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EMERGENCY DRUGS
USED IN ORAL SURGERY
&
COMMON DRUG INTERACTIONS
IN ORAL SURGICAL PRACTICE
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CONTENTS* Introduction
* Classification of the emergency drugs
* Individual emergency drug
* Drug interactions
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EMERGENCY DRUGS USED IN ORAL SURGERY
1. Adrenaline 11. Pancuroniumbromide
2. Atropine 12. Styptochrome
3. Dopamine 13. Ethamsylate
4. Metoclopramide 14. Ketorolac5. Phenaramine maleate 15. Aminophylline
6. Hydrocortisone 16. Succinyl choline
7. Dexamethasone 17. Dextrose
8. Diazepam 18. Sodium bicarbonate
9. Fortwin-pentazocin 19. Calcium gluconate
10. Furosemide 20. Chlorphenaraminemaleate
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CLASSIFICATION
Emergency drugs
Injectables Non Injectables
Oxygen
Vasodilators
Respiratory stimulants
Anti Hypoglycaemic
agents
Bronchodilators
Primary Secondary Drug foradvanced cardiac life
support
1) Adrenaline 1) Analgesic 1) Lidocaine
2) Antihistamine 2) Vasopressor 2) Atropine
3) Anti convulsant 3) Corticosteroid 3) Sodium bicarbonate
4) Narcotic antagonist 4) Antihypoglycaemic
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ADRENALINE
INTRODUCTION :
- It is an adrenergic drug.
- It increases heart rate,force of contraction and cardiac output.
- It constricts blood vessels.
- It increases mean BP.
- Potent bronchodilator
- It causes mydriases in eye that is pupil dilatation.
INDICATIONS :
- Anaophylactic shock
- In bronchial asthma
- In cardiac arrest
- With local anaesthesia
- To control post extraction haemorrhage
- To treat open angle glaucoma
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CONTRAINDICATIONS
- Hypersensitivity
- Hyperthyroidism
- Hypertension- Angina pectoris
- Diabetes mellitus
TRADE NAME : Adrenor, Asmotone
DOSAGE : 0.2-0.5 mg s.c , 0.5 % aerosol
in case of im /iv in conc of 1:10,000 to 1:1,00,000
ADVERSE EFFECTS
- Marked increase in BP
- photosensitivity, skin rashes
- palpitation, arrythmias
-anginal pain, ventricular failure
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ATROPINE
INTRODUCTION
- It is a parasympathetic drug
-Anticholinergic action- Antispasmodic action
- Antisecretory action
- Anti muscarinic action
- It causes tachycardia
- Anti dote for organo phosphate poisoning.
INDICATIONS
- Motion sickness
- Colics and dysmenorrhoea
- Anti parkinsonism
- Pre operatively to reduce secretions & salivation
- In bronchial asthma
- Severe sinus bradycardia
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CONTRAINDICATIONS
- Hypersensitivity to belladona alkaloid
- Glaucoma
- Prostatic hypertrophy
- Cardiac failure
- Thyrotoxicosis
TRADE NAME : Atro, Tropine, Atropine sulphate
DOSAGE : Children : oral 0.2 mg/kg
inj --0.3-0.6 mg i.m
Adults : 0.6- 2 mg/ml i.m
ADVERSE EFFECTS- Dry mouth, decreased salivation
- Decreased sweating
- Constipation
- Tachycardia, palpitations, arrythmias
- Mydriasis and cycloplegia
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DOPAMINE
INTRODUCTION
- Potent sympathomimetic agent
- Agonist for dopamine receptors in CNS,renal and other vascular beds
- Agonist for beta adreno receptors in heart
- At high doses it causes vasoconstriction
- At low doses it causes increase in renal blood flow, GFR, and sodium
excretion.
INDICATIONS
- Cardiogenic shock
- Septic shock
- Septicaemia
- Congestive heart failure
- Renal failure
- Heart failure
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CONTRAINDICATIONS
- Atrial/venticular tachy arrythmias
- Hyperthyroidism
- Pheochromocytoma
TRADE NAMES : Dopamine, Dopinga, Dopapins, Dopar, Dopat.
DOSAGE : Children 2-20 microgram/kg/min i.v
Adults -- 2-50 micrograms/kg/min i.v
ADVERSE EFFECTS
- Nausea , vomitting
- Tachycardia
- Palpitation
- Anginal pain
- Atopic beats
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METOCLOPRAMIDE
INTRODUCTION
- It is a pro kinetic drug -- causes forward propulsion of contents of stomach
- Centrally acting dopamine antagonist
- Acts on chemoreceptor trigger zone
- Peripherally acts to enhance the effect of A-ch at muscarinic receptors ingut
INDICATIONS
- As an anti emetic in nausea, vomitting
post operative vomitting
drug/disease induced vomitting
radiation sickness
morning/ motion sickness
- Gastritis
- Reflux oesophagitis
- Gastroenterology
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CONTRAINDICATIONS
- Gastro intestinal perforation/ obstruction
- Epilepsy
- Parkinsonism- Breast cancer
TRADE NAMES : Reglan, Perinorm, Metaclop, Emenil, Vominil
DOSAGE : oral 5-10 mg TDS
INJ. 2 ml TDS
ADVERSE EFFECTS
- Dizziness
- Diarrhoea
- Trismus,
- Tremors
- Gynaecomastia,
- Galactorrhoea
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PHENARAMINE MALEATE
INTRODUCTION
-It is an alkylamine derivative
- Antihistaminic
- Anti cholinergic property
- Anti muscarinic property
- Central sedative property
INDICATIONS
- In allergies urticaria
itching
angioedema
dermatitis
- Common cold
- Motion sickness
- Insect bite
- To decrease the BP
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CONTRAINDICATIONS
-Hypersensitivity
-Acute porphyria
TRADE NAME : Avil, Avil Retard
DOSAGE : Children-- syrup ------- 1-3 yrs : 2.5 ml TDS
3-12 yrs: 5 ml TDS
Inj ------- 0.6 2 ml i.m OD/BD
Adults -- oral ---- 25 50 mg TDS
inj ---- 1.2 ml i.m TDS
ADVERSE EFFECTS
- Abuse potential
- Dry mouth
- Blurred vision
- Constipation
- Retention of urine
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HYDROCORTISONE
INTRODUCTION
- It is a glucocorticoid ( corticosteroid)
- It causes adreno pituitary axis suppression
- They maintain fluid electrolyte balance
- They maintain functional status of skeletal, muscles and nervous system
INDICATIONS
- Acute allergic reactions
- Anaphylactic shock
- Status asthmaticus
- Addisons disease- Rheumatoid arthritis
- Pruritis
- Tubercular meningitis
- Infective eczema
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CONTRAINDICATIONS
- Neonates , infants
- Local/systemic infections
- Herpetic/fungal keratitis
- Cataract
TRADE NAMES : Corts, Lycortin, Primacort, Lutisoft cream, Neosporin H
DOSAGES : Anaphylaxis 100-150 mg/sec i.m 6 hourly
Status asthmaticus 100-200 mg i.v 6 hourly
ADVERSE EFFECTS
- Hyperglycaemia
- Hyperkalemia
- Delayed wound healing
- Water and sodium retention
- Osteoporosis
- Calcium deposition
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DEXAMETHASONE
INTRODUCTION
- Corticosteroid derivative
- Long acting, very potent, highly selective glucocorticoid
- It causes marked pituitary adrenal suppression
- Anti-inflammatory and anti-allergic properties
INDICATIONS
- Allergic conditions
- Overwhelming infection
- Inflammation in eye disorder
- Shock due to trauma
- Rheumatoid arthritis
- Adjuvant anti emetic
- Adrenal crisis
CONTRAINIDICATIONS
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CONTRAINIDICATIONS
-Diabetes mellitus
- Congestive heart failure
- Renal failure
- Tuberculosis
- Pyschosis
- Osteoporosis
TRADE NAME : Dexona, Dexavin, Decadan
DOSAGES : Children - 0.1 0.5 mg/kg/fay
Adults - 4-20 mg/day s.c/i.m/i.v
ADVERSE EFFECTS- Hyperglycaemia, glycosuria
- Delayed wound healing
- Osteoporosis
- Cushing syndrome
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DIAZEPAM
INTRODUCTION
- Prototype of benzodiazepine
- Sedative hypnotic action
- Skeletal muscle relaxant
- Anti convulsant actiond
- Potentiates the neural GABA mediated inhibition in CNS
INDICATIONS
- Anxiety, tension
- Psychosomatic and behaviour disturbances
- Status epilepticus
- Tetanus
-Dysmenorrhoea
- Termination of prolongd seizure
- Local anaesthetic seizure
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CONTRAINDICATIONS
- Hypersensitivity to benzodiazepines
- Acute narrow angle glaucoma
- Myasthenia gravis
TRADE NAMES : Calmpose, Calmod, Placidox
DOSAGES : Oral - 5-20 mg/day i.m in divided doses
inj 10mg/2ml i.v
ADVERSE EFFECTS
- Respiratory depression
- GIT disturbance
- Drug dependance and abuse
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FORTWIN PENTAZOCINE
INTRODUCTION
- Opioid analgesic
- Morphine like action
- It has agonist antagonist type action that is weak antagonist and
marked agonist actions
INDICATIONS
- Chronic , recurrent, moderate to severe pain which is
assosciated with - - - surgery
trauma
fractures
labour pains
burns
cancer
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CONTRAINDICATIONS
- Children below 12 years
- Hypertensives
- Ischaemia
- Myocardial infarction
TRADE NAMES : Fortwin, Fortagesic, Pentazocin, Pentawin
DOSAGES : 30 60 mg / ml i.v 3-4 hourly
ADVERSE EFFECTS
- Nausea, vomitting
- Euphoria- Respiratory depression
- Hypertension, tachycardia, palpitation
- Withdrawl syndrome (rarely)
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FUROSEMIDEINTRODUCTION
- It is a diuretic
- It causes loss of Nacl, Ca, K, Mg, PO 4, Na, water loss
- It causes pooling of blood in peripheral deep veins
- This effect occurs before the diversion and is important for the treatmentof
left ventricular failure and pulmonary edema
INDICATIONS
- Oedema in congestive heart failure, hepatic disease,
renal disease and pulmonary oedema
- Hypertension
- To treat hypercalcaemia
- To treat drug overdose ------ by inducing forced diuresis and
facilitate rapid elimination of drug
CONTRAINDICATIONS
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CONTRAINDICATIONS
- Hypovolaemia
- Hypotonia
- Hepatic coma
- Renal failure with anuria and potassium defenciency
TRADE NAMES : Lasix, Frusenex, Salinex
DOSAGES : Children : 20 40 mg / day
Adults : Oral -- 40 100 mg
Inj -- 20 mg / 2 ml inj
ADVERSE EFFECTS
- Fluid and electrolyte imbalance
- Visual impairment
- Hearing impairment, deafness
- Muscle cramps
- Paraesthesia
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PANCURONIUM BROMIDE
INTRODUCTION
- Long acting, non depolarizing, peripherally actingskeletal muscle relaxant
- Competitive antagonist of acetyl choline at neuro muscular junction
INDICATIONS
- Long acting skeletal muscle relaxant in surgical anaesthesia
- Assisted ventilation
CONTRAINDICATIONS
- Hypersensitivity
- Inadequate general aneasthesia
- Depressed ventilation
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TRADE NAMES : Pavulon, Fancuron
DOSAGES : 2 mg/ ml i.v
ADVERSE EFFECTS
- Hypotension
- Bronchospasm
- Reduction in GI motility
- Wheel and flare reactions at site of injection
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STYPTOCHROME
INTRODUCTION
- It is a haemostatic agent
- It is a preparation of adrenochrome mono semi carbazone
- It exerts haemostatic action by reducing capillary fragility
- It prevents microvessel bleeding
INDICATIONS
- Epistaxis
- Retinal haemorrhage
- Secondary haemorrhage from wounds
- Haematuria
- Menorrhagia
CONTRAINDICATIONS
- Hypersensitivity
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TRADE NAMES : Styptochrome, Cadisper c, Styptocid
DOSAGES : Pre operatively 2-6 ml at suitable intervals
Postoperatively 1-2 ml every 2 hours
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ETHAMSYLATE
INTODUCTION
- It is a haemostatic agent
- It decreases capillary bleeding when platelets are adequate
- It inhibits PGI 2 production
- It corrects abnormal platelet function
INDICATIONS
- Epistaxis
- After tooth extraction
- Hematuria
- Malena- After abortion
- Menorrhagia
- Post surgical conditions
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CONTRAINDICATIONS
- Hypersensitivity
- Porphyria
- History of thrombocytopenia
purpura
haemophillia
TRADE NAMES : Ethamsyl, Hemsyl, Stat
DOSAGES : Oral -- 500 mg tab post operatively
inj -- pre operatively - - 1-2 ampules 1 hour before surgery
postoperatively - - 1-2 ampules 4 to 6 hourly
ADVERSE EFFECTS
- Nausea , headache
- Skin rashes
- Fall in BP after i.v injection
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KETOROLAC
INTRODUCTION
- It is a non steroidal anti inflammatory drug (NSAID)
- It is a pyrrolo-pyrrole derivative of non selective cox inhibitor (conventionalNSAID)
- It is a potent analgesic, antipyretic, and anti inflammatory agent
- It relieves pain by peripheral mechanism
INDICATIONS
- Management of acute pain
- Post operative and acute musculoskeletal pain
- Renal colic
- Migraine
- Pain due to bony metastasis
- Post operative --inflammation
itching
allergy
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CONTRAINDICATIONS
- Hypersensitivity
- After ocular surgery
- Peptic ulcer
-Coagulation disorder
TRADE NAMES : Ketorol, Ketotifen, Ketanov, Cadolac
DOSAGES : Oral - - 20 40 mg/day
Inj - - 4 6 ml i.m
ADVERSE EFFECTS
- Gastric disturbances
- Ocular irritation
- Wound healing abnormalities
- Superficial keratitis
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AMINOPHYLLINE
INTRODUCTION
- It is a bronchodilator
- Stable mixture of theophylline and ethylene di amine
- Directly relaxes smooth muscles of bronchi and lungs
- Stimulates CNS
- induces diuresis
- Increases gastric acid secretion
INDICATIONS
- Reversible airway obstruction
- Severe acute asthma
CONTRAINDICATIONS
- Hypersensitivity
- Hypertension
- Peptic ulcer
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TRADE NAMES : Aminophylline, Deriphylline, Minophyl
DOSAGES : Oral - - 200-300 mg 3-4 times a day
Inj - - 200-500 mg slowly over 20 minutes
ADVERSE EFFECTS-Tachycardia
- GI disturbance
- Convulsions
- Severe hyperventilation
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SUCCINYL CHOLINE
INTRODUCTION
- It is an ultra short actiong ,peripherally acting , neuro muscular blockingskeletal muscles relaxant
INDICATIONS
- During General Anaesthesia
- During seizures
- Respiratory arrest during tracheal intubation
CONTRAINDICATION
- Glaucoma
- Myasthenia gravis
- In case of burns
- History of malignant hyperthermia
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TRADE NAMES : Scoline, Scolax, Succinyl chloride, Succin inj
DOSAGES : 20- 100 mg
ADVERSE EFFECTS
- Hypertension
- Hyperkalemia
- Hyperthermia
- Raised intra cranial pressure
- Muscle pain- Respiratory depression
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DEXTROSE
INTRODUCTION
- It is a hyperglycemic agent
- It rapidly elevates the blood glucose level by mobilizing hepatic
glycogen and converting it to glucose
INDICATIONS
- Severe hypoglycaemia
- Diagnostic tool in unconsciousness and
seizures of unknown origin
- Cardiogenic shock (rarely)
CONTRAINDICATIONS
- Chronic hypoglycaemia
- Hyperglycaemia
- Starvation states
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TRADE NAMES : Glucagon
DOSAGES : 1md dry powder + 1 ml diluent
(50 ml bottle for emergency kit 50 % dextrose)
ADVERSE EFFECTS
- Nausea, vomitting
- Allergic reaction
- Tissue necrosis if there is infiltration
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SODIUM BICARBONATE
INTRODUCTION
- It is an antacid n used to correct acidosis assosciated with hypoxia
cardiorespiratory arrest
metabolic acidosis
- Adequate ventilation is necessary whenever sodium bicarbonate is givenbecause
carbon di oxide is produced in this procedure
INDICATIONS
- Reversal of metabolic acidosis occurring during anaerobic metabolism in
cardiopulmonary arrest
- Calcium and vitamin D defeciency states
- Pregnancy and lactation
- Bladder washes\
- Auricular lavage
- Bronchial lavage
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CONTRAINDICATIONS
- In alkalosis
- Respiratory depression
- Hypocalcaemia
- Sodium overload
TRADE NAMES : Sodium bicarbonate
DOSAGES : 90 180 mEq / lit
ADVERSE EFFECTS
- Metabolic alkalosis with impairment of release of oxygen from Hb
- Sodium and water overload- Local pain
- Venous irritation
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CALCIUM GLUCONATE
INTRODUCTION
- Essential for cardiac function
muscle contraction
nerve activity and
blood coagulation
- To maintain standard integrity of all membranes
- It causes neuro transmitter release
DEFENCIENCY SIGNS AND SYMPTOMS :
- Osteoporosis
- Pathologic fracture
- Brittle nails and hair
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INDICATIONSORAL INJECTIONS
Mild hypocalcaemia Severe
hypocalcaemia
Growing children Hypoparathyroidis
Pregnancy Hyperkalemia
Lactation Cardiac arrest
Post menopausal women Every fourth bottleof
Rickets blood transfusion
Osteomalacia
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CONTRAINDICATIONS
- Renal calculi
- Hypophosphataemia
- Hypercalcemia
- Hypoparathyroidism
TRADE NAMES : Calciium sandoz, Calcid, Calcibom
DOSAGES : Oral -- 1 gram
Inj -- 10 % inj
ADVERSE EFFECTS
- Constipation
- Abdominal discomfort
- Bloating
- Dyspepsia
-Excess gas
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C d i i i l i l i
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Common drug interactions in oral surgical practice
Drug Interacting Drug Drug Interaction
1)Antihistamine CNS depressants Increased drowsiness and sedation
2)Salicylates 1) Anticoagulants
2) Antacids
3) Corticosteroid
4) Methotrexate
5) Oralhypoglycaemics
6) Phenytoin
Increased risk of bleeding
Premature release of aspirin
Increased risk of gastroitestinal
bleeding
Increased risk of methotrexate toxicity
Potentiates hypoglycaemic drugseffect
Increased effect of antiepileptics
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3) Atropine 1) Alcohol Impaired motor performance andincreased drowsiness.
4)Carbamazepine
5)Corticosteroids
1)Alcohol
2)Barbiturates,doxy cycline
oralhypoglycemicssteroids
3)Erythromycin
1)Anti diabeticdrugs
2)Anti hypertensives
3)Oral cotraceptives
Depressed CNS
Depressed CNSRetarded effect of drug
Increased carbamazepine isoniazidplasma level resulting in sedation
Corticosteroids may exacerbate diabetic
state by hypoglycemic actionAntagonism due to fluid retention
Increased anti-inflammatory response totopical steroids
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6) Cotrimoxazole 1)Diuretics
2)Anti coagulants,anti epileptics,oral hypoglycemics
Increased risk of thrombocytopenia inelderly
Potentiate action of these agents
7)Diazepam CNS depressants Intensified sedative effects
8) Doxy cycline 1) Penicillin
2) Barbiturates,antiepileptics
Reduced effect of penicillin
Possiblility of reduced plasmaconcentration of Doxy cycline.
9) Metronidazole 1) Alcohol
2) Antiepileptics
3) Anticoagulants
4) Barbiturates
Antagonism, therefore alcohol should beavoided
Incereased risk of toxicity of phenytoin
Potentiated anticoagulant effect
Reduced plasma level of metronidazole
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10)Penicillin oral Contraceptives Increased bleeding, possibly withcontraceptive failure
11)Tetracyclines Oral contraceptives
Oral hypoglycemic
Methotrexate
Increased bleeding due to contraceptivefaliure
Increased hypoglycemic effect
Incerased methotrexate toxicity
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References :
1. Essentials of medical pharmacology(By K.D.Tripathi).
2. A text book of pharmacology
(Satoskar).3. A text book of Oral and Maxillofacialsurgery (By B. Srinivasan).4. Contemporary Oran and MaxillofacialSurgery
(By Peterson).
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