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DY PATIL DENTAL SCHOOL, PUNE – II BDS – Under MUHS

GENERAL AND DENTAL PHARMACOLOGY – PRACTICAL RECORD BOOK

CONTENTS Page Date Signature

(A) GENERAL & MEDICAL DISPENSING PHARMACY

1. Prescription Order / Prescription Writing…….......... 3

2. Prescription exercises 8-11

3. Abbreviations, Weights, Measures, Exercises... 12-14

4. Basic Pharmacy Concepts & Dosage forms………. 15

5. Exercise 22

(B) DENTAL PHARMACY PRACTICALS 25

1. Astringent Gum Paint………………………………... 26

2. Condy’s Lotion………………………………………... 29

3. Tooth Powder............………………………………... 32

4. Simple Mouth wash…………………………………... 35

5. Obtundent Mouth Wash……………………………... 38

6. Cleansing Tooth Paste……………………………..... 41

(C) DENTAL PHARMACOLOGY .....……………… 44

(D) CLINICAL PHARMACOLOGY 59

1. Drugs of choice (Medical)…………………………… 60

2. Drugs of choice (Dental)……………………………. 73

3. Criticism and correction of wrong prescription……. 79

4. Intelligent questions/Therapeutic problems............ 110

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1. PRESCRIPTION ORDER / PRESCRIPTION WRITING

Prescription Order is a written order given by a physician to the pharmacist,

which contains names and details of the medications / preparations prescribed
along with the strength & type of preparations to be dispensed and the quantity to
be dispensed.

The prescription order should contain the patient details such as name, age,
sex, weight, address, as well as the date.

Prescription contains the typical symbol –“RX“ (the symbol called “Recipe”
in Latin equivalent to “receive”) - meaning “Take thou of” means “you take
the following”.

It also contains the formulae and instructions to the pharmacist for

compounding and dispensing.

At the end, the prescription order contains the instructions to the patient
regarding the detailed information of drugs to be taken and also other associated
precautions and instructions.

The prescription order has to contain the physician’s signature and registration
number.

The prescription letterhead must contain the physicians name,

qualifications, the branch of medicine (allopathy / homeopathy etc),
registration number, address, and contact details.

“Prescription Order’ has 4 parts.

Simple method to remember -
“Super” means top or above or upper
“In” means the body or the core
“Sub” means below
“Trans” means to give or to transfer / identify / instruct

1) Superscription: It is the uppermost part of the prescription. Contain

physician’s name, qualifications, branch of medicine the physician belongs to,
his/her address, and contact details including phone no, email ID, and most
importantly the date. It must have the prescription serial number. It also contains
the patient’s age, sex, body weight, address, and the symbol “ RX “ for “Take thou
of”.

2) Inscription: Is the body or core of prescription. It contains the names of the

medications in CAPITAL and legible letters, the formulations (tablet/capsule etc),
its strength (mg/g etc), and the quantities of various ingredients of the
preparations.

3) Subscription: Contains the instructions given to the pharmacist for

compounding and dispensing.
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4) Signature or Transcription: Contains the instructions to the patient including

how much, how, and when the medication is taken and any other precautions
related to the medication use, along with the physician’s signature, registration
number, and the stamp.

Below the names of the medications, the prescription must contain a sentence –
“or any other generic medications as per the choice of the patient”, so as to
allow autonomy to the patient to choose generic medications.

Below the transcription / signature, there needs to be an area for use of

pharmacist indicating which and how much quantity of medications has
been dispensed on a particular date, with pharmacist’s stamp and signature.
It should also indicate if the “refill” is allowed or not, and if allowed how
many refills, so that the patient does not use the same prescription again and
again to buy and take the medications prescribed earlier.

In a traditional prescription, the doctor prescribes one compound, which is to be

prepared by the pharmacist by mixing various substances. So the
transcription/signature can be distinctly seen as a separate part of prescription.
Whereas in a commercial prescription, there are many different medications
commercially available (and there is nothing to be mixed or compounded), and
hence the transcription (instruction about use) comes after each medication, and
cannot be shown as a single part. (See commercial prescription)

So also, in a traditional pharmacy prescription, usually only one medication is

ordered which is prepared by compounding various ingredients. Hence, the
quantities are mentioned in front of each ingredient. To avoid the confusion and
ambiguity in numbers and decimal points, a T line or Decimal line is drawn to
replace the decimal points. Complete/whole numbers are written before the
decimal line (on the left side of decimal line), and the fractions after the decimal
line (on the right side of decimal line). In a traditional pharmacy prescription, solids
are always mentioned in grams (g) and liquids in milliliters (ml).

In a commercial prescription, the medications to be ordered are not to be

compounded. The medications are readymade available on the market. Hence the
T line or decimal line is not needed.
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MAHARASHTRA MODEL PRESCRIPTION FORMAT

Doctors (Prescribers) Full NameD1
Qualification (e.g. M.B.B.S., M.D.) D2
Reg.No.(Specify alphabets specifying pathy) / Reg.No.D3
Full Address,D4 Contact: (Telephone no. Email etc)D5

Date:DD/MM/YY D6
Prescription Serial Number D9

Patient’s full Name P1

Patient’s Address and phone numberP2
SexP3 AgeP4 WeightP5

RXD10

1) Name of MedicineM1, As far as possible, generic name in capital

letters, StrengthM2, dosage formM3, dosage instructionM4, duration and
quantityM5.
2)
3)
“or any other cheaper generic medicine as per choice of patient.”

Doctor’s Signature & Date D7

Doctor’s StampD8

Refill: Yes / No
If Yes, Refill: 1 / 2 / 3
(If the entire prescription is not dispensed, specify name or number of
medicine and quantity dispensed)
Names and quantities of medicines dispensed.
Dispensed by: ___________ (Pharmacist’s Name,Reg No. & Signature)
Name and Address of Medical Store:_______________________
Date of Dispensing:______________
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Guidelines for Doctors / Prescribers

No Suggestions
1 Changes in Prescription :
-If any changes are warranted in prescription, please issue fresh prescription.

2 Do not use prescription pad with the name of medical store.

-Doctors should not use prescription pads with pre-printed messages like “Available at
XYZ medical stores “
3 Do not print names of more than one doctor on the prescription.
-One should avoid having names of two or more doctors on the same prescription pad
(even if it is a husband and wife team).
4 Do not use prescription pad of another doctor.
- A doctor should not use another doctor’s prescriptions pad, even with her/ his consent.
Conversely a doctor should not allow other doctor to use his/her prescription pad.
5 Precaution about computer generated prescription
-If the doctor types or generates her/his prescription on a computer, he/she must ensure
that he/she issues it with her/his full, recognizable dated signature in ink, and must sign as
close as possible to the last drug in the list, so that no gap is left between the last drug
and the signature.
6 Prescription of certain medicines by specialist
Certain medicines can be supplied on the prescription by specific specialist only. For
example, Sildenafil citrate can be prescribed by only Urologist, Psychiatrist,
Endocrinologist, Dermatologist or Venerologist. Letrozole can be prescribed by a Cancer
specialist only.
7 Recognize the service of Pharmacist
As per the internationally recognized practice, especially followed in the developed world,
doctors should recognize importance of services of pharmacist as they are required to
supervise sale of medicine under the law and are also responsible for counseling the
patients. The pharmacist is trained to recognize therapeutic incompatibility, absorption
incompatibility, etc. of medicines in addition to various facets of pharmacological effects of
medicine. In view of the above, the doctors should consider her/him as a resource person
and his/her view should be considered with due regard to her/his knowledge.
Food & Drugs Administration, Maharashtra State, Survey No. 341, Bandra Kurla Complex,
Bandra (East), Mumbai-400 051 Tel- 022-2659 2361, 62,63,64,65.
Email- comm.fda-mah@nic.in Web site- fda.maharashtra.gov.in
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REFILL: YES / NO
REFILLS: 1 / 2 / 3
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EXERCISE - 1 : Mark the parts for the following prescription.

TRADITIONAL PRESCRIPTION which orders compounding, mixing etc

Dr. Amar Pednekar MD

Reg No 54545/ Allopathy
122, Ishwar-Parvati Hospital, Doctors’ Colony,
Gadhinglaj -341 143
Phone-330346
Email: amp@gmail.com
Date: 26/09/2020
Prescription Serial No. 19/346

Mr. Nitin A. Patil

House No. 321, Government Colony,
Gadhinglaj 341 143

Male 35 Years 56 kg

RX
1. SODIUM SALICYLATE 1 8
2. SODIUM BICARBONATE 1 4
3. SIMPLE SYRUP 6 0
4. WATER TO MAKE 90

Mix all constituents to make a solution.

One dose of 30 ml to be taken three times a day after meals.

Doctor’s Signature
25/09/19
Reg. No. 54545
Doctor’s Stamp
Refill: Yes / No If Yes, Refill: 1 / 2 / 3
Names and quantities of medicines dispensed
No Medication dispensed Quantity
1
2
3

Name and Address of Medical Store:

Dispensing Pharmacist:Name: RegNo. Signature: Date:
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EXERCISE – 2: Mark the parts for the following prescription.

COMMERCIAL PRESCRIPTION ordering readymade medications

Dr. Amar Pednekar MD
Reg No 54545 / Allopathy
122, Ishwar-Parvati Hospital,Doctors Colony,
Gadhinglaj -341 143
Phone-330346
Email: amp@gmail.com
Date 02/10/2016
Prescription Serial No. 19/517

Miss. Shruti R. Patil

Flat No.7, Flying Height Society,
Gadhinglaj-341 143.

Female 22 Years 49 kg

RX
(1) CAPSULE AMOXYCILLIN (250 mg)- (9) capsules
Dispense such 9 capsules.
One capsule to be taken 3 times a day for 3 days after food.

(2) TABLET IBUPROFEN (400 mg) – (9) Tablets

Dispense such 9 tablets.
One tablet to be taken 3 times a day for 3 days after food.

Drink plenty of water.

Doctor’s Signature
25/09/19
Reg. No. 54545
Doctor’s Stamp
Refill: Yes / No If Yes, Refill: 1 / 2 / 3
Names and quantities of medicines dispensed
No Medication dispensed Quantity
1
2
3

Name and Address of Medical Store:

Dispensing Pharmacist:Name: Reg No. Signature: Date:
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EXERCISE – 3
Mention the missing or inappropriate / incorrect items in this prescription.
Dr. Amar Pednekar MD
122, Ishwar-Parvati Hospital,
Doctors Colony,
Gadhinglaj 341 143
Phone 330346
Email: amp@gmail.com
Prescription Serial No. 19/346

Mr. Nitin A. Patil

House No. 321, Government Colony,
Gadhinglaj 341 143

Male 56 kg

Sodium Salicylate 1 8
Sodium Bicarbonate 1 4
Simple Syrup 6 0
Water to make 90

Mix all constituents to make a solution.

One dose to be taken three times a day after meals.

Doctor’s Signature
Doctor’s Stamp

----------------------------------------------------------------------------------------------------------------------
Missing or inappropriate items
N What is missing ? Where ?
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EXERCISE – 4
Mention the missing or inappropriate / incorrect items in this prescription.
Dr. Amar Pednekar
Reg No 54545/ Allopathy
122, Ishwar-Parvati Hospital,
Doctors’ Colony,
Gadhinglaj 341 143
Date 03/01/2021
Miss. Shruti R. Patil
Flat No.7, Flying Height Society,
Gadhinglaj 341 143.

Female 22 Years

RX

Capsule AMOXICILLIN ---- (9) capsules

Dispense such 9 capsules.
Take 3 capsules everyday for 3 days.

Tablet Ibuprofen -----(9) Tablets

Dispense such 9 tablets.
One tablet to be taken 3 times a day for 3 days after food.

Drink plenty of water.

Doctor’s Signature
Refill: Yes / No If Yes, Refill: 1 / 2 / 3
Names and quantities of medicines dispensed
No Medication dispensed Quantity
1
2
3
-----------------------------------------------------------------------------------------------------------------------
Missing or inappropriate items
N What is missing ? Where ?
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ABREVIATIONS
Abbreviation Latin English
A Ante Before
Ac Ante cibos/cibum Before meal
Ad Ad To, up to
Ad lib Ad libitum As much as one desires / add freely
Aq Aqua Water
b.i.d Bis in die Twice a day
C Cum With
Dil Dilutes Diluted
Et Et And
Ext Extractum Extract
h.s. Hora somni At bedtime
in d In die During daytime
i.c. Inter cibos Between meals
liq. Liquor Solution
M Misce Mix
Mist. Mistura Mixture
Mitt. Mitte Send
o.d. Onus in die Once a day
o.h. Omni hora Every hour
o.m. Omni mane Every morning
p.o. Per os / per oral By mouth
p.c./ p.p. Post cibos / cibum / postprandial After meals
p.r.n. Pro re nata As needed
Pulv Pulvis Powder
q.h. Quaque hora Every hour
q.i.d. Quarter in die Four times a day
q.o.d. Quaque other die Every Other / Alternate day
q.d. Quaque die Every day
q.s. Quantum sufficit As much as required
Rx Recipe Take thou of (You take the following)
Ss Semi, semis One half
S Sine Without
s.o.s. Si opus sit If necessary
stat. Statim Immediately
t.i.d. Ter in die Three times a day
Tab Tabelle Tablet
Ung Unguentum Ointment
Vap Vapor Inhalation
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WEIGHTS AND MEASURES

MASS
(1) METRIC SYSTEM
1 kilogram (kg) = 1000 grams
1 gram (gm) (g) = 1000 milligrams
1 milligram (mg) = 1000 micrograms
1 micrograms (µg)(mcg) = 1000 nanograms
1 nanogram = 1000 picogrames
1 picogram = 1000 femtograms
1 femtogram = 1000 altograms

(2) BRITISH SYSTEM / IMPERIAL SYSTEM

1 Pound (Ib) = 16 ounces = 7000 grains
1 Ounce (oz) = 437.5 grains
1 Ounce (apothecary) = 480 grains
1 Drachm = 60 grains

(3) RELATION BETWEEN METRIC AND IMPERIAL SYSTEM

1 Kg = 2.205 pounds (Ibs)
1 pound (Ib) = 0.4536 kg = 453.6 g
1 gm = 0.03527 ounce
1 ounce = 28.349 g
1 drachm =4g
1 grain = 60 mg

VOLUME
(1) METRIC SYSTEM
1 liter (L) = 1000 milliliters (ml)
1 ml = 1000 microliters (µl)

(2) BRITISH SYSTEM/ IMPERIAL SYSTEM

1 gallon = Volume occupied by 160 ounce of water at 62ºF
1 Pint = 20 ounces
1 fluid ounce = 8 drachms = 480 minims
1 fluid drachms = 60 minims

(3) RELATION BETWEEN METRIC AND IMPERIAL SYSTEM

1 Pint = 0.568 litres
1 liter = 1.76 pints = 944.9 grams
1 gallon = 4.536 litres
1 litre = 0.220 gallons
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EASY CONVERSIONS
LITERS INTO PINTS = Multiply by 7 & divide by 4
PINTS INTO LITERS = Multiply by 4 & divide by 7
LITERS INTO GALLON =Multiply by 2 & divide by 9
GALLONS INTO LITERS= Multiply by 9 & divide by 2

DOMESTIC MEASURES
½ teaspoonful (tsf) Ξ 2 ml Ξ 1/2 drachm
1 teaspoonful Ξ 5 ml Ξ 1 drachm Ξ 1 gram
1 desertspoonful (dsf) Ξ 8 ml Ξ 2 drachm Ξ 2 grams
1 tablespoonful (tsf) Ξ 15 ml Ξ ½ ounce Ξ 4 grams
2 tablespoonful Ξ 30 ml Ξ 1 ounce (fluid)
1 wineglassful Ξ 60 ml Ξ 2 ounce (f)
1 teacupful Ξ 120 ml Ξ 4 ounce (f)
1 glassful Ξ 180 ml Ξ 6 ounces (f)
1 tumblerful Ξ 300 ml Ξ 10 ounces (f)

EXERCISE

Fill in the blanks

1) Take the tablet qid means ________________________________________________

2) Take the whole quantity h.s. means _________________________________________

3) P.P. Blood Sugar means __________________________________________________

4) Mist. Alkaline means ______________________________________________________

5) Rx means ______________________________________________________________

6) Give 4 tablets stat means __________________________________________________

7) Then given 1 tablet sos means ______________________________________________

8) Preparation for PO administration means ______________________________________

9) Pulv Sodium Bicarbonate means ____________________________________________

10) Amoxicillin capsules should be ingested t.i.d means ____________________________

________________________________________________________________________
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3. BASIC PHARMACY CONCEPTS AND DOSAGE FORMS

Any time you begin your Pharmacy Practical, please follow these steps in sequence.
1. Understand what is to be prepared.
2. Make a rough note of the procedure to be followed (step by step).
3. Make a rough note of what instructions are to be given to the pharmacist.
4. Make a rough note of what instructions are to be given to the patient.
5. Write the prescription in the correct prescription format.
6. Write the label on your sheet.
7. Get the prescription and label approved by your teacher.
8. Calibrate the bottle/container.
9. Prepare the formulation.
10. Prepare the label to be attached on the bottle.
11. Attach the label.
12. Show the sheet and the formulation to the teacher.
13. Put back all the weights in appropriate weight boxes.
14. Keep the chemicals you used in the racks.
15. Remove the label on your bottle/container and put that paper in the dustbin.
16. Wash the container thoroughly.
17. Clean your working space.

COMPONENTS OF MIXTURE & RULES FOR LABELING

Basis: The Main active ingredient in a mixture.
Adjuvant: The ingredients which helps the main ingredient by similar or different actions.
Corrective: The ingredients which are helpful to correct the undesirable effects or disadvantageous
properties of a mixture. Correctives may be sweetening or flavoring or coloring agents or those
impart aroma to the mixture.
Vehicle: The medium in which the mixture is prepared.

Label: Rule for size and position

When a mixture is to be labeled, the usual rule for size and position of the label is –
Label should occupy the middle 1/3rd (of the height of the bottle) and the lateral ½ of the
circumference.
The sole purpose of this rule is easy visibility of the liquid which is present inside the bottle.

The legal and regulatory issues make it mandatory to write too many things on the label. So, now-a-
days we see the labels on the bottles flooded with information in unreadable font sizes.
So also, if the container is too small, it is difficult to follow the rule of “middle 1/3rd and lateral ½”.

In such situation, flexibility may be taken to make the label bigger to accommodate the most
essential information so that it is readable. The main objectives are the medication inside the
container should be visible, and the most essential information should be available and readable
easily.
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The label should begin with the name of the preparation written in BOLD CAPITAL letters on
the top of the label in the center.

After this, any secondary instructions about most essential precautions or storage
precautions should be mentioned, again in CAPITAL BOLD letters.

Primary labeling: The most important primary instructions given to the patient regarding “how
much, when, how many times a day - the drug is to be taken or used” is called primary
labeling. It should appear on the label after the patient’s name, age, sex, weight etc. Since this is
about the drug dosage (administration of drug), it is called primary labeling.

Secondary labeling: These are the instructions regarding storage/preservation of the drug, and
also sometimes indicating some precautions to be taken while using the drug. Secondary labeling
may include instructions such as “How to store a drug, keeping it away from children, or the
drug being only for external use, or shaking/or/not shaking the drug before use”. Since the
instructions are not about frequency of administration or dosing of drug, it is called secondary
labeling.
Although called secondary, it appears on the top of the label in capital bold,immediately after the
name of the preparation.

Calibration of dispensing bottle: It means demarcating the bottle with the help of a marker, at the
level of total volume of liquid medicament to be prepared. Calibration should be the first step while
starting to prepare a liquid medicament. This means that the final volume of the mixture that you will
prepare should not exceed the calibrated mark. (Fill the bottle with the total required volume of
water; make a marking at the highest level, then throw away the water. When you actually prepare
the mixture, see that the total volume does not go above the marking you made at the beginning)

Trituration: Trituration is a process in which the contents in a mortar are broken into fine particles or
mixed thoroughly with constant pressure exerted by a circular movement with a pestle. The pressure
needs to be constant and firm, and the movement needs to be unidirectional. Change in the
direction may lead to breaking/cracking of an emulsion or a suspension.

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Classification of Dosage forms / Formulations / Preparations
(A) Liquid medicaments for internal administration (Mixtures)
(B) Medicated preparations / applications
(C) Solid dosage forms
(D) Parental preparations

(A) LIQUID MEDICAMENTS FOR INTERNAL ADMINISTRATION

MIXTURES: Mixtures are liquid medicaments meant for internal administration and
dispensed in more than one dose.
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MIXTURE dispensed in a SINGLE DOSE is called DRAUGHT.

Advantages of mixtures:
1) Time spent in disintegration and dissolution is saved, hence the onset of action is rapid.
2) Administration is easy, especially for children.
3) Unpalatable substances can be made palatable by giving them in the form of a mixture.
4) Some substances are effective only when given in the form of mixture e.g. Bismuth Kaolin for
diarrhea.
5) Psychological effect

Types of mixtures:
SOLUTIONS, SUSPENSIONS, EMULSIONS

Solutions: Mixtures in which all solids and/or liquids are soluble.

Suspensions and Emulsions contain insoluble or immiscible ingredients.

Suspensions and Emulsions are kept in a homogenous form with or without the help of a
suspending agent (for suspensions) and emulsifying agent (for emulsions).

Suspension is a mixture of insoluble / immiscible solids and / or liquids. The solids are finely
divided and are distributed uniformly in liquid vehicle with or without the help of a
suspending agent. Sometimes suspensions may be used for external application in the form
of lotions.
Suspending agents are the substances which help insoluble ingredients to remains in uniform
distribution throughout the liquid vehicle for a sufficient length of time after shaking the medicament.
Suspending agent usually increases the viscosity of the vehicle.
Suspending agents are usually pharmacologically inert. e.g. syrups, mucilages, gums, glycerin,
bentonite.
Choice or need of the suspending agent depends upon density of the powder to be suspended.
For light powders, no suspending agent required.
For powders with intermediate density, suspending agents like glycerin, or syrups may be used.
For heavy powders, gums may be used as suspending agents e.g. Gum Acasia, Gum
Tragacanth.

Emulsion is a mixture of TWO immiscible LIQUIDS. These two are kept in uniform
distribution with the help of an emulsifying agent. One liquid is broken down / dispersed into
fine globules (internal or dispersed phase) throughout into the other liquid (the medium or
the external or the dispersion phase), and is kept together with the help of an emulsifying
agent (intermediate phase). Emulsions are mainly of two types: 1. Oil in water. 2 Water in oil.

Advantages of Emulsion:
1) Masking the bad taste and increasing the palatability.
2) Normally immiscible liquid can be kept together.
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3) Because one of the components is broken down into globules, the surface area and rate of absorption is
increased.

Methods of Preparing an Emulsion:

1) Wet Gum Method: Gum is taken first and triturated with water. Afterwards oil is added.
2) Dry Gum Method: All the three constituents are taken together in the mortar at one time and trituration is
done. This method is unlikely to be successful without skill and experience.

At the end of formation of the primary emulsion, a crackling sound is heard. This indicates appropriate
preparation of an emulsion. On prolonged standing, oil globules are likely to stand out separately. (This is
called creaming of an emulsion). Hence the instruction – SHAKE WELL BEFORE USE is necessary for
every emulsion.

Cracking / Breaking of an Emulsion means complete separation of two liquids and even after shaking well,
there is no uniform distribution of the ingredients, which means the preparation of emulsion is not appropriate.

Causes of Cracking / Breaking

1) Change in the direction of trituration.
2) Measuring oil in a measuring cylinder containing small quantity of water OR Measuring water in an oily
measuring cylinder.
3) Use of a wrong emulsifying agent, not able to keep the ingredients together.
4) Impurities.
5) Using wrong proportion of ingredients in the primary emulsion. The correct proportion is 1:2:4 i.e.
(Emulsifying Agent : Water: Oil).

Although suspension, solution, emulsion are the types of a mixture, and by definition the mixture is
for internal administration, still the terms suspension, solution, emulsion may be used as general
pharmacy terms or chemistry terms to explain if all the ingredients are
soluble/insoluble/miscible/immiscible. Thus a paint or lotion meant for external application may be a
solution or suspension or emulsion.

Apart from the terms solution, suspension, and emulsion, some other terms used to describe
the various forms of mixtures are as follows:

Syrups / Elixirs / Linctuses / Oral Drops / Spirits / Mucilage / Glycerins / Extractives.

Syrups: are concentrated aqueous solutions of sucrose or other sweetening agents. Syrups may be
medicated or non-medicated. Non- medicated syrups may be used as vehicles.
Elixirs: are sweet aromatic hydroalcoholic liquids for oral administration. They are less sweet and
less viscous than syrups and due to the alcohol content, elixirs keep the water-soluble and the
alcohol-soluble components in solution.
Linctuses: are liquids containing sucrose and medicinal substances and possess demulcent,
expectorant, and sedative properties.
Oral Drops: are liquids intended to be given in small volumes, in drops, especially to the younger
children.
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Spirits: are alcoholic solutions of volatile agents. They should be stored in closed containers
because both the solvent and the solute are volatile. These are used as flavoring and medicinal
agents.
Mucilages: are thick, viscous, aqueous solutions of gum-like-substances and are used for preparing
suspensions or emulsions.
Glycerins: are solutions of medicinal agents in Glycerin.
Extractives: are used when active principle of the vegetable drug is not fully known or the activity is
due to presence of multiple constituents.
Extractives are:
(a) Tinctures: alcoholic solutions prepared from vegetable materials.
(b) Extracts: concentrated preparations from vegetable or animal source prepared by the extraction
of active constituent with suitable solvents. Extracts may be semisolid/ solid /liquid.

(B) MEDICATED PREPARATIONS / APPLICATIONS

1) Eye/Ear/Nasal drops
2) Aerosols in the form of Nebulizer/Spinhaler for injection or application to nose or throat//Rotahaler
capsules
3) Liquids/Semiliquid preparation for application to skin: Eg. Benzyl Benzoate Application.
4) Collodions: Liquid preparation usually containing pyroxylin in a mixture of ether and alcohol and
intended for application to the skin.
5) Paints: Liquid but more viscous preparations for application to skin (Betadine paint,
Boroglycerin Paint, Gentian Violet Paint ) or mucous membranes [Mandl’s Paint (KI plus
Iodine - compound iodine), Astringent gum paints (tannic acid), Antiseptic/Obtundent paints
(Phenol-glycerin)]
6) Gargles /Washes/Waters: Liquid preparation for topical action on mouth/throat/pharynx. May be
antiseptic, stimulant, astringents or demulcent. (mouth washes)
7) Sprays: Solutions for Spraying on throat by means of a sprayer (Nebulizer)/ Nasal spray/ Spray
for analgesic/counterirritant effect to relieve the pain
8) Inhalations: Solutions or suspensions intended to release vapor/steam (steam inhalation) or
volatile constituents when placed or added to hot water (Medicated steam inhalation)
9) Enemas: Aqueous/Oily solutions/Suspensions for Rectal Administration
10) Suppositories/Pessaries/Condoms: For use in the external genital tract or body cavities
11) Ointments/Creams- For skin/mucous membrane/wounds etc. These are semisolid medicaments.
12) Lotions: Liquid medicaments for skin or mucous membrane (for external application)
used without rubbing (without friction). Rubbing is not intended because the lotion is
expected not to penetrate deep, but to stay over the surface for longer time to produce the
intended desired action of soothing / antisepsis / astringent or protective effect. E.g.
calamine lotion applied over the skin, Condy’s lotion (Potassium permanganate lotion for
oral cavity used as mouth wash or gargle water). Depending on the nature of the ingredients,
lotion may be a clear solution or suspension, mostly in water but may contain alcohol to accentuate
the cooling nature of the lotion. Lotions are preferred over semisolid preparations because of the
non-greasy character, and their increased spreadability over large area of the body.
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13) Liniments: Liquid medicaments used for external application to the unbroken skin with
slight rubbing. Rubbing implies slight penetration leading to counterirritant effect. E.g.
turpentine liniment applied over a joint to relieve the joint pain.
14) Pastes: are ointment-like semisolid preparations but are less greasy and release the
medicament more easily than ointment. They usually contain high proportion of finely or very
finely divided solids finely dispersed in basis/vehicle. E.g. Tooth paste
15) Plasters: are semisolid adhesive masses spread upon suitable application.
16) Gels: Semisolid preparations containing solution or dispersion of active ingredients in hydrophilic
or hydrophobic bases and are intended for application to skin or mucous membrane. Eg. Lignocaine
gel used for local anesthetic effect, Diclofenac gel used for relief of pain

17) POWDERS: Described below under solid dosage forms.

(C) SOLID DOSAGE FORMS

(1) POWDERS: Mixtures of finely granulated particles of drugs.
Powders may be used for –
1. Local application (dusting/wound dressing/cleansing of teeth)
2. Inhalation (as used in rotahaler capsules)
3. Oral administration: in the form of tablets / capsules or powder itself – or –
4. For preparing solutions for various purposes such as: solutions for local application in various
forms to skin or mucous membranes –or-- instillation as drops or sprays into ears, eyes –or--
irrigation into cavities or solutions for systemic administration such as intramuscular or intravenous
injections, --or— powders to be dissolved and the solution to be used for nebulization, --or—
effervescent powders or granules to be dissolved and taken by oral route
Classifications of Powders
Class I: Simple Powders (contain one active ingredient) or compound powders (more than one
active ingredient)
Class II: Powders enclosed in capsules
Class III: Powders compressed in tablets
Class IV: Effervescent powders and granules
Class V: Powders for external use/application to wounds, dusting powders for topical
application, antifungal (Clotrimazole) powders, powders enclosed in rotacaps to be sprayed with
force (Salbutamol or Beclomethasone), Snuffs, Tooth powders for cleansing teeth or powders
used for making lotions.

(2) GRANULES: Solid, dry, agglomerates, irregularly shaped powder particles (usually more stable
than powders)

(3) TABLETS: Solid dosage forms containing a unit dose of 1 more active ingredients and they are
made by compression in various sizes, shapes, and colours. They vary in Size / shape / colour /
weight / hardness / thickness / Disintegration properties.
They may be – PLANE or SCORED (GROOVED), contain a SYMBOL or MARKING or may be
coated. Coating may mask the taste, modify odor, prevent the tablet from air/light or gastric
 21

destruction and it may prevent the gastrointestinal irritation by the drugs as well as may
extend or modify, the time course of drug action and also may give a finished look to the
tablet.

Tablet may be ORAL, SUBLINGUAL, Dental Cones, Solution tablets (For mouth wash, gargle,
lotion, douche etc.), Lozenges (Dissolve slowly and act on throat), Effervescent Tablets or, Vaginal
Tablets (Inserts / Implants), or Enteric-coated or Slow-release (S-R) or Time-disintegrating or Time-
release (T-R) or Extended-release (ER) or may be instant release tablets/dispersible tablets/soluble
tablets.

(4) CAPSULES: are forms of medicinal agents enclosed in hard or soft gelatin shells of various
shapes and capacities.
Hard Capsule: Has hard shells with 2 cylinders enclosed into each other; one called a Body / Base
and the other one called a cap.
Soft Capsule: Has a hard shell and is sealed and may contain semisolid or liquid substances.
Enteric Coated: Covered with a coating to be degraded, and the release desired only in the intestine
for the purpose of increasing the bioavailability by protecting it from drug-destroying enzymes in the
proximal part of GIT –or— for the purpose of preventing drug release in the stomach for avoiding
gastric irritation.
Time Release/ Time Disintegration/ Slow Release: The release is intended to modify the time course
of drug action, and/ or the place of release. (RETARD/ SPANSULES/TIMESULES)

(D) PARENTERAL PREPARATIONS

These are sterilised preparations intended for administration by injection, infusion or
implantation.
Eg. intravenous infusions / concentrated solutions or powders to be prepared for injection /
implants.

The solvents used for injection may be –

(a) Water for injection
(b) Normal saline / Ringer Lactate / Dextrose Solution
(c) Non-aqueous solvents: e.g. Fixed vegetable oil, dilute alcohol, propylene glycol, glycerin and
others may be used as solvents for injection.

Dosage Forms- (Parenteral Route)

1) Ampoule
2) Big Ampoule
3) Vial
4) Phial (big vial)
5) Bottles / bags for infusion
6) Hypodermic Implants.
-------------------------------------------------------------------------------------------------------------------------
Newer drug delivery systems
1. Dermojets (mass inoculations)
 22

2. Dermal implants, pellets, sialistic/biodegradable implants (medroxyprogesterone acetate,

testosterone, levonorgestrel)
3. Transdermal Therapeutic Systems(TTS) or patches- clonidine, nitroglycerin, nicotine
4. OCUSERT – pilocarpine for glaucoma
5. Targetted drug delivery systems
(monoclonal antibodies)
6. Liposomes incorporated with drugs (I.V.) (daunorubicin,doxorubicin,gentamicin, amphotericin B)
7. Computerized, miniature syringe pumps (insulin,GnRH,NTG)
8. Pen devices, programmed pumps, jet injections
9. Nebulizer with Microprocessor-controlled vibrating mesh (Amikacin for pneumonia – local action)
10. Drug eluting stents
11. Antibiotic-impregnated polymethyl-methacrylate cement beads for antibiotic delivery to bones
(Gentamicin)
12. Oral Transmucosal Technology: Transmucosal Immediate Release Formulation (TIRF) – e.g.
Fentanyl

EXERCISE

1) DRUG:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
2) PHARMACY:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
3) PHARMACOLOGY:
_______________________________________________________________________________
_______________________________________________________________________________
4) PHARMACOGNOSY:
_______________________________________________________________________________
_______________________________________________________________________________
5) PHARMACOPOIEA:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
6) DOSE:_________________________________________________________________________
 23

7) POSOLOGY:____________________________________________________________________
8) MATERIA MEDICA: ______________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
9) BIOSTANDARDISATION:__________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
10) PHARMACO-ECONOMICS:________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
11) PRESCRIPTION ORDER: __________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
12) SUPERSCRIPTION:______________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

13) INSCRIPTION:___________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
14) SUBSCRIPTION:_________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
15) SIGNATURE/TRANSCRIPTION:_____________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
 24

16) PRIMARY LABELING: ____________________________________________________________

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
17) SECONDARY LABELING: _________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

18) BASIS:_________________________________________________________________________
_______________________________________________________________________________
19) ADJUVANT:_____________________________________________________________________
_______________________________________________________________________________
20) CORRECTIVE:___________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
21) VEHICLE: _______________________________________________________________________
22) DECIMAL LINE/ T LINE: ___________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
 25

DENTAL PHARMACY PRACTICALS

 26

1. ASTRINGENT GUM PAINT

AIM:

Prescribe, Prepare, and Dispense Astringent gum paint.

PROCEDURE:
Weigh 1 g of Tannic acid powder and transfer it to a clean dry mortar. Add 10 ml
of glycerin, drop by drop and triturate gradually uni-directionally, in an anti-clockwise direction.
Mix to make a paint. Transfer the contents to the dispensing bottle. Label the bottle.

INSTRUCTIONS TO THE PATIENT:

Massage the gums, 2 to 3 times a day, with Gum paint.

Find out if tannic acid completely dissolved in glycerin. If not, the patient additionally needs
to be instructed to shake the bottle well before use each time.

MECHANISM OF ACTION:

Tannic acid acts as an astringent and mild antiseptic. It precipitates superficial proteins and forms a
protective layer, which protects the underlying cells from bacterial invasion and irritation. It also
prevents the capillary oozing. The astringent effect may also be useful to decrease the sensitivity of
exposed dentin thus helping for obtundent effect.

Glycerin acts as a vehicle, mild antiseptic, and a soothening agent (The action of this preparation
can be enhanced by the addition of antiseptic like Tincture iodine and can be flavoured by addition
of menthol.)

Glycerin being a hygroscopic solvent, relieves pain of inflamed gums by withdrawing fluid from
inflamed tissues.

Paint: Definition: Liquid but more viscous preparations for application to skin (Betadine paint,
Boroglycerin Paint, Gentian Violet Paint) or mucous membranes [Mandl’s Paint (KI plus
Iodine - compound iodine), Astringent gum paint (tannic acid), Antiseptic/Obtundent paints
(Phenol-glycerin)]

USES:

1. Gingivitis
2. Inflamed Gums
3. Acute Necrotizing Ulcerative Gingivitis (ANUG) (Vincent’s Disease)
4. Also tannic acid may be useful as an obtundent
5. Astringents may produce styptic action and be useful to stop the local bleeding.
27
 28

1. Astringent Gum Paint: Exercise

What is the primary action of tannic acid? How does it help healing?

What is the function of glycerin?

What is catechu? What is the active principle in catechu?

The paint you prepared looks like a solution or suspension? Why?

What is going to be the secondary labeling / secondary instruction for this preparation? Why ?

Explain the terms:

Astringent:
Adsorbent:
Protective:
Ulcer healing:

Search and mention which substances are “Gastrointestinal Adsorbents and Protectives”. Explain
their uses.
 29

2. CONDY’S LOTION (Potassium Permanganate Lotion)

AIM: Prescribe, Prepare, and Dispense 50 ml of 0.1% (1:1000) Potassium Permanganate Lotion
(Condy’s Lotion) for a patient, suffering from stomatitis.

PROCEDURE: Calibrate the bottle for 50 ml. Weigh 50 mg (0.05 g) of Potassium Permanganate
and take it in a clean dry beaker. Add water and stir to dissolve. Transfer the contents to the
dispensing bottle and make the volume 50 ml. Label the bottle.

INSRUCTIONS TO THE PATIENT: Dilute and prepare fresh every time by adding 1 tablespoonful
(15 ml.) of the lotion in 60 ml of water and use as a mouth wash - 3 to 4 times a day. Decide if you
need to write “Shake well before use” as a secondary instruction for this preparation.

MECHANISM OF ACTION: Potassium Permanganate is a strong oxidizing agent. (Liberates

Nascent Oxygen). So it destroys the bacterial protoplasm. Due to oxidizing effect, it acts as an
antiseptic, disinfectant, and deodorant. It is useful in various diseases (mentioned below under uses) as
well as water treatment industry, fruit preservation, and as a laboratory reagent for synthesis of organic
compounds. Potassium permanganate is a salt of potassium and manganese (MnO4 ions). In 1659, Johann
Rudolf Glauber prepared potassium permanganate from manganese dioxide and potassium carbonate. Later
in 1850, a London-chemist, Henry Bollman Condy fused manganese dioxide with sodium
hydroxide/potassium hydroxide, and obtained a more stable form of potassium permanganate. The
solution/lotion/fluid came to be known as Condy’s lotion or fluid.

Potassium permanganate may produce staining, and at higher concentration it may produce chemical burn
and blisters. Potassium Permanganate solution should be of light magenta colour. Change in colour from
magenta to brown indicates that the solution is no more effective.

Lotions: Liquid medicaments for skin or mucous membrane (for external application) used without
rubbing (without friction). Rubbing is not intended because the lotion is expected not to penetrate
deep, but to stay over the surface for longer time to produce the intended desired action of soothing /
antisepsis / astringent or protective effect. E.g. calamine lotion applied over the skin, Condy’s lotion
(Potassium permanganate lotion for oral cavity used as mouth wash or gargle water). Depending on
the nature of the ingredients, lotion may be a clear solution or suspension, mostly in water but may contain
alcohol to accentuate the cooling nature of the lotion. Lotions are preferred over semisolid preparations
because of the non-greasy character, and their increased spreadability over large area of the body. (As
opposed to lotions, liniments are the liquid medicaments used for external application to the unbroken skin
with slight rubbing. Rubbing implies slight penetration leading to counterirritant effect. E.g. turpentine liniment
applied over a joint to relieve the joint pain.)

USES:

1) As Mouth wash / gargles in various types of gingivitis, stomatitis.

2) 1:1000 solution in water is used for cleansing ulcers, wounds, and abscesses.
3) 1:5000 solution may be used as stomach wash for alkaloidal poisoning with drugs like opium,
strychnine and chloral hydrate. It is useful for gastric wash in organophosphorous poisoning.
4) Solid Potassium Permanganate can be used locally as first aid treatment in case of snake bite to
destroy the venom.
5) 1:50,000 solutions can be used for vaginal irrigation.
6) Potassium Permanganate wet dressings may be used for weeping skin lesions, and ivy poisoning
(a woody creeper plant which is poisonous).
30
 31

2. Condy’s lotion- Exercise

What is the important mechanism of action of potassium permanganate?

Mention the parts of prescription.

What is nascent oxygen? How is it useful?

Why it is called Condy’s lotion?

Mention disadvantages of potassium permanganate.

What kind of a preparation is this – Solution / Suspension / or Emulstion? Why?

Do you need to write “Shake well before use” for this preparation? Yes or Not ? And Why?

Who prepares the label? ___________________________________________________________

 32

3. CLEANSING TOOTH POWDER

AIM:

Prescribe, Prepare, and Dispense 10 g of simple tooth powder for cleaning the teeth.

PROCEDURE:

Weigh 5 g of Calcium Carbonate, 4 g of Magnesium Carbonate and 1 g of Sodium Bicarbonate.

Take these three powders in a mortar. Mix and triturate dry to prepare the fine homogenous powder.
Add 0.5 ml. of Peppermint oil to the mortar and triturate.
Transfer to the container. Label the container.
(This preparation is not a paste. So it will NOT give semisolid consistency. It remains as a solid
powder).

INSTRUCTION TO THE PATIENT:

To be used as a tooth powder for cleaning teeth in the morning and at bed times, and after all
meals.

MECHANISM OF ACTION:

Magnesium Carbonate and Calcium Carbonate work as abrasives and antacids. They as well as
Sodium Bicarbonate help to produce an alkaline medium in mouth cavity which may be lethal to
some of the micro- organisms.
Abrasives action means mechanical removal of food particles, stains, and debris from the teeth.
The mechanical friction also subserves the function of polishing the surfaces.

Sodium Bicarbonate works as an antacid.

Peppermint oil works as a flavouring and sweetening agent.

USES: For routine use to clean the teeth for maintaining good oral hygiene and for preventing
infections..
33
 34

3. Cleansing tooth powder - Exercise

What is a dentrifice? What is the difference between Abrasive and Dentrifice?

What is the role of calcium carbonate in this preparation? And Define “Powder”

Why is this called simple tooth powder? It is which class of powders?

Mention the types of abrasives.

Search and prepare a list of common microorganisms associated with oral cavity infections.

Mention some antimicrobial agents to which common oral cavity microorganisms are sensitive.

Enlist the differences between “Powder” and “Paste”

 35

4. SIMPLE MOUTH WASH ( GARGLE WATER )

AIM:

Prescribe, Prepare, and Dispense 15 ml of concentrated solution of zinc sulphate – glycerin solution
to be used as a mouth wash or gargle water.

PROCEDURE:
Calibrate the bottle for 15 ml. Take 0.050 g (50 mg) of zinc sulphate powder in a mortar.
Measure 3 ml of glycerine solution in a small measuring cylinder. Add this drop by drop to the
mortar, while triturating it thoroughly.

Then add Peppermint Oil drop by drop with constant trituration, to make the total volume 15 ml.
Transfer the contents to the dispensing bottle, and label the bottle.

(This is a concentrated solution. This is to be diluted in the ratio 1:1 with water every time before
use).

INSTRUCTIONS TO THE PATIENT:

To be used as a mouth wash or gargle water after dilution with water (1:1), 3 to 4 times a day.

MECHANISM OF ACTION:

Zinc sulphate has antiseptic and astringent actions.

Glycerin has smoothening action.

Peppermint Oil acts as a vehicle and also flavouring agent.

The solution produces antiseptic and astringent effect, and also mechanically cleans the oral cavity
to remove the detachable particles and debris from the teeth by flushing action. It also works as a
mouth freshener. The same solution can be used for throat gargles for antiseptic and smoothening
action.

Hygroscopic action of glycerin extracts water and helps in decreasing the swelling.

USES:

1) Stomatitis
2) Various types of gingivitis
3) Infective conditions in dentistry
4) Throat infections.
36
 37

4. Simple mouth wash - Exercise

Enumerate types of mouth wash with examples. (Read Dental Pharmacology Section)

Mention mechanism of action of glycerin in this preparation, and its various properties.

What is calibration of a bottle?

What is subscription?

Mention mechanism of action of zinc sulphate.

What are the advantages of adding peppermint oil?

What is T line?
 38

5. OBTUNDENT MOUTH WASH (Obtundent Solution)

AIM:

Prescribe, Prepare, and Dispense “Obtundent mouth wash” in 2 ml of Phenol.

PROCEDURE:

Weight 2 g of Thymol and 1 g of Camphor. Triturate and mix till a homogenous mass is obtained.
Add 2 ml of Phenol and triturate to make a homogenous mixture. Transfer to a dispensing bottle,
and label the bottle.

INSTRUCTIONS TO THE PATIENT:

Isolate the affected areas and apply with a cotton plug soaked in the solution, 3 to 4 times a day.

Check if all the constituents in the mixture are dissolved in each other. Based on this decide, if you
need to give instruction to the patient if before use the bottle should be shaken or not.

MECHANISM OF ACTION:

Camphor and Thymol are Volatile oils and they act by paralyzing the nerve fibrils.
Phenol acts as an astringent and precipitates the superficial proteins in the nerve cells.
Thus this solution abolishes the sensitivity of exposed dentin by acting on nerve fibrils as well as
odontoblastic processes.
[Phenol (0.2 to 1%) is bacteristatic. Its concentrated solution (2 to 5%) act as bactericidal, and is
used as a disinfectant].

USES:

For local treatment in Painful tooth Cavities, to abolish the pain due to sensitivity of exposed dentin.

(Causes of exposure of dentin:

-Attrition, Abrasion, Erosion
-Trauma leading to crown fracture etc. and
-Faulty tooth brushing technique or
-Some dental procedures like cavity cutting and reduction of tooth for crown and bridge, and
Preparation of crown and bridge

Tooth sensitivity is due to the exposure of dentin, the part of the tooth which covers the nerve. The
dentin gets exposed either through loss of the enamel layer or recession of the gums. Recession
of gums can be a sign of trauma from dental abrasion due to excessive toothbrushing or brushing
with a too abrasive tooth powder or toothpaste, or chronic periodontitis.
Temperature changes and certain foods (acidic or sweet) can cause the tooth / teeth to be painful.

Other causes are acid erosion (e.g. related to gastroesophageal reflux disease, bulimia nervosa or
excessive consumption of acidic foods and drinks), and periodontal root planing.
Dental bleaching is another known cause of hypersensitivity.
Other causes include smoking tobacco, which can wear down enamel and gum tissue, cracked
teeth or grinding of teeth (Bruxism).
39
 40

5. Obtundent Mouth Wash - Exercise

Define “Obtundent”:

Enumerate 3 different important mechanisms of obtundent action.

Make a list of various obtundents used in clinical dental practice.

Mention prerequisites for an ideal obtundent.

What is the active ingredient in clove oil?

Mention uses of obtundent.

Mention causes of dentin hypersensitivity.

Mention the commonly used drug of choice in practice for treating exposed hypersensitive dentin.
 41

6. CLEANSING TOOTH PASTE

AIM:

Prescribe, Prepare, and Dispense 5 g of cleansing tooth paste.

PROCEDURE:

Take 40 mg of Gum tragacanth in a mortar and triturate with 0.1 ml of Glycerin and 100 mg of
Saccharin Sodium. A very small quantity of water (drops) may be added if necessary.

Then add 4 g of Calcium Carbonate with continuously triturating with drops of water.
To this, add 500 mg of powdered soap and 0.1 ml. of Menthol oil until a homogenous paste is
formed.
The quantity of water should not exceed 1.5 ml. as far as possible, although the amount of water
may be variable so as to give consistency of a paste.
(Addition of excess water may lead to formation of a liquid.)
(Excessive trituration in the presence of soap should be avoided)

INSTRUCTIONS TO THE PATIENT:

Use with or without the help of a tooth brush, for cleaning the teeth in the morning and at bedtime
and after all meals.

MECHANISM OF ACTION:

This is a cleansing toothpaste.

Calcium carbonate acts as an abrasive.
Glycerin acts as a humectant.
Soap acts as a detergent.
Gum is a binding agent.
Saccharin acts as a sweetening agent.
Menthol oil gives flavor and can be replaced according to the taste required.
Water is a wetting agent.

NOTE: The formula can be modified using insoluble salts and also can be medicated with
antiseptics or deodorants. Obtundents may be added to reduce the sensitivity in cases of exposed
hypersensitive dentin

USES:

As a cleansing tooth paste for maintenance of oral hygiene and for prevention of infection.
42
 43

6. Cleansing Tooth Paste - Exercise

Search and mention the differences between paste and powder.

What is the purpose of adding 1. sodium bicarbonate 2. Gum tragacanth?

Define “Paste”: __________________________________________________________________

What is the rule for the size and position of the label?

What is the action of calcium carbonate?

What do you mean by abrasive? _____________________________________________________

What is the difference between an abrasive and a dentrifice?

What are humectants?

Mention advantages of foaming agents.

 44

DENTAL
PHARMACOLOGY
 45

NOTES ON DENTAL PHARMACOLOGY

1. DENTRIFICES
Agents or mechanical aids used with tooth brush or with rubbing for cleaning and
polishing accessible teeth surfaces.
Dentrifices may be in the forms of : Tooth paste, powder, gel
Components of a dentrifice:
An ideal dentrifice should contain one each of the following:
1) Abrasive [Calcium carbonate, (Prepared chalk), dibasic CaCO3, MgCO3,
Stannic Oxide]
2) Antacids [NaHCO3, Mg(OH)2]
3) Antiseptic
4) Binding Agent
5) Humectant
6) Soaps / Detergents
7) Flavouring Agents (Peppermint oil) / Sweetening Agents (Glycerin, Sorbitol) 8)
Liquid vehicle.

Tooth pastes or powders or gels may contain additional ingredients such as

obtundents which are used to decrease the pain and sensitivity associated with
exposed hypersensitive dentin.

2. ABRASIVES
Fine preparations used to help the scouring/rubbing action mechanically by
grinding, rubbing or scrapping. They are usually insoluble
substances/powders and are usually inorganic salts of low solubility. They
mechanically remove food particles and stains, after friction. They polish the
surface.
The abrasive should have fine particles to avoid scratching of the teeth surfaces.
Generally powders are more powerful abrasives than the pastes.
Examples:
1. CaCo3 (Prepared chalk): Precipitate form is preferred because it is finer and
less gritty (strength: 40-60%). It is also an antacid property. It is the first and most
essential constituent of dentrifice.
2. Dibasic CaCo3: Good abrasive, polishing agent
3. MgCo3: This forms the second largest constituent of the dentrifice. It has
antacid properties.
4. Mg(OH)2: 7.5% Suspension in water. Works as abrasive, has antacid property
and is called Milk of Magnesia.
5. Stannic Oxide: It is a fine amorphous powders which is an abrasive and
polishing agent. It gives glossy appearance to teeth.
6. Calcium phosphate
7. Charcoal
 46

8. Silicates
9. Powder pumice
10. Kaolin
11. Stannic oxide
Uses of abrasives:
1. Polishing the teeth and the fillings
2. Cleaning the teeth
3. As constituents of tooth powders and pastes
Types of Abrasives:
(i) Finishing abrasives- Hard, coarse - Used initially - to develop contour and
remove gross irregularities e.g. coarse stones.
(ii) Polishing abrasives- Fine particles, less hard than finishing abrasive, Used
for smoothening the surfaces that have been roughened by coarse stones e.g.
pumice, polishing cakes, calcium carbonate
(iii) Cleansing abrasives- Soft material, small particle size, Used to remove soft
deposits that adhere to enamel or restorative material

3. BINDING AGENTS
Agents added to pastes/Tooth Pastes to keep the solid and liquid phase together.
These are mostly suspending or emulsifying agents.
1. Gums: Acasia, Tragacanth and Caraya.
2. Bentonite: Colloidal aluminium silicate, forms a stable tooth paste. But powder
is gritty and may stain pale gray.
3. Sodium Alginate: Strong binding agent, incompatible with soluble calcium salts.

4. HUMECTANTS:
Substances added to the Tooth Paste to retain the moisture of the preparation, so
that when exposed to air, the preparation does not get dried up or does not
harden.
E.g. Glycerin, Propylene Glycerin, Sorbitol.
Glycerin and Sorbitol are also sweetening agents. Propylene Glycerin (Propylene
glycol) has a bad taste and is usually not employed.

5. DETERGENTS AND FOAMING AGENTS

They are cleansing agents. They act by:
-Decreasing surface tension, thus they possess emulsifying properties.
-Dissolving fatty substances and mucous plaques
-Foaming – on scrubbing the teeth, detergents foam and act as lubricants.
-Loosening the debris that is adhered to teeth
-Some of them liberate oxygen, and have antiseptic properties.
-They act as deodorants.
Example: Sodium lauryl sulfate and soaps
 47

Sodium lauryl sulfate is a pale yellow powder, and is effective in acidic as well as
alkaline medium, and also in hard water. It is also used as a skin cleansing agent,
and also in mediated shampoos.

6. OBTUNDENTS
Substances which are used to reduce or abolish the sensitivity of exposed dentin
so that the excavation becomes painless.
Mechanisms of action:
I - Destroy the nervous tissue: Absolute alcohol
II - Paralyze the sensory nerve endings:
Phenol, Creosote, Benzyl alcohol, Benzocaine
Volatile oils: Camphor, Thymol, Menthol, Eugenol (Clove oil) (Clove oil may
produce staining)
III - Precipitate proteins from odontoblastic fibrils and destruction of sensitive
tissue: Silver nitrate, Zinc chloride, Ethyl alcohol (70%), Phenol

-Alcohol- (80-95%) penetrates easily into the dry cavities. Does not have very
deep penetration. Does not stain the teeth.
-Benzyl Alcohol- Produces dehydration and possesses local anesthetic activity. It
may be used alone or with chloroform in the ratio 1:2.
-Phenol- C6H5OH – (Carbolic acid) (Same as benzenol or hydroxybenzene) – is
an aromatic organic compound, and a petroleum product, and is a protoplasmic
poison. It paralyzes the nerves. It produces initial irritation followed by numbness.
It has a rapid action. Its penetrability is poor, and it can be increased by combining
with KOH and glycerin. It does not stain healthy dentin; however, can darken the
infected dentin.
-Eugenol- Is the active constituent of Clove oil. May increase the pain slightly
(initially), but later on paralyses nerve fibers. Does not penetrate deep. May cause
slight yellow staining of dentin.
-Chlorbutanol- Also called chloritone. Strength - 10%. It is a volatile oil, Produces
paralysis of nerve fibers.
-Menthol, Thymol, Camphor, Clove oil- All are volatile oils, and produce paralysis
of sensory nerve fibrils just as chlorbutanol. There is some initial irritation followed
by numbness. Clove oil may stain the dentin yellow.
-Formaldehyde- (4-10% solution). It is volatile. Penetrates deep, action is slow. No
staining of teeth. May penetrate the pulp and cause inflammation, and pulp
damage This is called caustic action.
-Paraformaldehyde – acts by release of formaldehyde. It is painless and
nonstaining. Pulp damage due to penetration and inflammation is possible
(caustic action).
-Silver Nitrate- (10-30%) Penetration not more than ½ mm. It precipitates Proteins
(Astrigent action). It has rapid action, but the penetrability is poor, and it stains
black. It is used for posterior Teeth / Milk teeth.
 48

-Zinc Chloride- (10%) Same action as silver Nitrate, but during precipitation of
proteins, liberates acid, which may cause an initial sharp pain. This is temporary
phenomenon. It has rapid action, and there is no staining of teeth. Used for
anterior teeth.

An Ideal obtundent –
-should penetrate the dentin sufficiently
-should not stain the dentin
-should be free from local irritation or pain
The disadvantages of obtundents include:
1. The pulp may shrink.
2. The irritants may stimulate formation of secondary dentin.

7. DENTAL DESENSITIZING AGENTS

Dentine hypersensitivity is a common problem affecting millions of people. Pain is
evoked by mechanical, chemical or thermal stimuli. Eg. On eating hot or cold,
sweet or sour food, or while brushing. Hypersensitivity is due to loss of enamel or
exposure of the root surface. Loss of enamel may follow mechanical wear or
chemical erosion due to acidic food. The root surface gets exposed due to
recession of gums as seen in old age, incorrect toothbrushing technique or
chronic periodontal diseases.

An ideal desensitizing agent should be nonirritant, nontoxic, painless, rapidly

acting, easy to use, and have a long-lasting effect.
(a) Agents occluding dentinal tubules / nerve desensitizing: Potassium
nitrate (5%), potassium oxalate, calcium hydroxide, sodium fluoride, strontium
fluoride, strontium chloride, K oxalate (28%), calcium phosphate, calcium chloride,
sodium citrate, formaldehyde, bioactive glass (SiO2-P2O5-CaO-Na2O), sodium
monofluorophosphate
(b) Agents precipitating proteins:
-- Astringents: Silver nitrate, Zinc chloride
--Precipitating tubule proteins causing occlusion: Strontium chloride,
formaldehyde, glutaraldehyde, strontium chloride hexahydrate
(c) Tubule sealents: 4- metha cryloxy ethyl trimellitate / Hydroxy-ethyl-
methacrylate (HEMA)
(d) Physical method: Restorations – Glass ionomers cements / composites /
fluoride varnishes, dentin bonding agents, oxalic acid and resin, adhesive resins,
Benzalkonium chloride
(e) Lasers: Neodymium yttrium al-garnet (Nd-YAG) laser, GaAIA (gallium-al-
arsenide) laser, Erbium-YAG laser

8. DISCLOSING AGENTS
Since the dental plaques may be relatively invisible, disclosing or revealing agents
are needed.
 49

Disclosing agent is a
--A dye / diagnostic acid
--Applied to the teeth to reveal the presence of dental plaque (bacterial deposits)
on teeth, tongue, saliva.

They are applied as:

--ChewableTablet / wafers
--Painting the teeth with a cotton swab dipped in the disclosing agent
-Rinsing the mouth with the solution of a disclosing agent
--Solution
--Floss

Examples”
-Erythrosine (6 mg tab): Most commonly used. Erythrosin makes the plaque area
red, but also may stain soft tissues.
-Fluorescein dye: stains the plaque yellow. It does not stain the soft tissues, but a
special light is required to see the stained plaque. Fluorescein dye is more
expensive.
-Two-tone dyes: a solution containing combination of two dyes. Mature plaques
are stained blue and the new plaques are stained red. The advantage is
differentiation between mature and immature plaques. In addition these two-tone
dyes do not stain the soft tissues.
-Iodine containing solutions: Their disadvantages are: High incidence of allergic
reactions and unacceptable taste. Hence not preferred.

The disclosing agents make the supragingival plaques visible.

The tablets, sold over-the-counter in many countries, contain a dye (typically a
vegetable dye, such as Phloxine B that stains plaque a bright color (typically red
or blue). After brushing, one chews a tablet and rinses. Colored stains on the
teeth indicate areas where plaque remains after brushing, providing feedback to
improve brushing technique. For self-examination, a dental mirror may be needed.
More sophisticated varieties contain several dyes, which selectively stain plaque
of different ages. With the most common variety, immature plaque stains red,
mature purple, and pathological acidic plaque blue. This is owing to the blue dye
washing off immature plaque, and acid degrading the red dye.
An example of a dye with a patented use as a "Dental Plaque Disclosing Agent"
is Erythrosine.

9. BLEACHING AGENTS
Bleaching is a process of removing discolouration of teeth by application of drugs.
Bleaching agents are the agents used to remove pigmentation of teeth.

Examples:
1. Oxidizing agents e.g. Hydrogen peroxide - perhydrol (30%), sodium
peroxide(50%), pyrozone
2. Reducing agents e.g sodium thio-sulphate: it removes iodine stains.
3. Chlorinated lime: removes stains by aniline dyes
 50

4. Weak ammonia, hypochlorite, acetic acid

5. Ultraviolet rays

a. Hydrogen Peroxide (H2O2): Strong Oxidising agent. Liberates nascent

oxygen and produces bleaching of organic colours. The various strengths
used are:
--- 3% (weak as bleaching agents but it is safe.)
---30% in water
---25% ether diluted: Stronger bleaching agent. Solution is applied with cotton
wool pellete and tooth is exposed to ultraviolet light for few minutes to
accelerate the action.
b. Sodium Hypochlorate: Chlorine releasing bleaching agent. Used as 5%
solution. After application, cavity should be washed thoroughly with distilled
water to remove residual chlorine. Hypochlorites remove silver and iron
stains.
c. Oxalic Acid: Organic acid. Strong corrosive action. Soft tissues may be
damaged. Preferable saturated solution sealed into the tooth cavity for 24
hours. Repeated applications may be required to remove whole of the
staining.
d. Hydrochloric acid (dilute-10%): Especially used to remove silver staining.
Strong bleaching agent. May destroy normal tooth tissue as well.

The factors producing discolouration or staining of teeth are:

a. Tobacco
b. Iron Salts
c. Moulds/ fungi
d. Infilration by decomposition of products of Tooth Pulp
(E.g. Methemoglobin- Yellowish stain, Hematin – Gray or Brown stain)
e) Systemic administration of Tetracyclines.
Procedure for bleaching:
1. Tooth Brushing with a suitable abrasive. Suitable for staining by
exogenous factors like tobacco/ fungus or if staining is superficial.
2. Use of Bleaching Agents: They are needed if staining is caused by
exogenous factors depositing decomposition products, and for nearly
permanent, deep stains.

10. MUMMIFYING AGENTS

Mummifying agents harden and dry the soft tissues in tooth pulp and root canal.
Drying makes the tissues resistant to infections. Mummifying agents mummify or
fix the pulp. Due to drying effect, the pulp becomes resistant to entry of bacteria
 51

Mummifying agents are used during pulpotomy. They are used when the tooth
pulp is devitalized or there is malformation of roots and the root canals are
inaccessible
Mummifying agents may be astringents or antiseptics.
Examples:
1. Beta- naphthol: Crystalline powders with phenolic odour. 1% solution in alcohol
is used. Alcohol gets evaporated and residual Beta naphthol penetrates the pulp
tissue. Solution has a buffy colour.
2. Cresol: Coal-tar product. Turns brown on air exposure. Can be incorporated
into a paste with equal parts of thymol and zinc oxide.
3. Liquid formaldehyde: 40% strength. It is diluted with 3 parts of water, due to its
severe penetration with irritation. Instead of using alone, it is combined with other
agents like thymol, cresol, zinc oxide, glycerin in the form of paste. Formaldehyde
fixes the exposed pulp.
4. Paraform / paraformaldehyde: acts by release of formaldehyde and combined
with zinc oxide and glycerin.
5. Iodoform: Acts by liberation of iodine. Has additional local anesthetics and
antiseptic activity. A mixture of Iodoform and Tannic acid in the ratio of 6:1 can be
combined with a volatile oil to be used as mummifying agent. Iodoform is often
made into a paste with eugenol, phenol, tannic acid, and glycerol.
6. Tannic Acid: has astringent effect. So it precipitates proteins and hardens the
tissue. It may also cause shrinking of the tissue. It may be used alone or in
combination,

11. ASTRINGENTS
Precipitate superficial proteins
They are used to diminish the excretion or exudation of superficial cells, for
healing of ulcers, reduce capillary permeability, exudation, edema, and
inflammation. They are also used as Hemostatics and mummifying agents. They
are used in the form of gum paints, mouth washes, lotions.

Astringents produce following actions:

1. Astringents precipitate superficial proteins
2. Form a protective layer which prevents the penetration of food particles
and bacteria
3. The protective layer promotes healing
4. It diminishes the excretion or exudation of superficial cells
5. Adsorb and trap the noxious substances and bacteria and their toxins.
6. Decrease the capillary permeability, exudation, edema, and inflammation
7. Also act as Local Hemostatics and mummifying agents

Astringents - Uses:
1. Gingival Ulcers (Ulcerative gingivitis), pyorrhea, bleeding gums
2. Apthous ulcers
 52

3. Glossitis, stomatitis
4. Chronic alveolar abscess
Astringents: Examples:
Tannic Acid, Catechu, Zinc Chloride, Zinc Sulfate, Copper Sulfate, Alum
Others: Ferric Chloride, Lead Acetate, Silver Nitrate, Mercuric Chloride

12. ANTISEPTICS IN DENTISTRY

The term antiseptic implies the prevention of septic influence or putrefaction in
wounds, and the healing of wounds by first intention or without suppuration
Antiseptics prevent infections and promote healing of wounds.
Antiseptics possess the capacity to arrest the process of putrefaction,

Antiseptics include:
Organic (vegetable) acids: Carbolic acid (Phenol), salicylic acid, benzoic acid:
Applied to tooth structures and tooth tissues
Inorganic (mineral) acids: Nitric acid, sulfuric acid, hydrochloric acid, boric acid,
chromic acid: Application restricted to tooth tissues
Iodides: Tincture iodine, iodoform, iodol, potassium iodide, aseptol, aristol
Mercurials: Bichloride and Biniodide of mercury
Oxidizing agents: Hydrogen peroxide, potassium permanganate
Essential oils: cajuput, cassia, peppermint, cloves, thyme, turpentine, caraway,
mustard, eucalyptus, juniper, gaultheria, cinnamon, eugenol, sassafras,
pennyroyal, valerian
Wood and coal-tar derivatives: Creasote, hydronaphthol, resorcinol, lysol
Heat

Methods of using antiseptics

-Irrigation or Antiseptic dressings
-Washing out cavities in teeth
-Applications to inflamed and infected surfaces
-Syringing abscesses
-Using mouth washes or lotions

Antiseptics – Choice and forms

-Choice of antiseptic depends on–
-Anatomical structure of the part on which they are to act
-Type of inflammation present (acute or chronic)
-Condition of the tissue: (septic or putrescent state)
Forms of antiseptic dressings or applications
-Powders
-Solutions
-Pastes, or
-Mixed with filling materials, such as the zinc preparations
 53

13. FLUORIDES IN DENTISTRY

The total concentration of fluorides required in drinking water is less than part per
million (ppm). The optimal level is 0.5-1 ppm and is found to be safe and effective.
More than 1-2 ppm may result in toxicity – dental fluorosis.
The surface enamel can concentrate the fluoride ions and become resistant to the
attack of the acid and dissolution. This is how fluorides are helpful in preventing
caries. Fluorine is the most electronegative of all elements and is therefore highly
reactive. The efficacy of fluorides in prevention of caries has been well
established.

The total action of 2% Sodium Fluoride applied to the teeth once a week can
prevent the incidence of caries. The course of treatment is one application per
week for 4 weeks. It is to be continued once in every 2-4 weeks for the age group
3 to 13 years. Other salts are
Stannous Fluoride (8%) or Stannous Flurofluoride. Fluoridation of drinking water is
the most effective measure in preventing caries.

The exact mechanism of action of fluorides may be related to physical or chemical

combination of fluorides with enamel to make it resistant to entry of acid and also
inhibition of bacterial enzymes which reduces the chance of fermentation. Their
actions include:
1. Inhibition of bacterial enzymes which produce acids and therefore
prevent decalcification of teeth
2. Conversion of hydroxyapatite of dentin and enamel to fluorapatite,
which is more resistant to destruction by acids. Fluorides make outer
layer of enamel harder and more resistant to demineralization.
3. Stimulating remineralization of enamel

Topical use of high dose of fluorides prevents caries. It may be used as:
1. Fluoride dentrifices
2. Fluoride mouthrinses: Stannous fluoride containing 900 ppm of fluoride
retained in mouth for 1 minute to be used twice a week
3. Topical application by a dentist of 2% sodium fluoride or 8% stannous
fluoride once a week for 4 weeks

Fluoride toxicity
Chronic toxicity: Mottling of enamel, brownish-black discoloration of teeth, joints
pain and swelling, osteosclerosis of spine and pelvis. Crippling fluorosis is
characterized by thickening of cortex of long bones and bony exostoses especially
in the vertebrae.
Acute toxicity: Accidental or suicidal overdose due to ingestion of fluoride-
containing rat poisons. Lethal dose: 2-2.5 g in adults. The manifestations include
nausea, vomiting, diarrhea, hypotension, hypocalcemia, hypomagnesemia,
cardiac arrhythmias, and acidosis. Treatment includes gastric lavage with calcium
 54

containing fluids, forced alkaline diuresis, treatment of hypocalcemia and cardiac

arrhythmias.

14. DENTAL CARIES

Caries is a degenerative condition characterized by decay of hard and soft parts
of the teeth.
Dental caries is the most commonly occurring illness, affecting the teeth. Infection
begins in enamel and if progresses, may extend deeper into the tooth, affecting
the dentin pulps. The starting point is fermentation of carbohydrates in the mouth
especially in the crevices between the teeth. This causes production of organic
acids like lactic acid, which react with calcium phosphate in the enamel and
dissolve and remove it. Acids convert insoluble calcium salts of the teeth into
soluble salts (=decalcification=removal of calcium). The micro-organisms are
mostly streptococcus and lactobacillus, which convert glucose into lactic acid. The
oral microflora produces proteolytic enzymes which digest the organic enamel
matrix. Thus both the inorganic and organic matter of the teeth are destroyed.
With the continuation of the process, the pulp is penetrated and the infection may
gain access into systemic circulation.

Dental plaque is a soft, non-mineralized bacterial deposit and a characteristic of

dental caries. The plaque is the material that adheres to the teeth and consists of
bacterial cells (mainly Streptococcus mutans and Streptococcus sanguis), salivary
polymers, and bacterial extracellular products. Plaque is a biofilm on the surfaces
of the teeth. The accumulation of microorganisms subjects the teeth and gingival
tissues to high concentrations of bacterial metabolites which results in dental
disease. If not taken care of, via brushing or flossing, the plaque can turn into
tartar (the hardened form) and lead to gingivitis or periodontal disease.

Measures for Prevention and Control:

1) Dental care at home: use of mouth washes, Regular and proper brushing of
teeth and rinsing to remove the fermentable carbohydrates from mouth cavity.
2) Dietary restrictions of carbohydrates (especially soluble carbohydrates in ice
creams, chocolates, sweets), avoiding too frequent eating
3) Immediate cleaning and brushing the teeth after carbohydrates intake.
4) Using antiseptic and detergents (present in many oral preparations), thought to
be beneficial in prevention.
5) Urea: Gets converted to Ammonia and it Prevents the growth of acid producing
organisms.
6) Antibiotics: Penicillins, Macrolids (e.g. erythromycin, azithromycin), and
Tetracyclines are effective. Vancomycin, Kanamycin, Chloramphenicol, Bacitracin,
and Polymyxin – B are useful as topical mouthrinses or gels or controlled delivery
systems containing tetracyclines for intra pocket insertion. These are helpful for
temporary Correction and by local treatment. Overuse may produce super-
infection or resistance.
 55

7. Alkaline salts: 60% NaHCo3 may neutralize acidity and help to control the
disease.
8. Fluorides used cautiously may reduce entry of microorganisms and chances of
fermentation
9. Educating on proper brushing techniques

Anti plaque agents: The agents acting against the plaque. They may act
by:
1. Antimicrobial action
Antibiotics: Penicillin, Vancomycin, Kanamycin, Niddamycin, Spiromycin,
tetracyclines, macrolids (erythromycin/azithromycin)
Enzymes: Protease, lipase, nuclease, dextranase, mutanase, glucose
oxidase, amyloglucosidase.
Bisbiguanide antiseptics: Chlorhexidine, Alexidine, Octenidine.
Quaternary ammonium compounds: Cetylpyridium chloride,
Benzoalconium chloride
Phenols and essential oils: Thymol, hexyl resorcinol, Ecalyptol, Triclosan
plus
Natural products: Sanguinarines
Fluorides: Sodium fluoride, sodium monofluorophosphate, stannous
fluoride, amine fluoride
Metal salts: Tin, zinc, copper
Oxygenating agents: Hydrogen peroxide, sodium peroxiborate,
sodium peroxycarborate (liberate nascent oxygen)
Detergents: Sodium lauryl sulfate
Amine alcohols: Octapinol, delmipinol
2. Plaque removing action
Enzymes: Protease, lipase, nuclease, dextranase, mutanase, glucose
oxidase, amyloglucosidase.
Oxygenating agents: Hydrogen peroxide, sodium peroxiborate, sodium
peroxycarborate
Detergents: Sodium lauryl sulfate
3. Plaque matrix inhibition
Amine alcohols: Octapinol, delmipinol

15. MOUTH WASHES

Mouth washes are aqueous solution containing one or more active ingredients,
used for topical action on mouth, throat and pharynx.

Types:
1) Antiseptic mouth wash
2) Astringent mouth wash
3) Demulcent / smoothening / emollient mouth wash
 56

4) Anodyne / obtundent mouth wash

5) Alkaline mouth wash
6) Flavouring / sweetening mouth wash

1) Antiseptic mouth washes:

Condy’s Lotion (KMNO4), H2O2 , Zinc sulphate, Chlorhexidine, providone iodine
(betadine) a combination of menthol + thymol + methyl salicylate + eucalyptus
2) Astringent Mouth Washes:
Tannic acid, Zinc sulphate, Zinc chloride.
These substances precipitate superficial proteins and form a protective layer,
which protect the ulcer from external irritation and helps healing (Astringent
action).
They also adsorb bacteria /bacterial proteins / bacterial toxins and render them
ineffective. Addition of AgNo3, Alcohol, phenol, peppermint oil, menthol, thymol,
camphor, chlorbutanol can serve an additional purpose of precipitation of proteins
in nerve fibrils and producing destruction of sensitive tissues in the tooth. Addition
of glycerin, liquid paraffin to the mouth washes may produces additional
smoothening effect.
Uses:
1) Bacterial stomatitis
2) Gingivitis/ Ulcerative gingivitis / spongy gums
3) Aphthous stomatitis
4) Glossitis
5) Dental caries
6) Acute necrotizing ulcerative Gingivitis(ANUG)
3) Demulcent / Smoothening / Emollient Mouth Washes:
Glycerin, liquid paraffin, menthol, peppermint, camphor.
4) Anodyne / Obtundent Mouth Washes:
Produces either local anti-inflammatory action and relieves by reducing
inflammation or relieves the pain by producing paralysis of nerve fibrils and
destruction of sensitive tissue.
E.g. Menthol, Phenol, Thymol, Camphor, Alcohol, Silver nitrate, Chlorbutanol,
sodium salicylate.
5) Alkaline Mouth Washes:
-NaCl (2%)
-NaHCO3 (2%)
-NaCl+NaHCO3+ Amaranth + Peppermint water
-NaHCO3 + NaCl + Peppermint water
-Double strength chloroform water, NaCl+NaHCO3+ Amaranth + Peppermint
water,
These neutralize the acid in the oral cavity and help to maintain the alkaline
medium which may be lethal or oral anaerobic bacteria. These mouth washes also
reduce pain and irritation.
6) Flavouring / sweetening mouth washes:
Peppermint oil, peppermint water, camphor, menthol, thymol.
 57

Uses of Mouth Washes:

1) Cleansing the oral cavity
2) Inflammation / infections of mouth, pharynx, throat:
Bacterial stomatitis, gingivitis, Vincent’s stomatitis, dental caries, spongy
gums, pharyngitis, glossitis
3) Employed in dental practice as a part of post-operative treatment, for
prevention of infection, better healing and soothing effect
4) Used during the course of operative procedures ,when such use adds to
the oral hygiene
5) For overcoming mouth odors in the management of halitosis
6) Soreness under dentures
7) Sensitive oral lesions
8) In bedridden patients for deodorizing the oral cavity and to maintain oral
hygiene

16. LOCAL HEMOSTATICS (STYPTICS)

Agents used to arrest bleeding, or to control oozing of blood from minute blood
vessel / local approachable sites
They act by --
-formation of an artificial clot, or
-providing a matrix which facilitates bleeding

Tooth extraction / dental procedures may lead to disruption of arterioles. The

bleeding occurs from too small blood vessels which cannot be surgically repaired
or sutured. Hence local hemostatics or styptics play an important role in such
situation. In the tooth socket, a cotton gauze pressure pack which may be aided
by use of local hemostatics.
Not only in dentistry, at all other places where suturing is not possible to control
the bleeding, local hemostatics / styptics are useful.

N Styptic agent Source Way to use Uses

1. Thrombin – Obtained from Used as dry Hemophilia,
Human /bovine Human plasma powder/solution neurosurgery,
or Bovine skin grafting.
plasma
2. Fibrin From human As sheets and Covering/
plasma foams, also may packing
be combined surfaces
with fibrin
3 Oxidized Cellulose is Sterile Only as
cellulose obtained from absorbable surface
wood pulp or knitted fabrics hemostatic
cotton prepared by for capillary,
 58

controlled venous and

oxidation of small arterial
regenerated bleeds
cellulose
4. Gelatin From collagen Spongy Packing
that comes from tablets/foams of wounds
body parts of different shapes
various animals moistened with
Saline/Thrombin
5. Russel viper From Russel As a solution
Hemophilia, for
venom viper (acts like local
thromboplastin application
6. Vasoconstrictor Adrenaline/nor As sterile cotton Epistaxis,
adrenaline guaze Tooth sockets
7. Astringents Tannic acid Solution Bleeding piles,
20% in glycerin Bleeding gums

The drugs used in the form of oral tablets to control bleeding are:Tranexamic acid,
ethamsylate – To stop capillary bleeding in epistaxis, after tooth extraction.
 59

CLINICAL
PHARMACOLOGY
 60

DRUGS OF CHOICE – MEDICAL CONDITIONS

Wherever more options have been suggested, choose only one of them, which is the most
suitable. [Please do not write all options suggested under “or”]

1. Organophosphorous poisoning
1. Injection Atropine Sulfate (3 mg) intravenously, immediately and repeat
1-2 ampoules (0.5-1 mg) every 15 minutes INTRAVENOUSLY (IV) till
adequate atropinization is obtained.

Monitor how much sufficient is the atropinisation, on the basis of - 1. Size of

pupils (Atropine should dilate the pupil) and 2. Heart rate (Atropine should
gradually lead to an increase in the heart rate)

As many as 50-100 ampoules may be needed depending upon the severity

of the poisoning.

2. Injection Pralidoxime (50 mg / ml) – 100 mg to be dissolved in 20 ml

saline, and given slowly IV

3. Injection Lorazepam or Injection Diazepam - 0.1 – 0.2 mg / kg

Intravenously (IV), if the patient has convulsions.

4. Injection Sodium Bicarbonate 1-2 mEq Intravenously to combat acidosis

2. Anaphylactic shock following penicillin injection

1. Injection Adrenaline Hydrochloride (1:1000)
0.3-0.5 mg Intramuscular (IM)
Or if needed –
1 mg in 10 ml of normal saline – intravenously (IV)

2. Injection Hydrocortisone (100 mg)

To be injected SLOW Intravenously (IV)

3. Injection Mepyramine Maleate (25-50 mg)

To be injected Intravenously (IV) or Intramuscularly (IM)

3. A 6-year-old child suffering from pneumonia and having convulsions

due to high fever
1. Injection Diazepam / Injection Lorazepam

0.05-0.1 mg / kg-body weight - To be injected Intravenously (IV) or

Intramuscularly (IM) to stop the convulsions
 61

2. Tablet Paracetamol 500 mg

Half (½) tablet administered orally 3 to 4 times a day

Or if needed –
Injection Paracetamol
7.5-15 mg / kg-body weight by Intravenous infusion over 15 minutes –
Repeated every 12 to 24 hours

3. Injection Cefuroxime
50 mg / kg / day divided in 3 doses – each injected intravenously (IV) every
8 hours for 5 days

4. Insomnia
Tablet Etizolam or Tablet Alprazolam (0.25 mg)
One tablet to be taken 1 hour before bedtime every night for 1 week
Follow up to continue or modify treatment as needed after 10 days

-or-

Tablet Diazepam (5 mg) – (10)

One tablet to be taken 1 hour before bedtime every night for 1 week
Follow up to continue or modify treatment, after 10 days

5. Immediate Post-operative pain after major surgery

Injection Pentazocine 30 mg
Inject 30 mg IM and Repeat as needed
--or –
Injection Tramadol 50-100 mg IM or Slow IV every 6-8 hours as needed
--or—
Injection Diclofenac 75 mg IM every 6-8 hours as needed
--or--
Injection Fentanyl 100 mcg IV and repeated as required
-- or -
Injection Butorphenol 2 mg IM or IV and repeated as needed

6. A 45-year-old suffering from pain due to osteoarthritis

Tablet Etoricoxib (90 mg)
Take 1 tablet twice daily after meals for 10 days
Followup to continue or modify the treatment

--or--

Tablet Diclofenac Potassium (50 mg)

 62

Take 1 tablet twice daily after meals for 10 days

Followup to continue or modify the treatment

--or--

Tablet Ibuprofen (400 mg)

Take 1 tablet three times a day after meals for 10 days.
Followup to continue or modify the treatment

7. Headache
Tablet Paracetamol (500 mg) – (5)
One tablet to be taken immediately and repeated as and when necessary.
Follow up after 10 days

8. Intestinal Amebiasis
1. Tablet Tinidazole (500 mg)
Two tablets to be taken twice daily after meals for 3 days
-or-
1. Tablet Metronidazole (400 mg)
Two tablets 3 times a day after meals for 8 days

2. Tablet Diloxanide Furoate (500 mg)

One tablet to be taken three times a day after meals for 10 days

9. Round worm Infestation

Tablet Mebendazole (100 mg) – (6)
One tablet to be taken twice a day after meals for 3 days

-or

Tablet Albendazole (400 mg)

One tablet to be chewed once only (Single dose treatment)

10. Pulmonary tuberculosis

Initiation phase
1. Tablet Isoniazid (300 mg) (5 mg/kg/day)
Take 1 tablet EVERY DAY after breakfast ---- for 2 months.

2. Tablet Rifampicin (450-600 mg) (10 mg/kg/day)

Take one tablet EVERY DAY early in the morning on empty stomach ---
for 2 months

3. Tablet Pyrazinamide (500 mg) (20-30 mg/kg/day)

 63

Take 3 tablets EVERYDAY after lunch --- for 2 months

4. Tablet Ethambutol (400 mg) (15-20 mg/kg/day)

Take 3 tablets EVERY DAY after dinner -- for 2 months

5. Tablet Pyridoxine (10 mg)

1 tablet EVERY DAY after dinner – for 2 months

--Then –

Continuation phase
After 2 months of above treatment,
Stop Drug no 3 (Pyrazinamide) and Drug no. 4 (Ethambutol), – and,

Continue -
Drug no 1 and Drug no 2 [Isoniazid and Rifampicin] – in the same
doses as above, for next 4 months.
With -
Tablet Pyridoxine (10 mg)
1 tablet EVERY DAY – after dinner – next 4 months

11. Multibacillary leprosy (BB, BL, LL)

1. Tablet Dapsone (100 mg)
1 tablet every day

2. Capsule Clofazimine (300 mg)

One capsule ONCE a month - Same date of each month

3. Capsule Clofazimine (50 mg)

One capsule every day
--or ---
Capsule Clofazimine (100 mg)
One capsule on alternate day

4. Tablet Rifampicin (600 mg)

One tablet ONCE A MONTH- Same date of each month – Take early in the
morning on empty stomach.

Followup after 1 month

Above treatment is to be continued for total period of 1 year.

12. Paucibacillary leprosy (BT,TT)

1. Tablet Dapsone (100 mg)
One tablet to be taken every day after breakfast
 64

2. Tablet Rifampicin (600 mg)

One tablet ONCE A MONTH – Same date of each month - Take early in
the morning on empty stomach.

Follow up and check up after 1 month.

Continue the above treatment for a period of 6 months to 1 year

13. Chronic Persistent Bronchial asthma

1. Tiotropium inhalation Metered Dose Inaler- 9 mcg – 2 times a day
2. Formoterol inhalation - 6 mcg – 2 times a day
or their combination
3. Beclomethasone dipropionate inhalation – 100 mcg – two times a day

If there is an attack during this treatment, then manage with -

4. Salbutamol inhalation – 100 mcg – (as and when needed if there is

acute exacerbation)

14. Acute attack of bronchial asthma

1. Salbutamol inhalation METERED DOSE INHALER (MDI) (100 mcg) –
immediately and continued every 8-12 hours Or by nebulisation.
And / or
2. Injection Deriphylline (Etophylline plus Theophylline) – 2 ml by
Intramuscular route

3. If required -
Beclomethasone Dipropionate (Inhalation) 40 mcg twice a day

4. If needed, Tablet Salbutamol (4 mg)

One tablet every 8 hours as needed

5. If needed, 100% oxygen inhalation (2-4 liters/min)

15. Status asthmaticus (Severe Acute Asthma)

1. Nebulized Salbutamol (2.5-5 mg) plus Ipratropium bromide (0.5 mg)
– Intermittent inhalations driven by oxygen
2. Injection Hydrocortisone – 100-200 mg IV – Every 4 to 6 hours
3. Humidified oxygen 50-60% by mask
4. Adequate rehydration with glucose saline and adequate potassium
5. Sodium Bicarbonate – IV infusion – 1-2 mEq/kg, Repeat as needed
6. Tablet Azithromycin (500 mg) 1 tablet every day for 5 days
or
 65

6. Capsule amoxicillin (500 mg) plus clavulanic acid (125 mg) – every 8
hourly for 5 days
7. Salbutamol or Terbutaline 0.4 mg SC or IM if needed.

16. Mild hypertension

1. Tablet Hydrochlorothiazide (12.5 mg) = 30
One tablet once a day for 30 days.

2. Tablet Atenolol (50 mg) = 30

One tablet once a day for 30 days

--or---

1. Tablet Hydrochlorothiazide (12.5 mg) = 30 tablets

One tablet once a day for 30 days
2. Tablet Telmisartan (20 mg) = 30 tablets
One tablet once a day for 30 days

--or---

1. Tablet Ramipril (5 mg) = 30 tablets

One tablet once a day for 30 days

--or---

2. Tablet Amlodipine (5 mg) = 30 tablets

One tablet once a day for 30 days

Monitor blood pressure. Follow up after 1 month for blood pressure

check, physical examination, and necessary modification in
treatment.

17. Moderate hypertension

1. Tablet Hydrochlorothiazide (25 mg) = 30 tablets

One Tablet once a day for 30 days
2. Tablet Atenolol (100 mg) = 30 tablets
One tablet once a day for 30 days

-or----

1. Tablet Hydrochlorothiazide (25 mg) = = 30 tablets

One Tablet once a day for 30 days
2. Tablet Telmisartan (40 mg) = 30 tablets
 66

One tablet once a day for 30 days

-or----

1. Tablet Ramipril (10 mg) = = 30 tablets

One tablet once a day for 30 days
2. Tablet Amlodipine (10 mg) = = 30 tablets
One tablet once a day for 30 days

Monitor blood pressure. Follow up after 1 month for blood pressure

check, physical examination, and necessary modification in
treatment.

18. Severe hypertension

1. Tablet Hydrochlorothiazide (25 mg) = 30 tablets
One Tablet once a day for 30 days
2. Tablet Atenolol (100 mg) = 30 tablets
One tablet once a day for 30 days
3. Tablet Dihydralazine Sulphate (10 mg) = 90 tablets
One Tablet 3 times a day

------ or ------

1. Tablet Hydrochlorothiazide (25 mg) = 30 tablets

One Tablet once a day for 30 days
2. Tablet Telmisartan (80 mg) = 30 tablets
One tablet once a day for 30 days

-------or-------

1. Tablet Hydrochlorothiazide (25 mg) = 30 tablets

One tablet once a day for 30 days
2. Tablet Ramipril (10 mg) = 60 tablets
One tablet every 12 hours for 30 days

------or----------

1. Tablet Ramipril (10 mg) = 60 tablets

One tablet every 12 hours for 30 days
2. Tablet Amlodipine (10 mg) = 60 tablets
One tablet every 12 hours for 30 days
 67

Monitor blood pressure. Follow up after 1 month for blood pressure

check, physical examination, and necessary modification in
treatment.

19. Hypertensive crisis

Injection Sodium Nitroprusside (50 mg)
Prepare fresh in distilled water and add to intravenous drip (IV Drip) of 5%
Dextrose.
Start with 0.5 mcg/kg/min, and gradually increased up to 10 mcg/kg/min.
(Drip to be protected from light)
(Use a colored bottle or cover the bottle with black paper)
(Dose to be modified with monitoring of blood pressure)

Or
Injection Nitroglycerin 5 mcg/min Intravenous infusion, increase in small
increments of 5-10 mcg/min as needed.

Or
Injection Labetolol – Bolus dose – 10-20 mg Intravenous (IV) or - 1-2
mg/min by continuous intravenous (IV) infusion titrated at half hourly
intervals

Or
Injection Fenoldopam – Intravenous (IV) infusion - 0.1 mcg/kg/min titrated
every 15 minutes

Or
Injection Clevidipine – Intravenous (IV) infusion – 1-2 mg/Hour – Dose is
doubled if needed

Or
Injection Phentolamine – 5-15 mg Intravenous (IV)

Or
Injection Nicardipine – 5-15 mg IV bolus – Repeated every 10-15 minutes

Or
Injection Esmolol – 250-500 mcg/kg/min IV over 1 minute – then 50-100
mcg/kg/min for 1 minute IV for 4 minutes, then increase to 300
mcg/kg/min if necessary

20. Congestive heart failure with edema

1. Tablet Ramipril (2.5) mg = 20
 68

One tablet twice a day

– or –
Tablet Enalapril (5 mg) = 20
One tablet twice a day
- or --
Tablet Lisinopril (10 mg) = 20
One tablet twice a day

2. Tablet Carvedilol Tablet (6.25 mg) =20

One tablet twice a day
- or –
Tablet Metoprolol Tablet (50 mg) =20
One tablet twice a day

3. Tablet Furosemide Tablet (40 mg) =5

One tablet every day

4. Tablet Potassium chloride (Klor-Con) Tablet (10 mEq) =30

One tablet three times a day

5. Tablet Spironolactone Tablet (50 mg) = 20

One tablet two times a day.

Continue the above treatment for 5-10 days, and monitor, and modify the
above treatment as needed.

21. Angina Pectoris (Acute attack)

Tablet Isosorbide Dinitrite (2.5 mg) – SUBLINGUAL TABLET
-or-
Tablet Nitroglycerin (0.3/0.4 mg) SUBLINGUAL TABLET
Place One tablet under the tongue at the onset of pain. Discard the tablet
as soon as the pain subsides.

If the pain does not subside within 5 minutes, repeat the tablet by same
route (Upto total 3 tablets)

22. Acute myocardial infarction

1. Tablet Nitroglycerin (0.3/0.4 mg) sublingual – for active chest pain
2. Tablet Aspirin Chewable/Soluble Tablet 325 mg – To be chewed or
swallowed immediately
3. Tablet Clopidogrel 300 mg immediately
4. Injection Tenecteplase 0.5 mg/kg - Single Bolus Dose – IV over 10
seconds
5. Tablet Buprenorphine 2 mg SUBLINGUAL
 69

6. Injection Buprenorphine 0.6 mg slow IV

--or—
6. Injection Morphine 2-4 mg IV Bolus, 2-4 mg IV repeated every 5-10 min
7. Injection Diazepam 10 mg IV
8. Unfractionated Heparin (UH) – An initial loading dose of 60 IU/kg with an
initial infusion of 12 IU/kg per hour
9. Tablet Atenolol 50 mg everyday
10. Injection Lidocaine Injection 100 mg – 1 ampoule – slow intravenous
11. 100% humidified oxygen 4 liters per minute
12. Injection Dextrose solution 5% (500 ml) – slow IV drip

23. Enteric Fever (Typhoid Fever)

1. Injection Ceftriaxone
Intravenous (IV) injection 2 grams everyday for 2 days,
Then 1 gram IV for next 3 days

-or

1. Tablet Cefuroxime (500 mg)

One tablet every 12 hours after meals upto 7 days after the temperature
subsides. (A total duration of 10 to 15 days may be needed)

2. Tablet Paracetamol (500 mg)

One tablet every 8 hours for 5 days

3. Tablet Pantoprazole (40 mg)

One tablet before lunch and 1 tablet before dinner for 10 days

Followup in 5 days to continue or modify the treatment.

24. H. Pylori Peptic Ulcer

2-week regimen: Triple therapy

Should include 2 Anti-H. pylori antibiotics plus one Proton pump
inhibitor (PPI)

The two Anti-H pylori antibiotics are used for 2 weeks

The PPI is used for total 4 weeks

1. One Proton Pump Inhibitor (PPI) given twice a day before meals for
total 4 weeks
(Omeprazole or Rabeprazole) [20 mg]
or Lansoprazole or Esomeprazole [30 mg]
or Pantoprazole 40 mg
 70

2. Capsule Clarithromycin 500 mg twice a day for 2 weeks or (Tab

Metronidazole 500 mg twice a day for 2 weeks)

3. Capsule Amoxicillin 1000 mg twice a day for 2 weeks or (Tab

Metronidazole 500 mg twice a day for 2 weeks)

(Usually Metronidazole is used in place of Amoxicillin, if the patient is

allergic to penicillins)
(Amoxicillin may also be sometimes replaced by Tetracycline 500 mg four
times a day)

Quadruple therapy (4 drugs)(Sequential therapy)

Should include 2 Anti-H. pylori antibiotics plus one Proton pump inhibitor

1. PPI plus amoxicillin for 5-7 days (Pantoprazole 40 mg BID and

amoxicillin 1 g BID for 7 days ), then -

2. PPI plus 2 other antibiotics for the next 5-7 days;

Either – Clarithromycin 500 mg twice a day and Metronidazole 500 mg
twice a day
Or – Tetracycline 500 mg four times a day and Metronidazole 500 mg twice
a day

25. Malaria

Plasmodium is the genus of the parasite that causes malaria. There are four different species -
Vivax, Malariae, Ovale, and Falciparum. Falciparum is supposed to be the most serious type.
Vector that transmits malaria is the Female Anopheles Mosquito, which is called Definitive Host,
because the sexual multiplication of parasite takes place in the mosquito; whereas Man is called the
Intermediate Host.

In Vivax and Falciparum, the fever occurs every 3rd day, so also named Tertian Malaria, whereas
in Malariae and Ovale, the fever occurs every 4th day, so they are named Quartan Malaria.
In Falciparum type, there is no relapse.

Most of the malarial parasites in many areas of the world – especially Falciparum – have slowly
become resistant to the age-old useful antimalarial – chloroquine.

Species Chloroquine Sensitive (25.1) Chloroquine-Resistant (25.2)

Vivax Option 1 1. Tab Quinine (600 mg Every 8
Malariae 1. Tab Chloroquine (250 mg hours) for 7 days
Ovale tablet)(150 mg base) – 4 tabs
 71

immediately, 2 tabs after 6 2. Doxycycline (100 mg Once a day)

hours, then 2 tablets daily for for 7 days
next 2 days

+ +
2. Tab Primaquine (15 mg) - 3. Tab Primaquine (15 mg) - 1 tab
1 tab every day for 2 wks every day for 2 wks (mainly For
(mainly For preventing preventing relapse)
relapse)

Option 2 Option 2
1. Tablet Mefloquine (250 1. Tablet Mefloquine (250 mg) – 5
mg) – 5 tablets as a single tablets as a single dose once only as
dose once only as a single a single dose
dose +
+ 2. Tab Primaquine (15 mg) - 1 tab
2. Tab Primaquine (15 mg) - every day for 2 wks (mainly For
1 tab every day for 2 wks preventing relapse)
(mainly For preventing
relapse)
Chloroquine Sensitive (25.3) Chloroquine-Resistant (25.4)
Falciparum Option 1 Option 1
1. Chloroquine (250 mg 1. Artesunate (100 mg twice a day
tablet)(150 mg base) – 4 tabs for 3 days
immediately, 2 tabs after 6 2. Sulfadoxine (500 mg) plus
hours, then 2 tablets daily for Pyrimethamine (15 mg) – 3 tablets
next 2 days as a single dose
+ or
2. Mefloquine (750 mg day 2 and
2. Tab Primaquine (15 mg)
500 mg on day 3)
– 3 tablets once only as a
Single dose (For +
gametocytocidal action) 3. Tab Primaquine (15 mg) 3
tablets as a single dose (For
gametocytocidal effect)

-Or Option 2 -Or Option 2

1. Tablet [Sulfadoxine 500 1. Tab Artemether (80 mg) +
mg + Pyrimethamine 25 mg] Lumefantrine (480 mg) = total 6
= 3 tablets. Take all the 3 tablets = 1 tablet to be taken every
tablets at a time 12 hours with fatty food or milk for 3
days
+ Or
 72

2. Tablet Primaquine (15 1. Tablet Quinine 600 mg every 8

mg) = 3 tablets - All three hours for 7 days + Doxycycline 100
tablets to be taken once mg every day for 7 days
only as a single dose.(For
gametocytocidal effect)
+
Tab Primaquine (15 mg) – 3
tablets once only as a single dose
(For gametocytocidal effect)

-Or Option 3 -Or Option 3

1. Tablet Mefloquine (250 1. Tablet Mefloquine (250 mg) – 5
mg) – 5 tablets as a single tablets as a single dose once only as
dose once only as a single a single dose
dose +
+ 2. Tablet Primaquine (15 mg) = 3
2. Tablet Primaquine (15 tablets - All three tablets to be
mg) = 3 tablets - All three taken once only as a single
tablets to be taken once dose.(For gametocytocidal effect)
only as a single dose.(For
gametocytocidal effect) -Or Option 4
Tablet Atovaquone (250 mg) +
Proguanil 100 mg)

Such 4 tablets (means atovaquone 1

g plus Proguanil 400 mg)-

These 4 tablets as a single dose

every day for 3 days

26. Prophylaxis (Prevention of malaria) while travelling to an area known to be

endemic for malaria
Tablet Mefloquine (250 mg)
One tablet ONCE A WEEK
Start 1-2 weeks before arrival in endemic area; continue 4 weeks after
leaving endemic area
-or-
Doxycycline tablet / capsule 100 mg
100 mg EVERY DAY
Begin taking 1-2 days before travel and continue daily during travel and for
4 weeks after traveler leaves malaria infested area
-or-
Atovaquone (250 mg) Plus Proguanil (100 mg)
One tablet EVERY DAY, beginning 1-2 days before travel to malaria-
endemic area and continued until 7 days after return
 73

DRUGS OF CHOICE – DENTAL

GUIDELINES ON ORAL / DENTAL CONDITIONS
Bacteremic risk of dental procedure
Highest risk
Dental extractions
Periodontal procedures including surgery, scaling, root planning, probing
Dental implant placement and replantation of avulsed teeth
Endodontic (root canal) instrumentation or surgery only beyond the apex
Initial placement of orthodontic bands (but not brackets)
Intraligamentary and intraosseous local anesthetic injections
Prophylactic teeth or implant cleaning where bleeding is anticipated
Lower risk
Restorative dentistry (operative and prosthodontic) with or without retraction cord
Nonligamentary / nonintraosseous local anesthetic injections
Intracanal endodontic treatment, post placement and build up
Placement of rubber dam
Postoperative suture removal
Placement of removable prosthodontic or orthodontic appliances
Taking of oral impressions
Fluoride treatments
Taking of oral radiographs
Orthodontic appliance adjustment

Dental Abscess / Dento-alveolar abscess / Tooth Abscess / Root Abscess : Localized

collection of pus associated with a tooth.

Three main types are:

-Gingival -Periodontal -Periapical

-Gingival abscess: involves only gum tissue, without affecting either the tooth or the
Periodontal ligament
-Periodontal abscess: begins in a periodontal pocket
-Periapical abscess: result of a chronic localized infection located at the tip or the apex
of the root of the tooth.

Pericoronal abscess: involves the soft tissues surrounding the crown of a tooth
(pericoronitis)
Combined periodontic-endodontic abscess: a periapical abscess and a periodontal
abscess have combined.
-------------------------------------------------------------------------------------------------------------------------------------
 74

1. Recurrent herpes labialis

1. Acyclovir 5% cream
Apply to the affected part 5 times daily
Or
1. Penciclovir 1% cream
Apply to the affecgted part every 2 hours while awake

Or

1. Tablet Famciclovir (500 mg)

Take 3 tablets as a single dose

Or

1. Tablet Valacyclovir (1 gram)

Take 2 tablets 2 times a day for 2 doses

Or

Tab. Acyclovir 200 – 800 mg 4 times a day for 7 -15 days

2. A patient who has undergone right upper third molar extraction,

now having moderate pain and great amount of swelling and fever
1. Cap. Amoxicillin 500 mg = 15 capsules
Take one capsule every 8 hours for 5 days

2. Tablet Diclofenac Potassium (50 mg) plus Paracetamol (500 mg)

plus Serratiopeptidase (10 mg) = Total 15 tablets
One tablet 3 times a day for 5 days

3. Bleeding after tooth extraction

Adrenaline 1:10,000 solution
Or
Topical haemocoagulase solution

Soak a cotton swab in any one of the above solutions and apply with
pressure over the bleeding area

4. Dento-alveolar abscess
1. Capsule Amoxicillin 500 mg Plus Clavulanic Acid 125 mg
One capsule twice daily after meals x 5-7 days
-or
Capsule Cephalexin (500 mg)
One capsule every 6 hours after meals x 5-7 days

2. Tablet Diclofenac Potassium (50 mg) plus Paracetamol (500 mg)

plus Serratiopeptidase (10 mg) = Total 15 tablets
One tablet 3 times a day x 5-7 days

For gram negative anerobic infection

 75

Tablet Metronidazole (400-800 mg)

One tablet every 8 hours after eating x 7 days

5. Dento-alveolar abscess in a penicillin-allergic patient

1. Tablet Azithromycin (500 mg)
One capsule every day for 5 days
-or-
1. Capsule Clindamycin (300 mg)
One capsule every 8 hours x 5-7 days
[The dose is 300-450 mg every 8 hours – the total daily dose being 20 mg/kg body
weight divided in 3 doses at every 8 hours]
-or-

2. Tablet Diclofenac Potassium (50 mg) plus Paracetamol (500 mg)

plus Serratiopeptidase (10 mg)
One tablet 3 times a day x 5 days

For gram negative anerobic infection

Tablet Metronidazole (400-800 mg)
One tablet every 8 hours after eating x 7 days

6. Acute peri-coronitis caused by penicillinase producing staphylococci

1. Capsule Dicloxacillin (500 mg)
Two capsules immediately and then 1 capsule every 6 hours for total 5 days
-or-
1. Capsule Amoxicillin 500 mg plus Clavulanic Acid 125 mg
One capsule every 8 hours x 5 days

2. Tablet Diclofenac Potassium (50 mg) Plus Paracetamol (500 mg)

Plus Serratiopeptidase (10 mg) = Total 15 tablets
One tablet 3 times a day x 5 days

For gram negative anerobic infection

Tablet Metronidazole (400-800 mg)
One tablet every 8 hours after eating x 7 days

7. Oral candidiasis
Local treatment
1. Nystatin (Swish and Swallow) (100,000 units/ml) (120 ml)
4-6 ml swished around in mouth for several minutes and then swallow.
Use in this way 4 times a day for 7-14 days

Or

1. Tablet Miconazole (50 mg) (for local application)

Apply 1 tablet to upper gum above incisor everyday for 14 days

Or

Clotrimazole Troche (10 mg)

 76

10 mg troche dissolved in mouth 5 times daily for 7-14 days

Or

Systemic treatment
Tablet Fluconazole (100 mg)
2 rablets on day 1 and then 1 tablet everyday for 7-14 days

Or

Tablet Itraconazole (100 mg)

2 tablets everyday or 2 times a day for 7-14 days

8. Nonspecific Xerostomia (Dryness of mouth)

Topical treatment
1. Oxidized glycerol tri-ester spray (Aquoral)
Spray inside the oral cavity 3-6 times a day or as needed
Keep away from children.

Or

1. Sodium carboxymethylcellulose (0.5% aqueous solution) (250 ml)

Rinse the mouth with 5 ml solution every 6 hours.
Keep away from children

And / Or

Systemic treatment
1. Tablet Pilocarpine 5 mg
Take 1 tablet 3 times a day.
(One day at the end of a week is kept as drug-free day)
(Dosage increased maximum upto 10 mg three times a day)

Or

1. Capsule Cevimeline 30 mg
One capsule 3 times a day
(One day at the end of a week is kept as drug-free day)

9. Exposed hypersensitive dentin

(In this condition, the substances called obtundents are needed, which decrease
the sensitivity and pain from the exposed dentin. Obtundents in general may act
by the two mechanisms – 1. Paralyze the nerve fibrils. and/or 2. Precipitate the
proteins (astringent effect) from the odontoblastic fibrils and thus destroying the
sensitive tissue)

1. Arginine mouth wash (0.8%)

To be used as a mouth wash 3-4 times a day and before bedtime.

Or
 77

1. Arginine containing tooth paste

Or

1. Strontium hexahydrate paste (10%) (15 grams)

Or

1. Sodium fluoride (1.1%), potassium nitrate (5%) paste

Or
1. Potassium nitrate and Sodium monofluorophosphate tooth paste

Apply to the part with help of a tooth brush, twice a day.

10. Trigeminal Neuralgia

Tablet carbamazepine (100 mg) = Total 20 tablets
One tablet every 12 hours after food for 10 days, and advised followup to modify
or continue the treatment further.

11. Muscle relaxant for craniofacial and cervical myalgia and swelling
Tablet Baclofen 10 mg BD
--or--
Tablet Chlorzoxazone 250 mg TDS
--or—
Tablet Diclofenac potassium 50 mg + Paracetamol 325 mg + Chlorzoxazone 100
mg
1 tablet every 8 hours

12. Insomnia due to toothache

1. Tablet Ibuprofen (400 mg)
One tablet three times a day after food for 5 days

2. Tablet Alprazolam (0.25 mg)

One tablet at bedtime for 3 days
---Or---
2. Tablet Diazepam (10 mg)
One tablet at bedtime for 3 days

13. Prescribe for a patient with acute dento-alveolar abscess of upper left
first molar. The tooth has been extracted and careful examination of socket
reveals that abscess has penetrated to the maxillary sinus.
1. Capsule Doxycycline (100 mg)
Take one capsule every 12 hrs for 10 days
2. Tablet Ibuprofen (400 mg)
Take one tablet every 8 hours after food for 5 days.

14. Prescribe for a patient severely convulsing in dental chair.

Injection Lorazepam (10 mg)
Or
 78

Injection Diazepam (10 mg)

Inject one ml intravenously and repeat if necessary.

15. Acute necrotizing ulcerative gingivitis

1. Tablet Metronidazole (400 mg) = 30
Take 1 tablet every 8 hours after food for 10 days
---or---
1. Capsule Amoxicillin 500 mg = 30
One capsule every 8 hours after food for 10 days
2. Tablet Diclofenac potassium 50 mg + Paracetamol 325 mg + serratiopeptidase
(10 mg)
One tablet every 8 hours for 10 days
3. Irrigation and debridement of necrotic areas
4. Maintain oral hygiene
5. Providone-Iodine (1%) mouth wash – Rinse the mouth and gargle 3-4 times a
day
 79

Criticism
And Correction
of Wrong
Prescription

Criticising and commenting in details on a given prescription.

Then, writing the correct prescription in complete prescription

format.
 80

Criticism and correction of wrong prescription

1. Pulmonary Tuberculosis
1. Tablet Streptomycin 2 grams BID
2. Tablet Rifampicin 600 mg ONCE IN A MONTH after lunch
3. Tablet Ethambutol 500 mg BID
4. Tablet Thiacetazone 100 mg BID
Continue the above treatment for 1 year
81
82
 83

2. Congestive heart failure with edema

1. Tab. Digoxin (250 mg)
One tablet TID for 5 days
2. Injection Adrenaline Hydrochloride (1:1000) – 0.3-0.5 ml IM
2. Inj. Furosemide (40 mg)
One injection Every day IM
3. Inj. Potassium Chloride (100 mg)
Inject 100 mg TID
84
85
 86

3. Multibacillary leprosy (BB, BL, LL)

1. Tab. Dapsone (500 mg)
One tablet Every day
2. Cap. Clofazimine (1 gram)
One tablet Alternate day
3. Tablet Rifampicin (600 mg)
One tablet after lunch and one tablet after dinner – Every day
The above treatment is to be given for 6 months
87
88
 89

4. Enteric Fever (Typhoid fever)

1. Capsule Chloramphenicol 500 mg
One tablet QID till 7 days after fever subsides
2. Tablet Aspirin 300 mg
2 tablets TID
90
91
 92

5. A 3-year-old with gram negative infection of oral cavity and fever

1. Ciprofloxacin Syrup
250 mg BID for 5 days
2. Doxycycline Syrup
50 mg OD for 5 days
3. Aspirin Tablet (300 mg soluble tablet)
Half tablet to be dissolved in water and taken 3 times a day
93
94
 95

6. Chronic Bronchial asthma with mild hypertension

1. Injection Adrenaline (0.5 ml) – IV
2. Inj. Aminophylline (40 mg) – IV
3. Tablet Atenolol (50 mg) One tablet Every day
4. Tablet Furosemide 40 mg TDS
96
97
 98

7. Acute attack of bronchial asthma

1. Tab Salbutamol (4 mg) 1 tablet TID for 3 days
2. Inj. Aminophylline 250 mg to be dissolved in 20 ml of 20%
dextrose and given slow IV over 10 minutes
3. Inj. Cromolyn Sodium (100 mg) IV
99
100
 101

8. Intestinal Amebiasis
1. Chloroquine Phosphate (250 mg) (150 mg base)
Two tablets immediately, 2 tablets after 6 hours, and then
2 tablets OD for next 2 days
2. Tablet Mebendazole (100 mg)
One tablet 2 times a day for 3 days
102
103
 104

9. Organophosphorous poisoning
1. Tablet Atropine (0.6 mg) TID
2. Injection Pralidoxime (50 mg/ml) – 100 mg to be dissolved
in 20 ml saline, and given slowly IV
3. Injection Physostigmine (15 mg) IV
105
106
 107

10. Mild hypertension

1. Injection Sodium Nitroprusside (100 mg) IV infusion
2. Tablet Furosemide (40 mg) 1 Tablet TID
3. Injection Atenolol (100 mg) IV
108
109
 110

Intelligent questions
(Therapeutic problems)
 111

Autonomic Nervous System (ANS)

1. Atropine is used in treatment of organophosphorous poisoning. Explain.

2. Atropine is not used in closed angle glaucoma. Explain.

3. Why are cardio-selective beta blockers preferred?

4. Explain: Physostigmine is useful in atropine poisoning.

5. Why oral salbutamol therapy causes muscle tremors?

 112

6. While incising paronychia, a house surgeon injected a local anesthetic that someone else
had filled in a syringe. Later, it was found that necrotic areas were developing at the
fingertips. Explain.

7. Oximes are useful in organophosphorous poisoning. Explain.

8. At the end of a procedure under general anesthesia, the anesthesiologist finds signs of
respiratory failure due to delay in the recovery of the relaxed skeletal muscles. What
medication can rapidly reverse the neuromuscular blockade, and why?

9. Can we instill procaine instead of xylocaine as a local anesthetic in the eye? Explain.
 113

10. Long-term beta blocker treatment should not be abruptly stopped. Explain.

11. Give reasons: Atropine is used as pre-anesthetic medication.

12. Beta blockers should be avoided in diabetic patients. Explain.

13. Amphetamine tablet should not be consumed after 4 pm.

14. Neostigmine is preferred to physostigmine for myasthenia gravis. Explain.

 114

15. Epinephrine is combined with lidocaine for local anesthesia. Explain.

16. Tamsulosin is used in a case of benign prostatic hypertrophy. Explain.

17. Glycopyrrolate is preferred to atropine. Explain.

18. Explain: Why adrenaline is useful in anaphylactic shock.

 115

CVS, Blood, and related topics

1. A patient on digoxin therapy develops severe bradycardia. What medication will be useful
to treat this bradycardia? and this medication acts on which type of receptors?

2. Low-dose aspirin is prescribed for prevention of myocardial infarction. Why?

3. A physician wants to start an angiotensin-converting enzyme inhibitor for his patient. The
physician says he would prefer to administer the first tablet of the medication to this patient
in his office. Why?

4. For treating barbiturate overdose, sodium bicarbonate is used, while in amphetamine

toxicity is treated with ammonium chloride. Explain.

5. A patient with anemia complained of tingling and numbness. Thinking of anemia, the
physician started folic acid. After 4 months of treatment, a slight improvement was seen in
anemia, however, the patient said the tingling and numbness is even worse than before.
Explain.
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6. Nitrates are combined with beta blockers in chronic prophylaxis in angina.

7. Spironolactone is used in heart failure. Explain.

8. Aspirin is used in Acute myocardial infarction. Explain.

9. Low molecular weight heparins are preferred to traditional heparins. Explain.

10. The onset of action of warfarin is slow. Explain.

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11. Shotgun hematinic (anti-anemia) preparations should not be preferred.

12. Mannitol is used in cerebral edema. Explain.

13. What adverse effect is expected if captopril is given along with spironolactone? Why?

14. A patient on aspirin therapy is started with warfarin. What is likely to happen? Why?

15. Long term Low dose aspirin treatment in a patient must be stopped before he goes for a
dental surgery. Explain.

16. Nitroprusside infusion bottle should be covered with black paper. Explain.
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Chemotherapy, GIT
1. Explain: Trimethoprim is combined with sulfamethoxazole.

2. Explain: Amoxicillin is combined with clavulanic acid.

3. Explain: Penicillins should not be combined with aminoglycoside in a syringe or infusion.

4. Why pantoprazole / omeprazole is prescribed empty stomach?

5. A patient on metronidazole therapy should not consume alcohol. Why?

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6. Explain: Ampicillin is combined with sulbactam.

7. A 50-year-old lady with rheumatoid arthritis is receiving hydroxycholroquine. Every month

she needs to go to a speciality clinic for certain follow-up. What is being monitored in this
patient every month and why?

8. Why metoclopramide is not preferred in children less than 5 yrs of age?

9. Allopurinol should not be prescribed to a patient who is receiving 6-mercaptopurine. Why?

10. A patient who was started on chloramphenicol therapy complained of sore throat and
ulcer on gums. Explain.

11. Rifampicin is advised early in the morning on empty stomach. Why?

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12. Tetracycline syrup preparations are banned. Why?

13. Non-systemic antacids are preferred to systemic antacids to manage hyperacidity. In

such combinations, why aluminium salts and magnesium salts are combined?

14. Ranitidine and sucralfate should not be used in combination. Explain.

15. You treat a patient with a diagnosis of intestinal amebiasis with metronidazole therapy for
10 days. At the end of this treatment, the patient asks you – “Doctor, is the treatment
complete?” You rightly answer to him – “No”. Then you start diloxanide furoate to this
patient. What is the purpose of this? Explain.

16. Milk/ milk products or calcium / magnesium / aluminium – containing antacids should not
be consumed with tetracyclines. Explain.

17. What will happen to the breast-fed infant if his mother starts receiving injection
streptomycin for the management of her tuberculosis? Explain.
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18. Fluoroquinolones should not be prescribed to children or old patients. Explain.

19. A patient on INH therapy complains of tingling and numbness in his feet. Why? And What
you will prescribe to this patient in what doses?

20. Why ethambutol is avoided in children?

Endocrines
1. Newer insulins are better than older insulins. Mention the reasoning points.

2. A diabetic patient whose blood glucose was otherwise well stabilized with his usual
antidiabetic treatment, started showing higher blood glucose values after being put on a new
medication by a dermatologist. Which is the most likely new medication? Explain the
interaction.
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3. Corticosteroids should be tapered gradually. Explain.

4. Why propanolol is used for treatment of thyrotoxicosis?

5. Propyl thiouracil is preferred to carbimazole during pregnancy. Explain.

6. If a patient on voglibose lands into hypoglycaemia, this hypoglycaemia may not get
corrected instantly with table sugar or biscuits. Why? Suggest what should be done.

7. A 30-year-old with lichen planus was receiving 60 mg prednisone every morning for last 2
years. Last night around 11 pm, he landed into hospital with acute abdominal colicky pain,
was managed conservatively. By 5 am today, the pain increased profoundly, and he was
taken to operating room for appendectomy. What strategy should be undertaken regarding
his steroid doses? Explain.
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Central Nervous System (CNS)

1. Ethyl alcohol can be used to treat mehyl alcohol poisoning. Explain.

2. Pentazocin should not be used to relieve pain of acute myocardial infarction. Explain and
suggest an alternative medication.

3. Barbiturates/benzodiazepines should be avoided for managing insomnia in a lady who is

receiving combination oral contraceptives. Explain.

4. Benzodiazepines are preferred to barbiturates as hypnotic agents. Explain.

5. Diphenoxylate is combined with subtherapeutic dose of atropine. Explain.

6. Morphine is contraindicated in head injury.

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7. A 34-year-old lady with schizophrenia is to be placed on clozapine therapy. She needs to

give a blood sample every month for a certain test. Which is this test and why is it needed?

8. Carbamazepine helps to relieve neuropathic pain. Explain.

9. A 40-year-old surgeon suddenly started with severe sneezing which was precipitated due
to dusting of a carpet at his home. He was to leave for his usual hospital duties. Which
antihistamine medication should he preferably take for his symptoms and why?

10. How carbidopa helps the action of levodopa?

11. A 30-year-old man had consumed a tablet of chlorpheniramine for his symptoms of cold
and cough. Then he went to attend a party where he consumed two pegs of alcohol. He
found himself too drowsy to drive back home. Explain.

12. Explain: Morphine should not be used to relieve pain in a patient with undiagnosed acute
abdomen.