therapeutics in dentistry

8/2/2019 Therapeutics in Dentistry

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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

therapeutics in dentistry

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