Drug Prescribing in Oral Surgery

8/13/2019 Drug Prescribing in Oral Surgery

1/27

Drug Prescribing in Oral

Surgery

Dr. Musab Abed

BDS,HS-OMFS,MFD,FFDRCSI,Jord.Board(OMFS)

Specialist Oral & Maxillofacial Surgeon

Assistant Prof. at Jordan University of Science & Technology

2 Feb. 2014


2/27

DRUG PRESCRIBING

BNF (British National Formulary)

Is an essential source of information

on drug actions, uses and dangers.

Within the BNF there is a list of drugs

which may be prescribed by dentists.

Doses quoted in the BNF are the

normal or accepted adult dose.

Guidance on suitable childrens doses

is included where appropriate.


3/27

Essential information to be

written :

1. Name of patient.2. Age of patient.

3. Total number of days of treatment

4. The generic name of the drug, itsform and strength (e.g. metronidazoletablets 200 mg)

5. Instructions as to how and when drugis to be taken, written in English withno abbreviations (e.g. one tablet to betaken three times daily with food).


4/27

6. Delete any space remaining on theform.

7. Date and prescribers signature.


5/27

Example:


6/27

PATIENTS AT PARTICULAR

RISKChi ldren

Doses should be appropriately

reduced by age or body weight.

Elixirs/Syrups are preferable for oralingestion.

Sugar-free preparations should be

prescribed where available.


7/27

Elderly

Elderly people may show exaggeratedreactions to drugs.

Gastrointestinal (GI) haemorrhage is

more likely with NSAIDS & theseshould be prescribed with caution.

Polypharmacy is common in the

elderly with possible interactions !!


8/27

Pregnancy

Only prescribe when absolutely

essential.

Use the safer preparations(category A,B).

Teratogenic effects are most likely in

the first trimester.

Second and third trimester effects are

mainly on growth.


9/27

Liver disease : Many drugs are metabolizedthrough the liver. Impaired liverfunction(cyrihosis or any patho-necrotic) mayaffect the breakdown of drugs so the drugmight accomulate and cousing toxic effect to

the patient, so we try to give the pt drug thatnot metabolize in the liver, eg; paracetamolmetabolize in the liver, we give the pt codieneor NSAIDs instead of.

K idney disease : Nephrotoxic drugs shouldbe avoided such as aminoglycosides whichshould be avoided in pt do dialysis, other safedrugs may require dose reduction accordingto the degree of impairment either halving the

dose or type of the drug.


10/27

ANALGESICS;

NSAIDS: Examples of such drugs are: aspirin

and ibuprofen.

Main actions : analgesic

anti-inflammatory

antipyretic.


11/27

Most NSAIDs interfere with theproduction or conversion of

arachidonic acid to

prostaglandins,(COX inhibitors).

Ibuprofen mostly used at dosage of

400mg or 600mg TID, For short termuse.


12/27

Patient groups at risk from

NSAIDS Peptic u lcerat ion

Inhibits P.Gs Increase acid production,

decrease mucin, increase risk of GI bleeding

!!

Bleeding disorders

Permanent antiplatlet effect by ASA or temporary

by Ibuprofen & others.

Ant icoagulants

Enhance effect of warfarin.

Children

Under age 12, ASA is contraindicated(Reyessyndrome).


13/27

Asthmat ics

Hypersensitivity may precipitate severe

bronchospasm. Pregnancy

In the third trimester may cause:*prolongation of labour ,

* bleeding at birth,

* Early closure of ductus arteriosus(Indomethasin).

Renal or hepat ic d iseaseRenal disease reduce dose or avoidNSAIDS

Liverdiseases may enhance bleeding!!


14/27

Paracetamol

Similar analgesic properties to aspirin

Antipyretic

little or no anti-inflammatory action

No significant GI irritation

Not implicated in Reyes syndrome

Dose : (500mg1g) oral ly 46

hour ly. Maximum adu l t dose 4 g

daily.


15/27

Opioids

Causes Depression of pain center.(not like NSAIDs whichwork periphrally)

But cause Stimulation of vomiting, salivation which are theparasympathatic way.

and cause Dependence (addiction), many times we see adultpatient seeking opioids for dental pain which is very common,

tramadol for dental pain as example Other problem with opioid which is the Tolerance, patient

taking opiods for more than 2 weeks he might dont givedesierd effect of the opiods, he might need increase thedose,, which we call it tolerance.

And it might causeConstipation.

Examples:

Codeine ; mostly mixed with paracitamol as Revacod500mg 1-2*3 .

Tramadol (Tramal); opioid like analgesic

50-100mg 1*3 PRN( to not couse

addiction).


16/27

ANTIBIOTICS

Antibiotics are given to prevent or treatinfection (theyrabiotic).

Different types, spectrum, pharmaco-

dynamics &kinetics.. The wide use of antibiotics may cause

Resistance !

Side effects (allergy(maybe fetal to thepatient), G.I disturbance(diaria),super-infections(fungal as thrush orbacterial as psedomembranious

colites).


17/27

Prophylactic antibiotics

Prophylaxis of endocardi t is: in the past there was plenty o findicat ion about endocardi t is NICE and AHA guidel ines

Nice; br i tsh guidelines dont indicate prophylaxisindo cardi t is for al l pat ients,, there is n o need fo rantibiotic prophylaxis at all. Its a new guidelines forbr i tshguidel ines.

Bu t we adot to am ir ican schoo l which is american hashassosat ion 2007(AHA ) they m inim ize num ber of p at ientsinto 4 small categiores;

Patients At Risk: (AHA 2007)

history of infective endocarditis

Cardiac prosthetic valve replacement

A heart transplant with abnormal heart valve function

Some conginital cardiac defects (Cyanotic).

These are accully very young and we see them in theperdiatric section.


18/27

Antibiotic regimens


19/27

Prophylaxis against SSI

Its Not indicated in most of cases!! It Might be indicated in cases of low immunity as

diabetes and immuno- compromisedpatients(eg;diabetis) .

Generally it is considered in contaminated

wounds not the clean or clean-contaminatedones, which means in extraoral surgerys which isclean surgery, so no role of antibiotic treatement,but intraorally, its consider a clean contaminatedbecouse of saliva.

Sometimes if there is pus or forign material weconseder it derty so we might prescribeantibiotic, let say for extraction of presentperiodontitis or pericoronitis so we can consederantibiotic in such case.


20/27

Treatment of infection

Ideally antibiotics must only supplement drainage. What the treatement of abccess? Incesion and drinage

What the treatement of acute periapical abcess?Access

What the treatment of gingivitis? Scaling and oral higen.

There is no role for antibiotic,, only supplemental ofthese in cereten people

Ind icat ions for ABx:

Systemic manifestations as fever, malaise,lymphadenopathy.

Cellulitis with rapid spread of infection Involvement of fascial spaces, trismus,dysphagia, with

risk on airway or vital structures as eyes.

Inadeqate drainage though its not an excuse!

Immuno-compromised Pt.


21/27

Examples on ABx:

Penicillins: Amoxicillin ; Ampicillin oral 500mg 1*3

Flucloxacillin for Staph(in salivary gland infection suchas ascending sialdenitis, most of them are mix staphand strep 250mg 3 to 4 t imes dai ly

Augmentin( co amoxyc lav) 625mg 1*3(given 3times daily).

Amoxyc alv( amoxyc i l l in+ clav icunic acid)

Metronidazol:

Flagyl for anaerobic bacteria and parasites

250-500mg 1*3daily .We can supplement in abcess amoxic i l l in+f lagyl

together,, in cases of perico ron it is f lagyl is the go ldstandard in treatment


22/27

Cl indamycin: 150-300mg 1*3for mix infection aerobes and anaerobes

for penicillin allergic pt.s( if the pt hypersensitive to penicillin wesheft to clindamycin or cefalosporin, but mostly clindamycinbecouse cyphalosporin has 10% cross sensittivity with

penicilin so one of 10 pts might have double seansitivity to

cyfalosporin and penicilln)if pts take for a long period of time clindamycin this may lead toantib iot ic assoc iated co l i t is!!

Cephalospor ins:

10% cross sensitivity as penicillin !!it has 4 generations, it mostly used by dental uses.

ex : cephalexin 500mg 1*3

cefuroxine 1gm IV/IM

cefutaxime 1gm IV/IM


23/27

Antifungals

Miconazol For oral candidiasis and angular chelitis

though it is effective against S. Aureus .

Oral gel 25mg/ml

2-5 ml 1*4 Cream 2%(extraorally at the angel of the

mouth)1*3

Fluconazole; given systematicly or oral

capsules 50-100 mg capsules daily for 2 weeks at

least.


24/27

Antivirals

Acyclovir

For herpes infections(herpes simplex

or zoster)

Topical cream 5% 1*4 on the lips atthe podrum symptoms

Oralpreparation called Zoverax 200-

800 mg daily for 10 days.


25/27


26/27

Oral ulcerations

Coating agents: Solcoseryl dental gel 1*3Aloclair dental gel/ M.W 1*4Anesthetics: Lidocaine M.W or Spray (Trachezan) Benzydamin HCL: 0.15% M.W 1*4

(Tantum Verde)

Steroids: cream/M.W/spray Hydrocotison cream1% 1*3 (less 1

week!) Triamcinolone gel 0.1% 1*3 (less 1

week!)


27/27

THANK YOU ALL

End of the Lecture

Documents

Drug Prescribing in Oral Surgery