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Parenteral Drug Administration Department of Anaesthesia University of Glasgow
Parenteral Route in Dentistry General Dental CouncilGeneral Dental Council –Intravenous sedation drugs –Emergency drugs
Drug Administration Absorbtion Plasma water Metabolism Excretion Site of ActionTissue oral intramuscular subcutanous topicalintravenous
Parenteral Injection Sites subcutanously intramuscularly intravenously
Subcutaneous Route Absorption depending on blood flowAbsorption depending on blood flow –Constant & slow absorption –Prolonged effect Drugs –Insulin –Heparin
Subcutaneous Injection Sites Abdominal wallAbdominal wall ThighThigh Deltoid areaDeltoid area
Intramuscular Route Absorption depending on blood flowAbsorption depending on blood flow –Rapid onset & shorter duration –Shock DrugsDrugs –Glucagon –Adrenaline
Intramuscular Injection Sites
Intramuscular Route LimitationsLimitations –Neurovascular damage –Bleeding (eg anticoagulant therapy) –Pain –Infection –Delayed absorption in shock –Interpretation of diagnostic tests
Intravenous Route Rapid immediate onsetRapid immediate onset Permits titrationPermits titration Administer slowlyAdminister slowly DrugsDrugs –Midazolam
Intravenous Injection Sites PeripheralPeripheral CentralCentral
Intravenous LimitationsLimitations –May be more difficult to obtain –Increased risk of adverse effects –Requires intravenous access –Infection –Pain
Anaphylaxis DefinitionDefinition –Immunologically mediated reaction to antigen causing systemic symptoms Potentially life threateningPotentially life threatening Frequent AntigensFrequent Antigens –Antibiotics –Latex –Anaesthetic agents –Colloid fluids
Anaphylaxis DiagnosisDiagnosis –Collapse –Difficulty breathing –Wheeze –Angio-oedema –Urticaria
Management Anaphylaxis PreventionPrevention –Avoid unnecessary drugs particularly iv –Take drug history Adequate staff training and facilitiesAdequate staff training and facilities
Immediate Management 1 Remove trigger agent –Stop injection or infusion of drug –Remove triggering materials Remember latex allergy Chlorhexidine –Summon assistance
Immediate Management 2 Basic life supportBasic life support –Check airway, breathing, circulation –Oxygen Give adrenaline (0.5-1mg im)Give adrenaline (0.5-1mg im) Elevate legsElevate legs (Give intravenous fluids)(Give intravenous fluids)
Subsequent Management AntihistaminesAntihistamines –Chlorpheniramine iv SteroidsSteroids –Hydrocortisone iv Intensive care unitIntensive care unit Immunological TestingImmunological Testing
Summary Parenteral drug administrationParenteral drug administration –Sites –Drug availability –Limitations AnaphylaxisAnaphylaxis
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