Commonly Prescribed Drugs

Non steroidal anti-

anti-inflammatory agents
Common Prescription Writing
Analgesic agents
for Dentists Antimicrobial agents
(antibiotics, antifungal, antiviral)
Corticosteroids
Antianxiety/sedative
Antianxiety/sedative agents (requires special
permit in NYS for dentists)

PHARMACOLOGICAL
THERAPY PAIN
Select the appropriate drug an unpleasant sensory and emotional
Prescribe the appropriate dose experience associated with actual or
Administer by the appropriate route potential tissue damage or described in
Schedule the appropriate dosing interval terms of such damage
damage
Anticipate, prevent and manage side effects
*IASP, 1986

PAIN
Noxious Stimulus (Nociception) ACUTE vs. CHRONIC
Central Modulation PAIN DISORDERS
Perception & Interpretation
Need to differentiate in order to
Emotional State (Suffering)
provide appropriate treatment
Reaction or pain behavior

1
 Acute Pain
Identifiable injury or disease focus
Usually self-
self-limited, resolving over hours to days
associated with a reasonable period for healing
Objective autonomic phenomenon
Responds to treatment NSAIDs,
NSAIDs, opioids,
opioids,
corticosteroids, benzodiazepines
Chronic Facial Pain
Estimated 7-7-8 million people - about 4%
of the U.S. population over the age of 18,
report pain in the face, jaws, or TMJ.
70% are female - which accounts for
approximately 6% of the female
population.
NIDCR/NIH Data. JADA, 2000.
PAIN MANAGEMENT
Pharmacological Therapy
Injection Therapy (Local anesthesia, steroids)
Exercise Therapy
Physical Medicine
Behavioral Medicine
Complementary & Alternative Medicine
Intravenous Therapy
Surgical Therapy
Chronic Pain
Pain that persists greater than 3-
3-6 months
May reflect separate mechanisms from the original insult
Sometimes no insult is identified
Vague descriptions of pain, difficulty in describing timing and
localization
Lack of heightened autonomic activity
Pain described with terms that have emotional associations
Interferes with activities of daily living
CHRONIC PAIN SYNDROME
Intractable pain greater than 4-
4-6 months
Marked alteration in behavior with depression and/or
anxiety
Marked reduction in daily activities
Excessive amounts of medications and fragmentation of
medical services
No clear relationship to an organic disorder
History of multiple non-
non-productive tests, treatments and
surgeries
Pain Management Strategies
2
 Pharmacological Therapy of Pain Acetaminophen (Tylenol)
Major Questions to be Answered: Principal active metabolite of phenacetin
Acute or Chronic? Antipyretic hypothalamus
Analgesic inhibit PG synthesis in CNS
Is etiology being addressed?
Anti-
Anti-inflammatory minimal
Does not inhibit platelet aggregation, affect
prothrombin responsiveness, or produce GI
ulceration
**Safe in pregnancy and breast-
breast-feeding

NONSTEROIDAL ANTI-
ANTI-
INFLAMMATORY DRUGS Mechanism of Action of NSAIDs
ARACHIDONIC ACID
Aspirin
Diflunisal (Dolobid)
Dolobid) Ketorolac (Toradol)
Toradol) Cox-
Cox-1 Cox-
Cox-2
Ibuprofen (Motrin) Naproxen (Naprosyn
(Naprosyn)) PROSTAGLANDINS
Nabumatone (Relafen)
TXA-
TXA-2 PGI-
PGI-2 PGE-
PGE-2 Inflammatory mediators

Hemostasis Gastric mucosa Kidney Pain Inflammation Fever

CYCLO-
CYCLO-OXYGENASE INHIBITORS
(COX-
(COX-1, COX-
COX-2) OPIOIDS (NARCOTICS)
COX-
COX-1 = housekeeping prostanoid biosynthesis Opioid receptors mu,
mu, kappa, delta, sigma
COX-
COX-2 = inducible by inflammation CNS effects analgesia, euphoria, sedation,
respiratory depression
Therapeutic effect through inhibition of COX-
COX-2
Produce analgesia over a wide range of doses
iso-
iso-enzyme with reduction of certain PGPGs
No ceiling effect to analgesia linear to the point of
COX-
COX-2 inhibitors = improved benefit/risk ratio by unconsciousness
producing anti-
anti-inflammatory effect without the unwanted
GI, antiplatelet and renal effects that accompany Tolerance to analgesic effect
inhibition of PG
PGs mediated by COX-
COX-1 Cross-
Cross-tolerance can develop between agents
Dependence

3
 OPIOIDS Contraindications
Adverse Effects

Respiratory depression tolerance develops rapidly

COPD
Mental clouding or confusion Biliary obstruction
Miosis no tolerance/accommodate Urinary retention
Nausea & vomiting tolerance develops rapidly MAO inhibitors
GI constipation tolerance develops slowly, if at all!!
Urinary retention
Pruritis and flushing
Histamine release (some narcotics)

OPIOID ANALGESICS OPIOID ANALGESICS

Not Recommended
Codeine Morphine Propoxyphene
Oxycodone Oxymorphone
Hydromorphone
Meperidine (nausea, vomiting)
Hydrocodone
Fentanyl Partial agonists (Buprenorphine
(Buprenorphine))
Methadone Agonist-
Agonist-antagonists (Butorphanol
(Butorphanol))

Prescribed analgesics/post-op/po Antimicrobials

Tylenol #3, Disp: #24, Sig. i-iiq4h prn pain Antibiotics (Oral flora-aerobes and anaerobes)
Ibuprofen 800mgs, Disp: #30, Sig. Iq8h Amoxicillin
Vicodin 5mg, Disp: #24, Sig: iq4h prn pain Clindamycin
(hydrocodone) Antifungals (Candidiasis)
Vicodin ES (or 10mgs), iq6h prn pain Nystatin
Percocet 5mg or 10mg, Disp: #24, Sig: iq4h prn Mycelex
pain (oxycodone) Antivirals (Herpes simplex)
Acyclovir and others

4
 Antibiotics
Pen VK 500mg, Disp #40, Sig: iq6h
Amoxicillin 500mg, Disp#30, Sig: iq8h
Augmentin 500mg, Disp #30, Sig iq8h
Clindamycin 150 - 300mg q6h for 10 days
Remember
Some drugs require monitoring of CBC,
liver enzymes, etc
Drug interactions
Antibiotics and birth control pills
Synergistic effects of narcotic analgesics and
other CNS depressants the patient may be on

Anxiolytics
If used for enteral sedation in the office a
Drugs for non-acute pain separate license and additional training is
required in some states (NY)

Benzodiazepines Drug Enforcement Agency

Alprazolam (Xanax)
www.dea.gov
Xanax) 12-
12-15 h
Clonazepam (Klonopin)
Klonopin) 18-
18-50 h Federal laws govern manufacturing,
Chlordiapoxide (Librium) 5-30 h prescribing and dispensing
Diazepam (Valium) 20-
20-50 h
Flurazepam (Dalmane)
Dalmane) 2-3 h
Requires DEA # to dispense Schedule
Lorazepam (Ativan)
Ativan) 10-
10-80 h drugs
Midazolam (Versed) 2h New York State Public Health law requires
Oxazepam (Serax)
Serax) 5-15 h
that prescriptions be written on specific
Temazepam (Restoril)
Restoril) 0-20 h
Triazolam (Halcion)
Halcion) 1.5-
1.5-5 h
forms

5
 Controlled Substances Controlled Substances
Schedules I-
I-V III Lesser degree of abuse potential and moderate
I No legal medical uses, except research. dependence.
High potential for abuse. (heroin, opium derivatives, Less than 15mg of hydrocodone,
hydrocodone, less than 90mg of codeine,
hallucinogens) ketamine
II Legal medical uses and a high abuse IV Low abuse potential and moderate dependence.
potential Propoxyphene,
Propoxyphene, benzodiazepines
(demerol,
demerol, fentanyl,
fentanyl, dilaudid oxycodone,
oxycodone, methadone, V Very low abuse potential and moderate-
moderate-low
amphetamines, barbiturates) dependence
Cough preparations with codeine

Prescription Writing Prescription Writing

Drug Instructions in detail Heading
Dosage Generic vs. brand Prescriber information
Amount (D.A.W.
D.A.W.)
Disp: dispense
Disp: dispense Legible!! Patient information
Examples: Electronic forms of Superscription-
Superscription-Rx (Recipe)
Forty (40) tabs
Thirty (30) tabs
submission to avoid error Inscription
= (the number per day)x(the number of Transcription (Signature)
days). Example:
Pen V 500mg is dosed q6h for 10 days for Refill information
odontogenic infection.
q6h = 4/day Signature of Prescriber
(4/day) x 10 days = 40 tabs

Prescriber Information
Name, address, phone #
License #
Drug enforcement administration #
Safeguard your prescription pads

Institution prescription
Institution DEA #
Resident Stamp

6
 Pediatric Dosing Common Abbreviations
Clarkes rule (age) ac - ante cibum before meals
bid - bis in die twice a day
Youngs rule (weight) gtt - gutta a drop
mg/kg/day divided into x # equal doses hs - hora somni at bedtime
pc - post cibos after meals
Dependent on pharmokinetics of the specific
po - per os by mouth
drug q_h - quiaque hora every_hours
One teaspoon = 5 cc qid - quarter in die four times a day
tid - ter in die three
three..

(UN)OFFICIAL NEW YORK STATE PRESCRIPTION

FRED JONES, DDS
1342 WEST 57TH ST
NEW YORK, NY 10248
(212) 555-1234
LIC. 5555555
PRINCIPLES OF TREATMENT
PRACTITIONER DEA NUMBER

Patient Name_______________________________ Date ___________________
*Establish a diagnosis (and etiology)
Address __________________________________________________________
Sex
City ______________________ State ______ Zip_______ Age _____ M F
*Prescribe treatment that is the most logical for
the diagnosis
Rx VICOPROFEN
Disp: 16 tabs
Sig: 1 tablet q4-6 h
5
MAXIMUM DAILY DOSE
(cibtrikked subances only)
Prescription Signature X___________________________________
THIS PRESCRIPTION WILL BE FILLED GENERICALLY UNLESS PRESCRIBER WRITES daw IN BOX BELOW
REFILLS None
Refills: ___________ 6HP2L1 21

Dispense As Written)
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Good news: from todays lecture

you do not need to memorize
long lists of drugs