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BDS3 Oral Surgery > Analgesia > Flashcards

Analgesia Flashcards

(76 cards)

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1
Q

what controls pain during dental procedures

A

local anaesthetic

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2
Q

what controls post operative pain

A

systemic analgesic drugs

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3
Q

name some artificial saliva substitutes

A

BioXtra
Saliveze

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4
Q

what are the analgesics in the dental practitioners formulary

A

aspirin
ibuprofen
diclofenac
paracetamol
dihydrocodeine
carbamazepine

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5
Q

what is the pain pathway called

A

arachidonic acid pathway

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6
Q

when is arachidonic acid produced

A

when there is injury to phospholipid cell membrane

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7
Q

what are the two outcomes that can be produced from arachidonic acid

A

prostaglandins or leukotrienes

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8
Q

what occurs when prostaglandins are produced from the arachidonic acid pathway

A

causes pain and inflammation

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9
Q

what occurs when leukotrienes are produced from the arachidonic acid pathway

A

causes bronchoconstriction, asthma attacks and smooth muscle contractions

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10
Q

what sensitises the tissues to other inflammatory products which can cause pain

A

prostaglandins

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11
Q

what is the function of prostaglandins

A

to sensitise the tissues to other inflammatory products such as leukotrienes which causes pain

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12
Q

what type of drug is aspirin

A

NSAID

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13
Q

what are the four properties of aspirin

A

analgesic
antipyretic
anti-inflammatory
metabolic

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14
Q

what is the chemical name for aspirin

A

acetylsalicylic acid

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15
Q

how does aspirin work

A

it inhibits the cyclo-oxygenases and therefore reduces production of prostaglandins

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16
Q

what COX is aspirin more effective at inhibiting

A

COX 1

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17
Q

what occurs when COX 1 is inhibited

A

reduces platelet aggregation and predisposes to damage of the gastric mucosa

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18
Q

where does action of aspirin occur

A

peripherally and centrally

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19
Q

do peripheral or central actions predominate for aspirin

A

peripheral

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20
Q

what are the analgesic properties of aspirin

A

it inhibits the prostaglandin synthesis in inflamed tissue by COX inhibition

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21
Q

what are the antipyretic properties of aspirin

A

prevents temperature raising effects of interleukin-1 and rise in brain prostaglandin level and so reduces elevated temperature

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22
Q

what are the anti-inflammatory properties of aspirin

A

prostaglandins are vasodilators and affect capillary permeability - apirin inhibits this

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23
Q

what are adverse effects of aspirin

A

GIT problems
hypersensitivity
overdose
aspirin burns

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24
Q

how does aspirin cause GIT problems

A

prostaglandins inhibit gastric acid secretion and also increase blood flow to gastric mucosa to help production of mucin by cells in stomach lining

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25
what are hypersensitivity effects of aspirin
acute bronchospasm, asthma type attacks skin rashes/ urticaria/ angioedema
26
what are effects of an overdose of aspirin
hyperventilation tinnitus, deafness vasodilation and sweating
27
what are aspirin related mucosal burns
direct effect of salicylic acid - when applied to the mucosa
28
who do you have to take caution with when prescribing aspirin
peptic ulceration bleeding abnormalities anitcoagulants asthma
29
why should people with peptic ulcerations avoid taking aspirin
gastric or duodenal ulcer could result in perforation
30
why should patients taking anti-coagulant be cautious with taking aspirin
aspirin enhances warfarin and other coumarin anticoagulants and displaces warfarin from binding sites on plasma protein which increases free warfarin - increases bleeding
31
why should aspirin be avoided in pregnant women
causes impairment of platelet function which is increased risk of haemorrhage, increased jaundice in the baby and can prolong/ delay labour
32
why should patients on steroids not be taking aspirin
patients on long term steroids will develop peptic ulcers - which could result in perforation
33
why should patients with renal/ hepatic impairment avoid aspirin
aspirin is metabolised in the liver and excreted in the kidney
34
what might inhibition of prostaglandin synthesis result in
sodium retention reduced renal blood flow renal failure
35
what are two effects related to the kidney that NSAIDs might have
interstitial nephritis and hyperkalaemia
36
what can occur if a breastfeeding mother takes aspirin
Reye's syndrome
37
what is Reye's syndrome
fatty degenerative process in the liver and profound swelling in the brain
38
in what groups of people is aspirin completely contra-indicated
children under 16 previous or active peptic ulceration haemophilia hypersensitivity to aspirin or NSAIDs
39
what is the prescription of aspirin for odontogenic pain
2 x tablets, 4 x daily 300mg
40
what should be prescribed to patients with peptic ulcers with odontogenic pain
lansoprazole - proton pump inhibitor
41
what is the prescription for ibuprofen for odontogenic pain
1 tablet 4x daily 400mg
42
what is the max dose of ibuprofen for an adult
2.4g
43
what are the main side effects of ibuprofen
GIT discomfort, bleeding and ulceration hypersensitivity reactions
44
what are symptoms of ibuprofen overdose
nausea vomiting tinnitus
45
how is ibuprofen overdose treated
activated charcoal followed by symptomatic measures
46
what is paracetamol
a simple analgesic without any anti-inflammatory activity
47
does paracetamol interact significantly with warfarin
no
48
how does paracetamol work
blocks the feedback of hydroperoxides which stimulate COX activity - especially in the brain
49
what is the three modes of action of paracetamol
analgesia antipyretic action no reduction in peripheral inflammation
50
what is the main site of action of paracetamol
thalamus
51
what are three contraindications of paracetamol
hepatic impairment renal impairment alcohol dependence
52
what is the prescription for paracetamol for odontogenic pain
2 tablets 4xdaily 500mg
53
what is the max dose for paracetamol
4g daily
54
what are examples of opioid analgesics
codeine dihydrocodeine fentanyl
55
where do opioid analgesics take their effect
they act in the spinal cord in the dorsal horn pathways
56
do opioid analgesics cause peripheral or central regulation of pain
central
57
how do opioid analgesics work
specific receptors that are closely associated with neuronal pathways that transmit pain to the CNS
58
what are problems with opioids
dependence tolerance constipation urinary and bile retention
59
what effects do opioids have on the CNS
pain centre higher centres respiratory centre cough centre
60
what is a dental related side effect of opioids
dry mouth
61
what are contra-indications of opioids
hypotension hypothyroidism asthma decreased respiratory reserve pregnant
62
what is codeine
natural alkaloid found in opium poppy
63
what is the only codeine combination on the dental list
dihydrocodeine
64
what are routes of entry for dihydrocodeine
subcutaneous intra muscular oral
65
what are side effects of dihydrocodeine
nausea constipation drowsiness
66
what are the main interactions with dihydrocodeine
antidepressants dopaminergics
67
when should you never prescribe dihydrocodeine
in raised intra-cranial pressure or suspected head injury
68
is dihydrocodeine effective for dental pain or post-operative dental pain
no
69
what occurs in an opioid overdose
varying degrees of coma and respiratory depression and pinpoint pupils
70
what is the specific antidote for opioid overdose
naloxone
71
what is neuropathic pain in dentistry
trigeminal neuralgia post-herpetic neuralgia
72
what is functional pain in dentistry
TMJ or atypical facial pain
73
what is the only neuropathic drug for dental pain we use
carbamazepine which is used to control trigeminal neuralgia
74
what drugs can be used to treat trigeminal neuralgia
gabapentin phenytoin both not on dental list
75
what are features of trigeminal neuralgia
severe spasms of pain unilateral periods of remission
76
what is the prescription of carbamazepine for trigeminal neuralgia
starting dose 100mg 2xdaily usual dose 200mg 3-4 times daily

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