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How safe are benzodiazepines?

This summary is based on the Rapid Response Report developed by the Canadian Agency for Drugs and Technologies in Health: High dose and watchful dosing of benzodiazepines: a review of the safety and guidelines Full Report (PDF)   Key Findings No “watchful dose” for benzodiazepines was identified. Benzodiazepines may be used in higher than 10 mg diazepam-equivalent doses in some circumstances, but data were limited. Context   Benzodiazepines are compounds that enhance the activity of gamma-aminobutyric acid (GABA)-A receptors by increasing the affinity of the receptors for GABA. Therefore, benzodiazepines are prescribed as anxiolytic medications. In Canada, the labeled indications include, the treatment of anxiety disorders, panic disorder, ...

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How and When Is Epinephrine Used As A Vasoconstrictor in Local Anesthetics?

This Prescription Drug Consult is presented by the JCDA Oasis Team and is also available through JCDA Oasis Mobile Epinephrine in LA (Adrenalin®) Presentation Epinephrine is a an alpha-/beta-agonist that is administered as an adjuvant in local anesthetic cartridges. Epinephrine is also used as an emergency drug for treatment of anaphylactic reaction and a vasoconstrictor to decrease systemic absorption of local anesthetics and to increase the duration of anesthetic action. The use of Epinephrine may decrease superficial hemorrhage. Dosage May be used in concentrations of 1:500,000 to 1:50,000. 1:100,000 and 1:200,000 is used most commonly in a typical 1.8 ml local anesthetic dental ...

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How Do I Manage A Patient Who Is On Anticoagulants?

We are very pleased to present this series of videos by Dr. Mark Donaldson, Director of Pharmacy Services at the Kalispell Regional Medical Center and faculty member at the University of Montana and the Oregon Health & Sciences University There is no such thing as medical clearance. In fact, the dentist retains the primary responsibility for the procedures carried out for the immediate management of many untoward complications. While it is always prudent to get a consult with a medical practitioner, such as the patient’s primary prescriber or cardiologist, at the end of the day, the onus is on the dentist ...

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Do You Know Your Ibuprofen?

 This Prescription Drug Consult is presented by the JCDA Oasis Team. It is also available in JCDA Oasis Mobile Ibuprofen  Addaprin [OTC]; Advil® [OTC]; Caldolor®; I-Prin [OTC]; Ibu®; Midol® Cramps & Body Aches [OTC]; Motrin® Infants’ [OTC]; NeoProfen Presentation Ibuprofen is a Non-Steroidal Anti-Inflammatory Drug (NSAID) which could be administered orally and through I.V. Ibuprofen is prescribed for inflammatory diseases, analgesia, dysmenorrhea, and as an antipyretic. Dosage Analgesic Children: < 4-10 mg/kg/dose every 6-8 hrs. Adults: 200-400 mg/dose every 4-6 hrs (maximum daily dose: 1.2 g, unless directed by physician). Analgesic, antipyretic: (Consult physician if treatment for > 10 days is required) Children 6 months to 11 years: Use of weight to select ...

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Which medications are most effective for moderate to severe post-operative dental pain?

The following question was posted by a practising dentist: There is quite a bit of variation in the office with respect to drugs dentists like to prescribe for post-operative pain. Which pain medications are the most effective for moderate to severe pain and have the least number of side effects? Dr. Mark Donaldson from the University of Montana and the Oregon Health & Sciences University provided this initial response: The goal should be: “the most effective dose for the shortest period of time.”  We want to get our patients out of pain as quickly as possible. Two good recent articles come to ...

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What is the QT-Prolonging effect of Epinephrine on Patients Taking SSRIs?

The following question was submitted by a practicing dentist: What may happen with patients who have a prolonged QT due to their SSRI or Prozac medication when they are administered a local anesthetics-containing epinephrine? The following response is provided by Dr. Joonyoung Ji, resident in the Department of Dental Anesthesia at the University of Toronto Main take-away message Epinephrine, stress, and using more than one psychotropic increases the QT interval. The majority of patients have significant medical co-morbidities in reported cases of arrhythmia associated with psychotropics. Therefore, limiting the use of epinephrine to under 40 mcg or no more than 2 cartridges of ...

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