INDEXANTIBIOTICS -Definition -systemic administration of antibiotics -Biological implication -Antibiotics used ANALGESICS -Definition -classes of antibiotics -Non opioid type of analgesics -opioid type of analgesics -Mechanism of strong analgesics -side effects of analgesics
ANTIBIOTICSDEFINITION
An Antibiotic is a naturally occuring,semisynthetic,or synthetic type of anti infective agent that destroys or inhibits the growth of selective microorganism,generally at low concentrations
SYSTEMIC ADMINISTRATIN OF ANTIBIOTICSBackground and RationaleThe treatment of periodontal disease is based on the
infectious nature of the disease.An ideal antibiotic for use in prevention and treatment of periodontal disease should be specific for periodontal pathogens,allogenic and nontoxic,substantive,not in general use of other diseases and inexpensive.
The treatment of patient should be based on the patient’s clinical status ,nature of colonizing bacteria and risk and benifits associated with the proposed treatment plan
Biological implicationsThe clinical diagnosis and situation dictate the need
for possible antibiotic therapy as a adjunct in controlling active periodontal disease. The patient diagnosis can change over a period of time.
Continuing disease activity,as measured by continuing attachment loss ,purulent exudate,and continuing periodontal pockets of 5mm or greater that bleed on probing is an indication of periodontal intervention.
Antibiotics for the periodontal disease are selected on the patient’s medical and dental status,current medications and results of microbial analysis if performed
Microbiological plaque sampling can be performedAntinfective agents can be used for enhancing
regenerative healing
Antibiotics used in priodontal diseases
TETRACYCLINEPHARMACOLOGY:Tetracyclines are group of antibiotics
produced naturally by certain species of streptomycin or derived semisynthetically.They are bacteriostatic and are affective against rapidly multiplying bacteria
CLINICAL USE :tetracycline is used in treatment of LAP.A.actinomycetemcomitans is a frequent causative microorganisam in LAP and is tissue invasive.Systemic tetracycline can elminate tissue bacteria and has been shown to arrest bone loss and supress A.actinomycetemcomitans in congunction with scaling and root planing
It is not advisable to advisable to prescribe long-term regimens of tetracycline because of possible development of resistant bacterial strains
Specific Agents : Tetracycline,Minocycline,Doxycycline
METRONIDAZOLEPHARMACOLOGY: It is a bactericidal to anaerobic
organism and is believed to disrupt bacterial deoxyribonucleic acid synthesis in condition with a low reduction potential.
It is also effevtive against anaerobes such as Poryphyromonas gingivalis and Prevotella intermedia
CLINICAL USE : It has been used clinically to treat gingivitis ,acute necrotizing ulcerative gingivits ,chronic periodontitis ,and aggresive periodontitis
It is used as monotherapy and used with root planning and surgery
Most common regimen is 250 mg three times daily SIDE EFFECT: metronidazole is an Antabuse effect when
alcohol is ingested ,it can result in severe cramps ,nausea ,and vomiting
PENICILLINSPHARMACOLOGY: They inhibit
bacterial cell wall production and therefore are bactericidal.
CLINICAL USE : Penincilins other than amoxicillin and amoxicillin-clavunate pottasium have not been shown to increase periodontal attachment levels.
SIDE EFFECT :It may induce allergic reactions and bacterial ressistance
CEPHALOSPORINS PHARMACOLOGY:The family of beta
lactams is similar in action and structure to penicillin.They are ressistance to number of beta lactamases .
CLINICAL USES :they are not generally not used to treat dental –related infection .Penincil are superior to cephalosporin in their range of action
SIDE EFECT: Rashes,urticaria,fever,and GI upset have been associated
CLINDAMYCINPHARMACOLOGY: it is effective
against anaerobic bacteria .it is effective in situation in which patient is allergic to penincillin
CLINICAL USE :Clindamycin has shown efficasy in patients with periodontitis refractory to tetracyclin therapy
SIDE EFFECT :It has been associated with pseudomembranous colitis.
CIPROFLOXACIN PHARMACOLGY: it is a quinolone active
against gram negative rods ,all facultative and some anaerobic putative periodontal pathogens.
CLINICAL USE :It is the only antibiotic in periodontal therapy to which all strains of A.actinomycetemcomitans are susceptible.
SIDE EFFECT: Nausea ,headache,mettalic taste in the mouth and abdominal discomfort .
MACROLIDESPHARMACOLOGY:Macrolides antibiotics
contain a many membered lactone ring to which one or more deoxy sugars are attached .They inhibits protein synthesis by binding to the 50S ribosomal subunits of sensitive microorganism
CLINICAL USE : (i)Erythromycin: it is not effective against most prutative periodontal pathogens (ii)Spiramycin:it is active against gram –positive organism (iii)Azithromycin:it is effective against anaerobes and gram negative bacilli
LOCAL DELIVERY OF ANTIBIOTICSRecently,advances in delivery technology
have resulted in close release of drugsThe requirements for targeting an
antiinfective agent to infection sites and sustaining its localized cocentration at efective levels for a sufficient time while concurrently evoking minimal or no side effects. The drugs used are:
Tetracycline-Containing FibersSubgingival DoxycyclineSubgingival MinocyclineSubgingival Metronidazole
DEFINITION: A drug that selectively relieves pain by acting in CNS or peripheral pain mechanism, without significantly altering consciousness
Analgesics are common pain relievers.Many analgesics also have antipyretic
properties as well. They can be used to reduce fever
Some analgesics are also anti-inflammatory drugs as well
CLASSES OF ANALGESICS DRUGSNON OPIOD TYPE OF ANALGESICS(mild analgesics)
OPIOID TYPE OF ANALGESICS(strong analgesics)
Salicylates-aspirin-diflunisalOther NSAIDs-ibuprofin-ketrolacAcetaminophen
Natural opium alkaloid
Morphine,codeine Semisynthetic
derivatives-Heroin and pholcodeine
Synthetic opioids Pethidine fentanyl
NON OPIOD TYPE OF ANALGESICAspirin
Aspirin is believed to inhibit the enzyme, Prostaglandin synthase which is formed at the site of an injury.
This inhibits the production of prostaglandins which produce fever and swelling as well as transmitting pain signals to the brain.
AcetaminophenAcetaminophen is a pain reducer,
such as Tylenol but does not reduce inflammation
When taken at recommended doses, it has negligible side effects
It can be used efficiently in controlling postoperative pain after open flap debridement in patients with bleeding tendency
Overuse and overdoses can lead to acute liver failure and kidney damage
IbuprofenIbuprofen is a more powerful
pain reliever than aspirin in high doses.
It helps to relieve both pain and inflamation of the gums
Side effects include gastrointestinal bleeding and irritation
OPIOD TYPE OF ANALGESICS Morphine
Naturally occurring in the poppy- Only needs to be isolated
Very strong pain reliever but also very addictive (2nd to Heroin)
Usually injected but can be smoked, sniffed or swallowed
The scientific result shows that morphine treatment reduced fiber attachment and alveolar bone loss without affecting the increased leukocyte count in gingivae
Codeine Most commonly used strong
analgesic
• Similar to Morphine except for the replacement of a (OH-) group for (OCH3) group
Commonly used with Tylenol as a more mild analgesic
1/6 as strong as Morphine and less addictive
Heroin•Synthesized from morphine in a esterification reaction with acetyl chloride.•It has higher lipid solublity because of which euphoric effects are faster and greater resulting in higher abuse potential.•Though it can be used asanalgesic but is banned in many countries
Synthetic opioids The active area of morphine has been
identified and can be synthesized.This has produced many synthetic
analgesics and has allowed scientists to eliminate some of the harmful side effects of more natural analgesics.
Pethidine is one of synthetic opioids being used
Mechanism of Strong AnalgesicsThe human body contains “natural opiates” in
the brain called endorphinsThese are produced in the body during
extreme conditions such as “running high” and extreme injuries.
When these are absorbed by receptors in the brain the body feels analgesia and the pain is reduced.
Opiates derieved from the poppy act in same way as endomorphins ,the “high” is produced because of the absorbtion is quicker than endorphins
Side Effects of Strong AnalgesicsShort term• Dulling of Pain
• Euphoria
• Slow Nervous system
• Overdoses can lead to death
• Possibility of stroke
• Overall slowdown of biological systems
Long Term• Addiction and very strong
withdrawal effects
• Constipation
• Disruptions in menstruation
• “Cross-tolerance”
• Loss of appetite