Dental Theraputic & Med Emergencies- Ch 30/COMPLETE

organic drugs

derived from living organisms such as plants or animals

inorganic drugs

synthesized in the laboratory

most modern drugs are deprived from chemical sources, this makes them

1. purer in form

2. natural sources

Drugs are identified in three ways

Chemical name: The atomic or molecular structure of the drug

Generic name: A name that any business firm may use

Brand name or trade name: Controlled by a pharmaceutical company as a registered trademark

drugs are classified in two categories

Patent: medicines are drugs that can be obtained without a prescription

• Also referred to as over-the-counter (OTC) drugs

Prescription: drugs are licensed medicines that are regulated by legislation and require a prescription before obtained from a pharmacist

• Also referred to as ethical drugs

What is the Drug Enforcement Agency (DEA)?

They regulate and enforces the disbursement of classified drugs.

What are the schedule of different drugs?

Schedule I: No current accepted medical usefulness and a high potential for abuse (Heroin, LSD)

Schedule II: High potential for abuse but accepted medical usefulness as well (Adderall, Percocet)

Schedule III: Less abuse potential and accepted medical uses (Didrex)

Schedule IV: Low abuse potential and accepted medical uses (Valium)

Schedule V: Not required to be prescribed (Robitussin AC)

Schedule VI: Added classification only in a few states(Marijuana)

What are perscriptions?

A written order for medication (oral, skin, etc) provided by a physician or dentist. 

Only a professional legally authorized to prescribe medications may write a prescription

A professional who is authorized to prescribe medications is issued a federal DEA identification number

Prescription pad in the dental office is to be kept in a locked drawer

Superscription

Patient name and address, the date, the symbol Rx

inscription

name and quantity of the drug

subscription

directions for mixing the medication

signature

Instructions for the patient on how to take the medication, when to take it, and how much to take

what does every prescription require?

Dentist’s signature

Dentist’s DEA number

Telephone guidelines

Narcotics cannot be ordered without a written prescription

Illegal for a dental assistant to “call in” a prescription

When a pharmacist calls, notify the dentist immediately; do not try and relay information between them

If the dentist is unable to come to the telephone, take the pharmacist’s name and telephone number so the dentist can return the call

Never attempt to evaluate a patient’s reaction to a drug

Drug reference materials

Printed drug references such as the Physicians’ Desk Reference (PDR) or Mosby’s Dental Drug Reference are comprehensive with a list of all the drugs.

Physicians’ Desk Reference

• Updated source of information supplied by drug companies about their products

Mosby’s Dental Drug Reference

• Dental-specific source

package inserts

Information sheet that describes the drug

Specific information includes the following:

1. How the drug will affect the body

2. For what condition, the drug is being prescribed

3. Any adverse effects (e.g., drowsiness)

4. Any adverse long-term effects

5. Special precautions to follow when taking the drug

6. Contraindications to taking the drug

7. Dosage and route for the drug

Drug dosage

A dose is the amount of a drug that a patient takes

Specific factors in determining the dosage are:

Age of the patient

Weight of the patient

The time of day the drug is to be taken

Patient tolerance to the drug

forms of drugs

Pills, capsules, liquids, drops, ointments, sprays, gases, and lotions

ways a drug can be administered

Local-action drug: Applied directly to site of use

Systemic-action drug: Affect the whole body by circulatory system

Stages of drug action in the body

absorption: drug is absorbed at the site of the entry

distribution: the chemical compound of a drug is circulated throughout the body to be released

metabolism: once the chemical compound is released, the drug becomes metabolized and is then excreted through the liver or the kidneys

excretion: the drug leaves the body by the way of kidneys, liver, saliva, breast milk, and sweat

Drugs Commonly Prescribed in Dentistry

Analgesics

Antibiotics

Antifungal agents

Antiviral agents

Antianxiety agents

• These medications will be used prior to or after a clinical procedure, or taken because of a condition that has affected the oral cavity

Analgesics

Prescribed for the relief of acute pain, postoperative pain, and/or chronic pain

This type of drug lessens the sensory function of the brain by blocking pain receptors

Example: acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and aspirin. which is Indicated for mild to moderate pain

The opioid analgesics are prescribed for moderate to moderately severe pain. Most common type of drug prescribed is codeine

Antibiotics

Can be classified as bactericidal or bacteriostatic

Bactericidal antibiotics such as penicillin directly kill an infecting organism

Bacteriostatic antibiotics such as tetracycline and erythromycin inhibit the production of bacteria

Dental antibiotics come in a variety of forms including gels, threadlike fibers, microspheres, and mouth rinses

The most common types of antibiotics found in the dental setting are:

• Penicillin-less toxic

• Cephalosporin

• Erythromycin-nausea and upset stomach

• Chlorhexidine

• Tetracycline

• (If patient is allergic to Penicillin, the drug Clindamycin is prescribed.)

Antibiotic Prophylaxis

The prescribing of an antibiotic to a patient to prevent bacterial colonization

For many years, patients with certain heart conditions were prescribed an antibiotic to be taken prior to their dental treatment

In 2008, the American Heart Association released a new recommendation that most patients with cardiac conditions no longer need short-term antibiotics.

Antibiotic Prophylaxis Recommendations

The 2008 guidelines support the prescribing of preventive antibiotics for patients with the following:

• Artificial heart valve

• History of infective endocarditis

• Serious congenital heart conditions and those with repaired congenital defect

• Heart transplant

Antifungal Agents

Certain types of antifungal drugs are better at fighting certain types of fungi

Fungal infections can be diagnosed in patients who are immunocompromised, poorly fitting prosthesis, patients with xerostomia, and patients who are taking antibiotics

One of the most commonly prescribed drugs is Nystatin

Antiviral Agents

Viral infections such as hepatitis, hand-foot-and-mouth disease, primary herpes simplex, recurrent herpes, herpes zoster, and human immunodeficiency virus (HIV) can all affect the oral cavity

With most viral infections, some type of lesion commonly appears in the mouth

• Antiviral agents are prescribed in capsule, tablet, liquid, and ointment forms

• The most common antiviral agent is acyclovir (Zovirax)

Antianxiety Agents

Antianxiety agents have become a large part of “pain-free dentistry”

For patients who have hesitated going to the dentist because of their fear of pain

Drugs Commonly Prescribed in Medicine

Important to have background knowledge of the:

1.drugs that your patients are taking and

2. how they affect the patient’s total health

3. how they could interfere with their dental care

Cardiovascular Drugs

A series of drug classifications can be prescribed for patients with cardiovascular disorders

• Statins: Cholesterol lowering

• Diuretics: Reduce fluid retention

• Anticoagulants: Prevent blood clotting

• Antiplatelet drugs: Also work to keep blood clots from forming

• Beta-blockers: Control blood pressure, slow fast arrhythmias, reduce angina chest pain

• Digitalis: Stimulates the heart to beat more forcefully

• Vasodilators: Reduce the work of the heart

Respiratory Drugs

Respiratory disorders that require the use of medications

Agents from two drug classifications can be prescribed

• Inhibitors or anti-inflammatory drugs

• Bronchodilators

Gastrointestinal Drugs

Gastrointestinal tract disorders include heartburn, acid reflux disease, peptic ulcer, diarrhea, Crohn’s disease, and ulcerative colitis

Most of these drugs are over-the-counter:

• Acid reflux disease and peptic ulcer disease

• Antidiarrheal drugs

• Crohn’s disease and ulcerative colitis

Neurologic Drugs

Neurologic conditions include diseases such as

1.seizure disorders,

2. Parkinson disease,

3. multiple sclerosis,

4. Alzheimer’s disease

Psychoactive Drugs

Include antidepressants and anxiety, antipsychotic, and antimanic drugs

Examples include:

• Antianxiety drugs

• Antidepressant drugs

• Antimanic/bipolar disorder drugs

• Antipsychotic drugs

Endocrine/Hormonal Drugs

Endocrine drugs correct the overproduction or underproduction of the body’s natural hormones

Specific drugs associated with diabetes are metformin and insulin

Estrogen and progesterone are used in birth control pills and are also prescribed to women for relief of symptoms of menopause

Adverse Drug Effects

The body's negative reactions to a drug

Review the printed insert with the patient to discuss any of the possible adverse effects that a drug could cause

Drugs can possibly interfere with normal function and may even create a potentially life-threatening circumstance

Common Adverse Effects of Medications

Hyperexcitability

Insomnia

Dizziness

Drowsiness

Central nervous system effects

Changes in bleeding time

Hypertension

Hypotension and fainting

Weight changes

Appetite changes

Edema

Blurred vision

Sexual dysfunction

Sweating

Opportunistic infections (yeast, fungal)

Photosensitivity

Drug Complications

Allergic reaction

• A drug triggers the immune response

• Reactions can range from a common rash to life-threatening anaphylactic shock

Drug toxicity

• Toxin-induced cell damage and cell death

Drug interaction

• When multiple drugs are introduced to the body system

Drug tolerance

• Loss of effectiveness of a drug over time

Drug addiction

• Physical dependence on a drug

Opioid Addiction

Opioids are a class of drugs that include:

• Heroin

• Fentanyl

• Pain relievers like oxycodone, acetaminophen and hydrocodone combination (Vicodin), codeine, morphine, and many others

Addiction crisis in the United States

Recommendations by ADA

• Consider using non-narcotic pain relievers as first line of treatment

• When an opioid pain reliever is indicated, prescribe fewer pills

• Counsel patients about benefits and drawbacks of using opioid analgesics

• Learn to recognize when a patient might have a substance abuse use disorder or be prone to addiction