Drug Prescription in Implant Dentistry

Iyad Abou-Rabii DDS. OMFS. MSc.PhD

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics) Therapeutics (Antibiotics) Q&A

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics) Therapeutics (Antibiotics) Q&A

Pharmacology Basics
Indication Contra-indication Text Dose

Denition

The reasons for administering a medication or performing a treatment

A factor that prevents the use of a medication or treatment (eg. Allergies)

The amount of a drug to be administered at one time

Pharmacology Basics
Effect
Text Side

effects

Toxic effects Effects that are an exaggeration of the effect that produces the therapeutic response

Denition

The desired result of administration of a medication

Effects that are not desired and that occur with normal dose

Medication names
Chemical names

Generic names

Trade name

Ofcial name

Routes of drug administration

Enteral tract routes Parenteral routes

Enteral and Parenteral Routes

Enteral route
Oral (PO) Orogastric /nasogastric (OG/ NG) Sublingual (SL) Buccal Rectal (PR)

Parenteral route
Topical Intradermal Intranasal Subcutaneous (SC) Intramuscular (IM) Intravenous (IV) Endotracheal (ET) Sublingual injection Intracardiac (IC) Intraosseous Inhalational Umbilical Vaginal Pulpal

Comparison of Enteral vs. Parenteral Routes

y Im Ver fo! In

ant ort p

No single method of drug administration is ideal for all drugs in all circumstances

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics) Therapeutics (Antibiotics) Q&A

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics Therapeutics (Antibiotics) Q&A

Prescription writing

Prescribing
The Dentist is legally responsible for the signed prescription Prescription should be indelible, dated, with full name and address of the patient Age of patient should be mentioned when under 12. Use generic drugs when possible

Essential Components of Prescriptions

All written prescriptions should contain: 1)Patient's full name and address 2)Prescriber's full name, address, telephone number, 3)Date of issuance 4)Signature of prescriber 5)Drug name, dose, dosage form, amount 6)Directions for use 7)Refill instructions

The Medication Order (Prescription)

Medication desired Dose desired Administration route Administration rate

Before any Drug prescription

Discuss with patient the possible consequences (god and bad) Prescribe drugs you know Keep updated (BNF, Vidalothers) Dose: consider age, physiology, and pathology Drug interactions

Prescribing instructions

Don`t use abbreviations for the drug names. Define the quantity supplied Directions should be in English with no use of the abbreviations

Prescribing instructions

When writing the dose Quantities of one gram is wrriten (1 g) Less than 1 g is written in milligrams (500 mg) Less than l mg should be written in microgram 100 microgram (not 0.1 mg) Nanogram and microgram should not be abbreviated

Latin Abbreviations

Rx : abbreviation of the Latin word "recipe x as a substitute period. # ac (ante cibum)

means "before meals" "twice a day"

# bid (bis in die) means

Latin Abbreviations

# po (per os)

means "by mouth" "after meals" means "as needed"

# pc (post cibum) means

# prn (pro re nata)

Latin Abbreviations

# q 3 h (quaque 3 hora)

means "every 3 hours"

# qd (quaque die)

means "every day"

# qid (quater in die) means

"4 times a day"

Clarks Rule
Clark's Rule Divide the childs weight (in pounds) by 150 to get the approximate fraction of the adult dose to give to the child. Example: For a 50 pound child give 50/150 (or 1/3) of the adult dose. Therefore, if the adult dose is 30 drops taken 3 times per day, the childs dose will be 10 drops taken 3 times per day (not 30 drops taken 1 time per day).

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics Therapeutics (Antibiotics) Q&A

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics) Therapeutics (Antibiotics) Q&A

Yes or No
The Dentist is the best judge of pain. A person with pain will always have obvious signs such as moaning, abnormal vital signs, or not eating. Addiction is common when opioid medications are prescribed. Morphine and other strong pain relievers should be reserved for the late stages of dying. Morphine and other opioids can easily cause lethal respiratory depression. Pain medication should be given only after the resident develops pain. No No No No No No

Ceiling Effect
100

75

50

25

Analgesics

Paracetamol

NSAIDS Opioids

Paracetamol
Indication Contraindication Dose

COX ?
Ibuprofen, ketorolac, diclofenac, aspirin

COX 1 COX 2

celecoxib ,rofecoxib, Nimesulide

Opioids
Action Efcacy Text Side effects

Opioids act on the central nervous system

Codeine Oxycodone, Hydrocodone Propoxyphene Dihydrocodeine Tramadol

nausea constipation dizziness sedation respiratory depression

What about Combination

Analgesic Analgesic

Analgesic

Paracetamol Combinations
Paracetamol Paracetamol/Codeine Paracetamol / Oxycodone or Hydrocodone More effective Rapid and long acting pain relief than did Tramadol or Paracetamol alone Paracetamol/ Tramadol

Mild Pain Short acting (2 hours) Mild to severe pain 30 min to 5 hours

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics) Therapeutics (Antibiotics) Q&A

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics Therapeutics (Antibiotics) Q&A

Best use of antibiotics

Cardinal Rules: Use the right drug. Use the right dose. Use the correct dosing schedule. Correct duration. Use a loading dose to rapidly achieve therapeutic blood levels. Avoid combinations of bacteriostatic and bacteriocidal drugs.

Best use of antibiotics

Chose well Narrow Spectrum? Extended/Broad Spectrum? Designer Antibiotics? Anaerobes? Consider if the infection is present > 3days or if no improvement

Best use of antibiotics

Identify your weapon Specic for the pathogen. Fewer disturbances of non-pathogenic bacteria. Fewer side effects. Rapid response for sensitive organisms. Ex: Pen VK, Pen G, Erythromycin Affects both Gram + and Gram - bacteria, better for mixed infections. May give up some effectiveness for Gram + to gain effectiveness for Gram Examples: Amoxicillin, Ampicillin

Best use of antibiotics

Identify you patients Age, allergies, compliance, pregnancy risk Patient function Renal, hepatic, immunosuppresion, route applicability Cost Brand name, length of course, alternatives?

Best use of antibiotics

Know your enemy (bacteria) Gram Positive? Gram Negative? Mixed Infection? Anaerobes?

Reminder
Broad Spectrum Narrow Spectrum Bacteriocidal Bacteriostatic Superinfection

Mechanism of Action:
1. Inhibition of Cell Wall Synthesis 2. Disruption of Cell Membrane 3. Inhibition of Protein Synthesis 4. Interference with Metabolic Processes

NB: Bactericidal Bacteriostatic

nt orta Imp ery V fo! In

Drainage is essential if there is pus: antibacterials will not remove pus;

What are the indications of antibiotic treatment ?

Indication of antibiotic treatment

(together with appropriate surgical drainage or other measures) Cervical fascial space infections; Osteomyelitis and osteoradionecrosis; Odontogenic infections in ill, toxic or susceptible patients (e.g. immunocompromised); Acute ulcerative gingivitis; Some instances of: pericoronitis; dental abscess; dry socket;

Prophylactic use of antibiotics

Infective endocarditis ; Cerebrospinal rhinorrhoea; Compound facial or skull fractures; Major oral and maxillofacial surgery (e.g. osteotomies or tumour resection); Surgery in immunocompromised or debilitated patients, or followi radiotherapy to the jaws.

Routes of antibiotics' administration

Topical
Text

Oral

Parenteral
Only when:
no oral preparation is available

Main point

Should usually be avoided, as they may cause the emergence of resistant strains.

Preferred in most instances

high blood levels are required rapidly

the patient cannot or will not take oral medications
the patient is to have a GA within the following 4 h.

Let us discuss about the best antibiotic to use...

Amoxicillin or oral Penicillin Erythromycin

Metronidazole

Clindamycin

Tetracycline

Conclusion
Odontogenic infections are typically polymicrobial. Anaerobes are implicated in many periimplantitis infections, and these often respond to penicillins or metronidazole Metronidazole is a good alternative. Erythromycin in another alternative (short courses) In severe cases: Tetracycline, or Clindamycin in limited cases.

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics Therapeutics (Antibiotics) Q&A

Agenda-Slide
1 2 3 4 5 Back to Basics Prescription writing Therapeutics (Analgesics) Therapeutics (Antibiotics) Q&A

Questions

Thank you.

Copyright notice
Feel free to use this PowerPoint for your personal, educational and business presentations with respect to proper referencing.

Do
Make a copy for backups on your hard drive or local network. Use this power point for your presentations and projects without modifications, or with referencing to it in case of partial utilization. Print hand outs or other promotional items. Link back to the presentation website. Display screenshots ooozy presentations on your website or blog. (should provide a link to the original site of the presentation no dowload purpose)

Please feel free to contact me on my email, if you do have any questions about usage.

Dont

Make it available on your website, portal or social network website for download. (Incl. groups, file sharing networks, Slideshare etc.) Edit or modify the downloaded presentations and claim / pass off as your own work.

All copyright and intellectual property rights, without limitation, are retained by Iyad Abou-Rabii. By downloading and using this presentation, you agree to this statement. dr.abourabii@gmail.com