Pharmacology

8/7/2017 SAMSONPLAB ACADEMY: Resources
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Name Dental Pharmacology- NEW
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Description these are notes on pharmacology
 Content Pharmacology


MAIN CONTENTS

 1. Antibiotics
2. Antifungal Drugs
3. Anti Viral Drugs
4. Pain Management
5. Drug Interaction
6. Mode of action of all drugs listed above
7. Side effects of commonly asked medication
Antibiotics
CLASSIFICATION ACCORDING TO SPECTRUM OF ACTIVITY.
broad‐spectrum, or
Depending on the range of bacterial species susceptible to these agents, antibacterials are classified as
narrow‐ spectrum. Note that the spectra of activity may change with acquisition of resistance genes.
Broad spectrum.
Narrow spectrum.
1. Broad spectrum antibacterials are active against both Gram‐positive and Gram‐negative organisms. Examples
tetracyclines, phenicols, fluoroquinolones, third‐generation and fourth‐generation
include:
cephalosporins.
http://www.samsonplab.co.uk/ot/resources/note_view/125/9 1/23
2. Narrow spectrum antibacterials have limited activity and are primarily only useful against particular species of
microorganisms. For example, glycopeptides are only effective against Gram‐positive bacteria, Aminoglycosides and
sulfonamides are only effective against aerobic organisms.
Bacteriostatic Antibiotics:These are antibiotics that restricts the growth and reproduction of
bacteria by interfering with protein production, DNA replication or other aspects
of bacterial cellular metabolism, not necessarily killing them. Examples are:
Lincosamides ‐ Clindamycin, Lincomycin

Macrolides ‐ Azithromycin, Claritromycin, Erythromycin
Oxazolidinones, Linezolid,
Sulfonamides ‐ Sulfadiazine, Trimethroprim‐ Sulfamethoxazole (Cotrimoxazole)

Tetracyclines ‐ Doxycycline, Minocycline
Bacteriocidal Antibiotics:these are antibiotics which kill the bacteria as well as inhibiting their growth and reproduction,
interfering with with bacterial cellular metabolism. Examples are:
Beta ‐Lactam antibiotics.
Penicillin derivatives.
Cephalosporins.
Antibiotic Grouping By Mechanism

Cell Wall Synthesis Penicillins
Cephalosporins
Vancomycin
Beta‐lactamase Inhibitors
Aztreonam
Polymycin
Bacitracin
Protein Synthesis Inhibitors Inhibit 30s Subunit

Aminoglycosides (gentamicin)
Tetracyclines
Inhibit 50s Subunit
Macrolides
Chloramphenicol
Clindamycin
Linezolid
Streptogramins
DNA Synthesis Inhibitors Fluoroquinolones

Metronidazole
RNA synthesis Inhibitors Rifampin
Mycolic Acid synthesis Isoniazid

inhibitors
Folic Acid synthesis Sulfonamides

inhibitors Trimethoprim
Penicillins
Mechanism
interfer with bacterial cell wall synthesis
Examples: ampicillin, penicillin,
Clinical use: Amoxillin is commonly used in dental practice.
Toxicity: hypersensitivity reaction e.g anaphylaxis
Resistance: Penicillase in bacteria ( a type of B‐lactamase) cleaves B‐ring, which

leads to resistance to penicillin treatment. In such a case you need to use a B‐
lactamase inhibitor like clavulanic acid , tazobactam, sulbaxtam. These Beta
lactamase inhibitors are often added to penicillin antibiotics to protect the
antibiotics from destruction by beta‐lactamase (penicillinase).
An example is co‐amoxiclav which contain amoxicillin and clavulanic acid.
Cephalosporins (Generartions I, II, III, IV )
This is a beta ‐lactam drugs that inhibit cell wall synthesis (bactericidal)
Mechanism
same mechanicsm of action as beta‐lactam antibiotics (such as penicillins)
Examples: cefotaxime, ceftriaxone, e.t.c
Fluoroquinolones
Mechanism
blocks DNA replication via inhibition of DNA gyrase
Side effects
inhibit early fracture healing through toxic effects on chondrocytes
increased rates of tendinitis, with special predilection for the Achilles tendon.
tenocytes in the Achilles tendon have exhibited degenerative changes when viewed
microscopically after fluoroquinolone administration.
recent clinical studies have shown an increased relative risk of Achilles tendon
rupture of 3.7.
examples
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
Aminoglycosides
Mechanism
bactericidal
inhibition of bacterial protein synthesis
work by binding to the 30s ribosome subunit, leading to the misreading of mRNA.
Examples
gentamicin, neomycin, Amikacin, streptomycin,
Toxicity: Nephrotoxicity, ototoxicity, Neuromuscular blockage
Vancomycin
Coverage
gram‐positive bacteria
Mechanism
bactericidal
an inhibitor of cell wall synthesis
indications for vancomycin
serious allergies to penicillins or beta‐lactam antimicrobials
serious infections caused by susceptible organisms resistant to penicillins (MRSA,

MRSE)
Also used in pseudomembraneous colitis causes by Clostridium diffcile
Side effects: nephrotoxicity, ototoxicity
Clindamycin:
Is a bacteriostatic, it inhibits 50S ribosomal subunit
Clinical use: Anaerobe infections e.g oral infections
Side effects: It commonly associated with pseudomembranous colitis ( Clostridium

difficile, fever, diarrhoea
TETRACYCLINES:
Mechanism: bacteriostatic, inhibits protein synthesis
Contraindicated in pregnancy
Causes GI upset
Causes discolouration of the teeth and inhibition of bone growth in

children, photosensitivity
Example: doxycycline, tetracycline
MACROLIDES
Mechanism‐inhibit protein synthesis by binding to 50S ribosomes subunit
Bacteriostatic
clinical use: Atypical pneumoniae, used in streptococcal infections if patient allergic

to penicillin)
Side effect: rash,
Examples: Azythromycin, clarithromycin, erythromycin
Fluoroquinolones
Examples: Ciprofloxacin, levofloxacin, ofloxacin e.t.c
Contraindicated in pregnancy, breast feeding mothers, and children under 18 years

due to possible damage to cartilage
Bacteriocidal antibiotics which inhibit DNA gyrase.
Metronidazole
Bateriocidal antibiotic, antiprotozoal
It forms toxic metabolites in the cell of the bacteria which damage the DNA
Clinical use: used in anaerobes infection ( e.g anerobic dental infections) and also in
clostridium difficile)
Side effects: it cause unwanted reaction if taken with alcohol i.e severe
flushing, headache, hypotension, tachycardia)
ANTIMYCOBACTERIAL DRUGS
Common combination: Rimfampicin, Isoniazid, Pyrazinamide, Ethambutol

(RIPE)
Clinical use: Treatment of Mycobacterial tuberculosis
RIFAMYCINS:
Examples: Rimfampicin
Mechanism: Inhibits RNA polymerase
Induces Microsomal P‐450
Clinical use: Treatment of TB.
ANTIFUNGAL
Examples: Nystatin, Amphotericin, Azoles ( Fluconazole, ketoconazole,

clotrimazole, Itraconazole, voriconazole)
Clinical use: Oral thrush, vaginal thrush, systemic fungal infection
Mechanism: Inbibit antifungal sterol synthesis, by inhibiting the P‐450 enzymes
Side effects: Testosterone synthesis inhibition ( gynaecomastia,

liver dysfunction due to inhibit of P450 enzyme.
ANTIVIRAL ( Acyclovir, famciclovir, valacyclovir)
mechanism: Inhibits viral DNA polymerase
Clincal use: Herpes simplex virus, herpes zooster varicella, Its not active
against
Benzyl Penicillin
It is inactive when given orally.

Only IM / IV dose.
Drug of choice in streptococcal infection.
Good tissue penetration except CSF
Side effects:
Hypersensitivity, rash, anaphylaxis.
Amoxicillin
Similar to ampicillin
Broad spectrum antibiotics
Dose
Adult = 500 mg three times a day PO

Children = 40mg/ kg daily in 3 divided doses
Both Amoxicillin & Ampicillin cause a maculo‐papular rash in patients with glandular fever, lymphatic leukaemia or
HIV infection
May interfere with the action of oral contraception
All penicillins decrease excretion of methotrexate, and increases the risk of toxicity.
Tetracycline
Broad spectrum antibiotic may be used in periodontal disease
Used topically for the treatment of apthae
Results in opportunistic infection with Candida albicans

Deposits in bone & teeth causing staining and hypoplasia hence
Avoid in children <12 years and pregnancy
Dose 250 mg ‐ 500 mg QDS PO

Decreased absorption with milk, therefore to be taken well before food
Should be avoided in lactating women.
Erythromycin
Similar spectrum to penicillin. Ãdult dose = 250 mg‐500mg/4 times a day
Bacteriostatic
Active against penicillinase producing organisms

Major problem: nausea, hepatic and renal impairment, ototoxicity
It is a good alternative in patient who are allergic to penicillin, but it has now been superceded by clindamycin.
Clindamycin
Used in staphylococcal osteomyelitis in conjunction with metronidazole (inhibits clostridium difficile)

Dose
Adult =150 mg ‐ 500mg every 6 hrs

Child ‐ 3‐6 mg/ kg every 6 hours
Causes antibiotic induced colitis called pseudomembranous colitis

Replaced erythromycin for single dose prophylaxis of infective endocarditis.
It is a good alternative if patient is allergic to penicillin.
Metronidazole
Anaerobicidal drug acts against acute dental and oral infections
Dose for NUG (NUG = Necrotising Ulcerating Gingivitis) 200 mg TDS PO for 3 days
Major side effects: nausea, causes vomiting with alcohol ‐ DISULFIRAM like reaction
‐Dose in Anaerobic infection
Adult = 400mg every 8 hours

Children = 7.5mg/kg every 8 hours
Should be avoided in lactating women.
Antibiotics in hospital practice
Flucloxacillin
Active against Penicillinase producing bacteria

Dose
Adults 500mg‐1g QDS ( Four times a day) PO/IV 30 Minutes before food
Children = 125 mg‐ 250mg QDS 30 Minutes before the food
Co Amoxiclav
Amoxicillin and Clavulanic acid‐ (destroys B‐lactamase)
Dose: Usually 600‐1200 mg TDS IV
Adult ‐ 250/125 mg every 8 hrs

Child ‐ 1‐6 yrs Ã 5ml of 125/31 every 8 hrs
Cefuroxime
Parental broad spectrum cephalosporin

Used in surgical prophylaxis in contaminated head and neck procedures along with metronidazole
Dose
Adult: 750‐1500 mg TDS IV (500 mg BD PO)
Child (>3 months age) 125 mg twice daily
Gentamycin
A bacterial aminoglycoside
Active against Gram ‐ve organisms
Topical usage in ear infections
Side effects ‐ dose related ototoxicity + nephrotoxicity hence levels should be monitored
Dose = 3‐5mg/kg in divided doses every 8 hrs
Chloramphenicol
Used in bacterial conjunctivitis (0.5% eye drops, 1 % eye‐ointments apply 3 hourly)

Systemic use is limited due to toxicity
Ointment is excellent wound dressing
Side effects‐ Neonatal grey baby syndrome
Vancomycin
Bactericidal antibiotic
Used in anti‐biotic induced colitis 125 mg QDS for 10 days PO
Used in prophylaxis of patients at high risk from infective endocarditits
Side effects: Ototoxicity , Nephrotoxicity , Phlebitis at the site of infusion, Red man's syndrome
Heparin
Anti‐coagulant ‐helps in preventing deep vein thrombosis and pulmonary emboli in patients at risk
It activates Anti‐thrombin III which in turn inactivates thrombin.
Side‐effects:
Heparin induced thrombocytopenia

Increased aminotransferase levels and hyperkalemia
Alopecia, osteoporosis
Overdose: severe bleeding
Antidote for heparin overdose = protamine sulfate
Warfarin
Indirectly inhibits vitamin K

Takes 2‐3 days to exert its full effect and takes about the same time to wear off
Drugs like metronidazole and macrolides should be avoided with warfarin, as they increase its toxicity, by reducing the
CYT P450
metabolism via inhibiting
Antidote for warfarin toxicity is Vitamin K
Warfarin Interactions with CYT P450

Cyt P450 Inducers =Drug is eliminated quickly from the blood
Carbamazapine
Rifampin
barbiturates
Phenytoin
CYT P450 Inhibitors==Drug stays for a longer time than normal in the blood
Sodium Valproate
Ciprofloxacin
Sulphonamides
Cimetidine/ Omeprazole
Antifungals, Amiadarone
Isoniazid
Erythromycin
Grapefruit Juice
INR
International Normalized Ratio, a laboratory test measure of blood coagulation, based on prothrombin time.
INR is typically used to monitor patients on warfarin or related oral anticoagulant therapy.
The normal range for a healthy person not using warfarin is 0.8‐1.2.
For patients on warfarin therapy, on INR of 2.0‐3.0 is usually targeted; although the target INR may be higher in particular
situations, such as for those with a mechanical heart valve.
‐ If INR is increased ‐‐‐> increased risk of bleeding
‐ If INR is decreased ‐‐‐‐> increased risk of developing a clot
Recommended therapeutic range for oral anticoagulant therapy*

(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305837/table/T1/#T1F1)
Indication INR
2.0‐
Treatment of venous thrombosis 3.0
2.0‐
Treatment of pulmonary embolism
3.0
Prophylaxis of venous thrombosis (high‐risk 2.0‐

surgery) 3.0
2.0‐
Prevention of systemic embolism
3.0
2.0‐
Tissue heart valves
3.0
2.0‐
AMI (to prevent systemic embolism)
3.0
2.0‐
Valvular heart disease
3.0
2.0‐
Atrial fibrillation
3.0
2.0‐
Bileaflet mechanical valve in aortic position
3.0
2.5‐
Mechanical prosthetic valves (high risk)
3.5
2.5‐
Systemic recurrent emboli
3.5
ANTIBIOTIC GUIDELINES FOR COMMON
INFECTION IN DENTISTRY
1. Osteomyelitis:
Flucloxacillin first choice of antibiotic.
If Penicillin allergy Clindamycin is the treatment of choice.
Suggested duration of treatment 6 weeks for acute infections.
If methicillin resistant Staphyloccocus aureus suspected, vancomycin is treatment of choice.
2. Pericoronitis
Antibacterial required only in presence of systemic feature of infection or trismus or persistant swelling despite of local treatment.
METRONIDAZOLE
alternative :AMOXICILLIN for 3 DAYS
3. GINGIVITIS: ACUTE NECTROTISING ULCERATIVE
Antibacterial required only in presence of systemic feature of infection
METRONIDAZOLE 200MG*3DAYS
OR
AMOXILLICIN 250MG*3DAYS
4. PERIODONTITIS
Antibacterial used as an adjunct to debridement in severe disease or disease unresponsive to local treatment
METRONIDAZOLE OR DOXYCYCLINE
5. PERIAPICAL OR PERIODONTAL ABSCESS
Antibacterial required only in severe disease with cellulitis or if systemic feature of infection.
AMOXICILLIN 500MG 3 times a day for 5 days

OR
METRONIDAZOLE 400MG 3 times a day for 5 days
6. SINUSITIS
Antibacterial should usually be used only for persistent symptoms and purulent discharge lasting at 7 days or if severe
symptoms.Also consider antibacterial for those at high risk of serious complications(eg in immunocompromised ,cyctic fibrosis)
First choice is AMOXICILLIN OR CLARITHROMYCIN*7DAYS
Second choice CLARITHROMYCIN*7DAYS
Consider oral co‐amoxiclav if no improvemrnt after 48 hours.
7. CELLULITIS
Flucloxacillin first choice of antibiotic.
If Penicillin allergy Clindamycin treatment of choice.
If methicillin resistant Staphyloccocus aureus suspected, vancomycin treatment of choice.
PAIN MANAGEMENT:
Acute and post‐op pain:
Usually controlled by LA
For systemic analgesics, paracetamol = 1g /PR/IV 4 hourly

Ibuprofen = 400 ‐ 600mg 8 hourly
Paracetamol and codeine could be combined e.g co‐codamol
Diclofenac = 50mg PO 3 times a day (8 hourly)
Opioid analgesics ‐ short term analgesic
a) Morphine 10mg every 3‐4 hourly
b) Metoclopramide (anti‐emetics) 10mg IM/IV
NSAIDs
Cox Pathway.
When there is an injury /cut, prostaglandins are formed via cyclooxygenase (COX) pathway, that results in pain and inflammatory
response.
NSAIDs block Cyclooxygenase, COX I. No prostaglandins formed No pain and inflammation
Provide effects of:

Analgesia‐Pain Killer.
Antipyretic‐To reduce fever and temperature.
Anti‐inflammatroy (at high doses)‐To reduce pain, inflammation, swelling, redness, temperature, and heat.
MECHANISM: inhibits cyclo‐oxygenase (COX1).
Diclofenac Sodium
Available in tablet, IM, suppository and in one daily slow release form.
A mild potency NSAID
Dose: For tablets = 50mg TDS after food

IM = 75MG BD ‐ for no more than 2 days (painful injection)
Suppositories = 100mg PR OD
Contraindications for NSAIDS
Age > 75 years

Hypersensitivity to Aspirin / any other NSAID
Pregnancy/breast feeding
History of Gastrointestinal bleed
Common side effects of NSAIDS
Ringing in the ears after overdose ‐ Aspirin

Liver damage after overdose ‐ Paracetamol
Constipation ‐ Codeine
Bronchospasm in asthmatics ‐ Ibuprofen
peptic ulcer disease
Chronic kidney disease
Aspirin:
the only NSAID able to irreversibly inhibit COX‐1
also indicated for inhibition of platelet aggregation.
This is useful in the management of arterial thrombosis and prevention of adverse cardiovascular events.
Aspirin inhibits platelet aggregation by inhibiting the action of thromboxane A2.
Side Effects:
Gastric bleeding
Reye's syndrome in children
Analgesics in hospital practice
Opioids
Act centrally to alter the perception of pain, but have no anti‐inflammatory properties.
Used for severe pain of visceral origin, post‐op (acting partly by sedation), in terminal care.
Opiates:
Mechanism of Action: Acts on Central opiate receptors
Divided into:
Weak opiates:
Examples: Codiene, Oxycodeine, dehydrocodiene, Tramadol
strong opiates:
Examples: Morphine, Diamorphine, Fentanyl, Oxycodone
Indications: Mainly used as an Analgesic
S.E:
constipation
dry mouth
nausea and vomiting
CNS depression
drowsiness
respiratory depression
Toxicity:
Pinpoint pupils
Respiratory depression
Side effects
Depression respiratory function.

Interferes with pupillary response.
Cough suppression.
Urinary retention.
Nausea, constipation (decreased gut mobility)
Tolerance, dependence.
Contraindicated in head injury
WEAK OPIATES.
1. Codeine Phosphate
A moderate opioid for short‐term analgesia

Dose = 30 ‐ 60mg 4 hourly IM/PO
2. Tramadol
Acts by two central methods

Lower side effects
Dose = 50 ‐100mg PO 4 hourly
Slow IV = 50 ‐100mg 4‐6 hourly
STRONG OPIATES
1. Morphine
Drug of choice in the management of terminal illness pain

Available in oral form (tablet, elixir or slow‐release tablet MST)
Always prescribe a laxative
Dose ‐ depends on previous analgesia

a) 10 mg 4 hourly or 30mg MST BD
b) IM / Post‐ op pain, 10‐20mg 2 ‐ 4 hourly + anti‐emetic or IV
Reversed by Naloxone.
There strong opiates includes: Diamorphine,
Oxycodone,
Fentanyl.
STEROID MEDICATION.
May be either analgesics / co‐analgesics
Topical Steroids
Hydrocortisone lozenges
2.5mg dissolved in mouth QDS
Betamethasone phosphate tablets

0.5mg soluble tablet made into a 1mg in 10ml mouthwash rinsed QDS
Betamethasone inhaler for use in asthma can be used as spray (1 spray = 100 mg)
Repeatable to a max of 800 mg
Hydrocortisone 1% and Oxytetracycline 3%
Ointment/ spray
(Hydrocortisone = 50mg; Oxytetracycline = 150mg per aerosol unit) QDS
Systemic Steroids
Main indication: Adrenocortisol suppression and also treatment of systemic diseases like SLE , Rheumatoid arthritis and Giant cell
arthritis
i) Hydrocortisone
ii) Prednisolone
iii) Methylprednisolone
iv) Dexamethasone
Drugs causing Xerostomia
Atropine (http://en.wikipedia.org/wiki/Atropine), atropinics and hyoscine

(http://en.wikipedia.org/wiki/Hyoscine)
Antidepressants (http://en.wikipedia.org/wiki/Antidepressant) (tricyclic antidepressants

(http://en.wikipedia.org/wiki/Tricyclic_antidepressant), selective serotonin reuptake inhibitors
(http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor), lithium
(http://en.wikipedia.org/wiki/Lithium))
Antihypertensives (http://en.wikipedia.org/wiki/Antihypertensive) (e.g. terazosin
(http://en.wikipedia.org/wiki/Terazosin),prazosin
(http://en.wikipedia.org/wiki/Prazosin), clonidine
(http://en.wikipedia.org/wiki/Clonidine), atenolol
(http://en.wikipedia.org/wiki/Atenolol),propranolol (http://en.wikipedia.org/wiki/Propranolol))
Phenothiazines (http://en.wikipedia.org/wiki/Phenothiazine)
Antihistamines (http://en.wikipedia.org/wiki/Antihistamine)
Anti reflux drugs (proton pump inhibitors (http://en.wikipedia.org/wiki/Proton_pump_inhibitor),

e.g. omeprazole (http://en.wikipedia.org/wiki/Omeprazole))
Opioids (http://en.wikipedia.org/wiki/Opioid)
Cannabinoids (http://en.wikipedia.org/wiki/Cannabinoid)
Diuretics
SEDATIVES:
Benzodiazepines:
Examples: Temazepam, Midazolam, Lorazepam, Clonazepam
Mechanism of action: Inhibit the neurotransmitter GABA via GABA‐ receptors
Indications:
Insomnia/Sedation
Anxiety
Alcohol withdrawal
Treament of Seizure
S.E:
Respiratory depression
CNS depression
Dependance
DRUGS USED IN ANGINA:
1. GTN:
Reduces preload (amount of blood coming to the heart) by vasodilatation.

Also causes coronary artery dilatation which increases osygen supply to the brain.
2. ASPIRIN:
Is an NSAIDs as well as an anti‐platelet.
3. Calcium Channel Blocker:

e.g: Nefidipine, Amlodipine
They may cause gum hypertrophy.
4. B‐Adrenoceptors Antagonists:
e.g: Atenolol, Metoprolol.
‐ used as antiangina
‐ used in prophylaxis of angina
DRUGS USED IN ASTHMA:

1. B‐Adrenoceptors Agonists:
Salbutamol:
Short acting Beta‐ agonists.
It dilates bronchi.
It acts on B‐2 receptors

Salmeterol:
long acting B‐2 agonist.
2. Steroids:
These can be inhaled steroids or oral steroids.
Inhaled: Beclomethasone, usually used in a brown inhaler.
Oral: Prednisolone.
DRUGS USED AS IMMUNOSUPPRESSANTS:
E.G: STEROIDS, METHOTREXATE, CYCLOPHOSPHAMIDE, AZATHIOPREM, CYCLOSPORIN
Indications:
Autoimmune diseases: SLE, Rheumatoid Arthritis
Hypersensitivity: Asthma
Transplant
Side effects:
Opportunistic infections as Oral Candidiasis.
Drugs Causing Gingival hyperplasia:
Phenytoin
Cyclosporin
Calcium channel blockers (especially nifedipine)
Other causes of gingival hyperplasia
SIDE EFFECTS OF COMMONLY ASKED MEDICATIONS
1. Ibuprofen, Aspirin and steroid causes peptic ulceration.
2. Ibuprofen and Aspirin is contraindicated in Asthma
3. NSAID enhances effects of anticoagulant like warfarin
4. Fluconazole, erthromycin, metronidazole increase INR
4. Vitamin K and Oral contraception pills decreases INR
5. Aspirin is contraindicated in children less than 16 years. It causes Reyes syndrome.
6. Gingival hyperplasia is caused by calcium channel blockers (nifedipine, amlodipine, diltiazem), cyclopsorin and phenytoin.
7. Vancomycin causes Redman's syndrome, it is used to treat MRSA infections
8. Carbamazepine causes erythema multiforme
9. Tetracycline causes teeth staining and contraindicated in pregnancy.
10. Steroids (beclomethasone, prednisolone) causes high glucose
11. Side effects of long‐term steroid are: weight gain, osteoporosis, Hypertension, Cataract, diabetes
12. Rimfampicin is used for the treatment of tuberculosis , causes red urine.
13. Omeprazole non carious tooth surface lose.
14. Diazepam interacts with fluconazole??
15. Clindamycin causes pseudomembranous colitis
16. In pregnancy the following medication can be given: amoxicillin, paracetamol, erythromycin, clindamycin
17. Metformin the drug of choice in obese patient with diabetes type 2. Metformin does not cause hypoglycaemia. It causes lactic
acidosis
18. Glibenclamide is preferred in patient with renal failure than metformin.
19. Inhaled steroid like beclomethasone can cause oral candidiasis
20. Lisinopril is an ACE‐I and can cause hyperkalemia and dry cough so it should not be prescribed if there are increased K levels in
the blood or if the patient develops a cough.
21. Codeine and co‐codamol are opiates derived drugs that cause constipation and they should be stopped if the patient develops
constipation while on pain relief medications.
22. NSAIDS such as ibuprofen cause broncho constriction and where therefore they are contraindicated in Asthma.
23. B‐Blockers cause broncho constriction and a wheeze and are also contraindicated in Asthma.
24. Aspirin is an anti platelet and it should be stopped if patient develops any bleeding such as hemoptysis.
25. Ibuprofen is a prostaglandin inhibitor which results in reduced renal perfusion and causes renal failure and so should be stopped
if patients's blood report shows raised urea and creatinine.
26. Amlodipine is a calcium channel blocker that does not affect kidney function and thus it is safe to be given in patient with renal
compromise.
Amlodipine does not aggravate asthma. Therefore it can be prescribed in patients suffering from both asthma and Hypertension.
27. Vitamin K reverses the effect of warfarin by allowing synthesis of clotting factors and should be administered :
‐IV in any minor or major bleeding with any raised INR.
‐Orally if there is no bleeding but INR is raised but >8.
‐In case of major bleeding, prothrombin complex should be added.
28. Co‐amoxiclav is an antibiotic that contains amoxicillin (penicillin) and should therefore not be given to patients who are allergic
to penicillin.
It can also be given safely for UTI in pregnancy (625mg 8 hourly for 3days).
29. Trimethoprim is a folate antagonist and is thus contraindicated in pregnancy because it can cause neural tube defects.
30. Metformin is an oral hypoglycaemic that increases insulin sensitivity and is associated with a risk of lactic acidosis but does not
cause hypoglycaemia.
31. Gliclazide is an oral hypoglycaemic that increases insulin production. Therefore sulfonylureas can cause hypoglycaemia and if
patients on Gliclazide develop hypoglycaemia, they should be advised to eat regularly and avoid skipping meals.
32. Long term Steroid therapy causes:
‐Increased risk of DM (monitor blood sugar regularly).
‐Increased risk of hypertension (monitor blood pressure regularly).
‐Increased risk of osteoporosis especially in elderly intaking strides for >3 months (e.g in polymyalgia rheumatic).
‐ G.I ulceration (Needs PPI e.g omeprazole for prophylaxis).
‐ Steroids should not be stopped abruptly as this may lead to addisonian crisis.
‐ Osteoporosis (Needs bisphosphonates for prophylaxis).
PRE‐OPERATIVELY
Aspirin, heparin and contraceptive pills should be stopped before surgery.
Metformin should be stopped a day before surgery as there is a risk of lactic acidosis.
Insulin should be stopped and converted to sliding scale.
Lithium should be stopped the day before surgery.
37. The maximum dose of paracetamol should not exceed 4G/day.
38. COCPs are contraindicated and should not be given in
‐migraine with aura
‐History of DVT.
39. Phenytoin is an anti epileptic: Common side effects of this drug includes dysarthria and gym hyperplasia. Theses may manifest
even while the blood levels of phenytoin are in normal range. I.E 40‐80 micromole?litre and the dose should still be reduced in
the presence of side effects provided the dose provides good seizure control.
40. Metformin is an oral hypoglycaemic that is best to be given in patients with obesity as it an appetite suppressant and thus
assists in weight loss.
41.Codeine
‐It can cause drowsiness, particularly at higher doses and thus not appropriate for use in those that need to drive or use heavy
machinery as part of their work.
‐Can commonly cause pruritus.
‐Can commonly cause constipation and patients should be advised to take additional laxatives.
Start Date 04 Oct 2014

End Date 04 Oct 2024
© The SAMSONPLAB ACADEMY Limited 2016. All rights reserved. Terms and Conditions. (http://www.samsonplab.co.uk/index.php/terms-and-conditions)

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8/7/2017 SAMSONPLAB ACADEMY: Resources

+44 0208 9800 039 / 02089810699

3. Anti Viral Drugs

6. Mode of action of all drugs listed above

7. Side effects of commonly asked medication

CLASSIFICATION ACCORDING TO SPECTRUM OF ACTIVITY.

Lincosamides ‐ Clindamycin, Lincomycin

Sulfonamides ‐ Sulfadiazine, Trimethroprim‐ Sulfamethoxazole (Cotrimoxazole)

Beta ‐Lactam antibiotics.

Antibiotic Grouping By Mechanism

Protein Synthesis Inhibitors Inhibit 30s Subunit

DNA Synthesis Inhibitors Fluoroquinolones

RNA synthesis Inhibitors Rifampin

Mycolic Acid synthesis Isoniazid

Folic Acid synthesis Sulfonamides

interfer with bacterial cell wall synthesis

Examples: ampicillin, penicillin,

Clinical use: Amoxillin is commonly used in dental practice.

Toxicity: hypersensitivity reaction e.g anaphylaxis

Resistance: Penicillase in bacteria ( a type of B‐lactamase) cleaves B‐ring, which

An example is co‐amoxiclav which contain amoxicillin and clavulanic acid.

Cephalosporins (Generartions I, II, III, IV )

same mechanicsm of action as beta‐lactam antibiotics (such as penicillins)

Examples: cefotaxime, ceftriaxone, e.t.c

blocks DNA replication via inhibition of DNA gyrase

inhibit early fracture healing through toxic effects on chondrocytes

inhibition of bacterial protein synthesis

Toxicity: Nephrotoxicity, ototoxicity, Neuromuscular blockage

an inhibitor of cell wall synthesis

indications for vancomycin

serious allergies to penicillins or beta‐lactam antimicrobials

serious infections caused by susceptible organisms resistant to penicillins (MRSA,

Also used in pseudomembraneous colitis causes by Clostridium diffcile

Side effects: nephrotoxicity, ototoxicity

Is a bacteriostatic, it inhibits 50S ribosomal subunit

Clinical use: Anaerobe infections e.g oral infections

Side effects: It commonly associated with pseudomembranous colitis ( Clostridium

Causes discolouration of the teeth and inhibition of bone growth in

Example: doxycycline, tetracycline

Mechanism‐inhibit protein synthesis by binding to 50S ribosomes subunit

clinical use: Atypical pneumoniae, used in streptococcal infections if patient allergic

Side effect: rash,

Examples: Azythromycin, clarithromycin, erythromycin

Examples: Ciprofloxacin, levofloxacin, ofloxacin e.t.c

Contraindicated in pregnancy, breast feeding mothers, and children under 18 years

Bacteriocidal antibiotics which inhibit DNA gyrase.

Bateriocidal antibiotic, antiprotozoal

Common combination: Rimfampicin, Isoniazid, Pyrazinamide, Ethambutol

Clinical use: Treatment of Mycobacterial tuberculosis

Mechanism: Inhibits RNA polymerase

Induces Microsomal P‐450

Clinical use: Treatment of TB.

Examples: Nystatin, Amphotericin, Azoles ( Fluconazole, ketoconazole,

Clinical use: Oral thrush, vaginal thrush, systemic fungal infection

Mechanism: Inbibit antifungal sterol synthesis, by inhibiting the P‐450 enzymes

Side effects: Testosterone synthesis inhibition ( gynaecomastia,

ANTIVIRAL ( Acyclovir, famciclovir, valacyclovir)

mechanism: Inhibits viral DNA polymerase

It is inactive when given orally.

Adult = 500 mg three times a day PO

Broad spectrum antibiotic may be used in periodontal disease

Used topically for the treatment of apthae

Results in opportunistic infection with Candida albicans

Dose 250 mg ‐ 500 mg QDS PO