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المزاج الحالي: مبتهج

تاريخ المشاركة 19/10/2010 - 22:08







Diclofenac sodium (Diclogestic, Voltarol)


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Description


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


Indications


Pain and inflammation associated with musculoskeletal disorders,

e.g. rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

Postoperative pain.


Effects on oral and dental structures


Patients on long-term NSAIDs such as diclofenac sodium may be

afforded some degree of protection against periodontal breakdown.

This arises from the drug’s inhibitory action on prostaglandin synthesis.

The latter is an important inflammatory mediator in the

pathogenesis of periodontal breakdown.


Effects on patient management


Rare unwanted effects of diclofenac sodium include angioedema and

thrombocytopenia. The latter may cause an increased bleeding tendency

following any dental surgical procedure. If the platelet count is

low (100,000) then the socket should be packed and sutured. Persistent

bleeding may require a platelet transfusion.


Drug interactions


Ibuprofen, aspirin and diflunisal should be avoided in patients taking

diclofenac sodium due to an increase in unwanted effects, especially

gastrointestinal ulceration, renal and liver damage. Systemic

corticosteroids increase the risk of peptic ulceration and gastrointestinal

bleeding.


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#32 MohdShaya

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المزاج الحالي: مبتهج

تاريخ المشاركة 19/10/2010 - 22:29







شكراً لك على الاستمرار ،، <<< متابع بقوة







الـتـوقـيــع

الـجـراد يـأكـل البـعـوض،
والعصفور يفترس الجراد،
والحيّة تصطـاد العصافير،
والـقنفـذ يـقـتـل الـحيّـة،
والـثعـلـب يأكـل الـقنفذ،
والـذئـب يفترس الثعلب،
والأسـد يـقـتـل الـذئـب،
والإنسان يصطاد الأسد،
والبعوض يميت الإنسان ...

هذه هي السلسلة الخالدة لا تبديل لها ولا تغيير.

إما أن تقتل الأسد وإما أن يقتلك البعوض !!
فيا شباب ! لا يغلبكم البعوض ولكن اغلبوا الأسود.

( علي الطنطاوي )


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المزاج الحالي: مبتهج

تاريخ المشاركة 28/10/2010 - 17:40








Digoxin (Lanoxin)


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Description


A cardiac glycoside that was originally obtained from the leaves of

the foxglove (Digitalis).


Indications


In the treatment of cardiac failure in association with atrial fibrillation.

Effects on oral and dental structures

Has been known to cause pain similar to trigeminal neuralgia in the

lower third of the face.


Effects on patient management


Digoxin is a drug with a low therapeutic index and a slight increase in

plasma concentrations can cause digoxin toxicity. Hypokalaemia predisposes

to digoxin toxicity and epinephrine containing local anaesthetic

solutions can cause hypokalaemia. No more than 3 cartridges

should be used at any one time on adult patients taking digoxin.


Drug interactions


NSAIDs, such as ibuprofen, may exacerbate heart failure, reduce GFR

and increase plasma concentrations of digoxin. Erythromycin

enhances the action of digoxin. Systemic amphotericin can cause a

hypokalaemia which enhances digoxin toxicity. Non-steroidal antiinflammatory

drugs (e.g. ibuprofen) may exacerbate heart failure andincrease plasma concentrations of digoxin leading to toxicity. Systemic

amphotericin will exacerbate a digoxin-induced hypokalaemia.



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المزاج الحالي: مبتهج

تاريخ المشاركة 28/10/2010 - 17:44









Warfarin sodium



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Description


A coumarin oral anticoagulant.


Indications


Prophylaxis of embolisation in atrial fibrillation, patients which

prosthetic heart valves; prophylaxis and treatment of venous thrombosis

and pulmonary embolism.


Effects on oral and dental structures


Warfarin therapy has been associated with haemorrhage into the

submandibular salivary glands. This can present as pain and swelling

in the floor of the mouth.


Effects on patient management


The main impact on patient management is the risk of haemorrhage

after any dental procedure associated with blood loss. Consultation

with the patient’s physician is essential if elective surgery, such as

removal of an impacted third molar, is required for patients taking

warfarin. This is to confirm that dosages can be altered. In most

instances, the patient will be required to stop their warfarin for

48 hours prior to the planned procedure. This time period is

required because the drug has a long half-life (37–38 hours) and

because of the variable rate of hepatic synthesis of the clotting proteins.

Prior to surgery, the patient’s INR may be reassessed.

Emergency single extractions can be carried out on patients taking

warfarin provided that their INR does not exceed 2–2.5 times the

normal value. Sockets should be packed and sutured. If haemorrhage

does occur, the anticoagulant effect can be reversed by the intravenous

administration of fresh frozen plasma. In very severe cases,

vitamin K (phytomenadione, 10–20 mg) should be given via an

intravenous infusion.

In some situations, a physician may be reluctant to stop a patient’s

warfarin therapy. In such instances, the patient is admitted to hospital

and their anticoagulant control switched to heparin. It may take

several days to achieve the appropriate haematological profile. However,

the short half-life of heparin (1–2 hours) allows for greater

flexibility in controlling the patient’s coagulation.


Drug interactions


Warfarin is extensively protein bound and is metabolized in the

liver. Thus any drug that competes with the protein binding site or

affects the drug metabolizing enzymes in the liver is going to affect

warfarin blood concentrations and its anticoagulant actions. Anticoagulant

effect of warfarin is increased by aspirin, diclofenac, diflunisal,

flurbiprofen, ibuprofen, mefenamic acid, and by prolongedregular use of paracetamol. Anticoagulant effect is reduced by cephalosporins,

erythromycin, co-trimoxazole, and metronidazole. Broad

spectrum antibiotics such as ampicillin, and tetracyclines can also

alter a patient’s INR. Fluconazole, ketoconazole and topical miconazole

all enhance the anticoagulant effect of warfarin. Carbamazepine

reduces the anticoagulant actions of warfarin.



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المزاج الحالي: مبتهج

تاريخ المشاركة 28/10/2010 - 17:47









Desmopressin (DDAVP, Desmotabs)



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Description


A synthetic posterior pituitary hormone.


Indications


Diabetes insipidus, primary nocturnal enuresis.


Effects on oral and dental structures


Can cause xerostomia leading to an increased risk of root caries,

candidal infections and poor denture retention. If the xerostomia is

severe, dentate patients should receive topical fluoride and be offered

an artificial saliva.


Effects on patient management


Nothing of significance.


Drug interactions


None of any dental significance.



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المزاج الحالي: مبتهج

تاريخ المشاركة 28/10/2010 - 17:50









Procaine


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Description


An ester local anaesthetic.


Indications


Used to provide local anaesthesia by injection. When used intraorally

the addition of epinephrine is advised. The only indication as a

dental local anaesthetic is for those extremely rare individuals who

are allergic to the amide group of anaesthetics but not hypersensitive

to the ester group. Another use for procaine other than for local

anaesthesia is as an intra-arterial injection to counter arteriospasm

produced by inadvertent intra-arterial injection (procaine is an

excellent vasodilator).


Presentations


2 mL ampoules of 2% solution.


Dose


The maximum recommended dose of procaine is 6.0 mg/kg with an

absolute ceiling of 400 mg.


Contraindications


Allergy to the ester group of local anaesthetics and allergy to parabens.


Unwanted effects


Allergic reactions to the ester anaesthetics is more common than to

the amides such as lidocaine, consequently procaine is seldom used

in dentistry.


Drug interactions


Procaine can antagonize the activity of the sulfonamide antibacterials.



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المزاج الحالي: مبتهج

تاريخ المشاركة 28/10/2010 - 17:56








Rifampicin (Rifadin, Rimactane, Rifater,

Rifinah 150, Rifinah 300, Rimactazid 150,

Rimactazid 300)


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Description


A rifamycin antituberculous drug.


Indications


Treatment of tuberculosis, brucellosis, Legionnaire’s disease, and

serious staphylococcal infections.


Effects on oral and dental structures


This drug causes stomatitis, candidiasis, thrombocytopenic purpura

and an orange-red discolouration of saliva. Stevens–Johnson syndrome

may occur with this drug.


Effects on patient management


Only emergency dental treatment should be performed during active

tuberculosis and care must be exercised to eliminate spread of tuberculosis

between the patient and dental personnel, e.g. masks and

glasses should be worn and where possible treatment should be

performed under a rubber dam to reduce aerosol spread. This drugmay cause thrombocytopenia, leucopenia, and anaemia. Thrombocytopenia

may cause postoperative bleeding. If the platelet count is

low (100,000) then the socket should be packed and sutured.

Persistent bleeding may require platelet transfusion. Leucopenia and

anaemia may affect healing adversely. Any anaemia will need correction

prior to elective general anaesthesia and sedation.


Drug interactions


Rifamycins decrease the anticoagulant effect of warfarin and nicoumalone.

The effects of phenytoin are reduced during combined

therapy. The efficacy of the antifungals fluconazole, ketoconazole,

and itraconazole is reduced by rifampicin. Similarly, the effectiveness

of rifampicin is reduced by ketoconazole. Rifamycins accelerate the

metabolism of diazepam and corticosteroids, thus reducing the

effectiveness of these drugs.



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المزاج الحالي: مبتهج

تاريخ المشاركة 28/10/2010 - 18:01







Benzyl penicillin (Penicillin G, Crystapen)



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Description


A beta-lactam antibacterial drug.


Indications


Used to treat bacterial infections such as dental abscesses.


Presentations


600 mg and 1.2 g vials of powder for reconstitution for intramuscular

or intravenous administration (Penicillin G).


Dose


Adult: 600 mg–1.2 g four times a day.

Child: 1–12 years 100–300 mg/kg daily in 4–6 doses.

Contraindications

Hypersensitivity.

Precautions

Renal disease.

Unwanted effects

Hypersensitivity reactions.

Gastrointestinal upset.


Drug interactions


Penicillin reduces the excretion of the cytotoxic drug methotrexate,

leading to increased toxicity of the latter drug which may cause death.

There may be a reduced efficacy of oral contraceptives and other

methods of contraception are advised during antibiotic therapy. Penicillin

activity is decreased by tetracyclines. Penicillin G rarely increases

the prothrombin time when given to patients receiving warfarin. Probenecid,

phenylbutazone, sulphaphenazole, sulphinpyrazone, and the

anti-inflammatory drugs aspirin and indomethacin significantly

increase the half-life of penicillin G.


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المزاج الحالي: مبتهج

تاريخ المشاركة 28/10/2010 - 18:04








Glipizide (Glibenese)



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Description


A sulphonylurea oral anti-diabetic.


Indications


Diabetes mellitus.


Effects on oral and dental structures


Glipizide has been cited as causing oral lichenoid eruptions, erythema

multiforme and orofacial neuropathy. The latter can manifest

as tingling or burning in the lips and tongue. The drug is a rare cause

of blood disorders including thrombocytopenia, agranulocytosis,

and aplastic anaemia. The blood disorders could cause oral ulceration,

an exacerbation of periodontal disease and spontaneous bleeding

from the gingival tissues. If the platelet count is low (100,000)

then the socket should be packed and sutured. Persistent bleeding

may require a platelet transfusion.


Effects on patient management


The development of hypoglycaemia is the main problem associated

with glipizide. This problem is more common in the elderly. Before

commencing dental treatment, it is important to check that the

patients have had their normal food intake. If there is any doubt,

give the patient a glucose drink. As with any diabetic patient try and

treat in the first half of the morning and ensure the patient can eat

after dental treatment. If a patient on glipizide requires a general

anaesthetic then refer to hospital.


Drug interactions


Aspirin and other NSAIDs enhance the hypoglycaemic actions of

glipizide. Antifungal agents such as fluconazole and miconazole

increase plasma concentrations of glipizide. Systemic corticosteroids

will antagonize the hypoglycaemic properties of glipizide. If these drugs

are required, then consult the patient’s physician before prescribing.



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المزاج الحالي: مبتهج

تاريخ المشاركة 28/10/2010 - 18:07









Ketoprofen (Orudis)


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Description


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


Indications


Pain and inflammation associated with musculoskeletal disorders,

e.g. rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.


Effects on oral and dental structures


Patients on long-term NSAIDs such as ketoprofen may be afforded

some degree of protection against periodontal breakdown. This

arises from the drug’s inhibitory action on prostaglandin synthesis.

The latter is an important inflammatory mediator in the pathogenesis

of periodontal breakdown.


Effects on patient management


Rare unwanted effects of ketoprofen include angioedema and thrombocytopenia.

The latter may cause an increased bleeding tendency

following any dental surgical procedure.


Drug interactions


Ibuprofen, aspirin, and diflunisal should be avoided in patients taking

ketoprofen due to an increase in unwanted effects, especially gastrointestinal

ulceration, renal, and liver damage. Systemic corticosteroids

increase the risk of peptic ulceration and gastrointestinal bleeding.


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