emergency drugs used in o.s. common drug interactions in o.s. practice oral surgery

8/9/2019 Emergency Drugs Used in o.s. Common Drug Interactions in o.s. Practice Oral Surgery

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EMERGENCY DRUGS

USED IN ORAL SURGERY

&

COMMON DRUG INTERACTIONS

IN ORAL SURGICAL PRACTICE


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CONTENTS* Introduction

* Classification of the emergency drugs

* Individual emergency drug

* Drug interactions


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EMERGENCY DRUGS USED IN ORAL SURGERY

1. Adrenaline 11. Pancuroniumbromide

2. Atropine 12. Styptochrome

3. Dopamine 13. Ethamsylate

4. Metoclopramide 14. Ketorolac5. Phenaramine maleate 15. Aminophylline

6. Hydrocortisone 16. Succinyl choline

7. Dexamethasone 17. Dextrose

8. Diazepam 18. Sodium bicarbonate

9. Fortwin-pentazocin 19. Calcium gluconate

10. Furosemide 20. Chlorphenaraminemaleate


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CLASSIFICATION

Emergency drugs

Injectables Non Injectables

Oxygen

Vasodilators

Respiratory stimulants

Anti Hypoglycaemic

agents

Bronchodilators

Primary Secondary Drug foradvanced cardiac life

support

1) Adrenaline 1) Analgesic 1) Lidocaine

2) Antihistamine 2) Vasopressor 2) Atropine

3) Anti convulsant 3) Corticosteroid 3) Sodium bicarbonate

4) Narcotic antagonist 4) Antihypoglycaemic


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ADRENALINE

INTRODUCTION :

- It is an adrenergic drug.

- It increases heart rate,force of contraction and cardiac output.

- It constricts blood vessels.

- It increases mean BP.

- Potent bronchodilator

- It causes mydriases in eye that is pupil dilatation.

INDICATIONS :

- Anaophylactic shock

- In bronchial asthma

- In cardiac arrest

- With local anaesthesia

- To control post extraction haemorrhage

- To treat open angle glaucoma


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CONTRAINDICATIONS

- Hypersensitivity

- Hyperthyroidism

- Hypertension- Angina pectoris

- Diabetes mellitus

TRADE NAME : Adrenor, Asmotone

DOSAGE : 0.2-0.5 mg s.c , 0.5 % aerosol

in case of im /iv in conc of 1:10,000 to 1:1,00,000

ADVERSE EFFECTS

- Marked increase in BP

- photosensitivity, skin rashes

- palpitation, arrythmias

-anginal pain, ventricular failure


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ATROPINE

INTRODUCTION

- It is a parasympathetic drug

-Anticholinergic action- Antispasmodic action

- Antisecretory action

- Anti muscarinic action

- It causes tachycardia

- Anti dote for organo phosphate poisoning.

INDICATIONS

- Motion sickness

- Colics and dysmenorrhoea

- Anti parkinsonism

- Pre operatively to reduce secretions & salivation

- In bronchial asthma

- Severe sinus bradycardia


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CONTRAINDICATIONS

- Hypersensitivity to belladona alkaloid

- Glaucoma

- Prostatic hypertrophy

- Cardiac failure

- Thyrotoxicosis

TRADE NAME : Atro, Tropine, Atropine sulphate

DOSAGE : Children : oral 0.2 mg/kg

inj --0.3-0.6 mg i.m

Adults : 0.6- 2 mg/ml i.m

ADVERSE EFFECTS- Dry mouth, decreased salivation

- Decreased sweating

- Constipation

- Tachycardia, palpitations, arrythmias

- Mydriasis and cycloplegia


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DOPAMINE

INTRODUCTION

- Potent sympathomimetic agent

- Agonist for dopamine receptors in CNS,renal and other vascular beds

- Agonist for beta adreno receptors in heart

- At high doses it causes vasoconstriction

- At low doses it causes increase in renal blood flow, GFR, and sodium

excretion.

INDICATIONS

- Cardiogenic shock

- Septic shock

- Septicaemia

- Congestive heart failure

- Renal failure

- Heart failure


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CONTRAINDICATIONS

- Atrial/venticular tachy arrythmias

- Hyperthyroidism

- Pheochromocytoma

TRADE NAMES : Dopamine, Dopinga, Dopapins, Dopar, Dopat.

DOSAGE : Children 2-20 microgram/kg/min i.v

Adults -- 2-50 micrograms/kg/min i.v

ADVERSE EFFECTS

- Nausea , vomitting

- Tachycardia

- Palpitation

- Anginal pain

- Atopic beats


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METOCLOPRAMIDE

INTRODUCTION

- It is a pro kinetic drug -- causes forward propulsion of contents of stomach

- Centrally acting dopamine antagonist

- Acts on chemoreceptor trigger zone

- Peripherally acts to enhance the effect of A-ch at muscarinic receptors ingut

INDICATIONS

- As an anti emetic in nausea, vomitting

post operative vomitting

drug/disease induced vomitting

radiation sickness

morning/ motion sickness

- Gastritis

- Reflux oesophagitis

- Gastroenterology


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CONTRAINDICATIONS

- Gastro intestinal perforation/ obstruction

- Epilepsy

- Parkinsonism- Breast cancer

TRADE NAMES : Reglan, Perinorm, Metaclop, Emenil, Vominil

DOSAGE : oral 5-10 mg TDS

INJ. 2 ml TDS

ADVERSE EFFECTS

- Dizziness

- Diarrhoea

- Trismus,

- Tremors

- Gynaecomastia,

- Galactorrhoea


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PHENARAMINE MALEATE

INTRODUCTION

-It is an alkylamine derivative

- Antihistaminic

- Anti cholinergic property

- Anti muscarinic property

- Central sedative property

INDICATIONS

- In allergies urticaria

itching

angioedema

dermatitis

- Common cold

- Motion sickness

- Insect bite

- To decrease the BP


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CONTRAINDICATIONS

-Hypersensitivity

-Acute porphyria

TRADE NAME : Avil, Avil Retard

DOSAGE : Children-- syrup ------- 1-3 yrs : 2.5 ml TDS

3-12 yrs: 5 ml TDS

Inj ------- 0.6 2 ml i.m OD/BD

Adults -- oral ---- 25 50 mg TDS

inj ---- 1.2 ml i.m TDS

ADVERSE EFFECTS

- Abuse potential

- Dry mouth

- Blurred vision

- Constipation

- Retention of urine


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HYDROCORTISONE

INTRODUCTION

- It is a glucocorticoid ( corticosteroid)

- It causes adreno pituitary axis suppression

- They maintain fluid electrolyte balance

- They maintain functional status of skeletal, muscles and nervous system

INDICATIONS

- Acute allergic reactions

- Anaphylactic shock

- Status asthmaticus

- Addisons disease- Rheumatoid arthritis

- Pruritis

- Tubercular meningitis

- Infective eczema


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CONTRAINDICATIONS

- Neonates , infants

- Local/systemic infections

- Herpetic/fungal keratitis

- Cataract

TRADE NAMES : Corts, Lycortin, Primacort, Lutisoft cream, Neosporin H

DOSAGES : Anaphylaxis 100-150 mg/sec i.m 6 hourly

Status asthmaticus 100-200 mg i.v 6 hourly

ADVERSE EFFECTS

- Hyperglycaemia

- Hyperkalemia

- Delayed wound healing

- Water and sodium retention

- Osteoporosis

- Calcium deposition


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DEXAMETHASONE

INTRODUCTION

- Corticosteroid derivative

- Long acting, very potent, highly selective glucocorticoid

- It causes marked pituitary adrenal suppression

- Anti-inflammatory and anti-allergic properties

INDICATIONS

- Allergic conditions

- Overwhelming infection

- Inflammation in eye disorder

- Shock due to trauma

- Rheumatoid arthritis

- Adjuvant anti emetic

- Adrenal crisis

CONTRAINIDICATIONS


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CONTRAINIDICATIONS

-Diabetes mellitus

- Congestive heart failure

- Renal failure

- Tuberculosis

- Pyschosis

- Osteoporosis

TRADE NAME : Dexona, Dexavin, Decadan

DOSAGES : Children - 0.1 0.5 mg/kg/fay

Adults - 4-20 mg/day s.c/i.m/i.v

ADVERSE EFFECTS- Hyperglycaemia, glycosuria

- Delayed wound healing

- Osteoporosis

- Cushing syndrome


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DIAZEPAM

INTRODUCTION

- Prototype of benzodiazepine

- Sedative hypnotic action

- Skeletal muscle relaxant

- Anti convulsant actiond

- Potentiates the neural GABA mediated inhibition in CNS

INDICATIONS

- Anxiety, tension

- Psychosomatic and behaviour disturbances

- Status epilepticus

- Tetanus

-Dysmenorrhoea

- Termination of prolongd seizure

- Local anaesthetic seizure


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CONTRAINDICATIONS

- Hypersensitivity to benzodiazepines

- Acute narrow angle glaucoma

- Myasthenia gravis

TRADE NAMES : Calmpose, Calmod, Placidox

DOSAGES : Oral - 5-20 mg/day i.m in divided doses

inj 10mg/2ml i.v

ADVERSE EFFECTS

- Respiratory depression

- GIT disturbance

- Drug dependance and abuse


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FORTWIN PENTAZOCINE

INTRODUCTION

- Opioid analgesic

- Morphine like action

- It has agonist antagonist type action that is weak antagonist and

marked agonist actions

INDICATIONS

- Chronic , recurrent, moderate to severe pain which is

assosciated with - - - surgery

trauma

fractures

labour pains

burns

cancer


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CONTRAINDICATIONS

- Children below 12 years

- Hypertensives

- Ischaemia

- Myocardial infarction

TRADE NAMES : Fortwin, Fortagesic, Pentazocin, Pentawin

DOSAGES : 30 60 mg / ml i.v 3-4 hourly

ADVERSE EFFECTS

- Nausea, vomitting

- Euphoria- Respiratory depression

- Hypertension, tachycardia, palpitation

- Withdrawl syndrome (rarely)


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FUROSEMIDEINTRODUCTION

- It is a diuretic

- It causes loss of Nacl, Ca, K, Mg, PO 4, Na, water loss

- It causes pooling of blood in peripheral deep veins

- This effect occurs before the diversion and is important for the treatmentof

left ventricular failure and pulmonary edema

INDICATIONS

- Oedema in congestive heart failure, hepatic disease,

renal disease and pulmonary oedema

- Hypertension

- To treat hypercalcaemia

- To treat drug overdose ------ by inducing forced diuresis and

facilitate rapid elimination of drug

CONTRAINDICATIONS


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CONTRAINDICATIONS

- Hypovolaemia

- Hypotonia

- Hepatic coma

- Renal failure with anuria and potassium defenciency

TRADE NAMES : Lasix, Frusenex, Salinex

DOSAGES : Children : 20 40 mg / day

Adults : Oral -- 40 100 mg

Inj -- 20 mg / 2 ml inj

ADVERSE EFFECTS

- Fluid and electrolyte imbalance

- Visual impairment

- Hearing impairment, deafness

- Muscle cramps

- Paraesthesia


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PANCURONIUM BROMIDE

INTRODUCTION

- Long acting, non depolarizing, peripherally actingskeletal muscle relaxant

- Competitive antagonist of acetyl choline at neuro muscular junction

INDICATIONS

- Long acting skeletal muscle relaxant in surgical anaesthesia

- Assisted ventilation

CONTRAINDICATIONS

- Hypersensitivity

- Inadequate general aneasthesia

- Depressed ventilation


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TRADE NAMES : Pavulon, Fancuron

DOSAGES : 2 mg/ ml i.v

ADVERSE EFFECTS

- Hypotension

- Bronchospasm

- Reduction in GI motility

- Wheel and flare reactions at site of injection


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STYPTOCHROME

INTRODUCTION

- It is a haemostatic agent

- It is a preparation of adrenochrome mono semi carbazone

- It exerts haemostatic action by reducing capillary fragility

- It prevents microvessel bleeding

INDICATIONS

- Epistaxis

- Retinal haemorrhage

- Secondary haemorrhage from wounds

- Haematuria

- Menorrhagia

CONTRAINDICATIONS

- Hypersensitivity


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TRADE NAMES : Styptochrome, Cadisper c, Styptocid

DOSAGES : Pre operatively 2-6 ml at suitable intervals

Postoperatively 1-2 ml every 2 hours


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ETHAMSYLATE

INTODUCTION

- It is a haemostatic agent

- It decreases capillary bleeding when platelets are adequate

- It inhibits PGI 2 production

- It corrects abnormal platelet function

INDICATIONS

- Epistaxis

- After tooth extraction

- Hematuria

- Malena- After abortion

- Menorrhagia

- Post surgical conditions


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CONTRAINDICATIONS

- Hypersensitivity

- Porphyria

- History of thrombocytopenia

purpura

haemophillia

TRADE NAMES : Ethamsyl, Hemsyl, Stat

DOSAGES : Oral -- 500 mg tab post operatively

inj -- pre operatively - - 1-2 ampules 1 hour before surgery

postoperatively - - 1-2 ampules 4 to 6 hourly

ADVERSE EFFECTS

- Nausea , headache

- Skin rashes

- Fall in BP after i.v injection


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KETOROLAC

INTRODUCTION

- It is a non steroidal anti inflammatory drug (NSAID)

- It is a pyrrolo-pyrrole derivative of non selective cox inhibitor (conventionalNSAID)

- It is a potent analgesic, antipyretic, and anti inflammatory agent

- It relieves pain by peripheral mechanism

INDICATIONS

- Management of acute pain

- Post operative and acute musculoskeletal pain

- Renal colic

- Migraine

- Pain due to bony metastasis

- Post operative --inflammation

itching

allergy


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CONTRAINDICATIONS

- Hypersensitivity

- After ocular surgery

- Peptic ulcer

-Coagulation disorder

TRADE NAMES : Ketorol, Ketotifen, Ketanov, Cadolac

DOSAGES : Oral - - 20 40 mg/day

Inj - - 4 6 ml i.m

ADVERSE EFFECTS

- Gastric disturbances

- Ocular irritation

- Wound healing abnormalities

- Superficial keratitis


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AMINOPHYLLINE

INTRODUCTION

- It is a bronchodilator

- Stable mixture of theophylline and ethylene di amine

- Directly relaxes smooth muscles of bronchi and lungs

- Stimulates CNS

- induces diuresis

- Increases gastric acid secretion

INDICATIONS

- Reversible airway obstruction

- Severe acute asthma

CONTRAINDICATIONS

- Hypersensitivity

- Hypertension

- Peptic ulcer


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TRADE NAMES : Aminophylline, Deriphylline, Minophyl

DOSAGES : Oral - - 200-300 mg 3-4 times a day

Inj - - 200-500 mg slowly over 20 minutes

ADVERSE EFFECTS-Tachycardia

- GI disturbance

- Convulsions

- Severe hyperventilation


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SUCCINYL CHOLINE

INTRODUCTION

- It is an ultra short actiong ,peripherally acting , neuro muscular blockingskeletal muscles relaxant

INDICATIONS

- During General Anaesthesia

- During seizures

- Respiratory arrest during tracheal intubation

CONTRAINDICATION

- Glaucoma

- Myasthenia gravis

- In case of burns

- History of malignant hyperthermia


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TRADE NAMES : Scoline, Scolax, Succinyl chloride, Succin inj

DOSAGES : 20- 100 mg

ADVERSE EFFECTS

- Hypertension

- Hyperkalemia

- Hyperthermia

- Raised intra cranial pressure

- Muscle pain- Respiratory depression


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DEXTROSE

INTRODUCTION

- It is a hyperglycemic agent

- It rapidly elevates the blood glucose level by mobilizing hepatic

glycogen and converting it to glucose

INDICATIONS

- Severe hypoglycaemia

- Diagnostic tool in unconsciousness and

seizures of unknown origin

- Cardiogenic shock (rarely)

CONTRAINDICATIONS

- Chronic hypoglycaemia

- Hyperglycaemia

- Starvation states


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TRADE NAMES : Glucagon

DOSAGES : 1md dry powder + 1 ml diluent

(50 ml bottle for emergency kit 50 % dextrose)

ADVERSE EFFECTS

- Nausea, vomitting

- Allergic reaction

- Tissue necrosis if there is infiltration


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SODIUM BICARBONATE

INTRODUCTION

- It is an antacid n used to correct acidosis assosciated with hypoxia

cardiorespiratory arrest

metabolic acidosis

- Adequate ventilation is necessary whenever sodium bicarbonate is givenbecause

carbon di oxide is produced in this procedure

INDICATIONS

- Reversal of metabolic acidosis occurring during anaerobic metabolism in

cardiopulmonary arrest

- Calcium and vitamin D defeciency states

- Pregnancy and lactation

- Bladder washes\

- Auricular lavage

- Bronchial lavage


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CONTRAINDICATIONS

- In alkalosis

- Respiratory depression

- Hypocalcaemia

- Sodium overload

TRADE NAMES : Sodium bicarbonate

DOSAGES : 90 180 mEq / lit

ADVERSE EFFECTS

- Metabolic alkalosis with impairment of release of oxygen from Hb

- Sodium and water overload- Local pain

- Venous irritation


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CALCIUM GLUCONATE

INTRODUCTION

- Essential for cardiac function

muscle contraction

nerve activity and

blood coagulation

- To maintain standard integrity of all membranes

- It causes neuro transmitter release

DEFENCIENCY SIGNS AND SYMPTOMS :

- Osteoporosis

- Pathologic fracture

- Brittle nails and hair


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INDICATIONSORAL INJECTIONS

Mild hypocalcaemia Severe

hypocalcaemia

Growing children Hypoparathyroidis

Pregnancy Hyperkalemia

Lactation Cardiac arrest

Post menopausal women Every fourth bottleof

Rickets blood transfusion

Osteomalacia


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CONTRAINDICATIONS

- Renal calculi

- Hypophosphataemia

- Hypercalcemia

- Hypoparathyroidism

TRADE NAMES : Calciium sandoz, Calcid, Calcibom

DOSAGES : Oral -- 1 gram

Inj -- 10 % inj

ADVERSE EFFECTS

- Constipation

- Abdominal discomfort

- Bloating

- Dyspepsia

-Excess gas


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C d i i i l i l i


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Common drug interactions in oral surgical practice

Drug Interacting Drug Drug Interaction

1)Antihistamine CNS depressants Increased drowsiness and sedation

2)Salicylates 1) Anticoagulants

2) Antacids

3) Corticosteroid

4) Methotrexate

5) Oralhypoglycaemics

6) Phenytoin

Increased risk of bleeding

Premature release of aspirin

Increased risk of gastroitestinal

bleeding

Increased risk of methotrexate toxicity

Potentiates hypoglycaemic drugseffect

Increased effect of antiepileptics


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3) Atropine 1) Alcohol Impaired motor performance andincreased drowsiness.

4)Carbamazepine

5)Corticosteroids

1)Alcohol

2)Barbiturates,doxy cycline

oralhypoglycemicssteroids

3)Erythromycin

1)Anti diabeticdrugs

2)Anti hypertensives

3)Oral cotraceptives

Depressed CNS

Depressed CNSRetarded effect of drug

Increased carbamazepine isoniazidplasma level resulting in sedation

Corticosteroids may exacerbate diabetic

state by hypoglycemic actionAntagonism due to fluid retention

Increased anti-inflammatory response totopical steroids


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6) Cotrimoxazole 1)Diuretics

2)Anti coagulants,anti epileptics,oral hypoglycemics

Increased risk of thrombocytopenia inelderly

Potentiate action of these agents

7)Diazepam CNS depressants Intensified sedative effects

8) Doxy cycline 1) Penicillin

2) Barbiturates,antiepileptics

Reduced effect of penicillin

Possiblility of reduced plasmaconcentration of Doxy cycline.

9) Metronidazole 1) Alcohol

2) Antiepileptics

3) Anticoagulants

4) Barbiturates

Antagonism, therefore alcohol should beavoided

Incereased risk of toxicity of phenytoin

Potentiated anticoagulant effect

Reduced plasma level of metronidazole


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10)Penicillin oral Contraceptives Increased bleeding, possibly withcontraceptive failure

11)Tetracyclines Oral contraceptives

Oral hypoglycemic

Methotrexate

Increased bleeding due to contraceptivefaliure

Increased hypoglycemic effect

Incerased methotrexate toxicity


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References :

1. Essentials of medical pharmacology(By K.D.Tripathi).

2. A text book of pharmacology

(Satoskar).3. A text book of Oral and Maxillofacialsurgery (By B. Srinivasan).4. Contemporary Oran and MaxillofacialSurgery

(By Peterson).


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emergency drugs used in o.s. common drug interactions in o.s. practice oral surgery

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