Drug Prescription in Dentistry

Drug Prescription in Implant DentistryIyad Abou-Rabii DDS. OMFS. MSc.PhD

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Prescription writing

Therapeutics (Analgesics)

Therapeutics (Antibiotics)

Q&A

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Pharmacology Basics

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The reasons for administering a medication or performing a treatment

A factor that prevents the use of a medication or treatment (eg. Allergies)

Definition

Indication Contra-indication

The amount of a drug to be administered at one time

Dose

Pharmacology Basics

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Effects that are not desired and that occur with normal dose

Effects that are an exaggeration of the effect that produces the therapeutic response

Definition

Toxic effectsSide effects

The desired result of administration of a medication

Effect

Medication names

Trade name

Chemical names

Official name

Generic names

Routes of drug administration

Enteral tract routes Parenteral routes

Enteral and Parenteral Routes

Enteral route Parenteral route• Oral (PO) • Orogastric /nasogastric (OG/

NG) • Sublingual (SL) • Buccal • Rectal (PR)

• Topical • Intradermal • Intranasal • Subcutaneous (SC) • Intramuscular (IM) • Intravenous (IV) • Endotracheal (ET) • Sublingual injection • Intracardiac (IC) • Intraosseous • Inhalational • Umbilical • Vaginal • Pulpal

Comparison of Enteral vs. Parenteral Routes

Very Important

Info!

No single method of drug administration is ideal for all drugs in all circumstances

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Therapeutics (Analgesics


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The Dentist is legally responsible for the signed prescription Prescription should be indelible, dated, with full name and address of the patient Age of patient should be mentioned when under 12. Use generic drugs when possible

Prescribing

Essential Components of Prescriptions

All written prescriptions should contain: 1)Patient's full name and address 2)Prescriber's full name, address, telephone number, 3)Date of issuance 4)Signature of prescriber 5)Drug name, dose, dosage form, amount 6)Directions for use 7)Refill instructions

The Medication Order (Prescription)

• Medication desired • Dose desired • Administration route • Administration rate

Before any Drug prescription

Discuss with patient the possible consequences (god and bad) Prescribe drugs you know Keep updated (BNF, Vidal…others) Dose: consider age, physiology, and pathology Drug interactions

Don`t use abbreviations for the drug names. Define the quantity supplied Directions should be in English with no use of the abbreviations

Prescribing instructions

• When writing the dose Quantities of one gram is wrriten (1 g) Less than 1 g is written in milligrams (500 mg) Less than l mg should be written in microgram 100 microgram (not 0.1 mg) Nanogram and microgram should not be abbreviated

Prescribing instructions

• Rx : abbreviation of the Latin word "recipe” x as a substitute period.

• # ac (ante cibum) • means "before meals"

• # bid (bis in die) means • "twice a day"

Latin Abbreviations

• # po (per os) • means "by mouth"

• # pc (post cibum) means • "after meals"

• # prn (pro re nata) • means "as needed"

Latin Abbreviations

• # q 3 h (quaque 3 hora) • means "every 3 hours"

• # qd (quaque die) • means "every day"

• # qid (quater in die) means • "4 times a day"

Latin Abbreviations

Clark’s Rule

Clark's Rule Divide the child’s weight (in pounds) by 150 to get the approximate fraction of the adult dose to give to the child.

• Example: For a 50 pound child give 50/150 (or 1/3) of the adult dose. Therefore, if the adult dose is 30 drops taken 3 times per day, the child’s dose will be 10 drops taken 3 times per day

• (not 30 drops taken 1 time per day). •

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The Dentist is the best judge of pain. A person with pain will always have obvious signs such as moaning, abnormal vital signs, or not eating. Addiction is common when opioid medications are prescribed. Morphine and other strong pain relievers should be reserved for the late stages of dying. Morphine and other opioids can easily cause lethal respiratory depression. Pain medication should be given only after the resident develops pain.

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Ceiling Effect

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Analgesics

12 Paracetamol

NSAIDSOpioids

Paracetamol

Indication

Dose

Contraindication

COX ?

COX 1

COX 2

Ibuprofen, ketorolac, diclofenac, aspirin

celecoxib ,rofecoxib, Nimesulide

Opioids

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Opioids act on the central nervous system

Codeine Oxycodone, Hydrocodone Propoxyphene Dihydrocodeine Tramadol

• nausea • constipation • dizziness • sedation

• respiratory depression

Action Efficacy Side effects

What about Combination

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Analgesic

Analgesic

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Paracetamol Combinations

Mild to severe pain 30 min to 5 hours

Mild Pain Short acting (2 hours)

More effective Rapid and long acting

pain relief than did Tramadol or Paracetamol

alone

Paracetamol/Codeine

Paracetamol / Oxycodone

or Hydrocodone

Paracetamol/ TramadolParacetamol

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Best use of antibiotics

Cardinal Rules:

• Use the right drug.

• Use the right dose.

• Use the correct dosing schedule.

• Correct duration.

• Use a loading dose to rapidly achieve therapeutic blood levels.

• Avoid combinations of bacteriostatic and bacteriocidal drugs.


Chose well

• Narrow Spectrum?

• Extended/Broad Spectrum?

• Designer Antibiotics?

• Anaerobes? Consider if the infection is present > 3days or if no improvement


Identify your weapon

• Specific for the pathogen.

• Fewer disturbances of non-pathogenic bacteria.

• Fewer side effects.

• Rapid response for sensitive organisms. Ex: Pen VK, Pen G, Erythromycin

• Affects both Gram + and Gram - bacteria, better for mixed infections.

• May give up some effectiveness for Gram + to gain effectiveness for Gram Examples: Amoxicillin, Ampicillin


Identify you patients

• Age, allergies, compliance, pregnancy risk

• Patient function

• Renal, hepatic, immunosuppresion, route applicability

• Cost Brand name, length of course, alternatives?


Know your enemy (bacteria)

• Gram Positive?

• Gram Negative?

• Mixed Infection?

• Anaerobes?

Broad Spectrum Narrow Spectrum Bacteriocidal Bacteriostatic Superinfection

Reminder

Mechanism of Action: 1. Inhibition of Cell Wall

Synthesis 2. Disruption of Cell Membrane 3. Inhibition of Protein Synthesis 4. Interference with Metabolic

Processes

NB: Bactericidal Bacteriostatic

Drainage is essential if there is pus: antibacterials will not remove pus;

Very Important

Info!

What are the indications of antibiotic treatment ?

(together with appropriate surgical drainage or other measures) – Cervical fascial space infections; – Osteomyelitis and osteoradionecrosis; – Odontogenic infections in ill, toxic or susceptible patients (e.g.

immunocompromised); – Acute ulcerative gingivitis; – Some instances of:

• pericoronitis; • dental abscess; • dry socket;

Indication of antibiotic treatment

– Infective endocarditis ; – Cerebrospinal rhinorrhoea; – Compound facial or skull fractures; – Major oral and maxillofacial surgery (e.g. osteotomies or tumour

resection); – Surgery in immunocompromised or debilitated patients, or following

radiotherapy to the jaws.

Prophylactic use of antibiotics

Routes of antibiotics' administration

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Should usually be avoided, as they may cause the emergence of

resistant strains.

Preferred in most instances

Only when:– no oral preparation

is available– high blood levels

are required rapidly

– the patient cannot or will not take oral medications

– the patient is to have a GA within the following 4 h.

Main point

Topical Oral Parenteral

Let us discuss about the best antibiotic to use...

Amoxicillin or oral Penicillin

Metronidazole

Erythromycin

Tetracycline Clindamycin

• Odontogenic infections are typically polymicrobial. • Anaerobes are implicated in many periimplantitis infections,

and these often respond to penicillins or metronidazole • Metronidazole is a good alternative. • Erythromycin in another alternative (short courses) • In severe cases: Tetracycline, or • Clindamycin in limited cases.

Conclusion

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Thank you.

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Drug Prescription in Dentistry