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Clincal Pharmacology cases for dentists

Dr Sameh AM Abdelghany

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EMERGENCY CASES

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Case(1):

Patient with vital signs are within normal limits althoughslightly elevated, which you attribute to his anxiety. Pulse 88,respirations 16, blood pressure 138/88. reviewing his personaloral hygiene puts him at ease. You notice that he had becomequite pale, hairs on his arms are standing up, he begins tosweat profusely, frequently yawns. You ask him if he is feelingwell and he states that he is fine, just a little nervous and a bitdizzy. You then notice he has lost consciousness.

What happen? How to treat?

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SYNCOPEo symptoms: pallor, diaphoresis, yawning,

piloerection, dizziness Treatment:1. Supine position with feet elevated.2. After regaining consciousness he remained in

supine position for 15 minutes.3. Dental procedure was postponed and sedative will

be given next visit

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Case(2):

Healthy female patient, she complains of severe pain in lastmolar tooth. You decided an extraction for the tooth. She hashistory of taking aspirin and cefoprazone(3rd generationcephalosporins). Once upon extraction of tooth, bleedingoccurs and not stop. Her condition get worse and pulsebecome weak and thread , pale skin and blood preesure50/70 and transmitted to ER unit for management.

What happen? How to treat?

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Hemorrhagic SHOCKo Aspirin and cefoprazone increase bleeding

tendency and result in this conditiono symptoms: weak thready pulse, confused state,

pale skin Treatment:1. Blood transfusion2. vital signs monitored.3. Once in the ER IV fluids where administered.

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Case(3):

Patient took premedication amoxicillinbefore treatment, complains of a scratchythroat, is beginning to itch all over,, sherequests a glass of water and is trying to catchher breath,, her eyes and lips begin to swell

What happen? How to treat?

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ALLERGIC REACTION(Moderate allergic reaction)Symptoms: systemic pruritus, urticarial,angioedema of eyes, lips and larynx,dyspnea, hypotension, bradypnea Treatment:1. Administer Antihistamine IM2. monitor vital signs.

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Case(4):

17 y male Patient complains of abcess in tooth 13. Youdecide to give him amoxicillin IV for treatment. Afterthat, patient took the injection and complains of ascratchy throat, beginning to itch all over, trying tocatch hir breath,, his eyes and lips begin to swell. Puksebecome so weak , Blood pressure decrease to 50/70and skin becomes pale. Patient transmitted to hospitalfor management

What happen? How to treat?

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Anaphylactic Shocko Symptoms: A severe fall in blood pressure occurs, with

bronchoconstriction, angioedema and sometimes death Treatment:1. Place the patient in recumbent position and elevate lower

extremities, Apply tourniquet proximal to the site of antigeninjection; remove every 10-15 minutes.

2. Adrenaline injection 0.5-1mg should be given I.M3. Subsequent injections 10-20 min later may be given until the

patient improves.4. H1- receptor blocker.5. Hydrocortisone (100mg I.V6. In severe anaphylaxis, 1-2 L of plasma substitute should be

infused rapidly.7. Oxygen and artificial ventilation may be necessary.

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Case(5):

Diabetic Patient comes in and states he skippedbreakfast, you notice he is salivating profusely. youask him where he is and he is confused andirrational, vital signs-bounding pulse and shallowrespirations, he is conscious.

What happen? How to treat?

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SEVERE HYPOGLYCEMIASymptoms: Profuse salivation,confusion, irrationality, boundingpulse.

Treatment:1. 6 glucose tablets2. monitor vital signs.

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Prescription

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Defintion

Is a physician written order to apharmacist for a specific medication fora specific

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General Pricinples

1) Try to make proper diagnosis before writing prescription2) Don not prescribe any drug except when it is essential for

patient condition3) Avoid adverse effects of drug-drug interaction:i. Ask about history of drug intakeii. Try to prescribe to avoid prescribing interacting drugs and if

mandatory restrict precautions should be considerediii. Avoid polypharmacy: write down least number of drugs

with least possible dose4) Instructions for pharmacist and patients should be clear

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ExaminationHistory

DecisionInvestigation

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Parts

1. Phycican’ name, professional degree, address andtelephone number

2. Name. address and age of patient3. Date4. Superscription: the symbol R/ at the start of prescription.5. Inscription: the prescribed medicines and their doses.6. Subscription: includes directions to the pharmacist.7. Transcription: includes directions to the patient in Arabic.8. The signature of the physician.

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Prescriptions for narcotics:

1) Narcotics should be written by licensed doctors onspecial form obtained from the ministry of health.

2) The doctor’s name, address, qualifications, and

number should be clear.3) The patient’s name, address, age and diagnosis should

be clear.4) The dose of the narcotic should be written in numbers

and litters.5) Doctor’s signature.6) Two copies are done, one for the doctor and the other

for the pharmacist.

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PRESCRIPTION FOR NARCOTICS

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Some abbreviations:• p.o. By mouth.• i.m. Intramuscularly.• i.v. Intravenously.• s.c. Subcutaneously.• o.d. Once daily.• b.i.d. Twice daily.• t.d.s. Three times daily.• q.d.s. Four times daily.• p.r.n. When required.• state Immediately

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Some household measures:

One tea spoonful = 5 ml. One table spoonful = 15ml. One coffee cupful = 30ml. One tea cupful = 120-150ml. One glassful = 240mg. One milliliter= 15 drops.

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Examples for Prescription

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Mild toothache:

R/Aspirin 500mg tablets

قرص عند اللزوم

OrR/Paracetamol 500mg tablets

قرص عند اللزوم

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Severe pain of dental origin:

R/Diclofenac 75 mg Ampoules

حقنه في العضل يوميا

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Dental abcess:

R/Metronidazole 500 mg tablets

أيام10مرات يوميا لمدة 3قرص بعد األكل

Cephradine 500 mg capsulesأيام10ساعات لمدة 6كبسولة كل

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Oral moniliasis:

R/Miconazole 2% oral gel

أيام10ساعات لمدة 6نصف ملعقه موضعيا بالفم كل

OrNystatin oral drops 100.000 unit/ml

أيام10ساعات لمدة 6مأل قطارة بالفم كل

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Prevention of dental caries:

R/Sodium fluoride 0.25mg tablets

قرص واحد يوميا

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THANKS