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THERAPUTICS

THERAPUTICS. DR.LINDA MAHER. DRUG. It is a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body. FORMS OF THE DRUG. FORMS OF THE DRUG. TABLETS CAPSULES LOZENGES SYRUP SOLUTION SPRAY

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THERAPUTICS

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  1. THERAPUTICS DR.LINDA MAHER

  2. DRUG It is a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body

  3. FORMS OF THE DRUG

  4. FORMS OF THE DRUG • TABLETS • CAPSULES • LOZENGES • SYRUP • SOLUTION • SPRAY • GEL • CREAM • OINTMENT • LOTION • SUPPOSITORY

  5. TABLET CAPSULE SYRUP LOZENGE SUPPOSITORY SPRAY

  6. OINTMENT INHALATION NEBULIZATION IV IM

  7. ROUTS OF DRUG ADMINISTRATION 1\ ENTERAL: DELIVERED THROUGH GASTRO INTESTINAL TRACT (GIT) (SYSTEMIC EFFECT) 2\ PARENTERAL: DELEVERED BY ROUTS OTHER THAN GIT (SYSTEMIC EFFECT) 3\ TOPICAL (LOCAL EFFECT)

  8. 1\ Enteral route PO PR

  9. 2\ Parentral route 1\ inhalation(INH) 2\Nibulization(NIB) 3\Injection(INTRA MUSCULAR –IM) (INTRAVENOUS- IV) OR( SUBCUTANEOUS –SC) 4\Per vagina(PV)

  10. 3\TOPICAL ROUTE • ADMINISTRATION OF DRUG DIRECTLY TO THE SKIN OR ANY MUCOUS MEMBRANE • EYE- NOSE –EAR …… ETC • FORMS OF TOPICAL ADMINISTRATION: • cream – ointment –lotion- gel-spray- solution –transdermal patch

  11. HOW TO PRESCRIBE A DRUG All written prescriptions should contain: 1\patient’s name ,and address 2\prescriber’s name ,address and telephone numb. 3\signature of the prescriber 4\drug name and dose 5\directions for use and refill instructions

  12. ABBREVIATIONs • od once a day • bd twice a day • tds three times per day • qds four times per day • Prn as required • q8 hours every 8 hours

  13. Prescription order 1\medication desired 2\dose desired 3\administration route 4\administration rate E.g. Paracetamol 500mg PO qds

  14. THERAPUTICS IN ORAL MEDICINE 1\COVERING AGENTS 2\ANALGESICS 3\ANTIBIOTICS 4\ANTIFUNGALS 5\ANTI INFLAMMATORY 6\ANTIDEPRESSENTS –ANTIHISTAMINS-SEDATIVES

  15. 1\COVERING AGENTS Number of gels and pastes that provide mechanical protection of ulcerative areas in the mouth. Example: Carmellose gelatin gel (orabase gel )

  16. 2\ANALGESICS Drugs that are used for pain relief (pain killers) Most of dental pain is inflammatory in origin and hence most responsive to drugs with an anti inflammatory components e.g. aspirin and NSAIDs (1)ASPIRIN: used in mild to moderate pain It is also a potent antipyretic *Side effect: can cause transient gut irritation

  17. *Contra indications of aspirin: 1\children <12 years 2\gastro intestinal ulceration 3\concurrent anti coagulant therapy *Dose of aspirin: 600-900 mg ,PO 4 hourly

  18. (2)IBUPROFEN Used for mild to moderate pain Has moderate antipyretic action Less irritant to gut than aspirin Dose: 400-600 mg PO 8hourly

  19. (3)PARACETAMOL: has no anti inflammatory action Moderate antipyretic Does not cause gastric irritation or interfere with bleeding times Over does can lead to liver failure Dose: 1000mg, PO, 6 hourly MAXIMUM DOES: 4g/24 hours in adults

  20. (4)diclofenac sodium: It is a med-potency NSAID(non steroidal anti –inflammatory) Available in tablets , IM injections and suppository Not usually used in general dental practice(mainly within hospitals) Useful alternative to opioids Dose: 50 mg tds after meals

  21. (5)opioid analgesics Analgesic drugs that act on central nervous system and have no anti inflammatory effect e.g. (Pethedine –dihydrocodeine –carbamezipine) Although opioids are effective analgesics in general, they show poor analgesic efficacy in dental pain and similar results can be achieved with other drugs with less sever side effects

  22. 3\ANTIBIOTICS(AB) Antibiotics are drugs that are used to prevent or treat bacterial infections Types of bacteria: 1\ACCORDING TO GROWTH REQUIREMENTS: -aerobic (grow in high oxygen levels) -anaerobic (grow in low oxygen levels) 2\ACCORDING TO GRAM STAIN: -gram + (have cell wall) -gram - (no cell wall)

  23. Types of antibiotics according to their action: 1\bactericidal: (kills microorganisms) 2\bacteriostatic:(inhibits the growth of microorganism) Types of(AB) According to the range of activity: 1\broad spectrum (active against large number of bacterial species 2\narrow spectrum (active against small number of bacterial species)

  24. Principles of antibiotic use Take into consideration: 1\the patient 2\the likely organism 3\the best drug

  25. 1\THE PATIENT: Patient influence the choice, in that 1-he may be allergic to various drugs 2-may have hepatic or renal impairment 3-immunocompromized 4-unable to swallow 5-pregnant or breast feeding 6-also consider the age and severity of infection

  26. 2\THE MICROORGANISM: Ideally the infective organism should be isolated and cultured to determine its sensitivity to antibiotics. But in reality most infections are treated blind. So, it is essential to know the common infecting organisms in dental field and their sensitivities

  27. 3\THE DRUG: consider: 1-mode of action 2-absorbtion and pharmacological properties 3-side effects

  28. PRESCRIBABLE ANTIBIOTICS IN DENTAL FIELD: 1\PENICILLINS a\natural penicillin e.g. penG B\amino penicillin e.g. amoxicillin and ampecillins amoxicillin: broad spectrum dose:250-500 mg PO tds Augmentine (amoxicillin + clavulanic acid) have prolong action than amoxicillin

  29. 2\TETRACYCLINE: Broad spectrum Contra indicated: 1\ in children <12 years 2\pregnant women Dose: 250-500 mg PO qds

  30. 3\ERYTHROMYCIN: similar spectrum to penicillin used in penicillin resistant microorganism dose: 250-500 mg PO/IV qds

  31. 4\cephalosporin: little value in dental practice

  32. Antibiotics can be used as: 1\Treatment of infections 2\Prophylactic cover to prevent infections(given before surgical treatment) Why use prophylaxis: We all have bacteria in our mouths, and a number of dental treatments—and even daily routines like brushing or flossing—can allow that bacteria to enter the bloodstream (bacteremia). For most of us, this isn’t a problem. A healthy immune system prevents these bacteria from causing any harm. There is concern, however, that for some people bacteremia can cause an infection elsewhere in the body.

  33. High risk patients: 1\ patient with infective endocarditis 2\ prosthetic (artificial) heart valves 3\some congenital heart diseases

  34. 4\ANTIFUNGALS Drugs that are used for treatment of fungal infections Main fungal pathogen in oral cavity is(Candida Albicans) Antifungal drugs are: 1\ nystatine 2\Amphotericin B 3\Miconazole 4\Fluconazole

  35. 5\ANTI INFLAMMATORY CORTICOSTEROIDS NON STEROID ANTI INFLAMMATORY DRUGS ( NSAIDs) Types: 1\topical steroid 2\intra lesional steroids 3\intra articular 4\systemic Examples : hydrocortisone Analgesic , antipyretic and anti inflammatory Examples: Aspirin ibuprofen

  36. THANK YOU .

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