EMERGENCY DRUGS
USED IN ORAL SURGERY
R.ANIL KUMAR
4TH BDS
CONTENTS * Introduction
* Classification of the emergency drugs
* Individual emergency drug
* Drug interactions
EMERGENCY DRUGS USED IN ORAL SURGERY
1. Adrenaline 11. Pancuronium bromide
2. Atropine 12. Styptochrome
3. Dopamine 13. Ethamsylate
4. Metoclopramide 14. Ketorolac
5. 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. Chlorphenaramine maleate
CLASSIFICATION
Emergency drugs
Injectables Non Injectables Oxygen
Vasodilators
Respiratory stimulants
Anti Hypoglycaemic agents
Bronchodilators
Primary Secondary Drug for advanced 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
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
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
ATROPINEINTRODUCTION
- 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
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
DOPAMINEINTRODUCTION
- 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
- In parkinsonism
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
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 in gut
INDICATIONS
- As an anti emetic – in nausea, vomitting
post operative vomitting
drug/disease induced vomitting
radiation sickness
morning/ motion sickness
- Gastritis
- Reflux oesophagitis
- Gastroenterology
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
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
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
HYDROCORTISONEINTRODUCTION
- 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
- Addison’s disease
- Rheumatoid arthritis
- Pruritis
- Tubercular meningitis
- Infective eczema
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
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
-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
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
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
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
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)
FUROSEMIDE INTRODUCTION
- 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 treatment of
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
- 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
PANCURONIUM BROMIDE INTRODUCTION
- Long acting, non depolarizing, peripherally acting
skeletal 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
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
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
TRADE NAMES : Styptochrome, Cadisper – c, Styptocid
DOSAGES : Pre operatively 2-6 ml at suitable intervals
Postoperatively 1-2 ml every 2 hours
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
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
KETOROLAC INTRODUCTION
- It is a non steroidal anti inflammatory drug (NSAID)
- It is a pyrrolo-pyrrole derivative of non selective cox inhibitor (conventional NSAID)
- 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
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
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
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
SUCCINYL CHOLINE INTRODUCTION
- It is an ultra short actiong ,peripherally acting , neuro muscular blocking
skeletal 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
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
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
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
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 given because
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
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
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
INDICATIONS ORAL INJECTIONS
Mild hypocalcaemia Severe hypocalcaemia
Growing children Hypoparathyroidism
Pregnancy Hyperkalemia
Lactation Cardiac arrest
Post menopausal women Every fourth bottle of
Rickets blood transfusion
Osteomalacia
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
Common drug interactions in oral surgical practice
DrugDrug Interacting DrugInteracting Drug Drug InteractionDrug Interaction
1)Antihistamin1)Antihistaminee
CNS depressantsCNS depressants Increased drowsiness and sedationIncreased drowsiness and sedation
2)2) Salicylates Salicylates 1)1) Anticoagulants Anticoagulants
2)2) AntacidsAntacids
3)3) CorticosteroidCorticosteroid
4)4) MethotrexateMethotrexate
5)5) Oral Oral hypoglycaemicshypoglycaemics
6)6) Phenytoin Phenytoin
Increased risk of bleeding Increased risk of bleeding
Premature release of aspirin Premature release of aspirin
Increased risk of gastroitestinal Increased risk of gastroitestinal bleedingbleeding
Increased risk of methotrexate Increased risk of methotrexate toxicitytoxicity
Potentiates hypoglycaemic drugs Potentiates hypoglycaemic drugs effect effect
Increased effect of antiepileptics Increased effect of antiepileptics
3) Atropine3) Atropine 1) Alcohol1) Alcohol Impaired motor performance and Impaired motor performance and increased drowsiness.increased drowsiness.
4)4)Carbamazepine Carbamazepine
5)5)Corticosteroids Corticosteroids
1)1) AlcoholAlcohol
2)2) Barbiturates, Barbiturates,
doxy cycline doxy cycline
oral oral hypoglycemics hypoglycemics steroidssteroids
3)3) Erythromycin Erythromycin
1)1) Anti diabetic Anti diabetic drugsdrugs
2)2) Anti Anti hypertensives hypertensives
3)3) Oral Oral cotraceptives cotraceptives
Depressed CNSDepressed CNS
Depressed CNSDepressed CNS
Retarded effect of drugRetarded effect of drug
Increased carbamazepine isoniazid Increased carbamazepine isoniazid plasma level resulting in sedation plasma level resulting in sedation
Corticosteroids may exacerbate Corticosteroids may exacerbate diabetic state by hypoglycemic action diabetic state by hypoglycemic action
Antagonism due to fluid retentionAntagonism due to fluid retention
Increased anti-inflammatory response Increased anti-inflammatory response to topical steroids to topical steroids
6) 6) CotrimoxazoleCotrimoxazole
1)1) Diuretics Diuretics
2)2) Anti coagulants, Anti coagulants, anti epileptics, anti epileptics, oral oral hypoglycemics hypoglycemics
Increased risk of thrombocytopenia in Increased risk of thrombocytopenia in elderly elderly
Potentiate action of these agents Potentiate action of these agents
7)Diazepam7)Diazepam CNS depressants CNS depressants Intensified sedative effects Intensified sedative effects
8) Doxy cycline8) Doxy cycline 1) Penicillin1) Penicillin
2) Barbiturates, 2) Barbiturates, antiepileptics antiepileptics
Reduced effect of penicillinReduced effect of penicillin
Possiblility of reduced plasma Possiblility of reduced plasma concentration of Doxy cycline. concentration of Doxy cycline.
9) Metronidazole 9) Metronidazole 1) Alcohol 1) Alcohol
2) Antiepileptics 2) Antiepileptics
3) Anticoagulants 3) Anticoagulants
4) Barbiturates4) Barbiturates
Antagonism, therefore alcohol should Antagonism, therefore alcohol should be avoided be avoided
Incereased risk of toxicity of phenytoinIncereased risk of toxicity of phenytoin
Potentiated anticoagulant effectPotentiated anticoagulant effect
Reduced plasma level of Reduced plasma level of metronidazole metronidazole
10)Penicillin10)Penicillin oral oral Contraceptives Contraceptives
Increased bleeding, possibly with Increased bleeding, possibly with contraceptive failure contraceptive failure
11)Tetracyclines11)Tetracyclines Oral Oral contraceptives contraceptives
Oral hypoglycemicOral hypoglycemic
MethotrexateMethotrexate
Increased bleeding due to Increased bleeding due to contraceptive faliure contraceptive faliure
Increased hypoglycemic effectIncreased hypoglycemic effect
Incerased methotrexate toxicityIncerased methotrexate toxicity
References :
1. Essentials of medical pharmacology (By K.D.Tripathi).
2. A text book of pharmacology (Satoskar).3. A text book of Oral and Maxillofacial surgery (By B. Srinivasan). 4. Contemporary Oran and Maxillofacial Surgery
(By Peterson).
Top Related