Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS3 ORAL SURGERY > 4 - Analgesia > Flashcards

4 - Analgesia Flashcards

1
Q

What are the common analgesics prescribed from the dental practitioners formulary?

A
  • aspirin
  • ibuprofen
  • diclofenac
  • paracetamol
  • dihydrocodeine
  • carbamazepine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How are prostaglandins produced?

A
  • trauma/infection lead to breakdown of membrane phospholipids which produces arachidonic acid
  • arachidonic acid breaks down to prostaglandins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the role of prostaglandins in pain?

A
  • sensitise other tissues to inflammatory products which results in pain
  • do not cause pain directly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the properties of aspirin?

A
  • analgesic
  • antipyretic
  • anti-inflammatory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the mechanism of aspirin?

A
  • inhibits cylco-oxygenases (COX1 and COX2)
  • this reduces the production of prostaglandins
  • COX1 inhibition reduces platelet aggregation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the analgesic properties of aspirin.

A
  • peripheral and central action
  • peripheral actions are more dominant
  • analgesia results from inhibition of prostaglandins in inflamed tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the antipyretic properties of aspirin.

A
  • prevents temperature raising properties of IL-1
  • prevents rise of prostaglandins in the brain
  • reduces elevated temperature, not normal temperature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the anti-inflammatory properties of aspirin.

A
  • prostaglandins act as vasodilators and affect capillary permeability
  • due to the reduction in prostaglandins, inflammation is reduced at site of injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the adverse effects of aspirin?

A
  • GIT problems
  • hypersensitivity
  • overdose
  • aspirin mucosal burns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the GIT problems caused by aspirin.

A
  • due to the COX1 inhibition, platelet aggregation is reduced which predisposes the GI mucosa to damage
  • prostaglandins usually protect the mucosal lining by increases blood flow through gastric mucosa and produce mucin cells which have a protective lining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Who should not be prescribed aspirin due to GIT problems?

A
  • ulcers
  • gastro-oesophageal reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe aspirin hypersensitivity.

A
  • acute bronchospasm (asthma attacks)
  • skin rashes
  • urticaria (hives)
  • angioedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who should not be prescribed aspirin due to hypersensitivity problems?

A

Care should be taken when prescribing aspirin to asthmatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe aspirin overdose.

A
  • hyperventilation
  • tinnitus (deafness)
  • vasodilator and swelling
  • metabolic acidosis
  • coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe mucosal burns caused by aspirin.

A
  • direct effect of salicylic acid
  • chemical burn of the mucosa when left in the mouth “to absorb”
  • aspirin has NO TOPICAL EFFECT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who is at risk when prescribing aspirin?

A
  • peptic ulceration
  • epigastric pain
  • bleeding abnormalities or those on anticoagulants
  • pregnancy or breastfeeding
  • steroids
  • renal/hepatic impairment
  • U16s
  • asthmatics
  • hypersensitivity to other NSAIDs or taking other NSAIDs
  • elderly
  • G6PD deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why are those with peptic ulcers at risk using aspirin?

A

Ulcers could perforate under the effects of aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why are those with epigastric pain at risk using aspirin?

A
  • could be due to reflux
  • undiagnosed ulcer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why are those with bleeding abnormalities at risk using aspirin?

A

Aspirin has anticoagulant properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why are those taking anticoagulants at risk using aspirin?

A
  • aspirin enhances the effects of warfarin and other anticoagulants
  • displaces warfarin from binding site on plasma and therefore increases free warfarin
  • increases bleeding tendency +++
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why are those who are pregnant at risk using aspirin?

A
  • platelet function is inhibited
  • +++ risk for haemorrhage
  • increased risk of jaundice of baby
  • prolong/delay labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why are those who are breastfeeding at risk using aspirin?

A

Increased risk of Reyes syndrome (brain condition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why are those taking steroids at risk using aspirin?

A

Patients on systemic steroids are at higher risk of developing peptic ulcers, if undiagnosed may perforate if prescribed aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why are those with renal/hepatic impairment at risk using aspirin?

A
  • aspirin is metabolised in liver and excreted in kidneys
  • if renal impairment, excretion may be delayed/reduced
  • not complete contraindication but reduce dose
25
Q

How are nephrotoxicity and aspirin linked?

A
  • prostaglandins are powerful vasodilators involved in control of renal blood flow and excretion of water and salt
  • inhibition of prostaglandins (aspirin action) may result in sodium retention, reduced renal blood flow or renal failure
26
Q

Why are those under 16 at risk using aspirin?

A

At risk for Reye’s Syndrome (50% mortality)

27
Q

What is Reye’s Syndrome?

A
  • fatty degenerative process in liver
  • profound swelling in brain
  • 50% mortality due to encephalopathy
28
Q

Why are those with G6PD deficiency at risk using aspirin?

A
  • glucose 6-phosphate dehydrogenase deficiency
  • prevalent in individuals originating from parts of Africa, Asia, Oceana and Southern Europe
  • susceptible to developing acute haemolytic anaemia
28
Q

What are the complete contraindications for aspirin?

A
  • under 16s and mothers who are breastfeeding
  • previous or active peptic ulceration
  • haemophilia
  • hypersensitivity to aspirin or other NSAIDs
29
Q

What is the standard dose of aspirin given for dental pain?

A

600mg x4 daily, after food

30
Q

What is prescribed alongside aspirin to avoid GI problems?

A
  • prescribed to those who have peptic ulcer (or history of) to prevent GI damage
  • lansoprazole
  • omeprazole
31
Q

What is the standard dose of ibuprofen given for dental pain?

A

400mg x4 daily, after food

32
Q

What is the maximum daily dose of ibuprofen?

A

2.4g

33
Q

How does ibuprofen compare to aspirin?

A
  • similar effect to aspirin
  • less effect on platelets
  • irritant to gastric mucosa but not as severe as aspirin
  • can cause bronchospasm
  • paediatric option available
34
Q

What are the potential side effects of ibuprofen?

A
  • GIT discomfort, occasionally bleeding or ulceration
  • hypersensitivity reaction eg rash, angioedema, bronchospasm
  • headache, drowsiness, depression, photosensitivity, fluid retention etc
35
Q

What are the symptoms of ibuprofen overdose?

A
  • nausea
  • vomiting
  • tinnitus
36
Q

How do you treat ibuprofen overdose?

A

Activated charcoal if more than 400mg/kg ingested within an hour

37
Q

What are the actions of paracetamol?

A
  • analgesic
  • antipyretic
38
Q

Describe paracetamol.

A
  • no anti-inflammatory action (peripheral)
  • no effects on bleeding time
  • does not interact with warfarin
  • less irritant to GI
  • suitable for children
39
Q

What is the mode of action of paracetamol?

A
  • hydroperoxides produced by the metabolism of arachidonic acid provide positive feedback to stimulate COX activity = more prostaglandins
  • feedback is blocked by paracetamol
  • especially effective in the brain and CNS
40
Q

Who should be cautioned when taking paracetamol?

A
  • hepatic impairment
  • renal impairment
  • alcohol dependence
41
Q

What are the side effects of paracetamol?

A
  • rashes
  • blood disorders
  • hypotension (infusion)
  • liver damage (kidney sometimes) following overdose
42
Q

What is the standard dose of paracetamol given for dental pain?

A

1g x4 daily

43
Q

Describe paracetamol overdose.

A
  • as little as 10-15g within 24 hours can cause hepatocellular necrosis
  • liver damages maximal 3-4 days after ingestion, leads to liver failure and death
44
Q

Where do opioid analgesics have their effect?

A
  • spinal cord
  • dorsal horn pathways
  • central regulation of pain
45
Q

What are some problems associated with opioid use?

A
  • dependence
  • tolerance (for drug to be effective dose needs to be progressively increased)
  • constipation
  • urinary and bile retention
46
Q

What effect do opioids have on the CNS?

A
  • depress pain centre (alters awareness)
  • depress higher centre
  • depress respiratory centre
  • depress cough centre
47
Q

What are the common side effects of opioid use?

A
  • nausea
  • vomiting
  • drowsiness
  • respiratory depression
  • hypotension
  • dry mouth
  • bradycardia
  • hallucinations
  • dysphoria
  • mood changes
  • dependence
48
Q

Who should be cautioned when taking opioids?

A
  • hypotension
  • hypothyroidism
  • asthmatics
  • decreased respiratory reserve
  • pregnant or breastfeeding
49
Q

What are complete contraindications for prescribing opioids?

A
  • acute respiratory depression
  • acute alcoholism
  • raised intracranial pressure/head injury
50
Q

What is the standard dose of dihydrocodeine given for dental pain?

A

30mg x4 daily

51
Q

What are the side effects of dihydrocodeine?

A
  • nausea and vomiting
  • constipation
  • drowsiness
52
Q

What are potential drug interactions of dihydrocodeine?

A
  • antidepressants MAOIs
  • dopaminergics (used to treat Parkinson’s)
53
Q

What are the symptoms of opioid overdose?

A
  • coma
  • respiratory depression
  • pinpoint pupils
54
Q

How do you manage opioid overdose?

A

Naloxone

55
Q

What drug can be prescribed to treat trigeminal neuralgia?

A

Carbamazepine

56
Q

What are the features of trigeminal neuralgia?

A
  • severe spasm of pain described as electric shocks
  • unilateral
  • older age group
  • trigger spot common
  • more common in females
57
Q

What is the standard dose of carbamazepine given for trigeminal neuralgia?

A
  • 100-200mg once or twice daily
  • max dose: 200mg x4 daily
  • begin with lower dose and increase if ineffective

BDS3 ORAL SURGERY (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions