Dental Pain

Question 1

What are the two main types of pain?

Answer 1

1-Musculoskeletal (somatic, inflammation)

2-Visceral

Question 2

Which 3 groups of neurotransmitters have a direct pain modulation on the brain?

Answer 2

1-Opioid narcotics
2-Glu, GABA
3-Antidepressants (5HT/NE)

Question 3

What two Neurotransmitters have descending modulation effects in the spinothalamic tract?

Answer 3

• Serotonin drugs

- Neuropeptides

Question 4

Which three groups of drugs have an effect on pain in the dorsal horn?

Answer 4

1-Local anesthetic
2-Opioids
3-NSAIDs

Question 5

Which two drugs affect peripheral nerves to modulate pain?

Answer 5

1-Local anesthetic

2-Opioids

Question 6

Which 4 drug groups modulate pain by acting on peripheral nociceptors?

Answer 6

1-Local anesthetic
2-NSAIDs (COX 1/2 inhib)
3-Acetaminophen
4-Capsaicin

Question 7

Arachidonic acid is converted by COX1 into PGE2 and Thromboxane A2 and has side effects in what 4 areas?

Answer 7

1-Gastric mucosal barrier
2-Renal function
3-Platelet Aggregation
4-Vasoconstriction

Question 8

Arachidonic acid is converted by COX2 into Prostaglandins and Prostacyclin and has side effects in what 3 areas?

Answer 8

1-Pain, inflammation, fever
2-Renal function
3-Vasodilation

*COX-1 can contribute to this as well

Question 9

What two drugs are Non-selective COX-1 and COX-2 inhibitors?

Answer 9

1-Salicylates (aspirin)
2-Ibuprofen-like

*Others as well

Question 10

Which drug is a Selective Cox 2 inhibitor?

Answer 10

Celebrex (Celecoxib)

Question 11

Which drug is NOT and NSAID but in a non-opioid analgesic?

Answer 11

Acetaminophen

*does not help with inflammation

Question 12

Salicylates are Cox-1 and Cox-2 inhibitors that are often combined with caffeine, acetaminophen or opioids for mild-moderate somatic pain. What are 3 dose dependent effects of these drugs?

Answer 12

1-Analgesia (600 mg)
2-Antiinflammation (1 gm)
3-Antipyretic (300-600 mg)

*4 hour duration

Question 13

What are the 4 side effects of salicylates?

Answer 13

1-G.I. Irritation and erosion
2-Reyes syndrome in children (Cold/flu)
3-Anti-clotting (lasts 1-2 weeks)
4-RInging in ears (tinnitis, at higher doses)

Question 14

Ibuprofen is a cox-1 and cox-2 inhibitor that is often a little better for mild-moderate pain and has what 3 effects?

Answer 14

1-Analgesia (400 mg)
2-Anti-inflammation (800 mg)
3-Antipyretic (400 mg)

*4 hour duration

Question 15

What are 3 side effects of ibuprofen?

Answer 15

1-GI ulcers (less than aspirin)
2-Anti-clotting (less than aspirin)
3-Cardiovascular effects

Question 16

Which Ibuprofen-like drug is more potent and has lower doses (50 mg/Capsule)?

Answer 16

Ketoprofen (Orudis)

Question 17

Which Ibuprofen-like drug is longer-lasting and slower acting?

Answer 17

Naproxen (Naprosyn)

*Aleve is also one of the longer lasting ones

Question 18

Which drug has the same analgesic potency as ibuprofen, lacks GI and anti-clotting action, has been linked with CV side effects and is a Cox-2 selective antagonist?

Answer 18

Celecoxib (Celebrex)

*Rx only

Question 19

Which drug is a potent non-selective NSAID used for arthritis but is not a common analgesic due to its side effects?

Answer 19

Indomethacin

*good for inflammation

Question 20

Which alternate drug preferentially inhibits Cox-2 over Cox-1 resulting in less GI problems?

Answer 20

Meloxicam

Question 21

Which drug is related to salicylates and is good for bone pain?

Answer 21

Diflunisal (Dolobid)

*Oral surgeons use frequently

Question 22

Which drug is not a Cox 1 or 2 inhibitor, is not an anti-inflammatory and has a mysterious mechanism (COX 3/Serotonin?)?

Answer 22

Acetaminophen

Question 23

Though acetaminophen does not achieve the same analgesia or anti-inflammation that aspirin can, what are 5 advantages to it?

Answer 23

1-Good antipyretic
2-Stable in solution (for kids)
3-No GI problem
4-No effect on clotting
5-No Reye's syndrome

Question 24

What is the main serious side effect of acetaminophen?

Answer 24

Liver toxin in high doses

*Do not use in those with compromised livers

Question 25

What are 6 situations in which you should be cautious or not use NSAIDs?

Answer 25

``` 1-Patients on anticoagulants 2-Hemophiliac 3-Ulcers 4-Already taking high doses (arthritis and other inflammatory disease) 5-Child (aspirin danger) 6-History of allergies ```

Question 26

What group of drugs is used for mild to severe somatic and visceral pain and is antitussive as well as antidiarrheal?

Answer 26

Opioid Narcotics

Question 27

What is the most potent narcotic group?

Answer 27

Fentanyl

Question 28

What are the two main narcotic types?

Answer 28

1-Morphine (more potent group) | 2-Codeine (less potent group)

Question 29

What are 4 common codeine type narcotics?

Answer 29

1-Lortab (30 mg) 2-Vicodin (30 mg) 3-Oxycontin (20 mg) 4-Percodan (20 mg)

Question 30

What are two common Morphine type narcotics?

Answer 30

1-Dilaudid (1.5 mg) | 2-Numorphan (1 mg)

Question 31

Which other narcotic drug is used for moderate to strong pain?

Answer 31

Meperidine (Demerol)

Question 32

Which 3 other narcotic drug are used to discourage abuse?

Answer 32

1-Pentazocine/Talwin (agonist/antagonist) 2-Methadone (long acting, minimizes withdrawl) 3-Buprenorphine/Suboxone (agonist/antagonist)

Question 33

Acting on mu receptors, what are the 4 main side effects of opioids?

Answer 33

1-Respiratory depression (decreased pulmonary reflex) 2-Constipation 3-Sedation/synergistic with other CNS depressants 4-Euphoria/dependence/addiction

Question 34

What is the main treatment for opioid overdose?

Answer 34

-Inject/mist of the mu antagonist naloxone (narcan)

Question 35

What are the 3 first line treatments for managing neuropathic/chronic pain?

Answer 35

1-Gabapentin (antiseizure-lyrica) 2-Duloxetine (antidepressant) 3-Nortriptyline (antidepressant)

Question 36

Which schedule 4 drug is a next-line treatment for neuropathic/chronic pain management?

Answer 36

Tramadol (ultram)