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المزاج الحالي: مبتهج

تاريخ المشاركة 03/10/2010 - 12:47







:cream:

:thanks:



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المزاج الحالي: مبتهج

تاريخ المشاركة 03/10/2010 - 12:49









Paracetamol = (Acetaminophen,
Panadol, Calpol)


.

.

Description

A non-opioid analgesic.

Indications

Mild to moderate pain (e.g. headache) and to reduce pyrexia.

Presentations

(i) A 500 mg tablet.
(ii) A 500 mg soluble (dispersible) tablet.
(iii) Oral suspension 120 mg/5 ml and 250 mg/5 ml.
(iv) Suppositories 60 mg, 125 mg and 500 mg.

Doses

Adults: 0.5–1 g every 4–6 hours.
Children: 3 months–1 year 60–120 mg every 4–6 hours.
1–5 years, 120–250 mg every 4–6 hours.
6–12 years, 250–500 mg every 4–6 hours.

Contraindications

Patients with renal failure, since chronic use of paracetamol and
overdose can cause both papillary and tubular necrosis. The problem
of renal failure is compounded when paracetamol is combined with
centrally acting analgesics. Paracetamol can cause bronchoconstriction
in asthmatics, although the incidence is much lower than for
aspirin or other NSAIDs. Paracetamol is hepatotoxic in overdose
(see later) and should be avoided in patients with liver failure.

Precautions

Impaired liver function and asthmatics.

Unwanted effects

The main unwanted effect of paracetamol is hepatotoxicity in overdose.
The problem is compounded if there is a history of alcohol
abuse. Following overdose with paracetamol, the normal pathways
for metabolism (glucuronidation and sulphation) become saturated.
As a consequence, metabolism of the drug is directed to the formation
of a reactive metabolite, N-acetyl-p-benzoquinoneimine. Thismetabolite is toxic to hepatocytes leading to necrosis and fulminant
liver failure. The problem of paracetamol overdose is further compounded
by the lack of obvious signs and symptoms in the early
overdose stages. The patient may feel nauseous and vomit, which
may reassure them that the paracetamol has been eliminated. This is
followed by a period of apparent recovery until signs of hepatic
necrosis supervene 48–72 hours after ingestion of the tablet. Hepatic
damage almost invariably accompanies ingestion of 15 g or more.
Measuring a patient’s INR is a good indicator of liver damage.
Paracetamol overdose has to be treated promptly to avoid progressive
liver damage. The compounds used are methionine 2.5 g orally
every 4 hours for 16 hours or N-acetylcysteine 150 mg/kg IV.

Drug interactions

Prolonged use of paracetamol may enhance the anticoagulant action
of warfarin. The mechanism of this drug interaction is due to
paracetamol (only with prolonged use) causing damage to the hepatic
parenchymal cells which will lead to reduced synthesis of the
Vitamin K-dependant clotting factors (II, VII, IX and X). Warfarin
also exerts its anticoagulant action by inhibiting the synthesis of the
Vitamin K clotting factors. Drugs that effect gastric emptying (metoclopramide
and domperidone) increase the absorption of paracetamol.
This has been used therapeutically to improve the onset of
action for paracetamol, e.g. in the treatment of migraine.


.

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المزاج الحالي: مبتهج

تاريخ المشاركة 05/10/2010 - 17:26








Ferrous gluconate



An iron salt.

Iron deficiency anaemia.


None reported.


Nothing of significance.


Iron salts chelate tetracyclines which in turn prevent their absorption.The two drugs should not be given together..
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المزاج الحالي: مبتهج

تاريخ المشاركة 06/10/2010 - 19:00









Bupivacaine (Marcain)

.


Description

An amide local anaesthetic.

Indications

Used to provide local anaesthesia, especially long-lasting anaesthesia
after regional block injection.

Presentations

(i) 10 mL vials of 0.25%, 0.375%, 0.5% or 0.75% bupivacaine
for injection (containing 25, 37.5, 50 and 75 mg bupivacaine
respectively).
(ii) 10 mL vials of 0.25% and 0.5% bupivacaine with 1 : 200,000
epinephrine for injection (containing 25 and 50 mg bupivacaine
respectively with 50 g epinephrine).

Dose

Recommended maximum dose is 1.3 mg/kg with an absolute ceiling
of 90 mg.

Contraindications

Allergy to amide local anaesthetics.

Precautions

Reduce the dose in hepatic disease. Epinephrine-containing solutions
have additional precautions (see epinephrine).

Unwanted effects

Bupivacaine is more cardiotoxic than lidocaine.

Drug interactions

Success of bupivacaine when used as a regional (spinal) anaesthetic is
reduced by concomitant administration of the anti-rheumatic drug
indomethacin and in individuals who abuse alcohol (the mechanism
is not understood). The depressant effect on the heart produced by
bupivacaine is exacerbated by calcium-channel blockers but this is
probably only important if accidental intravascular injection of
the local anaesthetic occurs. As with lidocaine beta-blocking drugs,
especially propranolol, increase the plasma concentration of bupivacaine.
Serum levels of bupivacaine are also increased by diazepam.
The toxicity of bupivacaine has been reported to be increased when
used in combination with mepivacaine (probably due to displacement
of bupivacaine from its binding sites).

.

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المزاج الحالي: مبتهج

تاريخ المشاركة 07/10/2010 - 18:42










Tetracycline = (Achromycin, Deteclo)

Description

A bacteriostatic antibiotic.

Indications

Tetracyclines are rarely indicated in the management of dental infections
but are used in the treatment of periodontal disease.

Presentations

(i) 250 mg tablets.
(ii) 250 mg capsules.
(iii) Incorporation into slow release devices for application into
periodontal pockets.

Dose

250 mg four times daily to treat infections. When used in the management
of periodontal disease the duration of therapy is two weeks.

Contraindications

Pregnancy.
Breastfeeding.
Children under 12 years.
Kidney disease.
Systemic lupus erythematosus.

Precautions

Liver disease.

Unwanted effects

Staining of teeth and bones.
Lichenoid reactions.
Fixed drug eruptions.
Opportunistic fungal infections (‘tetracycline sore mouth’).
Hypersensitivity.
Photosensitivity.
Facial pigmentation.
Headache and visual disturbances.
Anaemia.
Hepatotoxicity.
Pancreatitis.
Gastrointestinal upset including pseudomembranous colitis.

Drug interactions

As tetracycline chelates calcium and other cations a number of drugs
(and foodstuffs such as dairy products) which contain cations reduce
the absorption of tetracycline. Among the drugs which reduce the
absorption of tetracycline are the ACE-inhibitor quinapril, antacids,
calcium, and zinc salts, ulcer-healing drugs such as sucralfate and
the ion-exchange resin colestipol. Similarly tetracyclines inhibit the
absorption of iron and zinc. Tetracyclines reduce the efficacy of
penicillins and cephalosporins.
Tetracycline raises blood urea levels and this effect is exacerbated
with combined therapy with diuretics. Tetracycline may enhance the
anticoagulant effect of warfarin and the other coumarin anticoagulants.
Tetracycline may interfere without the action of oral contraceptives
and alternative methods of contraception should be advised
during therapy. Tetracyclines have a hypoglycaemic effect and their
administration to patients receiving insulin or oral hypoglycaemics
should be avoided.
Tetracycline may increase the serum levels of digoxin, theophylline
and the anti-malarial medication mefloquine. Tetracycline may also
increase the risk of methotrexate toxicity. Combined therapy with
ergotamine can produce ergotism (the most dramatic effect of ergotism
is vasospasm which can cause gangrene). Patients who use a
contact lens cleaner containing thiomersal have reported ocular
irritation during tetracycline therapy. Cranial hypertension leading
to headache and dizziness may result with the combined use of tetracycline
and retinoids.


.


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المزاج الحالي: مكافح

تاريخ المشاركة 07/10/2010 - 19:01







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المزاج الحالي: مبتهج

تاريخ المشاركة 08/10/2010 - 17:00







يعطيك العافيه صراحه موضوع مفيد جدا

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المزاج الحالي: مبتهج

تاريخ المشاركة 08/10/2010 - 17:06









Tranexamic acid (Cyklokapron
)


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.



Description



An anti-fibrinolytic drug which inhibits plasminogen activation and
fibrinolysis.

Indications

To facilitate haemostasis in haemophilia, menorrhagia, and in
thrombolytic overdose. Also useful in hereditary angioedema.

Effects on oral and dental structures


None reported.

Effects on patient management


None of any significance.

Drug interactions

None of any dental significance.

.

.








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المزاج الحالي: مبتهج

تاريخ المشاركة 10/10/2010 - 00:53








Ibuprofen (Brufen, Nurofen, Fenbid)


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.



Description


A peripherally acting, non-steroidal anti-inflammatory analgesic that

is derived from propionic acid.


Indications


Pain with a significant inflammatory component (e.g. postoperative

pain after dental surgical procedures). Also used in the management

of musculoskeletal pain, dysmenorrhoea, and to reduce fever.


Presentations


A 200, 400 and 600 mg tablet.

As a suspension (Ibuprofen 100 mg/5 ml).

Effervescent granules (Ibuprofen 600 mg).


Dose


Analgesia for adults, Ibuprofen 1.2–1.8 g daily in divided doses. For

children, 20–40 mg/kg.


Contraindications


Ibuprofen is contraindicated in patients with a history of allergy to

aspirin or any other NSAID. The drug should not be prescribed to

asthmatics (can precipitate bronchoconstriction) or patients with a

history of angioedema and urticaria. Ibuprofen should not be prescribed

to patients with active peptic ulceration (ibuprofen is ulcerogenic)

or to patients with haemorrhagic disorders since it will affect

platelet aggregation. Ibuprofen should be used with caution in patients

who exhibit renal, cardiac or hepatic impairment since the repeated use

of the drug can result in a deterioration in renal function.


Precautions


Elderly, pregnancy, and breastfeeding mothers.


Unwanted effects


Ibuprofen is ulcerogenic although of all the NSAIDs, it has one of the

lowest risk of gastrointestinal irritation. This unwanted effect can be further

reduced by taking the drug with food or milk. Other rare unwanted

effects include blood disorders, fluid retention, renal damage, eye

changes, and the precipitation of Stevens–Johnson syndrome. Patients

who suffer from systemic lupus erythematosus may be susceptible to a

NSAID-induced aseptic meningitis. Excessive high doses of ibuprofen

can cause a metabolic acidosis; if untreated, this can lead to coma.


Drug interactions


Ibuprofen should not be given with other NSAIDs or aspirin since

using such combinations will increase the risk of unwanted effects.

The anticoagulant effects of both warfarin and heparin are enhanced

by ibuprofen and could increase the risk of haemorrhage. Ibuprofencan antagonize the hypotensive effects of the ACE inhibitors (e.g.

captopril, lisinopril). There is the additional increased risk of renal

impairment and hyperkalaemia with these drugs and ibuprofen. Antidiabetic

drugs such as the sulphonylureas are extensively protein

bound and can be displaced by ibuprofen leading to hypoglycaemia.

Ibuprofen can increase the risk of gastrointestinal haemorrhage if

given to patients taking antiplatelet drugs such as clopidogrel. Ibuprofen

should be avoided in patients taking beta-adrenoceptor blockers

as there will be an antagonism of their hypotensive effect. Ibuprofen

may exacerbate heart failure, reduce glomerular filtration rate and

increase plasma concentration of digoxin. Both ibuprofen and corticosteroids

(systemic) cause peptic ulceration, therefore avoid the combination.

The excretion of methotrexate is reduced by ibuprofen

which can lead to increased toxicity. Ibuprofen reduces the excretion

of the muscle relaxant baclofen. The excretion of lithium is reduced

by ibuprofen, thus increasing the risk of lithium toxicity.


.


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المزاج الحالي: مبتهج

تاريخ المشاركة 11/10/2010 - 18:27







Salbutamol (Accuhaler, Aerolin, Airomir,

Asmasal, Easi-breathe, Evohaler, Nebules,

Rotacaps, Ventodisks, Ventolin)


.


.


Description


A beta2-adrenoceptor stimulant.


Indications


Used in the management of asthma, and obstructive airway disease.

Effects on oral and dental structures

Xerostomia, taste alteration, and discolouration of the teeth may

occur.


Effects on patient management


respiratory problems. Aspirin-like compounds should not be prescribed

as many asthmatic patients are allergic to these analgesics.

Similarly, sulphite-containing compounds (such as preservatives in

epinephrine-containing local anaesthetics) can produce allergy in

asthmatic patients. Xerostomia may increase caries incidence and

thus a preventive regimen is important. If the xerostomia is severe,

artificial saliva may be indicated. The use of a rubber dam in patients

with obstructive airway disease may further embarrass the airway. If

a rubber dam is essential then supplemental oxygen via a nasal cannula

may be required.


Drug interactions


may be exacerbated by a reduction in potassium produced by high

doses of steroids and by epinephrine in dental local anaesthetics.


........................................................................................................................



Vancomycin (Vancocin)


.


.



Description


A glycopeptide antibiotic.


Indications


The only indication in dentistry is for the prophylaxis of endocarditis in

those having a general anaesthetic and who cannot receive amoxicillin.


Presentations


(i) 250 mg and 500 mg capsules.

(ii) Powder for reconstitution for injection in vials containing

250 mg or 500 mg.


Dose


As prophylaxis for endocarditis 1 g given by slow intravenous infusion

over 100 minutes prior to the procedure (gentamycin must be

administered in conjunction with this treatment at induction of

general anaesthesia). For children under 10 years the dose of vancomycin

is 20 mg/kg.


Contraindications


History of deafness.

Pregnancy and breastfeeding.


Precautions


Renal disease.


Unwanted effects


Ototoxicity.

Neuromuscular blockade.

Hypersensitivity reactions.

Haematological disorders (such as reduction in white cells and platelets)

may occur after prolonged use.

Rapid intravenous infusion can cause a number of reactions including

severe hypotension leading to shock and cardiac arrest. In addition

dramatic flushing may occur (‘red man’ syndrome).


Drug interactions


the adverse renal effects produced by the aminoglycosides such asgentamicin, amphotericin B, bacitracin, polymixin N, colistin, ketorolac,

viomycin, and cisplatin. The ototoxic effect of vancomycin is exacerbated

by aminoglycoside antibiotics such as gentamicin and by loop

diuretics. Vancomycin produces some neuromuscular blockade and

can thus enhance the action of neuromuscular blocking drugs such as

vecuronium and suxamethonium. The hypotension produced by rapid

intravenous infusion of vancomycin may be exacerbated by vasodilatory

drugs such as the calcium-channel blocking agent nifedipine.

Vancomycin enhances the anticoagulant effect of warfarin but not

to a significant degree. However monitoring of coagulation is advised

if vancomycin is administered to a warfarinized patient. The

reduction in white cell count produced by long term use of vancomycin

is exacerbated by concurrent therapy with the HIV treatment

drug zidovudine. When used to treat pseudomembranous colitis the

action of vancomycin in the gut is reduced when administered

concurrently with the ion-exchange resin cholestyramine. This effect

is not important when the antibiotic is administered parenterally.


.


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تم تعديل هذه المشاركة بواسطة Amber: 11/10/2010 - 18:44

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