Pharmacology & Prescriptions

Baltimore College of Dental Surgery

Dept of Oral & Maxillofacial Surgery
Prepared by: Gregory D. Winter DDS
 Introduction
• As a faculty, we have identified that pharmacology &
prescription writing needs more instruction.
• This presentation contains the most commonly
prescribed medications written in the oral surgery
clinic.
• Not all prescription entries in Axium are accurate!
– You are responsible for knowing appropriate dosage and
instructions for use.
• Our expectation is that you know these medications
& be able to write the correct prescriptions.
 Prescription Format
• Rx – Medication, dosage & form
– Ex: Amoxicillin has multiple doses and can be either a
tablet or a suspension
• Disp – the amount of medication to be dispensed to
the patient
• Sig – directions for taking the medication
– How much to take (1 tab, 2 tabs, etc)
– What route (PO, PR, IM, etc)
– How often (BID, TID, QID etc)
– Why (infection, pain, etc)
 Important Acronyms
• P.O. – “per oris” by mouth
• B.I.D. – twice per day
• T.I.D. – three times per day
• Q.I.D. – four times per day
• PRN – as needed for
• Q#H – every # of hours
• Ex: Q8H – every 8 hours
Sample Prescriptions

ANTIBIOTICS & PRE-MEDICATIONS

 Antibiotics
• 7 Day Course
– Rx: Penicillin VK 500mg
– Disp: 28 tablets
– Sig: Take one tab PO QID until Rx complete
• Translation: Take one tab by mouth four times a day until prescription
is finished

• 10 day course
– Rx: Penicillin VK 500mg
– Disp: 40 tablets
– Sig: Take one tab PO QID until Rx complete
 Antibiotics
• 7 day course
– Rx: Amoxicillin 500mg
– Disp: 21 tabs
– Sig: Take one tab PO TID until Rx complete
• Translation: Take one tab by mouth three times a day until
prescription is finished

• 10 day course
– Rx: Amoxicillin 500mg
– Disp: 30 tabs
– Sig: Take one tab PO TID until Rx complete
 Antibiotics
• Rx: Azithromycin 250mg
– Z Pack
• Disp: One pack (5 tablets)
• Sig: Use tapering dose as directed
– 2 tabs on day one: 250x2 = 500mg
– 1 tab on day #2,3 & 4 = 250mg
 Antibiotics
• 7 day course
– Rx: Augmentin (amoxicillin/clavulanic acid) 500/125mg
– Disp: 21 tabs
– Sig: Take one tab PO Q8H until Rx complete

– Rx: Augmentin (amoxicillin/clavulanic acid) 875/125mg

– Disp: 14 tabs
– Sig: Take one tab PO Q12H until Rx complete
 Antibiotics
• 7 day course
– Rx: Clindamycin 300mg tabs
– Disp: 28 tabs
– Sig: Take one tab PO Q6H until Rx complete

• 10 day course
– Rx: Clindamycin 300mg tabs
– Disp: 40 tabs
– Sig: Take one tab PO Q6H until Rx complete

• Clindamycin (Cleocin®) can cause diarrhea and in some patients, C.

difficle infection
– Important to inform patient they may have GI upset due to this medication.
 Antibiotics
• 7 day course
– Rx: Clindamycin 150mg tabs
– Disp: 56 tabs
– Sig: Take two tabs PO Q6H until Rx complete

• 10 day course
– Rx: Clindamycin 150mg tabs
– Disp: 80 tabs
– Sig: Take two tabs PO Q6H until Rx complete

• Some pharmacies only carry 150mg tabs of clindamycin. May

have to alter the number of tabs and the dosage if this is an
issue.
 Antibiotics
• 7 day course
– Rx: Metronidazole (Flagyl) 500mg
– Disp: 21 tablets
– Sig: Take one tab PO Q8H until Rx complete

• 10 day course
– Rx: Metronidazole (Flagyl) 500mg
– Disp: 30 tablets
– Sig: Take one tab PO Q8H until Rx complete

• Metronidazole will react with alcohol resulting in a disulfiram

reaction. Patient cannot consume alcohol while on this medication
 Antimicrobial Rinse
• Rx: Chlorhexidine gluconate 0.12%
– Peridex
• Disp: One bottle
• Sig: Rinse with 15mL and expectorate. Do not
swallow.
Cardiac Premedication
 Prosthetic Joint (PJI) Premedication

• In cases where antibiotics are deemed

necessary, it is most appropriate that the
orthopedic surgeon recommend the
appropriate antibiotic regimen and when
reasonable write the prescription
 Premedication Prescription
• Rx: Amoxicillin 500mg tabs
• Disp: 4 tablets
• Sig: Take four tablets (2 grams) PO one hour prior to dental
appointment

If allergic to Penicillin (PCN)

• Rx: Clindamycin 150mg tabs

• Disp: 4 tablets
• Sig: Take four tablets (600mg) PO one hour prior to dental
appointment
Sample Prescriptions

ANALGESICS
 Analgesics
• Pain control in dentistry is short term
• Swelling & inflammation peak around 72 hours
• Clinical goal is to treat post-op pain for 72-96
hours with medication & to transition the
patient off narcotics and onto OTC analgesics as
soon as possible.
• The amount dispensed is at the discretion of
the attending faculty.
 Analgesics
• Sample 5 day course

– Rx: Ibuprofen 600mg

– Disp: 20 tabs
– Sig: Take one tab PO Q6H prn pain

– Rx: Ibuprofen 800mg

– Disp: 15 tabs
– Sig: Take one tab PO Q8H prn pain
 Analgesics
• Sample 5 day course

– Rx: Ibuprofen 600mg

– Disp: 20 tabs
– Sig: Take one tab PO Q6H prn pain

– Rx: Acetaminophen 650mg

– Disp: 30 tabs
– Sig: Take one tab PO Q4H prn pain

• Alternating doses of Advil & Tylenol is quite effective at relieving pain.

• Advil is metabolized by the kidneys and Tylenol is metabolized by the
liver, so there are no interactions between the two medicines.
 Analgesics
• Sample 5 day course

– Rx: Tylenol #3 (30/300mg)

• 30mg of codeine, 300mg of acetaminophen
– Disp: Twenty (20) tabs
– Sig: Take one tab PO Q4-Q6H prn pain

• Tylenol #3 is not a very strong analgesic. Studies have

indicated that 800mg of Ibuprofen is just as effective.
• 10% of people lack the enzyme to break down codeine;
this results in nausea.
 Analgesics
• Sample 5 days course

– Rx: Tramadol (Ultram) 50mg

– Disp: 20 tabs
– Sig: Take one tab PO Q6H prn pain

– Rx: Tramadol (Ultram) 100mg

– Disp: 20 tabs
– Sig: Take one tab PO Q6H prn pain

• Tramadol is a synthetic opioid. It is DEA Schedule IV.

 Analgesics
• Sample 3 day course

• Rx: Hydrocodone/acetaminophen (Vicodin, Lortab)

– Dosage: 5/325, 7.5/325, 10/325
– First number (5, 7.5, 10) refers to the dose of hydrocodone
– 325mg of acetaminophen
• Disp: Twelve (12) tabs
• Sig: Take one tab PO Q4-Q6H prn pain

• Vicodin is used for more extensive surgical cases; multiple

teeth, surgical extractions, alveoplasty
• It is now a Schedule II drug per the DEA. Prescriptions cannot
be called into a pharmacy or changed over the phone.
 Analgesics
• Sample 3 day course

• Rx: Oxycodone/acetaminophen (Percocet)

– Dosage: 5/325, 10/325
• First number (5, 10) refers to dosage of oxycodone
• 325mg of acetaminophen
– Disp: Twelve (12) tabs
– Sig: Take one tab PO Q4-Q6H prn pain

• Percocet is the strongest pain medication prescribed in the OS

clinic. It is reserved for the most extensive surgical procedures;
impacted 3rd molars, full mouth extractions, significant
alveoplasty, tori removal.
• Like Vicodin & Lortab, Percocet is a Schedule II drug per the DEA.
 Analgesics
• Maximum daily dosages
– Ibuprofen: 3200 mg/day
– Acetaminophen: 4000 mg/day
– Codeine: 360 mg/day
– Tramadol: 400 mg/day
– Hydrocodone: 60 mg/day
– Oxycodone: 80 mg/day
• Important values to know to avoid toxicity
 Summary
• Any additional review of pharmacology of
these antibiotics & analgesics can be
accomplished via referencing
• LexiComp database online through HS/HSL
• Drug Information Handbook for Dentistry (DIHD)
• Dr. Wynn’s Pharmacology lectures
• It is highly recommended that you download
Epocrates for your iPhone or Android; it is an
excellent mobile pharmacologic reference app
as well as a drug interaction checker. http://
www.epocrates.com
 Sources
• Lexicomp for Dentistry
– Online database through HS/HSL
• Prevention of infective endocarditis: Guidelines
from the American Heart Association
– http://jada.ada.org/article/S0002-8177(14)62745-8/pdf
• The use of prophylactic antibiotics prior to dental
procedures in patients with prosthetic joints
– http://
jada.ada.org/article/S0002-8177(14)00019-1/fulltext?n
av=rotatorJanmain