EMERGENCY DRUGS USED IN DENTISTRY

Introduction
In dental practice different types of emergecy can occur which the dentist has to treat his own if no physician is available at that time. The emergencies which can occur are syncope,hypoglycemia,diabetic coma,convulsions,asthamatic attack,anaphylactic shock,angina pectoris,acute myocardial infarction,cardia arrest,acute adrenal cortical insufficiency and drug related emergency.

CATEGORY OF EMERGENCY DRUGS

A. Injectable drugs
Primary or essential 1.Epinephrine 2.Antihistamine 3.Narcotic antagonist 4. Anticonvulsant Secondary or non essential 1.Analgesic 2.Vassopressor 3.Corticosteroid 4. Antihypoglycemic Drugs for advanced cardiac life support 1.Sodium bicarbonate 2.Lidocaine 3.Atropine

B. Non-injectable drugs 1.Oxygen 2.Vasodialating agents 3.Respiratory stimulant 4.Antihypoglycemic agents 5.Bronchodialating agents

INJECTABLE DRUGS
PRIMARY INJECTABLES DRUGS 1. EPINEPHRINE a)Properties-it has got rapid onset of action,potent action as a bronchial smooth muscle dialator,anti-histaminic properties and vassopressor properties b)Side effects-tendency to predispose the heart to arrhythmias and relatively short duration of action. c)Indication cardiac arrest,anaphylaxis or an acute asthmatic attack d)Prfecaution-it should not be used in treatment of shock because it can decrese the venous return with increased ischemia and it can also precipitate ventricular fibrillation. -it should be used with caution in pregnency as it decreses the placental blood flow and may induce premature labor.

e)The rationale for the use of epinephrine for cardiac arrest is the beta-stimulation of the myocarium f)Availability-For parentral administration supplied in 1:1000 concentration each ml will contain 1mg of agent g)Administration- it can be administarted by I.V or Intra cardiac route.Dental personnel may give it into the frenulum under the tongue.Dose is 0.320.5mg of solution Sub-cutaneously or Intramuscularly

2.Antihistamine a)Drugs of choiceChlorpheniramine,diphenhydramine,pheniramine malate(Avil). b)Indication-It is usually used in delayed allergic reaction in which onset of symptoms is more than 1 hour after administration of allergens. c)Precaution-It is contraindicated in management of acute asthmatic episode,as thickening of bronchial secretion results from the drug drying action.

d)Availability-Chlorpheniramine(10 mg/ml I.V),Diphenhydramine(10 mg/ml) and pheniramine maleate(amp 1-2ml I.M) 3.ANTICONVULSANT a)Drug of choice-Diazepam and alternative drug is Barbiturate. b)Action-Diazepam or Barbiturate will terminate seizure activity without pronounced depression of respiratory and cardiovascular system. c)Side effects-Respiratory depression.

d)Availabitity and doses-Valium 5mg /ml e)Administration-It should be administrated I.V or I.M 4.NARCOTIC ANTAGONIST a)Drug of choice-Naloxone b)Indication- It is pure opioid antagonist and it is the drug of choice for opioid induced apnea. c)Action-More than one admionistration may be needed because of its short duration of action. d)Administration-It is given I.V but can be given sub-cutaneously or I.M

e)Dose-0.4mg/dl
SECONDRY INJECTABLE DRUGS 1.ANALGESIC DRUGS

a)Drug of choice-Morphine sulphate or Mepiridine. b)Indication-Acute myocardial infarction,congestive heart failure,intense prolonged pain and anxiety c)Side effects-CNS and Respiratory depression

d)Precaution-It is contra-indicated in head injuries and multiple trauma.It is also used with care in patient with compromised respiration. e)Availability-Morphine sulphate 10mg/ml and Mepiridine 50mg/ml 2.Vassopressor a) drug of choice methoxamine and phenyl ephrine b) action adrenergic agonist. It produces mild increase in blood pressure due to peripheral vasoconstriction

c) Indication acute adrenal insufficiency, drug overdose,hypotension and allergic reaction d)Precaution used in caution with hyperthyroidism, bradycadia,partial heart block,myocardial disease and atherosclerosis. e)Dose methoxamine 10mg/ml , phenyl ephrine 10 mg/ ml IV or IM 3.CORTICOSTEROID: a)Drug of choice hydrocortisone sodium succinate

b) Indication allergic reaction ,anaphylaxis and adrenal crisis. c) Action slow onset of action. 4.ANTIHYPOGLYCEMIC: a) Drug of choice 50% dextrose solution. b) B) indication to manage hypoglycemic episodes c) Administration - IV or IM

INJECTABLE DRUG FOR ADVANCED CARDIAC LIFE SUPPORTS

1.SODIUM BICARBONATE : It is effective in management of metabolic acidosis It elevates the pH of blood by combining with hydrogen in blood. Dose 300-500ml of 5% sodium bicarbonate IV 2.ATROPINE SULPHATE: It is a parasympathetic drug that decrease vagal tone. Indication sinus bradycardia accompanied symptomatic hypotension. Precaution not indicated in patient with MI.

3.LIDOCAINE: Used in cardiac arrhythmias especially those of ventricular orgin. NON INJECTABLE DRUGS: 1.OXYGEN: Most important drug in emergency Patient with chronic obstructive pulmonary disease should be given with caution because apnoea may result.

2.VASODIALATOR: Drug of choice nitroglycerine or amyl nitrate Indication to manage acute anginal attack and MI. Contraindication not given in hypotensive patient. Action taken sublingually, it acts in 1-2 mts Availability tab nitroglycerine- 0.1,0.3,0.6 mg Nitroglycerine spray 0.4mg Amyl nitrate vaporous 0.3ml

3.RESPIRATORY STIMULANT: Aromatic ammonia spirit used to treat syncope Action irritating the membrane of upper respiratory tract resulting in stimulation of respiration and blood pressure. Contraindication used with caution in asthma as it may precipitate asthma. Availability silver-grey vaporole- 0.3ml

4.ANTIHYPOGLYCEMIC AGENTS: Oral glucose or any available liquid carbohydrate is used to manage oral hypoglycemia in concious and semiconcious diabetic patients. 5.BRONCHODIALATING AGENTS: Drug of choice metaproterenol or epinephrine, isoproterenol Indication management of bronchoconstriction and allergic reaction. Contraindication tachy arrhythmias. Dose 1or2 inhalations every hour.

CONCLUSION: In dental practice different type of emergencies can occur which the dentist has to treat on his own if no physician is available at that time. the dental office emergency kit need not and indeed should not be complicated. It ought to remain as simple as possible.