Clinical drugs I

What is an **indication to alendronoc acid?**

* Osteoporosis

What are the **oral health considerations for alendrotnic acid?**

* Oesophageal irritation
* Risk of osteonecrosis of the jaw especially with IV form

What is the **pharmacological classification of androgenic acid?**

* Bisphosphonates (Others: Zoledronate & Pamidronate)

What is an indication to %%**Amitriptyline?**%%

* Depression
* Neuropathic pain (damage to the nervous system)

What are the **oral health consideration in** %%**Amitriptyline?**%%

* Consider issues associated with **xerostomia**

What are the pharmacological classification of Amitriptyline?

* Tricyclic antidepressants (TCAs)

What are the common types of Tricyclic antidepressants (TCAs)?

* Amitriptyline
* Amoxapine
* Desipramine (Norpramin)
* Doxepin
* Imipramine (Tofranil)
* Nortriptyline (Pamelor)
* Protriptyline
* Trimipramine

What are the common side effects in TCAs?

Some common possible side effects include:

* Drowsiness
* Blurred vision
* Constipation
* Dry mouth
* Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
* Urine retention

What are the indication(s) for %%**Amlodipine?**%%

* Blood pressure

What are the oral health considerations for %%**Amlodipine?**%%

* Increased risk of gingival overgrowth
* Consider blood pressure and haemostatic management following oral surgery.

What is the pharmacological classification for %%**Amlodipine?**%%

* Calcium channel blockers (Other: Nifedipine)

What do calcium channel blockers do?

* CCBs are used to lower blood pressure
* Used to control high blood pressure (hypertension), angina, and irregular heartbeats (arrhythmia)  

What is the %%**indications for Amoxicillin?**%%

* Bacterial antibiotics

what does amoxicillin do and what is it used to treat?

* Amoxicillin is a penicillin antibiotic
* It is used to treat bacterial infections, such as chest infections (including pneumonia) and dental abscesses.

What are the pharmacological classifications for Amlodipine?

* Penicillin antibiotic (Others: Ampicillin, Co-Amoxiclav)

What is the indications for Apixaban?

* Atrial Fibrillation
* PE (pulmonary embolism) & DVT (deep vein thrombosis)
* Stroke prevention
* e.g., knee or hip replacement surgery

What does Apixaban do?

* Apixaban is an Anticoagulant
* It makes your blood flow through your veins more easily, which means your blood is less likely to make blood clots
* It's used to treat people who have had a health problem caused by a blood clot, such as: a blood clot in the leg (deep vein thrombosis, or DVT)

What are the types of anticoagulants?

They are commonly called blood thinners and increase the time it takes for a blood clot to from

Types:

* Rivaroxaban
* Dabigatran
* Apixaban
* Edoxaban
* Warfarin

What do %%**Antiplatelets do?**%%

* %%**Antiplatelet agents prevent platelets from clumping**%% and also **prevent clots from forming and growing.**
* Antiplatelet drugs can reduce the chance of a heart attack because they prevent abnormal clotting in the arteries by telling platelets not to stick together and form a blood clot.

What are the different types of Antiplatelet drugs?

* **ASA,** also called ***acetylsalicylic acid*** (Aspirin, Asaphen, Entrophen, Novasen)
* Clopidogrel
* Prasugrel
* Ticagrelor
* Cilostazol
* Dipyridamole

What are the oral health considerations of Apixaban?

* Consider haemostatic management following oral surgery.
* Patients undergoing treatment with oral **anticoagulants have a greater risk of haemorrhaging when receiving invasive dental treatments**

How do you assess a bleeding risk?

Assessing Bleeding Risk:

• Assess whether the required dental treatment is likely to cause bleeding and, if so, whether it has a low or higher risk of bleeding complications.

• Ask the patient about their current or planned use of anticoagulants or antiplatelet drugs and other prescribed and non-prescribed medications, when taking or confirming their medical history.

• Ask the patient whether their drug treatment is lifelong or for a limited time.

• Ask the patient about any medical conditions that they have.

• Ask the patient about their bleeding history.

Bleeding risks for dental procedures?

***Dental procedures that are unlikely to cause bleeding:***

* Local anaesthesia by infiltration, intraligamentary or mental nerve block
* Local anaesthesia by inferior dental block or other regional nerve blocks
* Basic periodontal examination (BPE)
* Supragingival removal of plaque, calculus and stain
* Direct or indirect restorations with supragingival margins
* Endodontics - orthograde
* Impressions and other prosthetics procedures
* Fitting and adjustment of orthodontic appliances

\
***Low risk of post-operative bleeding complications:***

* Simple extractionsd (1-3 teeth, with restricted wound size)
* Incision and drainage of intraoral swellings
* Detailed six-point full periodontal examination
* Root surface debridement (RSD)
* Direct or indirect restorations with subgingival margins

\
***Higher risk of post-operative bleeding complications:***

* Complex extractions adjacent extractions that will cause a large wound or more than 3 extractions at once

**Flap raising proceduresf including:**

•Elective surgical extractions

• Periodontal surgery

• Preprosthetic surgery

• Periradicular surgery

• Crown lengthening

• Dental implant surgery, Gingival recontouring, Biopsies

What are the pharmacological classification of Apixaban?

* NOACs (new oral anticoagulants) (Others: Rivaroxaban, Dabigatran)
* NOACs help to prevent harmful blood clots from forming in your blood vessels by making your blood take longer to clot, or by affecting the way in which clotting occurs

What are the indications of Aspirin?

* They decrease platelets aggregation
* Low-dose aspirin **helps to prevent heart attacks and strokes in people who are at high risk of them**.
* They are also NSAID - non-steroidal anti-inflammatory drug

What are the oral health considerations for Aspirin?

* Mouth ulcers as a result of placement of tablet along the buccal mucosa.
* Surgical interventions and haemostatic management
* Dry mouth

What are the pharmacological classification of aspirin?

* Anti-platelets
* Antiplatelet medications, such as **aspirin and clopidogrel**, are commonly used to reduce the risk of heart attack. 
* Antiplatelet drugs are **medications that prevent blood clots from forming**. They work by stopping your platelets from sticking together.

What do anti-platelets do?

* **Antiplatelet drugs can reduce the chance of a heart attack** because they prevent abnormal clotting in the arteries by telling platelets not to stick together and form a blood clot.
* **Aspirin irreversibly inhibits cyclo-oxygenase and blocks the production of thromboxane**

What is the indications of Azathioprine?

* Organ rejection
* Chronic inflammatory & autoimmune diseases
* Prevents renal transplant rejection

What is the oral health considerations for Azathioprine?

* Increased susceptibility to infections
* Development of mouth sores and ulcers

What are the pharmacological classification for Azathioprine?

* Immunosuppressant

What does Azathioprine do?

* Medication that treats diseases that have to do with your immune system.  
* Azathioprine is an **anti-inflammatory medicine used to treat rheumatoid arthritis and other inflammatory conditions**.

What is the indications for Bendroflumethiazide?

* Oedema
* Hypertension (high blood pressure)

What are the oral health considerations for Bendroflumethiazide?

* Consider issues associated with xerostomia
* Consider blood pressure and haemostatic management following surgical involvement

what are the indications for Biologics?

* Autoimmune disease
* e.g., types of arthritis, such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Biologics work by disrupting the inflammation process that leads to joint pain and destruction

what are the oral health considerations for Biologics?

* Impaired healing

What is the pharmacological classification for Biologics?

* Also called TNF blockers or anti-TNFs, these include: 
* adalimumab, certolizumab pegol, etanercept, golimumab and infliximab, and rituximab

What is the pharmacological classification for Bisoprolol?

* Beta adrenoreceptor blocker
* Atenolol

What are the indication for Bisoprolol?

* Hypertension
* Angina
* Heart Failure
* High blood pressure (hypertension)
* Classed at a Beta blocker - works by relaxing the blood vessels and slowing heart rate

What are the oral health consideration for Bisoprolol?

* Consider blood pressure and haemostatic management following surgical involvement.
* Dry mouth
* Cause blood sugar level changes

What are the indication for Candesartan?

* Hypertension

What is the pharmacological classifications for Candesartan?

* Angiotensin receptor blockers (ARBs)
* Used to treat high blood pressure and heart failure
* Others: irbesartan, valsartan, and losartan

What are the oral health consideration for Candesartan?

* Consider blood pressure and haemostatic management following surgical involvement
* Numbing of the lips and mouth
* Jaw pain
* Bleeding gums

What are the indications of Carbamazepine?

* Epileptic seizures
* Neuropathic pain
* Trigeminal neuralgia

What are the oral health consideration for Carbamazepine?

* Consider issues associated with xerostomia.
* Consider protocols for medical emergencies involving seizures.
* Consider management of trigeminal neuralgia.

What is the pharmacological classification for Carbamazepine?

* Anti-epileptics

What do Anti-epileptics (AEDs) do?

* Antiepileptic medications work in different ways to prevent seizures, either by decreasing excitation or enhancing inhibition

What are the types of anti-epileptic drugs?

* sodium valproate.
* carbamazepine.
* lamotrigine.
* levetiracetam.
* topiramate

What is used in a medical emergency for an epileptic seizure?

* Midazolam and diazepam
* %%**Buccal (oromucosal) midazolam**%% – is given into the buccal cavity (the side of the mouth between the cheek and the gum).
* ^^**Rectal diazepam – is given rectally (into the bottom)**^^

What are the indications for Citalopram?

* Depression

What are the oral health considerations for Citalopram?

* Consider issues associated with xerostomia.

What are the pharmacological classification for Citalopram?

* Selective serotonin reuptake inhibitor (Others: Sertraline, Escitalopram)
* Other drugs:
* citalopram
* dapoxetine
* escitalopram
* fluoxetine
* fluvoxamine
* paroxetine
* sertraline
* vortioxetine

What do selective serotonin re-uptake inhibitors do?

* SSRIs treat depression by increasing levels of serotonin in the brain. 

what are the indications for Clopidogrel?

* Decrease platelet aggregation - Decreased platelet aggregation may be due to: Autoimmune disorders that produce antibodies against platelets.
* Whereas - Platelet aggregation, the process by which platelets adhere to each other at sites of vascular injury

What are the oral health considerations for Clopidogrel?

* Surgical interventions and haemostatic management
* Bleeding more easily than normal (gingival bleeding)

Is Clopidogrel a blood thinner?

%%**YES**%% - Clopidogrel is an **antiplatelet blood-thinning medicine** that may help prevent future heart attacks, strokes, and other clot-related diseases in patients who have already had a heart attack, stroke, or have certain cardiovascular conditions

What is the pharmacological classification for Clopidogrel?

* Anti-platelets

What do anti-platelets do?

* Antiplatelets work by making your blood less sticky. This prevents arteries and stents from being plugged by clots.

What are the indications for Digoxin?

* Heart Failure
* Atrial Fibrillation

What are the oral health considerations for Digoxin?

* Consider protocol for medical emergencies MI & stroke.
* Gingival overgrowth
* Bleeding gums

What is the pharmacological classification for Digoxin?

* Cardiac Glycosides

what do Cardiac Glycosides do?

* Cardiac glycosides improve cardiac output (irregular heartbeat)in people who have heart failure

What is the indications for Ferrous Fumarate/Ferrous Sulphate?

* Anaemia

What are the oral health consideration for Ferrous Fumarate/Ferrous Sulphate?

* Consider symptoms of iron deficiency:
* Recurrent mouth ulcers
* Pallor of mucosa
* Glossodynia
* Atrophic glossitis

What is the pharmacological classification for Ferrous Fumarate/Ferrous Sulphate?

* Iron supplements
* Fumarate: Fersamal & Galfer
* Ferrous fumarate is a type of iron that's used as a medicine to treat and prevent iron deficiency anaemia
* Sulphate
* This medication is an iron supplement used to treat or prevent low blood levels of iron (such as those caused by anemia or pregnancy)

what do Ferrous Fumarate/Ferrous Sulphate do?

* Used to treat and prevent iron deficiency anaemia

What are the indications for Furosemide?

* CHF (congestive heart failure) - one or both heart chambers sop pumping blood
* Oedema

What are the oral health considerations for Furosemide?

* Consider issues associated with xerostomia

What is the pharmacological classification for Furosemide?

* Loop Diuretics
* Loop diuretics are **medications used in the management and treatment of fluid overload conditions such as heart failure**
* Drugs:
* The most commonly used loop diuretics are %%***furosemide, bumetanide, and torsemide***%%

What are the indictions for Gabapentin?

* Epileptic seizures
* Neuropathic pain

What are the oral health consideration for Gabapentin?

* Consider protocols for medical emergencies involving seizures.
* Consider issues associated with xerostomia.

What is the pharmacological classification of Gabapentin?

* Anti-epileptics

What are the indication for Glicazide?

* Types II diabetes (causes the level of sugar (glucose) in the blood to become too high)

What are the oral health consideration for Glicazide?

* Impact wound healing and periodontal disease
* Consider protocols for medical emergencies involving hypoglycaemia

What id the pharmacological classification of Gilcazide?

* Sulfonylureas
* Other drugs:
* Gliclazide
* Glipizide
* Glimepiride
* Tolbutamide

What do sulfonylureas do?

* They work mainly by stimulating the cells in the pancreas to make more insulin. They also help insulin to work more effectively in the body

what are the indications for Glyceryl Trinitrate (GTN) Spray?

* Angina
* Angina is **chest pain caused by reduced blood flow to the heart muscles**.

What are the oral health considerations for Glyceryl Trinitrate (GTN) Spray?

* Consider protocols for medical emergencies involving MI
* Use your **GTN medicine**. Take another dose after 5 minutes if the first one does not help.  Call 999

Where do you spay the GTN spray?

* Either the spray or tablet should be used under the tongue so they are absorbed most quickly.
* GTN also widens the blood vessels that go to the brain, which can cause some people to get a headache.

what is the pharmacological classification for Glyceryl Trinitrate (GTN) Spray?

* Nitrates
* Nitrates can reduce the stress on the heart by improving blood flow to the heart muscle. This will relieve angina symptoms.

what are the indications for Ibuprofen?

* Pain and inflammation

What is the oral health considerations Ibuprofen?

* Avoid prescribing to asthmatic patients

what is the pharmacological classification Ibuprofen?

* Non-steroidal antiinflammatory drug
* **Non**-**steroidal anti**-**inflammatory drugs** (NSAIDs) are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature. 

Examples of NSAIDs?

* Examples of **nonsteroidal anti**-**inflammatory drugs** are aspirin, ibuprofen, ketoprofen, celecoxib, diclofenac, and ketorolac

What are the indications for Insulin?

* Types I / II diabetes

What are the oral health considerations for Insulin?

* Impact wound healing and periodontal disease
* Consider protocols for medical emergencies involving hypoglycaemia

What is the pharmacological classification of Insulin?

* Insulin

What does insulin do?

* Insulin helps blood sugar enter the body's cells so it can be used for energy

What are the indications for Lansoprazole?

* GI diseases
* GORD (gastro-oesophageal reflux disease)

What are the oral health considerations for Lansoprazole?

* Dental relevance of GORD
* Bleeding gums
* Teeth erosion
* Enlarged gums
* Dry mouth

What are the pharmacological classification Lansoprazole?

* Proton pump inhibitor (Others: Omeprazole, Pantoprazole)
* omeprazole
* lansoprazole
* pantoprazole
* rabeprazole
* esomeprazole
* dexlansoprazole

What do Lansoprazole do?

* **Proton pump inhibitors** (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach.

What are the indications for Levetiracetam?

* Epileptic seizures

What are the oral health considerations Levetiracetam?

* Consider protocols for medical emergencies involving seizures.

What are the pharmacological classification for Levetiracetam?

* Anti-epileptic

What are the indications for Levothyroxine?

* Hypothyroidism (underactive thyroid)
* Hypothyroidism happens **when the thyroid gland doesn't make enough thyroid hormone**. 

What are the oral health considerations for Levothyroxine?

* Consider macro-glossia, salivary gland enlargement, burning mouth syndrome.

What are the pharmacological classifications for Levothyroxine?

* Thyroid hormones
* An underactive thyroid (hypothyroidism) is usually treated by taking daily hormone replacement tablets called levothyroxine.
* Levothyroxine replaces the thyroxine hormone, which your thyroid does not make enough of.

What are the indications for Metformin?

* Type II diabetes