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Medicine

Which are safe drugs for patients suffering from renal failure?

This information is courtesy of Dr. Mark Donaldson Dr. Mark Donaldson is Director of Pharmaceutical Services at the Kalispell Regional Medical Center,  Clinical Professor in the Department of Pharmacy at the University of Montana, and Clinical Associate Professor in the School of Dentistry at the Oregon Health and Sciences University Safe Drugs in Renal Failure (PDF)   Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca You are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on ...

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How do you treat an oral infection in a patient with a history of C. Difficile?

This question was submitted by a general dentist: A patient presents with an oral infection for which I would like to consider antibiotics as part of overall care. However, she has a history of C.Difficile infection and there is concern that the antibiotic chosen might reactivate the residual C.Difficile in her gut. What is the best course of action in treating the oral infection? Dr. Dan Haas, DDS, PhD, FRCD(C) Professor and Dean, Arthur Zwingenberger Decanal Chair, Faculty of Dentistry at the University of Toronto Dr. Dan Haas provided the following quick and initial response:  A recent history of Clostridium Difficile-associated colitis ...

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Misuse of opioid pain medication in dentistry: Fact or fiction?

Derived from the Chronic Orofacial Pain Workshop of the Network for Canadian Oral Health Research, IMHA, Canadian Institutes of Health Research, Montreal, November 2013 Gilles Lavigne, DMD, PhD, FRCD,  Professor, Faculté de médecine dentaire, Université de Montreal Mary Lynch, MD FRCPC,Professor Anesthesiology Psychiatry Pharmacology,Dalhousie University, To understand the misuse of prescription opioid analgesics (POA), it is critical to examine the definitions used in the research. The Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) is an ongoing national survey that examines alcohol and drug use in Canadians 15 years of age and older. CADUMS defines the nonmedical use of prescription ...

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Are local anesthetics still controversial for patients taking oral anticoagulants?

This summary is based on the article published in the British Journal of Oral and Maxillofacial Surgery: Safety of local anaesthesia in dental patients taking oral anticoagulants: is it still controversial? (January 2012) Purpose of the Study To investigate the safety of local infiltration techniques and the inferior alveolar nerve block (IANB) in dental patients taking oral anticoagulants. Main Findings Bleeding as a result of the use of local anaesthesia in patients with therapeutic INR is unlikely, provided that the IANB is done correctly. IANB in patients with INR within therapeutic range is safe. Haemorrhagic complications after local anaesthesia, including the IANB (possibly even other nerve blocks), ...

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Can addictive behaviour be altered? The concept of drug-evoked synaptic plasticity

This summary is based on the article published in the Journal of Neuroscience: Drug-Evoked Synaptic Plasticity Causing Addictive Behavior (November 2013) Context The core element of the addiction process: an initially neutral stimulus becomes attractive when associated with drug consumption, and even after prolonged periods of abstinence this cue may trigger craving and cause the subject to relapse. Therefore, many researchers have argued that the secret to understanding addiction lies in the elucidation of the “memory trace” that links the cue to the compulsive drug use. The implicit underlying hypothesis is that addictive drugs generate an inappropriate learning signal that leads to the encoding of a unique trace, which, when reactivated, has ...

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How can dentists prevent the abuse of prescription opioids?

This summary is based on the article published in the Journal of the American Dental Association: Prevention of prescription opioid abuse: the role of the dentist (July 2011) Full-text article (PDF) Context  Opioids are analgesics that have potential for misuse, abuse or addiction. Up to an estimated 23 percent of prescribed doses are used non-medically. As prescribers of 12 percent of immediate-release (IR) opioids in the United States, dentists can minimize the potential for misuse or abuse. The authors participated in a two-day meeting in March 2010 co-hosted by Tufts Health Care Institute Program on Opioid Risk Management, Boston, and Tufts University School of Dental Medicine, Boston. The ...

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What is the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (CNCP)?

Canadian medical regulatory authorities undertook guideline development in response to: Physicians and other stakeholders seeking guidance regarding safe and effective use of opioids  A growing concern about opioid misuse creating patient and public safety issues, and  The lack of systematically developed national guidelines on opioid use for CNCP. Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: Executive Summary and Background (PDF) Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: Recommendations for Practice (PDF) Summary of the Recommendations Cluster 1: Deciding to Initiate Opioid Therapy R01 Before initiating opioid therapy, ensure comprehensive documentation of the patient’s pain ...

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Follow-up: Anti-infectives pediatric dosage

This is a follow-up post to the Refresher: Why use anti-infectives? A number of dentists inquired about the pediatric doses for the anti-infectives mentioned in the post. Sources of information: Lexicomp and e-Therapeutics.ca Amoxicillin Children ≤3 months: Oral: 20-30 mg/kg/day divided every 12 hours Children >3 months and <40 kg: Oral: 20-100 mg/kg/day in divided doses every 8-12 hours Children >3 months and ≥40 kg: Refer to adult dosing. Children ≥12 years: Oral: Extended-release tablet: 775 mg once daily Amoxicillin and Clavulanate Susceptible infections: Infants <3 months: Oral: 30 mg/kg/day divided every 12 hours using the 125 mg/5 mL suspension Mild-to-moderate ...

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