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Commonly Used Medications

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Prescription ď Ź

A written order or authorization directing a pharmacist to furnish certain drugs to a patient

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Writing the Prescription 

Five Parts – – – – –

Superscription Inscription Subscription Signa (Sig.) Signature

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Writing the Prescription 

Superscription – The patients name, address and symbol Rx (“take thou”)

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Inscription The body of the prescription  Contains the official names and quantities of drug prescribed 

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Subscription The directions to the pharmacist ď Ź Indicates dosage form and quantities to be dispensed ď Ź

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Signa (sig) ď Ź

The instruction to the patient for use of the preparation

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Signature The prescriber’s signature and professional degree  DEA number for controlled substances  Refills 

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Commonly Used Medications Analgesics  Antibotics  Corticosteroids  Decongestants  Muscle Relaxers  Anxiolytics 

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Antibiotics Have the ability to destroy or inhibit growth of bacteria and other microorganisms  Organic substances produced by microorganisms  Synthetic or semi-synthetic 

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Antibiotics 

Considerations – – – –

1) Determine need 2) Previous adverse reactions 3)Susceptibility of microorganism 4) Knowledge of side effects

Dosages based on MIC (3-4 times)  Decreased efficacy of oral contraceptives 

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Microflora 

Skin – Staph. epidermis, Staph. aureus

Maxillary sinus – Strep., Staph., Haemophilus

Mouth – Mixed aerobic (Staph., Strep.,) and anaerobic (Bacteroides, Peptostreptococcus) www.indiandentalacademy.com


Penicillin Beta lactam antibiotic  Most commonly used  Gold standard  Bactericidal (interferes with cell wall synthesis)  5-10% adverse reaction (less common orally) 

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Penicillin Penicillin G used parenterally  Phenoxymethyl penicillin (Pen V) used orally  Resistance (beta-lactamase) increases with repeated use  Covers oral flora 

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Pencillin V 

Adult Dose – 500 mg. QID ( four times per day )

Pediatric Dose – 50 mg/kg/3 or 4

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Penicillin VK 250-500 mg p.o. q6h  Pen VK 500 mg #28 i p.o. q6h until gone 

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Extended Spectrum Penicillins Modified to include Gram negative aerobic rods  Lack resistance to beta-lactamase  Ampicillin, Amoxicillin 

– Effective for sinus coverage (H. Influenzae)

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Ampicillin Available for oral, parenteral administration ď Ź 250-500 mg p.o. q6h ď Ź

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Augmentin Amoxicillin-Clavulinic acid  Beta-lactamase resistance and Staph. coverage  250-500 mg amoxicillin with 125mg clavulinic acid, p.o. q8h 

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Amoxicillin-Clavulanate 

Adult Dose – 250-500 mg tid

Pediatric Dose – 20 mg/kg/3

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Erythromycin Macrolide antibiotic  Mainly bacteriostatic  Spectrum similar to Pen V  Less effective against oral anaerobes 

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Erythromycin GI side effects  Avoid liver disease (estolate and ethylsuccinate)  Adjust dosage in patients taking theophylline and cyclosporins 

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Erythromycin Adult Dose 500 mg. Qid  Pediatric Dose 40 mg/kg/4 

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Erythomycin 

Base, stearate, estolate – 250-500 mg p.o. q6h

Ethylsuccinate – 200-400 mg p.o. q6h

Consult reference

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Clindamycin Lincosamide antibiotic  Very effective against oral anaerobes and Staph.  Good bone penetration  useful in severe odontogenic infections 

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Clindamycin Expensive  Pseudomembranous colitis rarely seen  Stool culture reveals C. difficile and toxin 

150-300 mg p.o. q6h  Available in parenteral form 

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Clindamycin 

Adult Dose – 300-450 mg q6h

Pediatric Dose – 10-20 mg/kg/4

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Bacterial Endocarditis AHD, ADA,guidelines  To reduce likelihood of resistance, prophylactic antibiotics should be used only during perioperative period  Alpha-hemolytic (viridans) streptococci 

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Cardiac Conditions     

Endocarditis prophylaxis recommended: Prosthetic cardiac valves, including bioprosthetic and homograft valve Previous bacterial endocarditis, even in the absence of heart disease Surgically contructed systemic pulmonary shunts Most congential cardiac malformations www.indiandentalacademy.com


Cardiac Conditions Rheumatic and other acquired valvular dysfunction  Hypertrophic cardiomyopathy  Mitral valve prolapse with valvular regurgitation 

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Prophylaxis NOT recommended:      

Isolated secundum atrial septal defect Surgical repair without residual beyond Secundum atrial septal defect Ventricular septal defect Patent ductus arteriosus Previous coronary without valvular regurgitation Physiologic, functional, or innocent heart murmurs www.indiandentalacademy.com


Prophylaxis NOT recommended: Previous Kawasaki disease without valvular dysfunction  Previous rheumatic fever without valvular dysfunction  Cardiac pacemakers and implanted defibrillators 

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Endocarditis prophylaxis recommended: Dental procedures likely to induce gingival or mucosal bleeding, including professional cleaning Surgical operations involving www.indiandentalacademy.com respiratory mucosa (maxillary


Endocarditis prophylaxis NOT recommended: Dental procedures not likely to induce gingival or mucosal bleeding such as simple adjustment of orthodontic appliances or fillings above the gum line  Injection of local intraoral anesthetic (except intraligamentary injections)  Shedding of primary teeth  New denture insertion 

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Analgesics A class of drugs which obtunds the perception of pain without producing unconsciousness  Non-narcotic  Narcotic  Consider placebo effect 

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Non-narcotic Analgesics Useful for mild to moderate pain  Analgesic, antipyretic, anti-inflammatory 

Salicylates, NSAIDs, Acetaminophen  Inhibit prostaglandin synthesis 

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Salicylates Acetysalicylic Acid (Aspirin, ASA)  Analgesic, antipyretic anti-inflammatory 

325 - 650 mg p.o. q4h  Prolongs bleeding time  Adverse GI side effects 

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NSAIDSs Ibuprofen is prototype (Motrin, Advil)  Analgesic, antipyretic, anti-inflammatory  400 mg p.o. q4-6h, 600 mg p.o. q6h or 800 mg p.o. q8h  Total dose not to exceed 3200 mg qd  Consider pre-operative dose 

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Acetaminophen Analgesic, anti-pyretic  Often combined with narcotic analgesics 

500-1000 mg p.o. q6h  Total dose not to exceed 4 gm q 24h  Risk of heptaic necrosis at toxic doses (10-15 gm qd) 

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Narcotic Analgesics Opioid agonists  All produce analgesia, euphoria, addiction, respiratory depression, sedation, emesis, constipation  Tolerance and cross-addiction occurs  Controlled substances (need DEA)  Reversed by naloxone (Narcan) 

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Narcotic Analgesics  Classification:

– Opium Alkaloids • Heroin, morphine, codeine

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Narcotic Analgesics  Classification

– Semi-synthetic derivatives • Morphine

– Dilaudid, Nubain , Hydrocodone

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Narcotic Analgesics  Classification

– Semi-synthetic derivatives • Codeine

– Oxycodone, Dihydrocodeine

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Narcotic Analgesics  Classification

– Synthetic narcotics • Meperidine group – Demerol, Sublimaze

• Methadone group – Darvon

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Codiene Analgesic, sedative, anti-tussive, antidiarrheal proerties  Similar analgesia to NSAIDs  Indicated in mile to moderate pain  Most commonly used in combination form 

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Codiene Doses of 60 to 120mg may cause respiratory depression  #3 (30mg), #4 (60mg)  Tylenol #3 (300 mg acetaminophen and 30mg Codiene) 

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Codiene Usual adult dose is 30-60mg  Tylenol #3 i-ii tabs p.o. q4-6h prn pain  Be wary of total acetaminphen dosage 

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Semi-synthetic Derivatives 

Moderate to severe pain – Hydrocodone • Vicodin, Lortab, Lorcet

– Oxycodone • Percodan, Percocet, Tylox

– Dihydrocodeine • Synalgos-DC

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Hydrocodone Less euphoria, GI side effects  Vicodin (Hydrocodone 5mg and 500 mg acetaminnophen)  Vicodin ES (Hydrocodone 7.5mg and 750mg acetaminophen)  Vicodin 1 tab P.O. q6h prn pain 

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Hydrocodone Analgesic dose 5 to 10mg  4 to 8 hours duration  Moderate to high addition potential 

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Oxycodone Greater side effects  Percodan (Oxycodone 5 mg and 325 mg ASA)  Perocet (Oxycodone 5 mg and 325 mg acetaminophen)  Tylox (Oxycodone 5 mg and 500 mg acetaminophen)  Percocet 1 tab q6h prn pain 

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Commenly used medications/ dental implant courses by Indian dental academy  

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