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THERAPEUTICS
INDENTISTRY
BYPROF.
MAGED NEGM
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ANXIET
Y PAIN
INFECTIO
N
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ANXIETYPHARMACOSEDATIONS
PAIN ANALGESICS
INFECTION ANTIBIOTICS
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ANXIETY
ANXIETY TRUE FEAR
SEDATION RELIEF OF
ANXIETY
IATROSEDATION
Iatro Greek prefix pertaining to the
doctor
SEDATION BASED ONBEHAVIOR OF THEDOCTOR
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FEAR LOWERS THE PAINTHRESHOLD.
Deal with fear first, then pain will be aminor problem
Hi hl nervous & fid et atients
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TRANQULIZERSRELAXATION TO THE
DEGREE OF DROWSINESS
e.g. chlorpromazine promazine
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NEVER TREAT ASTRANGER
Sir William
Osler
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Conscioussedation
Oral
I.V.I.M.I.R.I.N.
Odontophobicpatients
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Intranasal sedation pediatricpatients
(I.N.midazolam)
I.N. Acute seizures inpediatric patients
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TREATMENT OF
ANXIETY
Benzodiazepines.Sedative hypnotics.
Antihistaminics.
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BENZODIAZEPINES
Diazepam (Valium).
Chlordiazepoxide (Librium).
Oxazepam (Serax). Lorazepam (Ativan).
Flurazepam (Dalman).
Midazolam (Versed).
Triazolam.
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Pharmacologic effects:
1. Antianxiety.
2. Anticonvulsant.
3. Sedative hypnotic.
4. Skeletal muscle relaxant.
5. Amnesic.
DIAZEPAM
(VALIUM)
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Well absorbed from GI. tract.
Administration: oral IV- IM.
Adult oral dose: 2-10mg.
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Adverse effects:
Drowsiness.
Ataxia .
Motor impairments.
CNS depression. Drug dependence.
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Contraindications:
Allergy
Glaucoma.
First trimester ofpregnancy
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MIDAZOLAM (VERSED)
Clinical sedation less thandiazepam
Watersoluble
I.VI.MI.N
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TRIAZOLAM
So popular in dental procedure.
Very potent.
Does not accumulate nowithdrawal
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1-BARBITURATES 2- NONBARBITURATES
SEDATION CALMING
HYPNOSIS SLEEPING
induced
SEDATIVE HYPNOTICS
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BARBITURATES
Pentobarbital (Nembutal).
Secobarbital (Seconal).
Phenobarbital (Luminal).
Methohexital (Brevital).
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Administration: Oral Rectal IV IM
Adult dose: 100 200 mg
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Barbiturates dosedependent.
Sedation HypnosisAnaesthesia
Death (respiratory depression)
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Adverse effects:
Psychological dependence.
Physical dependence.
Fall in heart rate.
Fall in blood pressure. Respiratory depression.
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Contraindications:
Allergy.
Respiratorydistress.Liver
damage.
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NON-BARBITURATES
Drugs not chemically related to
barbiturates yet they possesssedativehypnotic properties.
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Differ from barbiturates in two aspects:
Less potent.
Not cross-allergenic withbarbiturates.
Possess the same adverse
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Benadryl. Phenergan.
Atarax.
Avil.
Anallerge ( chlorpheniramine).
ANTIHISTAMINES
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Adverse effects:
Dizziness.
Drowsiness. Motor incoordination.
Blurred vision.
CNS depression.
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INHALATION SEDATION
(N2O-O2)Inhalation sedation
N2O-O2 + sedativeagents
Minimumto
Moderatesedation
Deep sedationorGeneralanesthesia
NITROUS OXIDE OXYGEN
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NITROUS OXIDE-OXYGENPHARMACOSEDATION.
Colourless inorganic gas compressedinto 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
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Subjective symptoms:
Euphoria
Dreaming.
Drowsiness. Mental and physical relaxation.
Indifference to surroundings and
passage of time.
Lessened pain awareness.
Feelings of warmth.
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Adverse effects:
Nausea.
Vomiting.
Perspiration.
Behavioralalterations.
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Contraindications:
History of psychosis.
Migraine.
Headache.
Prolonged drug abuse (neurologicdamage).
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An unpleasant sensory andemotional experience associated withactual or potential tissue damage, ordescribed in terms of such damage.
International Association for theStudy of Pain IASP.
PAIN
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Drugs having the ability to raise thepain threshold at asubcortical level.
ANALGESICS
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Types ofnociceptors
A- delta
C- fibers
Nociceptivesignals
Trigeminal
nerves
Trigeminal
nucleus caudalis
INFLAMMATORY
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INFLAMMATORYMEDIATORS
Prostaglandins (PGs).
Cyclooxygenase enzyme systems (COX) produceprostaglandins
Cyclooxygenase
(COX)
COX -1
COX -2
ac ors regu a e p ay a
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ac ors regu a e p ay arole in pulpal and
periapical inflammation:1.PGs sensitize peripheralnociceptors
neuronal excitability.
PGs increase algogenic (pain producing)
Properties of serotoninbradykinin
2.Serotonin neurotransmitter &
antidepressant.
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4.Cytokines neuroplastic changeshyperalgesia.
5.Sprouting of C-fiber terminals.
6.Voltage-gated sodium channels (VGSCs)
a change occurs in their activity &distribution.
7.Tetrodotoxin (TTX) blocka e of some
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v VGSCs (Na v1.8 & Na v1.9) increase2 to 4 fold.
v Na v1.8 & Na v1.9 tetrodotoxinresistant (TTX-R).
v TTX-R sensitized byprostaglandins (PGs).
v Na v1.8 & Na v1.9 (TTX-R)
resistant to LA.
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The decrease of
concentration of PGs ininflamed tissues
NSAI
Ds
Corticosteroi
ds
achieve
d by
Opiates
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NSAIDs are classifiedaccording to their ability for
blocking
COX-1
COX-2Both
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Blockad
e of
COX -1 GI irritation &ulceration
COX -2Cardiovascular risks
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COX-2 inhibitors increasethromboxane.
Heart attack
Thromboxane ThromboembolicStroke
tendency
Thrombosis
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For safety
Manage pain with
Non-COX-2 selectivedrugs
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NON-NARCOTIC ANALGESICS
Non steroidal anti inflammatory Antipyreticanalgesics
agents (NSAIAs or NSAIDs)
Classification of analgesics:
NarcoticNon-Narcotic
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ANALGESICS
Non steroidal anti-inflammatory agents(NSAIAs)
Differing inchemical structure
Group of drugs
Sharingpharmacologic &
toxicolo ic
Pharmacologic properties of NSAIDs
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Pharmacologic properties of NSAIDs.
Analgesic.
Antipyretic.
Anti-inflammatory.
Anti-rheumatic.Toxicologic properties of NSAIDs.
Allergy.
GI. irritation.
Bleeding.
Liver damage.
(A t l S li li A id)
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(Acetyl Salicylic Acid)ASPIRIN
Introduced byArthur Eichengrn a German Chemist in Bayer
between 1848-1868.
Mode of action :
1. Hypothalamus.
2. Peripheral vasodilatation.
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Aspirin hypothalamusdecrease synthesis of prostaglandins.
Pain sensitizing effect. Anti
inflammatory effect.
Aspirin inhibits COX irreversibly.
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-Well absorbed from the upper part ofsmall intestine.
-Metabolized in the liver.
-Food slows rate of absorption but notits effect.
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ASPIRIN IS AN:
Analgesic - Antipyretic Antiinflammatory Antirheumatic Keratolytic.
Adverse effects:
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Adverse effects:
GI. irritation.
Allergy.
Bleeding (decrease plateletsagglutination).
Analgesic nephropathy (renalendothelial damage).
Liver toxicity (liver damage). Aspirin intolerance.
Salicylism (intoxication).
Terato enic effect.
A i i i t l d
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Aspirin intolerance syndrome:
Urticaria Angioedema Bronchospasm Severe rhinitis Shock.
Occur within 3 hours.
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Salicylism (intoxication):
Headache Dizziness Tinnitus
Drowsiness - Nausea Vomiting.
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Teratogenic effect:
Prolongs pregnancy and labour.
Decreases birth weight.
FDA warning againstthe use of Aspirin in
the 3rd trimester.
Contraindications:
Allergy.
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Drug interaction:
Aspirin + NSAIDs severebleeding and ulcerations.
Aspirin + corticosteroidspotentiate GI. ulceration.
Aspirin inhibits vit. C action.
Aspirin + alcohol gastrichemorrhage.
Aspirin potentiates penicillins.
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Adult dose 1-2 gm / 8 hours
Aspirin should be stopped oneweek before surgery
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IBUPROFEN
( Motrin, Advil)
Analgesic Antipyretic Antiinflammatory Antirheumatic.
Well absorbed when taken orally.
Food delays rate but not total amountabsorbed.
Excreted via kidneys as metabolites.
Adverse effects:
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Adverse effects:
GI. irritation (only half as common as
with aspirin). Epigastric pain.
Anorexia.
Nausea.
Vomiting.
Dizziness. Vertigo.
Headache.
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Contraindications:
Allergy.Peptic ulcers.
Adult dose 400-800 mg
Dexketoprofen
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Dexketoprofen
(Dextrafast)
v Isomer of ketoprofen
v Similar effect of ketoprofen but withhalf dose
v Rapid onset of action
v Greater analgesic efficacy in the first
hourv 50% reduction in dosage
reduces renal load
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(Rheuxicam- Xefo)
Member of group of OXICAM
Orally effective.
Food decreases degree and rate ofabsorption.
Metabolized in the liver and excreted
by the kidneys.
NON SELECTIVE - COX
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Contraindications:
Allergy.Severe platelet
deficiency.
Severe liver impairment.
Severe renal impairment.
Pregnancy and breast feeding.Patients under the age of 18.
Adult dose 8-16mg/ day.
Effects and adverse effects are
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PIROXICAM
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Special warnings concerning
piroxicam:
Do not use piroxicam right before or
after bypass heart surgery. Piroxicam increases the risk of
stomach ulcers and bleeding
especially in elderly patients. Piroxicam should not be used in the
3rd.Trimester of pregnancy like
Aspirin.
DIFLUNISAL
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DIFLUNISAL(Dolobid)
v Derivative of Salicylic acid andpossesses the same pharmacologicand toxicologic properties of NSAIAs.
v Long term duration of action (8-12hours), with a slow onset of
action (3 hours).
Contraindicated in patients withaspirin intolerance.
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(Voltaren,
Cataflam)v Well absorbed orally. Can also betaken parenterally.
v The same effects, adverse effects
and indications like the rest ofNSAIDs.
Adult dose 50-75
mg/8hours.
Relatively COX-2 selective drug
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COX-2 SELECTIVES
(inhibitors)COXIBS
CELECOXIB(Celebrex)
ROFECOXIB(Vioxx)
CELECOXIB
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CELECOXIB(Celebrex)
v Structure: Benzenesulfonamide.
v Eliminated mainly through the liverwith a little excreted unchanged
through urine and feces.
Oral capsules 100-200 mg.
COX-2 Selective.
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Contraindications:
Allergy tosulfonamides &aspirin
Cardiacpatients
Adult dose 200- 400mg / daily
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ANALGESICS
ACETAMINOPHEN
Analgesic & Antipyretic.
Introduced as an Aspirin Substitute.
Marketed under more than 200formulations.
The most known one is Tylenol.
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Does not cause GI. irritation
Does not affect platelet aggregation
Does not affect prothrombinsynthesis
Rarely causes allergy
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Absorption in the small intestine
Food decreases the rate but nottotal amount absorbed
Detoxified in the liver
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Adverse effects:
Urticaria
Hypoglycaemia Jaundice
CNS disturbance(stimulation or
depression)
The most serious effect is severe,fatal hepatic necrosis with high
extended doses.
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Contraindications:
Impaired hepatic function
Impaired renal functionAnaemic patients
Chronicalcoholism
CORTICOSTEROIDS
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CORTICOSTEROIDS
IRRITATION
Release of inflammatorymediators
Corticosteroids reduce
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Corticosteroids reduceinflammation by suppressing
vasodilatation
Migration ofPMNLs
Phagocytosis
Arachidonic acidformation
Blocking of COX
& PGs
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Dexamethasone
Local (IC.) solution or
cream
Systemic (orally)
0.75 12mg/6-8hours
Dexamethasone tablets 0.75-12mg/6-8 hours
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v Patients on daily steroid therapysurgical procedures adrenal crisis.
v Minor surgery 25mg hydrocortisone(5mg prednisone) / day of surgery
v Moderate surgery 50-75mghydrocortisone / day of surgery + next day
NARCOTIC ANALGESICS
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These drugs work on the narcoticreceptors in the CNS
Narcotic Opioid
or opiate
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MORPHINE
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MORPHINE
Natural constituent of opium alongwith narcotine,papaverine & codeine.
Well absorbed parenterally butpoorly absorbed orally
Adult dose : 5-20mg
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Morphine is the drug of choice forsevere pain:
Postoperative pain-traumatic pain-accidental pain & neoplastic pain.
Effects & adverse effects:
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1. Analgesia
2. Sedation
3. Euphoria
4. Dysphoria
5. Emesis
6. Constipation
10. Respiratory
depression
11. Coughsuppression
12. Mood alteration
13. Mental clouding
14. Delirium15. Insomnia
16. Sweating
19. Dizziness 26. Allergy
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20. Drowsiness
21. Tennitus
22. Narcosis
gy
27. Hallucination
28. Coma
29. Psychicdependence
30. Physicaldependence
31.
Tolerance32. Asthma
Contraindications:
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Contraindications:
Head injury
Increased intracranial pressure
Asthmatics
Allergy
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METHADONEv Well absorbed both orally and
parenterally(IM or subcutaneously).
Adult dose 2.5-10mg orallyIM,SC,.
v Effects,indications andcontraindications are comparable to
morphine.
(Demerol)
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(Demerol)
v
Well absorbed both oral andparenteral.
v Metabolized in liver.
Possesses atropine-like effects andhence contraindicated with glaucomaand prostatic patients.
Adult dose 50-100 mg.v Effects, adverse effects and
contraindications are similar to
mor hine.
HYDROMORPHONE
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HYDROMORPHONE(Dilaudid)
Synthetic derivative of morphine.
8 times more potent then morphine.
Adult dose 2mg oral orparenteral
Pharmacologic effects and adverse
effects are similar to morphine.
CODEINE
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CODEINE
Commercially synthesized frommorphine
Pharmacologic effects are
qualitatively similar butquantitatively less than morphine.
Well absorbed both orally and
parenterally. Drug of choice for cough
suppression.
Adult dose 15-60 m
TRAMADOL
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TRAMADOL
Used for short lasting as well aschronic pain.
Oral parenteral.
IV. 100mg tramadol 10mgmorphine
Images
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Narcotics are contraindicated with
monoamine oxidase- inhibitors
Narcotics inhibit reuptake ofserotonin
& norepinephrine
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INFECTI
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An infection is thecolonization of a host organism byparasite species, using the hosts
resources to reproduce, and oftenresulting in a disease.
INFECTI
ON
ANTIBIOTICS
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Antibiotics are indicated for:
Treatment and prevention.
Microorganisms suppress orkill other microorganisms
Mechanism of Action of
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Action Agents1. Inhibition of cell
wall synthesis.Penicillins,cephalosporins,vancomycin.
2. Inhibition ofprotein synthesis.Tetracyclines,lincomycin,chloramphenicol.
3. Interference ingenetics.
Ciprofloxacin,gatifloxacin,ofloxacin,metronidazole.
4. Antimetabolicaction.
Sulfonamides.
Antimicrobial Agents
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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
Mechanisms of clearance of
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drugs
Renal Penicillins
Cephalosproins
Aminoglycosides
Non-renal Macrolides
Doxycycline
Chloramphenicol
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Mechanisms of bacterial resistance toantibiotics:
Drug tolerance or Drugdestruction
Forms of bacterial resistance to
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Forms of bacterial resistance toantibiotics are:
Presence of outer phospholipidcovering prevents access of
antibiotics to their site of actionwithin the microorganism.
Deposition of a protein protective
layer to the cell wall.
Alteration in the enzymatic targetsites for antibiotics.
Resistance to antibiotics is achieved by
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one of three approaches:
1. Natural (mutational): spontaneous,random mutation of bacterial genesindependently of contact to
antibiotics.2. Acquired: occurs in presence of
contact with antibiotics.
3. Transferred (infectious): conferringresistance from an antibiotic-resistance bacterium to an
antibiotic-sensitive bacterium
Steps of prophylactic use of antibiotics:
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p p p y
1. Diagnose the type of
microorganism.
2. Choose the specific antibioticagainst this organism.
3. Select the proper dose.
4. Begin antibiotic administration 1 to2 hours prior to procedure.
5. Extend duration of drugadministration to the proper period.
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General antibiotic toxic and allergiceffects:
1. Direct toxicity.
2. Allergy.
3. Biologic and metabolic alteration inthe host.
Penicillins and cephalosporins free fromdirect toxicity.
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y
highly
antigenic (allergenic).
Erythromycin Direct toxicity(transient
deafness).Extremely low allergenic.
Tetracyclines Direct toxicity (liver damage tooth
discoloration).
Moderately allergenic.
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Antibiotics
Antimicrobial Reducethe effect of drugs oralcontraceptives
Antifungals
ANTIBIOTIC AGENTSPENICILLINS
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PENICILLINS
Penicillins are derived from Penicilliumfungi (Penicillium notatum)
Discovered byAlexanderFlemingin1928
A generic term for a closely relatedantibiotics that differ in:
1. Antibacterial spectrum
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Classification:
1. Natural (penicillin G)
2. Semisynthetic (penicillins V).
PENICILLIN G(B l i illi )
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(Benzyl penicillin)
The only completely naturalpenicillin used clinically.
Forms
Crystalline
ProcaineBenzathine
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Spectrum:
Generally effective against: Gram +ve and
gram ve cocci.Most anaerobic
organisms.
Organism resistant:
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Most Gm ve bacilli
Enterococci
Staphylococci of community andhospital variety.
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When orally administered 2/3rds or3/4th are destroyed in the stomach.
Actively secreted by kidneys.
Procaine penicillin long actinghighly
allergenic
Adverse reactions:
Penicillin is the most commonly
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Penicillin is the most commonlyallergenic of all drugs.
Allergenic reaction to penicillin canbe classified into:
1. Immediate (within 20 minutes):characterized by urticaria andanaphylactic shock.
2. Accelerated (2 to 48 hours): urticaria,fever and laryngeal oedema.
3. Late (3days and longer): urticaria, serum
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Penicillins are crossallergenic
Antigenic test is done by injecting0.1cc. SC.
Penicillins & cephalosporinsare
rerelatively free of druginteractions
(Phenoxymethyl
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( y ypenicillin)
Semisynthetic penicillin.
Simillar to penicillin G.
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Stable and resistant to gastric acid.
Approximately 65% of the drugabsorbed when taken orally.
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Penicillin G and V are drugs ofchoice for orofacial infectionscaused by both
aerobes
anaerobes.
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v Bactericidal against many Gm +veand Gm ve bacteria.
v Some of them are mixed with
antipenicillinase oranticephalosporinase enzyme suchas:
Augmentin (amoxicillin +clavulanic acid)
AUGMENTIN
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(Amoxicillin+ clavulanicacid)
Amoxicillin effective against
Gm+ve aerobes & anaerobes
Gm-ve aerobes &anaerobes
Clavulanic acid effective against
UNASYN(Sultamicillin)
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(Sultamicillin)
Ampicillin + Sulbactam (B-lactam inhibitor)Sultamicillin.
Excreted unchanged in the urine.
Adult dose: tablets 375-750mg /12 hours
suspension 250mg (one
teaspoonful) / 12 hours
CEPHALOSPORINS
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Introduced by Guy Newton & EdwardAbrahams at the Sir Williams DunnSchool of Pathology, University of Oxfordin 1964.
Broad spectrum group.
Classified as 1st 2nd 3rd 4th & 5thgenerations.
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Spectrum:
Streptococcus and staphylococcusorganisms
Most anaerobic species.
Gm +ve are more sensitive than Gm ve.
Administration:
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Cephalexin (Keflex).
Oral
Cefaclor (Ceclor).Cefadroxil (Duricef).
Oral and parenteral Cephradine(Velosef)
Cefotaxime
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Most of Cephalosporins are excretedunchanged by the kidney within 6hours.
Adult dose 250-500mg/ 6 to8 hours.
Children 125mgsyrup.
Adverse effects:
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Cross allergy between penicillins andCephalosporins being closely relatedchemically.
Skin rash fever serum sickness
eoxinophilia.
CephalosporinsGeneration Name
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Generation Name
1st Cephalexin (Keflex)Cefadroxil (Duricef)Cefradine (Velosef)
2nd Cefuroxine (Zinacef 500 tab. 750 IV. IM.)
Cefaclor (Ceclor)Cefprozil (Cefzil E. faecalis)
3rd Cefotaxime (Claforan 1gm IM.- Cefotax)Ceftriaxone (Rocephin 500 IV. IM. long
acting)Ceftazidime (Fortum 500,1g,2g IV.IM.)Cefdinir (Cefdin 300mg)
4th Cefepime (Maxipime)Cefpirome (Cefrom)
MACROLIDES
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Macrolide antibiotics arecharacterized by a large macrolidering.
Erythromycin(Erythrin)
Macrolides
Clarithromycin(Klacid)
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Macrolides push theophylline(bronchodilator)
to toxic levels.
Macrolides + Hismanal (non
sedating antihistaminic)serious cardiac arrhythmia
ERYTHROMYCIN
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Either bactericidal or bacteriostaticdepending on microorganism andconcentration.
Destroyed by gastric acid and henceit is enteric-coated.
Detoxified in liver and hence it is safein case of impaired renal function.
M bi d bi
Spectrum:
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Many aerobic and some anaerobic
Streptococci and some forms ofstaphylococci.
Not effective against most Gm ve
aerobic bacilli.
Adult dose: tablets 250 500 mg / 6 to8 hours.
Could be increased u to 4 m /da
m:
Administration:
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Mostly related to GI. tract such asnausea, vomiting, diarrhea, epigastricpain.
High, long doses cause transientdeafness.
Allergy is extremely rare.
Adverse
effects:
CLARITHROMYCIN
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Clarithromycin a macrolide a semisynthetic derivative oferythromycin.
Clarithromycin has
greater antibacterial
spectrum.
less
GI u set
(Klacid)
LINCOMYCN
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Clindam - Lincocin - Dalacin- Cleocin
Antibacterium spectrum is similar toerythromycin.
However clindamycin has greatereffect against anaerobes thanerythromycin.
Administration :
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Administration :
Well absorbed orally.
Food does not decrease absorption.
Adult dose: tab. 150-300mg /6-8 hours.
Adverse effects:
v Nausea, vomiting, diarrhea, abdominal
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Nausea, vomiting, diarrhea, abdominalpain, urticaria, skin rash.
v Major adverse effectpseudomembranous colitis (fatal)
v
Pseudomembrane consists of fibrin,mucous, inflammatory cells, epithelialdebris necrotizinginflammation of the bowl. This
membrane covering the mucosapeels off bleeding death.
TETRACYCLINES
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Availability:1. Tetracycline (Achromycin).
2. Oxytetracycline (Terramycin).
3. Chlortetracycline (Aureomycin).
4. Demeclocycline (Declomycin).
5. Doxycycline (Vibramycin).
6. Methacycline (Rondamycin).
7. Minocycline (Minocin, Vectrin)
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Spectrum:Bacteriostatic to gm+ve and gm-ve.
Staphylococcus and Streptococcusbacteria.
Neisseria, Actinomyces and Shigella.
Administration:
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Administration:
Orally, however they areincompletely 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.
Usually 250 to 500 mg.
Adverse effects:
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The most directly toxic antibiotic. Moderately allergenic.
Epigastric pain, nausea, vomiting,renal impairment, liver damagemanifested as jaundice, acidosis andshock.
Staining of the developingdentition.
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Contraindications:Allergy
Liver damage
Renal failure
v Tetracyclines are rarely the drug ofchoice for facial and dental
METRONIDAZOLE(FLAGYL)
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Bactericidal against obligateanaerobic microorganismsparticularly bacteroides species.
Rapidly and completely absorbedfrom the GI. tract.
Detoxified in liver and excreted inurine.
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v Metronidazole acts on obligateanaerobes.
v Endodontic infections containnumerous facultative anaerobes.
v Metronidazole alone is not sufficient.
Adverseeffects:
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Nausea, headache, metallic taste andxerostomia.
Metronidazole kills normal gut floralack of vit. K bleeding.
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As a result of its effect on DNAsynthesis concerns have been raisedregarding its mutagenic, teratogenic
and carcinogenic potentials.
Therefore you must use it
cautiously and avoid prescribing it fora long term treatment.
Administration:
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Orally, rectally and IV. Injection.
Adult dose: tablets 250-500mg / 6 to8 hours.
QUINOLONES
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Synthetic broad-spectrum antibiotics
q Ciprofloxacin (Ciprobay):
Oral 250-500mg / 12hours.
q Norfloxacin (Conaz):
Oral 400mg / 12hours.q Gatifloxacin (Tequin):
Oral, IV. 200-400mg / 12-24 hours.
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q Levofloxacin (Tavanic):Oral 500mg / day.
q Ofloxacin (Floxin):
Oral 500mg / day.
Mode of action: interfere with DNAreplication
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replication
(bactericidal).
Excreted by the kidney.
Adverse effects:
Development of clostridium difficile
infection (severe).Tendinitis or tendon rupture, CNStoxicity, cardio-vascular toxicity.
IMIPENEM(TIENAM)
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(TIENAM)
Thienamycin compound subgroupcarbapenems.
Available as imipenem / cilastatin 1:1.
Cilastatin prevents its degradation withrenal enzymes.
Very stable in presence of B-lactamase. Excreted unchanged by the kidney.
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The bestdrug
in case of
Severe infections.
Hospital and communityinfections.Septicaemia.Immuno compromised
patients.
Contraindications
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allergy to penicillin and
cephalosporins.
Adult dose: 500 750mg IV- IM.
IM/12 hours IV. / 6-8 hours
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THANK YOU
G d L k