THIS CLASS IS IN BRIEF FOR UNDERGRADUATE UNDERSTANDING AND EXAMINATION PURPOSE

1. Dr. RAGHU PRASADA M S
MBBS,MD
ASSISTANT PROFESSOR
DEPT. OF PHARMACOLOGY
SSIMS & RC.

2. Tendencies for longer dental procedures
Increased use of drugs
Secondary diseases in geriatric populations
The conditions are
Anaphylaxis
Uncontrolled Bleeding
Unconciousness-vasovagal attack
Hypoglycemia
Seizures
Arrhythmia
Cardiac arrest

3. 1.Anaphylactic Shock 1:1000 adrenaline
0.5 ml for adults IM
0.3ml for child 6-12 years
May be repeated after 10-20 minutes .
Avoid I/V because fatal ventricular fibrillation may occur.
Contraindications: Hyperthyroidism, HTN
Arrhythmias
2. Oxygen –high flow
3. Cardiopulmonary resusitation
4. IV hydroocortisone 100-200mg
5. Chlorpheniramine IM 20 mg

4. Cotton swab dipped in 1% adrenaline solution packing
Common causes
patients on antiplatelet drugs
patients on antico-agulation therapy
hemophiliacs
Long term glucocorticoid therapy

5. Premonitory stage-diazepam-10-15mg repeated once
after 15 min
Early status-lorazepam-0.1mg/kg repeated once
after 15 min
Give usual AED medications if already on treatment
Established status-fosphenytoin infusion15-20mg/kg
Refractory status-general anaesthesia-propofol 2-
10mg/kg/hr
-midazolam-0.5mg/kg/hr
-Thiopental sodium 3-5mg/kg
Anaesthesia continued for12-24 hrs after last clinical or
electrographic seizure
5

6. 6

7. 1. Pain and anxiety-- -GTN, morphine
2. Opioid analgesics and Antianxiety agents
3. Pethidine, Diazepam, alprazolam
4. General measures-O2 therapy, dopamine,
5. atropine, diltiazem,
6. Maintainance of blood volume-Saline , dextran
7. Correction of acidosis- sod. Bicarbonate infusion
8. Prevention of treatment of arrhythmias
9. -beta blocker
7

8. 7. Pump failure-furosemide, vasodilators, ionotropic
drugs
8. Prevention of thrombus extension, venous
thrombosis- aspirin, heparin, anticoagulants-
dalteparin, Enoxaparin
9. Thrombolysis and reperfusion-fibrinolytic agents-
streptokinase, urokinase
10. Prevention of remodeling and CHF-ACE inhibitors,
ARBs- lisinopril, ramipril
11. Prevention of future attacks-platelet inhibitors-
clopidogrel, β blockers, statins
8

9. Hypovolemic, Septic, Cardiogenic , Anaphylactic
Neurogenic and Obstructive
Hypovolemic Shock
Airway Breathing Circulation
Establish 2 large bore IVs or a central line
Crystalloids
Normal Saline or Lactate Ringers-Up to 3 liters
Packed Red Blood Cells
O negative or cross matched
Control any bleeding
Arrange definitive treatment

10. “Crystalloids”
Normal saline (just NaCl).
Lactated ringers
Plasmalyte-balanced crystalloid solution with
multiple electrolye solution
Normosol-solution of balanced electrolytes in water
for injection.
Last 3 have K+ and other stuff (acetate, Mg++, etc.)

11. Crystalloids enter entire ECF: ISF (3/4 of ECF) and IVF
(1/4 of ECF).
3 or 4:1 for replacement of blood loss with crystalloid
Colloids only enter IVF (in short term– 16 hour half-
time for entrance into ISF)
1:1 replacement of blood loss with colloid

12. 12
Epinephrine , β1, (β2) 2-10 µg/min
Norepinephrine , β1 0 - 2-20 µg/min
Dopamine β1, DR, (α ) 1 - 30
Dobutamine β1, β2 2 - 20
Phenylphrine  20-200µg/min
Vasopressin Angiotensin III 5 - 20
Amrinone PDI 2 -15
Drug Receptor CO SVR Dose Range
0 -
(µg/kg/min)
1
0

14. Careful replacement of fluid deficits.
Correction of acidosis & hyperglycemia via Insulin
administration.
Correction of electrolytes imbalance.
Treatment of underlying cause.
Monitoring for complications of treatment.

15. Hypoglycemia-(bld glucose < 60mg)
due to large dose or missed meals symptoms counter
regulatory sympathetic stimulation- sweating, anxiety,
palpitation and tremors
Those symptoms due to deprivation- dizziness,
headache, visual disturbance, hunger
Treatment
20% dextrose IV 100ml or
50ml 50% dextrose IV

16. Condition precipitated by sudden withdrawal of
steroids after long term administration
ACTH (adrenal corticotropic hormone) regulates
hormone secretion by the cortex of the adrenal glands.
ACTH- stimulates –Glucocorticoids, mineralocorticoid
and androgens. ACTH-stimulated by trauma and stress
It presents as weakness , hypotension, dehydration
Treatment
Hydrocortisone hemisuccinate 100mg every 4-6hrs
Correction of fluid and electrolyte balance

17. Due to hypocalcemia
Presents as muscle cramps, paraesthesias,
laryngospasm and convulsions
Treatment
Slow IV injection of 5-20 ml 10% calcium gluconate

18. Acute attach of bronchial asthma
Oxygen free flow
Nebulization with salbutamol and ipratropium bromide
Nebulization with budesonide
IV injection of deriphylline and dexamethasone

19. 19
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