronic Pain
Pain that persists greater than 3Pain that persists greater than 3--6 months6 monthsMay reflect separate mechanisms from the original insultMay reflect separate mechanisms from the original insultSometimes no insult is identified Sometimes no insult is identified Vague descriptions of pain, difficulty in describing timing and Vague descriptions of pain, difficulty in describing timing and localizationlocalizationLack of heightened autonomic activityLack of heightened autonomic activityPain described with terms that have emotional associationsPain described with terms that have emotional associationsInterferes with activities of daily livingInterferes with activities of daily living
Chronic Facial PainChronic Facial Pain
Estimated 7Estimated 7--8 million people8 million people--about 4%about 4%of the U.S. population over the age of 18,of the U.S. population over the age of 18,report pain in the face, jaws, or TMJ.report pain in the face, jaws, or TMJ.70% are female70% are female--which accounts forwhich accounts forapproximately 6% of the femaleapproximately 6% of the femalepopulation.population.
NIDCR/NIH Data. JADA, 2000.NIDCR/NIH Data. JADA, 2000.
CHRONIC PAIN SYNDROMECHRONIC PAIN SYNDROME
Intractable pain greater than 4Intractable pain greater than 4--6 months6 monthsMarked alteration in behavior with depression and/or Marked alteration in behavior with depression and/or anxietyanxietyMarked reduction in daily activitiesMarked reduction in daily activitiesExcessive amounts of medications and fragmentation of Excessive amounts of medications and fragmentation of medical servicesmedical services No clear relationship to an organic disorder  No clear relationship to an organic disorder History of multiple nonHistory of multiple non-- productive tests, treatments and  productive tests, treatments and surgeriessurgeries
PAIN MANAGEMENTPAIN MANAGEMENT
Pharmacological TherapyPharmacological TherapyInjection Therapy (Local anesthesia, steroids)Injection Therapy (Local anesthesia, steroids)Exercise TherapyExercise TherapyPhysical MedicinePhysical MedicineBehavioral MedicineBehavioral MedicineComplementary & Alternative MedicineComplementary & Alternative MedicineIntravenous TherapyIntravenous TherapySurgical TherapySurgical Therapy
Pain Management StrategiesPain Management Strategies
 
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Pharmacological Therapy of Pain
Major Questions to be Answered:
 –Acute or Chronic? –Is etiology being addressed?
Acetaminophen (Tylenol)Acetaminophen (Tylenol)
Principal active metabolite of Principal active metabolite of  phenacetin phenacetinAntipyreticAntipyretic –  – hypothalamushypothalamusAnalgesicAnalgesic –  – inhibit PG synthesis in CNSinhibit PG synthesis in CNSAntiAnti--inflammatoryinflammatory –  – minimalminimal
 Does not  Does not 
inhibit platelet aggregation, affectinhibit platelet aggregation, affect prothrombin prothrombinresponsiveness, or produce GIresponsiveness, or produce GIulcerationulceration**Safe in pregnancy and breast**Safe in pregnancy and breast--feedingfeeding
 NONSTEROIDAL ANTI NONSTEROIDAL ANTI--INFLAMMATORY DRUGSINFLAMMATORY DRUGS
AspirinAspirinDiflunisalDiflunisal((Dolobid Dolobid ))Ibuprofen (Motrin)Ibuprofen (Motrin)KetorolacKetorolac((ToradolToradol)) Naproxen ( Naproxen ( Naprosyn Naprosyn)) Nabumatone Nabumatone(Relafen)(Relafen)
Mechanism of Action of Mechanism of Action of NSAIDsNSAIDs
ARACHIDONIC ACIDARACHIDONIC ACIDCoxCox--11CoxCox--22PROSTAGLANDINSPROSTAGLANDINS
TXATXA--2 PGI2 PGI--2 PGE2 PGE--22Inflammatory mediatorsInflammatory mediators
HemostasisHemostasisGastric mucosa KidneyGastric mucosa KidneyPain Inflammation FeverPain Inflammation Fever
CYCLOCYCLO--OXYGENASE INHIBITORSOXYGENASE INHIBITORS(COX(COX--1, COX1, COX--2)2)
COXCOX--1 = housekeeping1 = housekeeping prostanoid  prostanoid  biosynthesis biosynthesisCOXCOX--2 = inducible by inflammation2 = inducible by inflammationTherapeutic effect through inhibition of COXTherapeutic effect through inhibition of COX--22isoiso--enzyme with reduction of certain PGenzyme with reduction of certain PGssCOXCOX--2 inhibitors = improved benefit/risk ratio by2 inhibitors = improved benefit/risk ratio by producing anti producing anti--inflammatory effect without the unwanted inflammatory effect without the unwanted GI, antiplatelet and renal effects that accompanyGI, antiplatelet and renal effects that accompanyinhibition of PGinhibition of PGs mediated by COXs mediated by COX--11
OPIOIDS (NARCOTICS)OPIOIDS (NARCOTICS)
Opioid receptorsOpioid receptors –  – mumu, kappa, delta, sigma, kappa, delta, sigmaCNS effectsCNS effects –  – analgesia, euphoria, sedation,analgesia, euphoria, sedation,
respiratory depressionrespiratory depression
Produce analgesia over a wide range of dosesProduce analgesia over a wide range of doses No ceiling effect to analgesia No ceiling effect to analgesia –  – linear to the point of linear to the point of unconsciousnessunconsciousnessTolerance to analgesic effectTolerance to analgesic effectCrossCross--tolerance can develop between agentstolerance can develop between agentsDependenceDependence

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