Post on 15-Feb-2017
INDIAN DENTAL ACADEMYLeader in continuing Dental Education
www.indiandentalacademy.com
www.indiandentalacademy.com
INDIAN DENTAL ACADEMYLeader in continuing Dental Education
- Clinical management of patients with multiple diseases and on multiple medications is not only complex but involves considerable risk.
- Adverse drug reactions can occur with a single drug or with multiple drugs.
- However the risk of ADR multiplies with “POLYPHARMACY”
www.indiandentalacademy.com
www.indiandentalacademy.com
Indian Dental academy
• www.indiandentalacademy.com • Leader continuing dental education• Offer both online and offline dental courses
Pathology
Immunology
www.indiandentalacademy.com
MAGNITUDE OF PROBLEM WITH POLYPHARMACY
6 %
50 %
100 %
www.indiandentalacademy.com
LIMITATION OF STUDYING ADR THROUGH RESEARCH
www.indiandentalacademy.com
RISK OF ADRRISK OF ADR
HEALTH
AGE
www.indiandentalacademy.com
www.indiandentalacademy.com
WHY DENTIST?? Therapeutic challenges to a practising dentist: Medical conditions necessitating polypharmacy will impact patients oral health. Oral side effects occur with administration of many medications. Current list of medications of the patient alters the dentist’s
prescribing pattern.
www.indiandentalacademy.com
Presence of chronic diseases may impair communication,
cognition and ability to comply with a drug regimen. Limited recall ability of older patients. Pts may not remember the names and dosages of the
drugs being taken. Consumption of Over The Counter drugs. Use of herbal medicines.
www.indiandentalacademy.com
TWO AREAS OF CONCERN FOR A DENTIST IN SUCH A SITUATION
-The impact of medical conditions DRUG-CONDITION-INTERACTION
--The impact of patient’s current list of medications
DRUG-DRUG INTERACTION
www.indiandentalacademy.com
DRUG CONDITION INTERACTIONS
1.Cardiovascular diseases 2. Respiratory diseases 3. Liver diseases 4. Endocrine diseases 5. Renal diseases 6. Neurogenic diseases 7. Sexually transmitted diseases 8. Blood diseases 9. Pregnancy & breast feeding
www.indiandentalacademy.com
DRUG-DRUG INTERACTION
www.indiandentalacademy.com
STEPS IN ASSESSMENT
www.indiandentalacademy.com
ASSESSMENT OF MCP
• -• - Health history- use reasonable prudence in taking• medical and drug history.• - Date of last physical examination• - Medical condition being treated• - Medications being used• - Allergies and emergencies• - Hospitalisation
“FIRST KNOW YOUR PATIENT”
www.indiandentalacademy.com
MANAGEMENT TOOLS
Lab tests-Complete Blood Count Platelet count TLC, DLC PT/INR, BT,PTT LFT Renal profile FBS,PPBS,Hb1Ac CD4 count and viral load Knowledge of Analgesic, Antibiotic, Anaesthetic
www.indiandentalacademy.com
Reviewing the existing medication list
Consideration prior to administering dental related medication
www.indiandentalacademy.com
aking
REVIEWING THE EXISTING MEDICATION LIST
1. Could any of these drugs be required medical emergency?
Nitroglycerine-angina Inhalers-COPD exacerbation
www.indiandentalacademy.com
2. Why is the patient taking these particular medications? Group by category to aid
in assessing over all risk in patient care?
Anti-hypertensives Anti-coaggulants
Immunosuppressants
www.indiandentalacademy.com
3. Do any of these drugs have potential to complicate or even create an emergency
situation?
Warfarin-excessive bleeding Prednisone-adrenal insufficiency
www.indiandentalacademy.com
4.Could any of these drugs compromise our dental treatment outcome?
Corticosteroids –delayed healing
www.indiandentalacademy.com
5. Do any of these drugs have potential oral
side effects?
Dilantin, Nifedipine-gingival enlargement Diuretics-Xerostomia
Calcium channel blockers-lichenoid reaction
www.indiandentalacademy.com
CONSIDERATIONS PRIOR TO PRESCRIBING MEDICATIONS
1. Does the person have specific drug allergy to the drug you intend to
prescribe?
Penicillin-skin rash
www.indiandentalacademy.com
2. Is the drug contraindicated for use? NSAIDs with history of gastrointestinal ulcers.
• 3. Is there a potential for an adverse drug interaction with the patients existing
medication? Erythromycin reducing warfarin clearance by 30%.
www.indiandentalacademy.com
4. Where will the dental drug be metabolized and is there any indication that the drug
elimination will be a problem for the patient?
Elderly may have decreased elimination of penicillin, erythromycin, cephalosporin.
www.indiandentalacademy.com
5.Could any of the dental drugs continue to
an emergency situation?
Prednisone-risk of non-compliances and patient failing to take prescribed dose resulting in
adrenal crisis.
www.indiandentalacademy.com
6. Is the dose prescribed in a safe range for the patient’s size and state of health. i.e., at
or below the maximum safe dose?
Acetaminophen prescribed should not exceed 4g per day for adults, but hepatotoxicity has
occurred with <4g in patients with cirrhosis.
www.indiandentalacademy.com
CONCLUSION
www.indiandentalacademy.com
ACKNOWLEDGEMENT
Dr Renuka Ammanagi Reader
Dr Zameera A Naik Reader
All my colleagues
www.indiandentalacademy.com
REFERENCES J Contemp Dent Practice 2005 November; (6)
4:144-151 Dent Clin N Am 2002; 46: 857-868 J Am Geratr Soc 1996; 44: 194-197 Am J Clin Nutr 1990; 51: 2233 J Gerontol A Biol Sci Med Sci 1998; 53A:
M59-M63 J Am Dent Assoc 1999; 130(2): 236-251 J Am Dent Assoc 1999; 130(2): 701-709
www.indiandentalacademy.com
www.indiandentalacademy.com
ADVERSE EFFECT OF DRUGS DRUG CAUSING XEROSTOMIA• One of the MC and potentially destructive oral side
effect.• in caries and suscIncrease eptibility to oral fungal
infections. • In elderly- easy trauma to mucosal tissues• Alters taste, impairs speech and swallowing. drugs are the most common cause of reduced
salivation. Most commonly implicated drugs are- TCA, antipsychotics, atropine and antihistamines www.indiandentalacademy.com
www.indiandentalacademy.com