You are on page 1of 159

THERAPEUTICS IN DENTISTRY BY PROF.

Click to edit Master subtitle style MAGED NEGM

4/29/12

ANXIET Y PAIN
INFECTIO N

4/29/12

ANXIETY PHARMACOSEDATIONS PAIN INFECTION ANALGESICS ANTIBIOTICS

4/29/12

4/29/12

ANXIET Y
ANXIETY SEDATION ANXIETY IATROSEDATION TRUE FEAR RELIEF OF SEDATION BASED ON BEHAVIOR OF THE DOCTOR

Iatro doctor 4/29/12

Greek prefix pertaining to the

FEAR THRESHOLD.

LOWERS THE PAIN

“Deal with fear first, then pain will be a minor problem”

Highly nervous & fidget patients

4/29/12

TRANQULIZERS RELAXATION TO THE DEGREE OF DROWSINESS

e.g. chlorpromazine – promazine
4/29/12

“NEVER TREAT A STRANGER”
“ Sir William Osler”

4/29/12

Conscious sedation

Ora l I.V. I.M. I.R. I.N.

Odontophobic patients

4/29/12

4/29/12

Intranasal sedation patients midazolam)

pediatric (I.N.

I.N. Acute seizures in pediatric patients
4/29/12

TREATMEN T OF ANXIETY

Benzodiazepines. Sedative – hypnotics. Antihistaminics.

4/29/12

BENZODIAZE PINES
• • • • • • •

Diazepam (Valium). Chlordiazepoxide (Librium). Oxazepam (Serax). Lorazepam (Ativan). Flurazepam (Dalman). Midazolam (Versed). Triazolam.
4/29/12

DIAZEPAM

Pharmacologic effects: (VALIUM)
1. 2. 3. 4. 5.

Antianxiety. Anticonvulsant. Sedative – hypnotic. Skeletal muscle relaxant. Amnesic.

4/29/12

Well absorbed from GI. tract. Administration: oral – IV- IM. Adult oral dose: 2-10

mg.

4/29/12

Adverse effects:
• • • • •

Drowsiness. Ataxia . Motor impairments. CNS depression. Drug dependence.
4/29/12

Contraindications:
Allergy Glaucoma. First trimester of pregnancy

4/29/12

MIDAZOLAM (VERSED)
Clinical sedation diazepam
Water soluble I.V I.M I.N

less than

4/29/12

TRIAZOLA M
So popular in dental procedure. Very potent. Does not accumulate withdrawal
4/29/12

no

1-BARBITURATES 2- NON BARBITURATES

SEDATIVE – HYPNOTICS

SEDATION HYPNOSIS “induced”

CALMING SLEEPING

4/29/12

BARBITURATES
• • • •

Pentobarbital (Nembutal). Secobarbital (Seconal). Phenobarbital (Luminal). Methohexital (Brevital).

4/29/12

Administration: Oral – Rectal – IV – IM Adult dose: 100 – 200 mg

4/29/12

Barbiturates dependent. Sedation Anaesthesia Hypnosis

dose

Death (respiratory depression)
4/29/12

Adverse effects:
• • • • •

Psychological dependence. Physical dependence. Fall in heart rate. Fall in blood pressure. Respiratory depression.

4/29/12

Contraindications:

Allergy. Respiratory distress. Liver damage.
4/29/12

NON-BARBITURATES
Drugs not chemically related to barbiturates yet they possess sedative–hypnotic properties.

4/29/12

Differ from barbiturates in two aspects: Less potent. Not cross-allergenic with barbiturates.

4/29/12

Possess the same adverse

ANTIHISTAMI NES
• • • • •

Benadryl. Phenergan. Atarax. Avil. Anallerge ( chlorpheniramine).
4/29/12

Adverse effects:
• • • • •

Dizziness. Drowsiness. Motor incoordination. Blurred vision. CNS depression.

4/29/12

INHALATION SEDATION (N2O-O2)
Inhalation sedation Minimum to Moderate sedation Deep sedation or General anesthesia

N2O-O2 + sedative agents
4/29/12

NITROUS OXIDE-OXYGEN PHARMACOSEDATION.

Colourless inorganic gas compressed into liquid. Non irritating to mucosa. Sweet odour. Rapid onset of action ( 3-5 min). Rapid recovery. Ease of administration. Small traces may be detected in the

• • • • • •

4/29/12

4/29/12

4/29/12

Subjective symptoms:
• • • • •

Euphoria Dreaming. Drowsiness. Mental and physical relaxation. Indifference to surroundings and passage of time. Lessened pain awareness. Feelings of warmth. 4/29/12

• •

Adverse effects: Nausea. Vomiting. Perspiration. Behavioral alterations.
4/29/12

Contraindications:
• • • •

History of psychosis. Migraine. Headache. Prolonged drug abuse (neurologic damage).
4/29/12

4/29/12

PAIN “An unpleasant sensory and
emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” “ International Association for the Study of Pain IASP.”

4/29/12

ANALGESI CS Drugs having the ability to raise the pain threshold at a subcortical level.

4/29/12

Types of nociceptors Nociceptive signals

A- delta C- fibers

4/29/12

Trigeminal nerves Trigeminal nucleus caudalis

INFLAMMATORY MEDIATORS
Prostaglandins (PGs). Cyclooxygenase enzyme systems (COX) produce prostaglandins

Cyclooxygenase (COX)

COX 1 COX 2

4/29/12

1. PGs nociceptors PGs producing) Properties of

Factors (regulate)play a role in pulpal and periapical inflammation:
sensitize peripheral neuronal excitability. increase algogenic (pain – serotonin bradykinin neurotransmitter &

2.Serotonin 4/29/12 antidepressant.

4.Cytokines neuroplastic changes hyperalgesia. 5.Sprouting of C-fiber terminals. 6.Voltage-gated sodium channels (VGSCs) a change occurs in their activity & distribution.
4/29/12 7.Tetrodotoxin (TTX)

blockage of some

v

VGSCs (Na v1.8 & Na v1.9) 2 to 4 fold. Na v1.8 & Na v1.9 resistant (TTX-R).

increase

v

tetrodotoxin

v

TTX-R sensitized by prostaglandins (PGs). Na v1.8 & Na v1.9 (TTX-R) resistant to LA. 4/29/12

v

The decrease of concentration of PGs in inflamed tissues achieve d by NSAI Ds Corticosteroi ds

Opiate s

4/29/12

NSAIDs are classified according to their ability for blocking

COX -1 COX -2 Both

4/29/12

Blockad e of

COX -1 ulceration

GI irritation &

COX -2 Cardiovascular risks

4/29/12

COX-2 inhibitors thromboxane.

increase

Heart attack Thromboxane Stroke tendency Thrombosis
4/29/12

Thromboembolic

For safety Manage pain with Non-COX-2 selective drugs

4/29/12

Classification of analgesics: Narcotic Non-Narcotic NON-NARCOTIC ANALGESICS

Non steroidal anti inflammatory analgesics
4/29/12 agents (NSAIAs or NSAIDs)

Antipyretic

NON NARCOTIC ANALGESICS
Non steroidal anti-inflammatory agents (NSAIAs) Differing in chemical structure Group of drugs Sharing pharmacologic &
4/29/12

toxicologic

Pharmacologic properties of NSAIDs.
• • • •

Analgesic. Antipyretic. Anti-inflammatory. Anti-rheumatic. Allergy. GI. irritation. Bleeding. Liver damage. 4/29/12

Toxicologic properties of NSAIDs.
• • • •

(Acetyl Salicylic Acid) ASPIRIN
Introduced by Arthur Eichengrün ‘ a German Chemist in Bayer’ between 1848-1868. Mode of action :
1. 2.

Hypothalamus. Peripheral vasodilatation.

4/29/12

4/29/12

Aspirin hypothalamus decrease synthesis of prostaglandins.

Pain sensitizing effect. inflammatory effect.

Anti

Aspirin inhibits COX irreversibly.
4/29/12

-Well absorbed from the upper part of small intestine. -Metabolized in the liver. -Food slows rate of absorption but not its effect.

4/29/12

ASPIRIN IS AN: Analgesic - Antipyretic – Anti inflammatory – Antirheumatic – Keratolytic.

4/29/12

Adverse effects:
• • •

GI. irritation. Allergy. Bleeding (decrease platelets agglutination). Analgesic nephropathy (renal endothelial damage). Liver toxicity (liver damage). Aspirin intolerance. Salicylism (intoxication).
4/29/12

• • • •

Teratogenic effect.

Aspirin intolerance syndrome: Urticaria – Angioedema – Bronchospasm – Severe rhinitis – Shock. Occur within 3 hours.

4/29/12

Salicylism (intoxication): Headache – Dizziness – Tinnitus – Drowsiness - Nausea – Vomiting.

4/29/12

Teratogenic effect:
• •

Prolongs pregnancy and labour. Decreases birth weight.

FDA warning against the use of Aspirin in the 3rd trimester.

Contraindications:

4/29/12

Allergy.

Drug interaction:

Aspirin + NSAIDs severe bleeding and ulcerations. Aspirin + corticosteroids potentiate GI. ulceration. Aspirin inhibits vit. C action. gastric Aspirin + alcohol hemorrhage. Aspirin
4/29/12

• •

potentiates penicillins.

Adult dose 1-2 gm / 8 hours Aspirin should be stopped one week before surgery

4/29/12

IBUPROFEN

( Motrin, Advil)

Analgesic – Antipyretic – Anti inflammatory – Antirheumatic. Well absorbed when taken orally. Food delays rate but not total amount absorbed. Excreted via kidneys as metabolites.
4/29/12

• •

Adverse effects:

GI. irritation (only half as common as with aspirin). Epigastric pain. Anorexia. Nausea. Vomiting. Dizziness. Vertigo. Headache. 4/29/12

• • • • • • •

Contraindications: Allergy. Peptic ulcers.

Adult dose 400-800 mg
4/29/12

Dexketoprofen (Dextrafast)
v v

Isomer of ketoprofen Similar effect of ketoprofen but with half dose Rapid onset of action Greater analgesic efficacy in the first hour 50% reduction in dosage reduces renal load

v v

v

4/29/12

LORNOXICAM (Rheuxicam- Xefo)
• • •

Member of group of Orally effective.

OXICAM

Food decreases degree and rate of absorption. Metabolized in the liver and excreted by the kidneys. NON SELECTIVE - COX

4/29/12

Contraindications: Allergy. Severe platelet deficiency. Severe liver impairment. Severe renal impairment. Pregnancy and breast feeding. Patients under the age of 18. Adult dose
4/29/12

8-16mg/ day.

Effects and adverse effects are

PIROXIC AM
4/29/12

Special warnings concerning piroxicam:
Ø

Do not use piroxicam right before or after bypass heart surgery. Piroxicam increases the risk of stomach ulcers and bleeding especially in elderly patients.

Ø

Ø

Piroxicam should not be used in the 3rd. Trimester of pregnancy like 4/29/12 Aspirin.

DIFLUNISAL (Dolobid)
v

Derivative of Salicylic acid and possesses the same pharmacologic and toxicologic properties of NSAIAs. Long term duration of action (8-12 hours), with a slow onset of action (3 hours).

v

Contraindicated in patients with aspirin intolerance.
4/29/12

DICLOFENAC (Voltaren, Cataflam)
v v

Well absorbed orally. Can also be taken parenterally. The same effects, adverse effects and indications like the rest of NSAIDs.

Adult dose 50-75 mg/8hours. Relatively COX-2 – selective drug

4/29/12

COX-2 SELECTIVES (inhibitors)COXIBS

CELECOXIB (Celebrex) ROFECOXIB (Vioxx)
4/29/12

CELECOXIB (Celebrex)
v v

Structure: Benzenesulfonamide. Eliminated mainly through the liver with a little excreted unchanged through urine and feces. Oral capsules 100-200 mg. COX-2 Selective.

4/29/12

Contraindicati ons:
Allergy to sulfonamides & aspirin

Cardiac patients

Adult dose 200- 400 mg / daily
4/29/12

ANTIPYRETIC ANALGESICS ACETAMINOPHEN
Analgesic & Antipyretic. Introduced as an Aspirin Substitute. Marketed under more than 200 formulations. The most known one is Tylenol.
4/29/12

• • •

Does not cause GI. irritation Does not affect platelet aggregation Does not affect prothrombin synthesis Rarely causes allergy

4/29/12

Absorption in the small intestine Food decreases the rate but not total amount absorbed Detoxified in the liver

4/29/12

Adverse effects:
• • • •

Urticaria Hypoglycaemia Jaundice CNS disturbance(stimulation or depression) The most serious effect is severe, fatal hepatic necrosis with high 4/29/12 extended doses.

Contraindications: Impaired hepatic function Impaired renal function Anaemic patients Chronic alcoholism

4/29/12

CORTICOSTEROIDS
IRRITATION

Release of inflammatory mediators
4/29/12

Corticosteroids reduce inflammation by suppressing vasodilata tion Migration of PMNLs

Arachidonic acid formation

Phagocyt osis

4/29/12

Blocking of COX & PGs

Dexamethas one

Local (IC.) solution or cream Systemic (orally) 0.75 – 12mg/6-8 hours

Dexamethasone tablets mg/6-8 hours
4/29/12

0.75-12

v

Patients on daily steroid therapy surgical procedures adrenal crisis. Minor surgery 25mg hydrocortisone (5mg prednisone) / day of surgery Moderate surgery 50-75mg hydrocortisone / day of surgery + next day

v

v

4/29/12

NARCOTIC

ANALGESICS

These drugs work on the narcotic receptors in the CNS Narcotic or opiate Opioid

4/29/12

4/29/12

MORPHINE

Natural constituent of opium along with narcotine,papaverine & codeine.

Well absorbed parenterally –but poorly absorbed orally Adult dose : 5-20mg
4/29/12

4/29/12

Morphine is the drug of choice for severe pain: Postoperative pain-traumatic painaccidental pain & neoplastic pain.

4/29/12

Effects & adverse effects:
1. 2. 3.

Analgesia Sedation Euphoria

10.

Respiratory depression Cough suppression Mood alteration Mental clouding Delirium Insomnia Sweating

11.

12. 4.

Dysphoria

13. 14. 15. 16.

5.

Emesis Constipation

4/29/12 6.

19.

Dizziness

26. 27. 28. 29.

Allergy Hallucination Coma Psychic dependence Physical dependence Tolerance Asthma

20.

Drowsiness

21.

Tennitus

30.

31. 22.

Narcosis

32.

4/29/12

Contraindications: Head injury Increased intracranial pressure

Asthmatics
4/29/12

Allergy

METHADONE
v

Well absorbed both orally and parenterally(IM or subcutaneously).

Adult dose 2.5-10mg orally IM,SC,.
v

Effects,indications and contraindications are comparable to morphine. 4/29/12

MEPERIDINE (Demerol)
v

Well absorbed both oral and parenteral. Metabolized in liver.

v

Possesses atropine-like effects and hence contraindicated with glaucoma and prostatic patients. Adult dose 50-100 mg.
v

Effects, adverse effects and contraindications are similar to 4/29/12 morphine.

HYDROMORPHONE (Dilaudid)
• •

Synthetic derivative of morphine. 8 times more potent then morphine.

Adult dose 2mg oral or parenteral

Pharmacologic effects and adverse effects are similar to morphine.

4/29/12

CODEINE
§

Commercially synthesized from morphine Pharmacologic effects are qualitatively similar but quantitatively less than morphine. Well absorbed both orally and parenterally. Drug of choice for cough suppression. Adult dose 15-60 mg

§

§

§

4/29/12

TRAMADOL

Used for short lasting as well as chronic pain. Oral – parenteral. IV. 100mg tramadol morphine
Imag es

• •

10mg

4/29/12

Narcotics are contraindicated with monoamine oxidase- inhibitors

Narcotics inhibit reuptake of serotonin & norepinephrine

4/29/12

4/29/12

“ An infection is the colonization of a host organism by parasite species, using the host’s resources to reproduce, and often resulting in a disease.”

INFECTI ON

4/29/12

ANTIBIOTICS
Microorganisms suppress or kill other microorganisms

Antibiotics are indicated for:
Treatment and prevention.
4/29/12

Mechanism of Action of Antimicrobial Agents
1.

Action Inhibition of cell wall synthesis.

2.

3.

4.

4/29/12

Agents Penicillins, cephalosporins, vancomycin. Inhibition of Tetracyclines, protein synthesis. lincomycin, chloramphenicol. Interference in Ciprofloxacin, genetics. gatifloxacin, ofloxacin, metronidazole. Antimetabolic Sulfonamides. action.

Drugs are cleared by
Renal mechanism Non-renal mechansim

Drug toxicity occurs when there is a defect in excretion, usually seen in hepatic and renal damage
4/29/12

Mechanisms of clearance of drugs

Renal

Non-renal

Penicillins Cephalosproins

Macrolides Doxycycline Chloramphenicol

• •

Aminoglycoside s

4/29/12

Mechanisms of bacterial resistance to antibiotics: or Drug

Drug tolerance destruction

4/29/12

Forms of bacterial resistance to antibiotics are:

Presence of outer phospholipid covering prevents access of antibiotics to their site of action within the microorganism. Deposition of a protein protective layer to the cell wall. Alteration in the enzymatic target sites for antibiotics. 4/29/12

Resistance to antibiotics is achieved by one of three approaches:
1.

Natural (mutational): spontaneous, random mutation of bacterial genes independently of contact to antibiotics. Acquired: occurs in presence of contact with antibiotics.

2.

3.

Transferred (infectious): conferring resistance from an antibioticresistance bacterium to an antibiotic-sensitive bacterium. 4/29/12

Steps of prophylactic use of antibiotics:
1.

Diagnose the type of microorganism. Choose the specific antibiotic against this organism. Select the proper dose. Begin antibiotic administration 1 to 2 hours prior to procedure. Extend duration of drug administration to the proper period.

2.

3. 4.

5.

4/29/12

General antibiotic toxic and allergic effects: Direct toxicity. Allergy. Biologic and metabolic alteration in the host.

1. 2. 3.

4/29/12

Penicillins and cephalosporins direct toxicity.

free from highly

antigenic (allergenic).

Erythromycin deafness).

Direct toxicity(transient Extremely low allergenic.

Tetracyclines – tooth

Direct toxicity (liver damage discoloration).

4/29/12

Moderately allergenic.

Antibiotics Antimicrobial the effect of drugs contraceptives Antifungals Reduce oral

4/29/12

ANTIBIOTIC AGENTS PENICILLINS
Penicillins are derived from Penicillium fungi (Penicillium notatum) Discovered by Alexander Fleming in 1928 A generic term for a closely related antibiotics that differ in:
1.

4/29/12

Antibacterial spectrum.

Classification: Natural (penicillin G) Semisynthetic (penicillins V).

1. 2.

4/29/12

PENICILLIN G (Benzyl penicillin)
The only completely natural penicillin used clinically.

For ms
4/29/12

Crystalli ne Procai ne Benzathi ne

Spectrum: Generally effective against: Gram +ve and gram –ve cocci. organisms. Most anaerobic

4/29/12

Organism resistant:
§ § §

Most Gm –ve bacilli Enterococci Staphylococci of community and hospital variety.

4/29/12

When orally administered 2/3rds or 3/4th are destroyed in the stomach. Actively secreted by kidneys.

Procaine penicillin allergenic
4/29/12

long acting highly

Adverse reactions: Penicillin is the most commonly allergenic of all drugs. Allergenic reaction to penicillin can be classified into:
1.

Immediate (within 20 minutes): characterized by urticaria and anaphylactic shock. Accelerated (2 to 48 hours): urticaria, fever and laryngeal oedema. Late (3days and longer): urticaria, serum 4/29/12

2.

3.

Penicillins are cross allergenic
Antigenic test is done by injecting 0.1cc. SC.
Penicillins & cephalosporins are rerelatively free of drug interactions

4/29/12

PENICILLIN V (Phenoxymethyl penicillin)
• •

Semisynthetic penicillin. Simillar to penicillin G.

4/29/12

Stable and resistant to gastric acid. Approximately 65% of the drug absorbed when taken orally.

4/29/12

Penicillin G and V are drugs of choice for orofacial infections caused by both aerobes

anaerobes. 4/29/12

Broad-spectrum penicillins
Ampicillin Amoxicillin
Both have similar antibacterial spectrum.
v

Amoxicillin is absorbed better & produces less diarrhea.
v

4/29/12

v

Bactericidal against many Gm +ve and Gm –ve bacteria. Some of them are mixed with antipenicillinase or anticephalosporinase enzyme such as: Augmentin (amoxicillin + clavulanic acid)

v

4/29/12

AUGMENTIN (Amoxicillin+ clavulanic acid) Amoxicillin effective against

Gm+ve aerobes & anaerobes Gm-ve aerobes & anaerobes Clavulanic acid 4/29/12 effective against

UNASYN (Sultamicillin)
Ampicillin + Sulbactam (B-lactam inhibitor) Sultamicillin. Excreted unchanged in the urine. Adult dose: tablets 375-750mg /

12 hours

suspension 250mg (one 4/29/12 teaspoonful) / 12 hours

CEPHALOSPORINS
Introduced by Guy Newton & Edward Abrahams at the Sir Williams Dunn School of Pathology, University of Oxford in 1964. Broad spectrum group. Classified as 1st – 2nd – 3rd – 4th & 5th generations.
4/29/12

Spectrum: Streptococcus and staphylococcus organisms Most anaerobic species. Gm +ve are more sensitive than Gm – ve.

4/29/12

Administration: Cephalexin (Keflex). Oral Cefaclor (Ceclor). Cefadroxil (Duricef). Oral and parenteral (Velosef)
4/29/12

Cephradine Cefotaxime

Most of Cephalosporins are excreted unchanged by the kidney within 6 hours.

Adult dose 250-500mg/ 6 to 8 hours. Children 125mg syrup. 4/29/12

Adverse effects: Cross allergy between penicillins and Cephalosporins being closely related chemically. Skin rash – fever – serum sickness – eoxinophilia.

4/29/12

Cephalosporins
Generation
1st

Name
Cephalexin (Keflex) Cefadroxil (Duricef) Cefradine (Velosef) Cefuroxine (Zinacef 500 tab. – 750 IV. IM.) Cefaclor (Ceclor) Cefprozil (Cefzil “E. faecalis”) Cefotaxime (Claforan 1gm IM.- Cefotax) Ceftriaxone (Rocephin 500 IV. IM. long acting) Ceftazidime (Fortum 500,1g,2g IV.IM.) Cefdinir (Cefdin 300mg) Cefepime (Maxipime) Cefpirome (Cefrom)

2nd

3rd

4th
4/29/12

MACROLIDES

Macrolide antibiotics are characterized by a large macrolide ring. Erythromycin

(Erythrin)

Macrolides

Clarithromycin(Klacid) 4/29/12

Macrolides push theophylline (bronchodilator) to toxic levels.

Macrolides + Hismanal (non sedating antihistaminic) serious cardiac arrhythmia
4/29/12

ERYTHROMYCIN

Either bactericidal or bacteriostatic depending on microorganism and concentration. Destroyed by gastric acid and hence it is enteric-coated. Detoxified in liver and hence it is safe in case of impaired renal function. 4/29/12

Many aerobic and some anaerobic Streptococci and some forms of staphylococci. Not effective against most Gm –ve Administrati aerobic bacilli. on:

Spectru m:

Adult dose: tablets 250 – 500 mg / 6 to 8 hours.
4/29/12 Could be increased up to 4gm /day

Mostly related to GI. tract such as nausea, vomiting, diarrhea, epigastric pain. High, long doses cause transient deafness. Allergy is extremely rare.

Adverse effects:

4/29/12

Clarithromycin a macrolide – a semisynthetic derivative of erythromycin. Clarithromycin has greater antibacterial spectrum.

CLARITHROMY CIN (Klacid)

4/29/12 GI upset.

less

CLINDAMYCIN & LINCOMYCN Clindam - Lincocin - Dalacin - Cleocin
Antibacterium spectrum is similar to erythromycin. However clindamycin has greater effect against anaerobes than erythromycin.
4/29/12

Administration : Well absorbed orally. Food does not decrease absorption. Adult dose: tab. 150-300mg / 6-8 hours.

4/29/12

Adverse effects:
v

Nausea, vomiting, diarrhea, abdominal pain, urticaria, skin rash. Major adverse effect pseudomembranous colitis (fatal) Pseudomembrane consists of fibrin, mucous, inflammatory cells, epithelial debris necrotizing inflammation of the bowl. This membrane covering the mucosa peels off bleeding death.

v

v

4/29/12

TETRACYCLINES
Availability:
1. 2. 3. 4. 5. 6.

Tetracycline (Achromycin). Oxytetracycline (Terramycin). Chlortetracycline (Aureomycin). Demeclocycline (Declomycin). Doxycycline (Vibramycin). Methacycline (Rondamycin). Minocycline (Minocin, Vectrin)

7. 4/29/12

Spectrum: Bacteriostatic to gm+ve and gm-ve. Staphylococcus and Streptococcus bacteria. Neisseria, Actinomyces and Shigella.
4/29/12

Administration:

Orally, however they are incompletely absorbed from the GI tract. Excreted in the bile, feces and urine. Adult dose: tablets 1 to 2 gm / day divided into 2 to 4 doses.
4/29/12

• •

Usually 250 to 500 mg.

Adverse effects:
Ø Ø Ø

The most directly toxic antibiotic. Moderately allergenic. Epigastric pain, nausea, vomiting, renal impairment, liver damage manifested as jaundice, acidosis and shock. Staining of the developing dentition.

Ø

4/29/12

Contraindications: Allergy Liver damage Renal failure

v

Tetracyclines are rarely the drug of choice for facial and dental 4/29/12

METRONIDAZOLE (FLAGYL)

Bactericidal against obligate anaerobic microorganisms particularly bacteroides species. Rapidly and completely absorbed from the GI. tract. Detoxified in liver and excreted in urine.
4/29/12

v

Metronidazole acts on obligate anaerobes. Endodontic infections contain numerous facultative anaerobes. Metronidazole alone is not sufficient.

v

v

4/29/12

Adverse effects:
Ø

Nausea, headache, metallic taste and xerostomia. Metronidazole kills normal gut flora lack of vit. K bleeding.

Ø

4/29/12

Ø

As a result of its effect on DNA synthesis concerns have been raised regarding its mutagenic, teratogenic and carcinogenic potentials.

Therefore you must use it cautiously and avoid prescribing it for a long term treatment.
4/29/12

Administration: Orally, rectally and IV. Injection.

Adult dose: tablets 250-500mg / 6 to 8 hours.

4/29/12

QUINOLONES
Synthetic broad-spectrum antibiotics
q

Ciprofloxacin (Ciprobay): Norfloxacin (Conaz): Gatifloxacin (Tequin):

Oral 250-500mg / 12hours.
q

Oral 400mg / 12hours.
q

Oral, IV. 200-400mg / 12-24 hours. 4/29/12

q

Levofloxacin (Tavanic): Ofloxacin (Floxin):

Oral 500mg / day.
q

Oral 500mg / day.

4/29/12

Mode of action: interfere with DNA replication Excreted by the kidney. Adverse effects:

(bactericidal).

Development of clostridium difficile infection (severe). Tendinitis or tendon rupture, CNS toxicity, cardio-vascular toxicity.
4/29/12

IMIPENEM (TIENAM)

Thienamycin compound – subgroup carbapenems. Available as imipenem / cilastatin 1:1. Cilastatin prevents its degradation with renal enzymes. Very stable in presence of B-lactamase. Excreted unchanged by the kidney.
4/29/12

• •

• •

The best drug in case of

Severe infections. •Hospital and community infections. •Septicaemia. •Immuno compromised patients.

4/29/12

Contraindications

allergy to penicillin and cephalosporins. Adult dose: 500 – 750mg IV- IM. IM/12 hours – IV. / 6-8 hours
4/29/12

THANK YOU
Good Luck
4/29/12