Transcript Various Drugs in Pedo [

VARIOUS DRUGS
USED IN
PAEDIATRIC
DENTISTRY
By :Jyoti Verma JR III
INTRODUCTION
“The adult may be treated as a child: the converse can lead to disaster.”
-Sir Lancelot Barrington
A drug can be defined as any substance or product that is used or is intended to be used to modify or
explore phsiological system or pathological states for the benefit of the recipient.(WHO,1966)
Drugs in pedodontic practice can be classified in following groups:
•Drugs for infection control: Antibiotics.
•Drugs for pain control:
•Non steroidal anti-inflammatory drugs
•Opioid analgesics.
•Local anaesthetics.
•Drugs for Conscious sedation
•Drugs for General anaesthesia.
•Miscellaneous drugs.
•Drugs for medical emergencies.
•Drugs as nutrition supplement.
Dose calculation in Paediatric dentistry practice:
Age
•Young’s Rule
•Dilling’s Rule
•Brunton’s Rule
•Fried ‘s Rule
•Cowling’s Rule
•Starkenstein’s Rule
Body
Weight
Body
Surface
Area
• Clarke’s rule
•Clark’s SA Rule
In the calculation of dosages, weight has a more direct bearing on
the dose than any other factor, especially in the calculation of
pediatric doses. The rule governing calculation of pediatric doses
for newborns and young infants with a normal lean body mass and
normal body development is Clark's Rule. For toddlers use Fried’s
Rule, and for older children Young’s Rule is used.
AGE
Young’s rule (for 1 to 12 years):
Paediatric dose = Age (in years) x adult dose
age+12
Brunton’s Rule:
Paediatric dose = age x adult dose
25
Dilling’s rule:
Paediatric dose = age (in years) x adult dose
20
Fried's Rule (for Infants and Children up to 1 to 2 Years):
Paediatric dose = age (in months) x adult dose
150
Cowling’s rule:
Pediatric dose = age(at next birthday in years) x adult dose
24
Starkenstein’s Rule:
Paediatric dose = age x adult dose
18
Clarke’s rule:
Body
Weight
Paediatric dose =
weight(in pounds) x adult dose
150
Body surface area (BSA) is determined from a west’s nomogram using the
child's height and weight.
Body
surface
area
Paediatric dose = child’s body surface area x adult dose
1.7m2
Clark’s SA Rule:
Paediatric dose = Surface area of child x adult dose
Surface area of adult
1) Drugs for infection control: Antimicrobial Agents
 An antibiotic is a chemical substance produced by various species of micro
organisms (bacteria, fungi, and actinomycets) that suppress the growth of
other microorganisms and may eventually destroy them.
May be :Synthetic drugs
Naturally obtained drugs
Choice of an antimicrobial agent depends upon
Patient Factors
Organism
related
considerations
Drug factors
•A)Beta Lactam Antibiotics
Penicillin and Cephalosporine
Penicillins: (1941)
Originally obtained from Penicillium notatum, now it is derived from
P.chrysogenum.
Inhibit the bacterial cell wall synthesis and are mainly active against the
gram positive baceria. The commonly used agents are:
Amoxicillin
Extended spectrum aminopenicillin
good oral absorption not interfered by food.
Drug of choice in orodental infectionsand in the antibiotic prophylaxis.
Ampicillin
an aminopenicillin with spectrum similar to amoxicillin with an incomplete oral
absorption as food interferes with it. This also frequently leads to diarrhea after
oral administration.
Clavulanic acid
It is a progressive beta lactamase inhibitor, with rapid oral
absorption.Its combination reestablishes the activity of
amoxicillin against resistant strains.
Cephalosporins
Group of semisynthetic antibiotic, having actions and properties
similar to penicillins with a difference in spectrum.
Cephalosporins used in pedodontic practice are:
• Cephalexin: orally effective first generation cephalosporin active
against most of penicillin sensitive organism, including beta lactamase
producing Staph.
• Cefadroxil: similar to cephalexin in spectrum and properties.
Antimicrobal
agent
DOSAGE
AVAILABILITY
ADULT
CHILDREN
AMOXICILLIN
0.5-2g oral/i.m./i.v
every 6 hrs
25-50mg/kg/day
Amoxylin,
Novamox,
Synamox
250, 500mg capsule
125mg/5ml dry
syrup
250,500 mg/vial inj.
AMPICILLIN
Same as Amox
Same as amox
Ampilin, Roscillin,
Biocilin 250,500 mg
cap
125,250 mg/5ml dry
syr,
100 mg/ml
pediatric drops
250,500 mg and 1 g
per vial inj
CLAVULANIC ACID
500mg amoxicillin
+ 125mg clavulanic
acid.
250mg
amoxicillin+125mg
clavulanic acid TDS.
Augmentin,
Enhancin, Amonate
375mg, 625mg tab.
CEPHALEXIN
0.25-1g 6-8
hourly,
25-100 mg/kg/day
cephaxin spoidex,
alcephalin
250,500 mg cap,
125 mg/5 ml dry
syr., 100mg/ml
pediatric drops
CEPHADROXIL
Dose: 0.5-1g BD
30 mg/kg /day
: droxyl 0.5,1g
tab, 250mg kid tab
Cefadrox 0.5g
cap,
250mg/5ml syrup,
125mg/5ml syrup
and.
ERYTHROMYCIN
250-500 mg/ 6
hourly (8 mg max)
30-60mg/kg/day
Erysafe 125, 250,
500 mg
tab,Althrocin 250,
500 mg tab, 125
mg kid tab
125mg/5ml and
250mg/5ml dry
syr. 100mg/ml
ped. Drops.
METRONIDAZOLE
400- 800 mg,
30-50 mg/kg/day.
Flagyl, metrogyl,
aldezole 200, 400
mg tab,
200mg/5ml susp.,
500mg/100 ml i.v.
infusion.
Erythromycin:
• Bacteriostatic at low but bactericidal at high concentration,
• Antibacterial spectrum narrow, includes mostly gram positive and a
few gram negative organism.
• Acid labile, supplied in enteric coated tablet and taken empty stomach.
• Indicated in patients allergic to penicillin.
Metronidazole:
• It is a nitroimidzole having a broad spectrum cidal activity against
protozoa and many anaerobic bacteria. In pedodontic practice, it is
indicated in anaerobic infections.
•



Adverseeffects :
metallic taste,
peripheral neuropathy
thrombophlebitis of the injected vein.
 Contraindication:
 blood dyscrasias,
 neurological disease
 first trimester of pregnancy
Tetracycline :
• broadspectrum, bacteriostatic antibiotics
• chelating property, leading to deposition of calcium tetracycline
chelate in developing teeth and bones.
• strictly contraindicated in pregnancy and children below 6 years of
age.
• pregnancy to 5 months of extra uterine life, deciduous teeth are
affected: brown discoloration and ill formed teeth.
• 3 months of age to 5 years affect permanent anterior dentition.
Repeated courses are damaging to teeth and bones.
Doxycycline and Minocycline are alternate drug to
tetracycline
High potency
Less renal and vestibular toxicity,and diarrhea
Chloramphenicol:
• Broadspectrum, bacteriostatic antibiotics
• Strictly contraindicated in pregnancy and in neonates.
•It leads to “gray baby syndrome” in children.
Anti fungal agents:
•The anti fungal agents are important in immune compromised
patients,
• children with rampant caries
•angular chelitis
•Drugs for oral candidiasis are:
•Nystatin (mycostatin ,1lac U /g oint.)
Ketoconazole (nizral, funginoc 2% oint)
Anti viral agents:
• The antiviral drugs are important due to a high prevalence of herpetic
infections in children.
• This is one of the most common infections transferred from children to the
pedodontist.
• Most common antiviral agent is Acyclovir (herpex 200 mg tab, 3% eye oint.,
5% skin cream
Antibiotic prophylactic regimens for certain dental procedures
SITUATION
Standard
Prophylaxis
ANTIBIOTIC
Amoxicillin
REGIMEN
Adults, 2.0 grams; children,50
milligrams/kilogram
orally one hour before
procedure
Cannot Use Oral
Medications
Ampicillin
Adults, 2.0 g IM or IV;
children, 50 mg/kg IM or
IV within 30 minutes
before procedure
Allergic to Penicillin
Clindamycin
Adults, 600 mg; children,
20 mg/kg orally one hour
before procedure
Cephalexin or cefadroxil
Adults, 2.0 g; children,
50 mg/kg orally one hour
before procedure
Azithromycin or
clarithromycin
Adults, 500 mg; children,
15 mg/kg orally one hour
before procedure
Clindamycin
Adults, 600 mg; children,
15 mg/kg IV one hour
before procedure
Cefazolin
Adults, 1.0 g; children,
25 mg/kg IM or IV within
30 minutes before procedure
Allergic to
Penicillin and Unable
to Take Oral
Medications
Drugs for pain control
 Analgesic is a drug that relieves pain by acting in the central nervous
system or on peripheral pain mechanisms.
Widely prescribed for pain relief, especially after a dental surgical
procedures, pulpitis, gingival infections and periapical infections,dental
extractions and teething.
Non steroidal anti-inflammatory drugs
Classified as
Opioid analgesics
Non steroidal anti inflammatory drugs:
(non narcotic or aspirin like and antipyretic analgesic)
CLASSIFICATION
A. Nonselective COX inhibitors (conventional NSAIDS)
Salicylates
Aspirin
Pyrazolone derivatives
Phenylbutazone, oxyphenbutazone
Indole derivatives
Indomethacin
Propionic acid derivatives
Ibuprofen,Naproxen, Ketoprofen,
Fenoprofen, Flurbiprofen.
Anthranilic acid derivative
Mephenamic acid
Aryl-acetic acid derivatives
Diclofenac
Oxicam derivatives
Piroxicam, Tenoxicam
Pyrrolo-pyrrole derivative
Ketorolac.
B. Preferential COX-2 inhibitors :
Nimesulide, Meloxicam, Nabumetone
c. Selective COX-2 inhibitors :
Celecoxib, Rofecoxib, Valdecoxib, Etoricoxib
D. Analgesic - antipyretics with poor antiinflammatory:
Paraaminophenol
derivative
Paracetamol (Acetaminophen)
Pyrazolone derivatives
Metamizol (Dipyrone), propiphenazone
Benzoxazocine derivative
Nefopam
• NSAIDS are weaker analgesics but they do not depress the central nervous
system and have no physical dependence.
COMMON PROPERTIES OF ALL NSAIDS
Analgesia
Antipyresis
Anaphylactoid
reactions
Antiinflammatory
Renal effects
Dysmenorrhoea
Gastric mucosal
damage
Antiplatelet
aggregatory
Parturition
Ductus
arteriosus
closure
Indications:
•Mild to moderate pain
•Fever
•Inflammation
•Dysmenorrhoea
•Thromboembolism
•Patent ductus arteriosus
Contraindications:
• Asthma.
•Gastritis.
•Pregnancy and lactating mothers.
•Diabetics, Congestive heart failure, hypovolemia, hepatic cirrhosis,
renal disease, those receiving diuretics and anti-hypertensives. Renal
effects of NSAIDS leading to Na+ retention and oedema.
•Chronic liver disease.
•NSAIDS should be stopped one week before elective surgery.
Ibuprofen
 Inhibits cyclooxygenase enzymes: cox-1 and cox-2
and block the prostaglandin synthesis.
 causes CNS side effects as headache, dizziness,
blurring of vision, tinnitus and depression.
anti-inflammatory drug in soft tissue injuries,
fractures and tooth extraction.
 Poor inhibitor of prostaglandin synthesis in peripheral
tissues but are more active on COX in brain.
Commonly
used NSAIDS
Paracetamol
Piroxicam
 Poor anti-inflammatory, good and promptly acting
antipyretic.
safer than aspirin in terms of gastric irritation,
ulceration and bleeding.
Long acting NSAID with anti-inflammatory
potency and good analgesic-antipyretic action less
ulcerogenic causing less occult fecal blood loss.
Ibuprofen:
Dose&Availability:
Brufen, emflam, ibusynth, 200, 400, 600
mg tab
Brufamol kid DT 200mg
Ibugesic 100mg/5ml susp.
Paracetamol :
Dose: Infants 50 mg, children (1-3 years) 60-80
mg, (4-8 years) 240-320 mg, (9-12 years) 300600 mg Adult.
Availability: Crocin, Metacin, Paracin 500mg
tab, 125mg/5ml syrup, 150 mg/ml paed. drops.
Ultragin, Pyrigesic 500 mg tab, 125 mg/5ml
syrup. Neomal, Fevastin febrinil 300mg/2ml inj.
Piroxicam:
Dose:
20mg BD for two days followed by 20 mg
OD.
Availability: Dolonex, Pirox 10,20 mg cap,
, 20 mg/ml inj. In 1 and 2 amps.
Adverse effects:
•Nausea, vomiting, epigastric distress, occult blood loss in stools.
•Hypersensitivity and idiosyncrasy.
•Dose related side effects and drug poisoning as salicylism and acute
paracetamol poisoning. acute
paracetampoisoning Serious toxicity can occur at >150mg/kg and fatality is common with
>250mg/kg.
Acute Paracetamol Poisoning:
• Specially in small children(>150 mg/kg or >10g in adult)
Fatal at >250mg/kg.
•Nausea, vomiting, abdominal pain,
• hepatic tenderness and leads to centrilobular hepatic necrosis,
•renal tubular necrosis and hypoglycemia.
•causes coma in 12-18 hours and jaundice in 2 days.
•Fulminating hepatic failure and death occurs if plasma levels are above
200ug/ml at 4 hours and 30ug/ml at 15 hours.
•Paracetamol is not recommended in premature infants (<2kg) for fear of
hepatotoxicty.
Treatment :
Induce vomiting and gastric lavage.
Activated charcoal is given orally to cause further absorption.
 N-acetyl cysteine 150mg/kg infused i.v. over 15 min followed by
same dose over next 20 hours.Alternatively 75mg/kg orally may be
given every 4-6 hours for 2-3 days. It replenishes the glutathione
stores in liver and prevents the toxic N-acetyl-benzoquinone-imine
from binding to other cellular constituents.
Other NSAIDS:
Frequently NSAIDS are cautiously used in children due to their hepatic and renal
toxicity.
Selective cox-2 inhibitors as rofecoxib and celecoxib have been found to interfere with
bone maturation and hence are not of paediatric importance.
Nimesulide considered safe for adult usage is not indicated in children due to their
hepatotoxicity.
Opioid analgesics:
Opium is a dark brown resinous material obtained from poppy (Papaver
somniferum
With the advent of recent safer alternatives and the problems
associated with the addiction and adverse effects of the opioids,their
use has been limited to poorly localized visceral pain and very severe
pain.
Classification:
Natural
Opiate
Semi
synthetic
Opiate
Synthetic
Opiate
•Natural opium alkaloids: Morphine, Codeine.
•Semi synthetic opiates: Diacetylmorphine (Heroin), Pholcodiene.
•Synthetic opioids: Pethidine, Fentanyl, Tramadol, methadone.
Indications:
• Dull, diffuse visceral pain.
•Milder pain as tooth ache, not controlled by non steroidal anti-inflammatory
drugs.
•Surgical analgesia in obstetric, abdominal, lower limb and pelvic operations.
•Preanaesthetic medication.
•Balanced anaesthesia and neurolept analgesia.
•Relief of anxiety and apprehension.
•Analog-sedation in management of uncooperative children.
Contraindications:
•Infants and elderly are more susceptible to the respiratory depressant
action of morphine.
•Patients with respiratory insufficiency.
•Bronchial asthma.
•Head injury.
•Hypotensive states.
•Undiagnosed acute abdominal pain.
•Elderly males.
•Hypothyroidism.
•Unstable personalities.
Adverse effects:
•Sedation, mental clouding, lethargy and even dysphoria.
•Idiosyncrasy and allergy: urticaria itching and swelling of the lips.
•Apnoea: may occur in new born when morphine is given to mother during
labour.
•Acute morphine poisoning at >250mg
•Tolerance and dependence.
Opioid analgesics in Pedodontic practice:
Tramadol
Dose: 50-100 mg oral/ i.m./ slow i.v. infusion 4-6 hourly.
1-2 mg/kg ( in children 4 to 16 years)
Drug name: contramal, domadol, tramazac 50mg cap and
50mg/ml inj. In 1 and 2 ml amps.
Fentanyl:
In the past associated with neurolept anaesthesia in combination with Droperidol.
Available as trofentyl 50ug/ml ,fentanyl citrate inj in 2 ml amp and 10 ml vial.
Local anaesthetics
 Local anaesthesia has been defined as a loss of sensation in a circumscribed
area of the body caused by a depression of excitation in nerve endings or an
inhibition of the conduction process in peripheral nerves.
 An important feature of local anaesthesia is that it produces this loss of
sensation without inducing a loss of consciousness.
Classification:
Based on chemical structure
ESTER
BENZOIC ACID
Butacaine
Cocaine
Benzocaine
Tetracaine
QUINOLINE
AMIDES
PABA
Chlorprocaine
Procaine
propoxycaine
Centbucridine
Bupivacaine
Dibucaine
Etidocaine
Lidocaine
Mepivacaine
prilocaine
Based on mode of application
Topical
Soluble
Cocaine
Lidocaine
Tetracaine
Injectable
Insoluble
Benzocaine
Butylaminobenzoate
Lidocaine
Mepivacaine
Tetracaine
Bupivacaine
Dibucaine
Classification of local anaesthetic substances according to biological site and mode of action
Classification
Definition
Chemical Substance
Class A
Agents acting at the receptor site on Biotoxins (e.g. tetrodotoxin and
external surface of nerve membrane saxitoxin)
Class B
Agents acting at receptor sites on
Quaternary ammonium analogues
internal surface of nerve membrane of lidocaine
(scorpion venom)
Class C
Agents acting by a receptor
independent physico-chemical
mechanism
Benzocaine
Class D
Agents acting by combination of
receptor and receptor-independent
mechanism
Most clinically useful local
anaesthetic agents(e.g. articaine,
lidocaine, mepivacaine, prilocaine)
Composition
 Lignocaine hydrochloride- 24.64 mg
 Adrenaline bitartrate





- 0.0125 mg
Sodium chloride/modified Ringer’s solution 6mg/ml
Sodium metabisulfide - 0.5mg/ml
Methyl paraben
- 1mg/ml
Thymol
- 1mg/ml
Water
local anesthesia
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Clinical uses of local anaesthetics:
The clinical uses of local anaesthetics in pedodontic practice may be divided
into:
1. Surface anaesthesia.
2. Infiltration anaesthesia.
3. Field block
4. Nerve block
5. Intraligamentary.
6. Intra pulpal.
Local anaesthetic agents used in pedodontic practice are as
follows:
Lidocaine:
•It is an amide type of agent having rapid onset of action and
producing more profound anaesthesia.
•Maximum recommended dose :4.4 mg/kg without adrenaline
:7mg/kg with adrenaline
•Duration of Pulpal anaesthesia :60 min
Soft tissue anaesthesia:2-3 hours.
Availability:
• Xylocaine, Gesicain 4% topical solution,
•2% Lidocaine jelly, 5% ointment,
•1% and 2% injection(with or without adrenaline),5% heavy for
spinal anaesthesia and 100mg/ml spray (10 mg per puff).
Mepivacaine:
•Mepivacaine 3% produces pulpal anaesthesia:25 min and soft tissue
anaesthsia : 90 min
• It was a popular drug till lidocaine came to picture.
•This drug requires additional caution when being administered to
young children.
Drugs for conscious sedation:
Drugs for
Oral concious
sedation
• Hydroxyzine
• Promethazine
• Chloral hydrate
• Meperdine
• Diazepam
• Triazolam
• Chlorpromazine
Drugs for
intramuscular
sedation
• Ketamine
Drugs for
Intravenous
sedation
• Midazolam
Midazolam
Hydroxyzine
Promethazine
H1 antihistaminic
drug which is mildly
sedative along with
antiemetic and
anticholinergic action.
It is also a H1 antihistaminic with
properties and
limitations similar to
hydroxyzine.
potentiates narcotic
and central nervous
system depressants.
Dose: 25-50 mg oral,
i.m.(1mg/kg).
Dose: 25-50 mg
oral/i.m.
Availability:
phenergan 10, 25 mg
tab, 10mg/5ml syr,
6mg/ml drops, 25
mg/ml inj.
• It is the oldest synthetic hypnotic used since 1869.
Chloralhydrat
e
• It is used for all levels of anxiety, has a wide range of safety.
• Not recommended in children below 6 years of age.
• Agitation is common in post operative period and has no analgesia.
• Dose: adults:1g, children: 0.25-0.5 g. Availability: Tricloryl 0.5g/5 ml elixir
Meperdine
• it is an opioid derivative producing analog-sedation.
• Best used in combination with promethazine and hydroxyzine for short procedures and
chloral hydrate for longer procedure.
• It has poor oral absorption and respiratory depression. Contraindicated in chronic
obstructive pulmonary disease and liver dysfunction.
• Dose: 2-4 mg/ kg every 3 hours.
• Availability: Demerol 50mg/5 ml
• It has an anti convulsant activity and good oral absorption.
Triazolam
• It has a rapid elimination with safety levels not fully established.
• Dose: 0.125-0.250 mg.
• Availability: Halcion 0.125-0.25 mg tablets.
•benzodiazepine, safe agent with good oral absorption for mild to
•moderate anxiety particularly in children with cerebral palsy, mental
Diazapam
•retardation and age less than 6 years.
•not effective in severe anxiety and multiple doses are required for sedation.
•Dose: 0.12- 0.8 mg/kg in 3 or 4 divided doses.
•Availability: valium: 5mg/5ml elixir, 2,5,10,15 mg tablets. .
• used in combination with meperdine and or promethazine.
Chlorpromazi
ne
• Though useful in severe behavior problems, it is unpredictable and less
studied.
• Dose: 2-3 mg/kg. availability: Thorazine 10mg/ml syrup, 10,25,50,100,200 mg
tablets.
• Limited control over reversibility
Drugs for intramuscular sedation:
Ketamine:
• Potent analgesic and a potential for oral use.
•Its safety for oral route has not yet been established
•Dose: 1-4 mg/kg. Availability: ketamin, ketlar10 mg and 50 mg/ml inj.
Midazolam:
• Hypnotic benzodiazepine with anticonvulsant and muscle relaxant properties.
Rapid onset of action, causes anterograde amnesia and is anxiolytic.
Dose: 0.07-0.08 mg/kg.
•Availability: inj. Midaz, benzosed 1mg/ml in 2ml and 10 ml vial,5mg/ml in1ml vial.
Drugs for intravenous sedation: Midazolam
General Anaesthetic agents:
a) Inhalational anaesthetics.
b) Intravenous anesthetics.
A combination of inhalation and intravenous anesthetics, often with opioids added
for pain relief and neuromuscular blockers for muscle paralysis, is called
balanced anesthesia.
Inhalation anesthetics:
Halothane
causes unconsciousness but provides little pain
relief; often administeredwith analgesics.
Nitrous oxide
Used with other drugs as thiopental to
produce surgical anesthesia.
The fastest induction and recovery time.
Has a pleasant smell and is therefore often the
anesthetic of choice when mask induction is
used with children.
Safest inhalation anesthetic because it does
not slow respiration or blood flow to the
brain.
relatively weak anesthetic, not suited for
major surgery.
It may be toxic to the liver in adults.
may be used alone for dental anesthesia,
should not be used as a primary agent in
more extensive procedures.
Enflurane
Isoflurane
Less potent, but
produces a rapid
onset of
anesthesia and
possibly a faster
recovery.
works quickly
Not toxic to the
liver but can
induce irregular
heart rhythms
Not used in
patients with
kidney failure.
Sevoflurane
can be
administered
through a mask
since it does not
irritate the airway.
On the other hand,
sevoflurane can
cause renal
damage.
Desflurane
•a secondgeneration
version of
isoflurane,
•irritating to
the airway
and
therefore
cannot be
used for
mask
(inhalation)
inductions,
especially
not in
children.
Intravenous anesthetics
Ketamine,
Thiopental (a barbiturate),
Methohexital (Brevital),
Etomidate,
Propofol (Diprivan),
Ketamine
 produces a different set of reactions from other intravenous
anesthetics.
Resembles phencyclidine, which is a street drug that may
cause hallucinations.
Because patients who have been anesthetized with ketamine
often have sensory illusions and vivid dreams during postoperative recovery, ketamine is not often given to adult patients.
 It is, however, useful in anesthetizing children, patients in
shock, and trauma casualties in war zones where anesthesia
equipment may be difficult to obtain.
Miscellaneous Drugs
•A)Drugs for medical emergencies:
•The use of pharmacological measures for behavior management and
the uncooperative nature of substantial majority of the patients, puts
the pedodontic practice at a greater risk.
•These drugs can prove to be life-saving when a situation arises.
•A practice requires a complete set of emergency drugs which are as
follows:
Drug group
Parenteral preparation
Analgesic
Anticonvulsant
Antihistamine
Antihypoglycemic
Corticosteroid
Narcotic antagonist
Sympathomimetic
Vagolytic
Common example
Purpose
Morphine sulphate
Diazepam, midazolam
Diphenhydramine, chlorpheniramine
50% dextrose in water, glucagon
Methylprednisolone,
Naloxone
Epinephrine
Atropine
Emergency pain relief
Convulsions
Allergic reactions
Hypoglycemia
Allergic reactions and anaphylaxis
Opioid overdose
Anaphylactic shock
Bradycardia,asthma
Oral preparations
Antihistamine
Antihypoglycemic
Vasodilator
Diphenhydramine, chlorpheniramine
Candy, fruit juice, sugar
Nitroglycerine
Allergic reactions
Hypoglycemia
Cardiac arrest
Inhaled preparation
Bronchodilator
Oxygen
Respiratory stimulant
Metaproterenol
Epinephrine bitartrate
Aromatic ammonia
Asthma, anaphylaxis
COPD, respiratory distress, cardiac
arrest
respiratory distress
B) Nutritional supplements
Mineral supplements
i.Calcium glubionate:
•
•
•
indicated in deficient serum calcium levels.
Dose : 800-1200 mg/day.
Available as calcium Sandoz, oscal syr 1.8g/5ml.
ii. Calcium lactate:
• indicated in deficient serum calcium levels.
•Dose: 400-500 mg/day in 3-6 divided doses.
•Available: tablets 325, 500 mg.
iii.Ferrous sulphate:
•indicated in iron deficiency anaemia, for prophylaxis and in preterm infants (not before
2 months of age).
Dose:
For iron deficiency anaemia- 6mg elemental iron/kg/day in three divided
doses.
For prophylaxis- 1-2 mg/kg/day in 2-3divided doses.
Availability: Durovit, Fezocar drops, Syrup iberol, syr fezocar, cap ElferriTR,
150 mg tab, pediatric drops 75mg (15mg iron)/0.6ml in 50ml,
125mg (25mg iron)/1ml in 50ml, 45mg(15mg iron)/0.6ml in 60ml.
 Vitamin supplements:
Vitamin B-complex:
i.
these formulations comprise of water soluble vitamin B1,B2,B3,B6,B12
and indicated along with antibiotics, prohylactically in Ariboflavinosis, and
malnutrition.
i.
Individual preparations of each vitamin are also available for selected
deficiencies.
ii.Vitamin D: indicated to prevent or treat rickets.
Dose: 10mcg/day, 400 IU/24 hour
Availability: calciferol,
ergocalciferol liq.8000 IU/ml in 60 ml.
References:
• Tripathi KD. Essentials of medical pharmacology.
• Stewart RE, Barber TK, Troutman KC, Wei SHY. Pediatric dentistry: scientific foundations
and clinical practice.
• Mcdonald RE, Avery DA, Dean JA. Dentistry for the child and adolescent. 2004, ed 8
• Malamed SF. Sedation: a guide to patient management.1982 ed 4,
• American academy of pediatric dentistry council on clinical affairs. Guidline on
appropriate use of antibiotic therapy for pediatric dental patients. Pediatr dent. 20052006;27
• Stephen HY Wei. Pediatric dentistry: total patient care.
• Committee on nutrition, American academy of pediatrics: policy statement on calcium
requirements of infants, children and adolescents. Pediatrics 1999;104(5): 1152-57.
Thank you