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Analgesics in Pediatric Dentistry
Concepts About Pain in Children.1. Children have higher tolerance to pain.2. Pain perception is low because of biologic
immaturity.3. Little or no memory of a painful
experience.4. More sensitive to side-effect of
analgesics.5. Special risk for addiction to narcotics.
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Classification of Analgesics
Centrally acting (narcotic) Peripherally acting (non-
narcotic)
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Centrally Acting Analgesics These are more effective against acute
pain. But have a greater incidence of adverse effect.
They usually are administered parenterally and are devoid of anti-inflammatory and antipyretic effect.
Recent Opioid Analgesics1. Alfentanil2. Remifentanil3. Tramadol
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Alfentanil & RemifentanilMechanism of action• Rapid onset (within 1-1.5 min)• Metabolized in liver• Half-life is 1-2 hoursUses • Short , pain full procedures requiring intense
analgesia and blunting of stress responses.• Remifentanil for longer neurosurgical
procedures where rapid emergence from anesthesia is important.
Commercial forms• ALFENTA (Alfentanil) • ULTIVA (Remifentanil)
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TramadolMechanism of action• Weak agonist at all type of opioid receptors
with some selectivity for µ receptors.Uses • Mild to moderate pre-and postoperative pain.• Severe acute or chronic pain, cancer painCommercial forms• CONTRAMAL• CONTRAAL DT• DOLOMED• DOLOTRAM• TRAMOL
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Peripherally acting Analgesics
These are less effective against severe pain. But have a lower incidence of adverse effects.
They usually are administered orally and are used for chronic low grade pain.
Some possess anti-inflammatory and antipyretic effect.
• Ibuprofen • Diclofenac• Nimesulide• Paracetamol.
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Combination therapy for pain Ibuprofen & Paracetamol. Diclofenac sodium & Paracetamol. Nimesulide & Paracetamol. Mefenamic & Paracetamol.
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Dose Calculation for Children
1. Clark’s rule child’s weight in Ib
X adult dose = child’s dose
150
2. Young’s rule Age of child
X adult dose = child’s dose Age + 12
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Commonly used Antibiotics in children
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AMOXICILLIN Action: interferes with cell wall replication
of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .
Dose: 20-40 mg/kg/day 3 divided doses Adverse reaction: increased thirst,
nausea, vomiting, diarrhea, pruritus urticaria, angione-urotic edema, bronchospasm, anaphylaxis.
Contra- indication: Hypersensitivity to penicillin, neonates.
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AMOXICILLIN + CLAVUNATE POTASSIUM Action: interferes with cell wall
replication of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .
Dose: 20-40 mg/kg/day 3 divided doses Adverse reaction: Discolored
tongue,glossititis,increased thirst, nausea, vomiting, diarrhea, pruritus,urticaria, bronchospasm, anaphylaxis.
Contra- indication: Hypersensitivity to penicillin, neonates.
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AMOXICILLIN + CLOXACILLIN Action: interferes with cell wall replication
of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .
Dose: 50-100 mg/kg/day 3 divided doses Adverse reaction: increased thirst, nausea,
vomiting, hyperkalemia, pruritus,urticaria, bronchospasm, anaphylaxis.
Contra- indication: Hypersensitivity to penicillin.
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AMPICILLIN Action: interferes with cell wall
replication of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .
Dose: 50-100 mg/kg/day 3 divided doses
Adverse reaction: Discolored tongue, glossititis, rush, increased thirst, nausea, vomiting, diarrhea, pruritus,urticaria, glomerulonephritis, angioneurotic edema, bronchospasm, anaphylaxis.
Contra- indication: Hypersensitivity to penicillin,
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CEPHALEXIN Action: inhibits bacterial cell wall synthesis,
rendering cell wall osmotically unstable. Doses: 50-100 mg/kg/day Adverse reaction: candidiasis, glossitis,
nausea, vomiting , diarrhea, anorexia, pseudomembranous colitis, nephrotoxicity, urticaria, rash, anaphylaxis.
Contraindications: hypersensitivity to penicillin, pregnancy, infants < 1 month.
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COTRIMOXAZOLE (sulfamethoxazole + trimethoprim ) Action: sulfamethoxazole interferes with
bacterial biosynthesis of proteins by competitive antagonism of PABA, trimethoprim blocks synthesis of tetrahydrofolic acid, this combination blocks 2 consecutive synthesis of essential nucleic acids, proteins
Doses: 8mg/kg/day Adverse reaction; candidiasis, stevens-johnson
syndrome, anaphylaxis, SLE, nausea, vomiting, diarrhea, hepatitis, enterocolitis, leukopenia, agranulocytosis, renal failure.
Contraindication : hypersensitivity to trimethoprim or sulfame-thoxazole megaloblastic anemia, infants < 2 months, pregnancy and lactation.
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ERYTHROMYCIN Action: binds to SDS ribosomal susceptible
bacteria and suppresses protein synthesis. Doses: 30-50 mg/kg/day Adverse reaction: candidiasis, rash,
pruritus, hypersensitivity, nausea, vomiting, diarrhea, hepatotoxicity, abdominal pain, pseudomembranous tinnitus.
Contraindications: hypersensitivity to pre- existing hepatic disease.
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METRONIDAZOLE Action: in anaerobic microorganisms
metronidazole is converted to active form by reduction of its nitro group. This gets bound to DNA and prevents nucleic acid formation.
Doses : 5 mg/ kg Adverse reaction ; dry mouth, furry
tongue,, bitter taste, metallic taste, leukopenia, bone-marrow aplasia, rash, urticaria, nausea, vomiting, diarrhea, abdominal pain, nephrotoxicity.
Contraindication: hypersensitivity to this drug, renal disease, pregnancy, lactation, hepatic disease, alcoholic patients.
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Recent advanced in Antibiotics
Fourth generation Cephalosporins Cefepime Developed in 1990s Antibacterial spectrum similar to 3rd generation Resistance to β-lactamases Cefepirome Recently marketed in India. Used for treatment of serious hospital-based
infection Better penetration through gram-negative
bacteria More potent than 3rd generation Resistance to β- lactamases.
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Newer Macrolides
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ROXITHROMYCIN Semi-synthetic, long acting, acid–stable with anti
microbial spectrum resembling erythromycin.Indication Respiratory infections ENT infections Skin & soft tissue infection Genital track infectionsDosage Adult 150 mg BD Children 2.5 -5 mg / kg BDCommercial forms ROXID ROXEM ROXIBID 150 mg & 50 mg kid tab.
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CLARITHROMYCIN Antimicrobial spectrum resembling
erythromycin Indication First line drug in Mycobacterium avium
complex in AIDS patients.Dosage 250 mg BD for 7 days Severe cases 500 mg BD for 14 daysCommercial forms CLARIBID CELEX CLARIMAC
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AZITHROMYCIN Antimicrobial spectrum expanded as compared to erythromycin. Active against H.influenzae. High activity on respiratory pathogens Good activity against Mycobacterium avium complex in AIDS
patients.Indication Pharyngitis Tonsillitis Sinusitis Staphylococcal & streptococcal skin & soft tissue infection MAC in AIDS patientsDosage 500 mg OD Children above 6 months 10 mg / kg of 3 daysCommercial forms ZITHROMAC AZITHRAL AZIWOK Available as 100 mg kids tab. Should be given 1-2 hours before
meal