GP2 CH8 Oral effects of medications
Oral effects of medication
How to take a drug history
Adverse drug reaction(ADR)
Whitening
Adverse effects of the drug藥物的不良反應
Side- effect
Drug toxicity
Adverse drug reaction
Drug abuse
Adverse event
irrespective of whether the drug is suspected of being the cause不論該藥物是否被懷疑是原因
harmful event that occurs while a patient is taking a drug
unwanted or harmful reaction that is experienced following the administration of a drug or combination of drugs under normal conditions
uspected to be related to the drug.
usually require the drug to be discontinued or the dose reduced
Any effect caused by a drug other than the intended therapeutic effect
whether beneficial, neutral or harmful
Adverse effects of a drug that occur because the dose or plasma concentration has risen above the therapeutic range.
misuse of recreational or therapeutic drugs
may lead to
addiction or dependence
serious physiological injury (such as liver damage)
psychological harm
death
abnormal behaviour patterns
hallucinations
memory loss
Type B: Bizzare
Type C : Chronic
Type A: Augmented
Type D : Delayed
Type E : End of use
Type F : Failure
Example
predictable from the known pharmacodynamic effects of the drug
Dose-dependent, common, usually mild.
Diarrhea due to antibiotics
Constipation caused by opioids
Hypotension caused by antihypertensives抗高血壓藥
Dehydration caused by diuretics
not obviously dose-dependent in the therapeutic range治療範圍內不明顯是劑量依賴性的
Example
Not predictable
Hypersensitivity (Anaphylaxis )due to penicillin
Rare and often severe
Patients are generally “hyper-susceptible高度易感” because of unpredictable inmunological or genetic factors
occur only after prolonged continous exposure to a drug僅在長期持續接觸藥物後才會發生
Example
Steroid decrease HPA(Hypothalamic–pituitary–adrenal )axis下丘腦 - 垂體 - 腎上腺軸
Osteoporosis caused by corticosteroids皮質類固醇引起的骨質疏鬆症
Retinopathy caused by chloroquine 由氯喹引起的視網膜病變
Example
Teratogenicity
delayed until long after drug exposure
carcinogenesis
difficult diagnosis.
Malignancies that may emerge after immunosupressive treatment post transplantation
these occur after abrupt drug withdrawal.藥物在突然停藥後發生。
Example
Precipitation of MI by Beta blocker withdrawal
Abrupt withdrawal of corticosteroids should be avoided as suppresses the hypothalamic- pituitary-adrenal axis應避免突然停用皮質類固醇抑制下丘腦 - 垂體 - 腎上腺軸
example
Teratogen
Drug with the potential to affect the development of the fetus in the first 10 weeks of intrauterine life.
Thalidomide disaster in early 1960s
OCP failure(Oral Contraceptive Pill Failure口服避孕藥)
highly concentrated bleaching agents 高濃度漂白劑的產品
certain risks related to tooth whitening
include home-based product
most frequently dental procedures
toothpastes
gels
films
Information from the patient (or carer護理人員)
Current prescribed drugs
Other medications that are often forgotten (over-the- counter drugs非處方藥)
Drugs that have been taken in the recent past
formulations配方
doses
routes of administration 給藥途徑
frequency and timing時間
duration of treatment
Previous drug hypersensitivity reactions(anaphylaxis)
Previous adverse drug reactions
Adherence to therapy
Information from the general practitioner全科醫生, medical records and/or pharmacist
Up-to-date list of medications最新的藥物清單
Previous adverse drug reactions
Last order dates for each medication每種藥物的最後訂購日期
inspection of medicines檢查藥品
name
dosage
number of dosage forms taken since dispensed配藥後服用的劑型數量
Direct contact with the oral mucosa
Chemical necrosis
Postanesthesic palatal necrosis麻痺性腭裂壞死
Acetylsalicylic acid乙酰水楊酸
Silver nitrate硝酸銀
Chlorhexidine洗必泰
Allergic stomatitis
Drug induced
Contact
Erythema, vesicles, blisters & ulcerations
Immune-complexes (Ig)
DD: primary herpetic stomatitis原發性皰疹性口炎
Cellular immunity細胞免疫力
Resins, metals & toothpastes
Oral ulceration of unknown mechanism
Metamizol and NSAIDs
Alendronate
Oral ulcers
Cocaine
Lesion starts at nose
Osteocartilaginous necrosis骨軟骨壞死
Gingival hyperplasia
Cyclosporine(immunosuppressant免疫抑製劑)
Nifedipine (calcium channel blockers鈣通道阻滯劑)
Hydantoin
Phenytoin (antiepileptic抗癲癇藥)
within 3 months
Gingivectomies牙齦切除術
Mucosal Pigmentation
Silver amalgam tattooing
not to miss-diagnosis with cancer不要錯過癌症的診斷