Final Exam- Pain management & analgesics

Question 1

• Pain with a timeframe of less than 4 weeks
• warning signal

Answer 1

Acute pain

Question 2

• Pain with a timeframe 4-12 weeks
• an “in between” pain
• Untreated, can lead to chronic

Answer 2

subacute pain

Question 3

• Timeframe: more than 12 weeks - 3 months
• May be constant or come and go
• repeated stimulation of pain nerves may change the structure of nerve fibers and cells (remodeling), making them more active or sensitive

Answer 3

Chronic pain (persistant)

Question 4

Pain caused by damage to body tissue (stimulates pain receptors)

Answer 4

Nociceptive pain

Question 5

What types of pain are considered “nociceptive pain”

Answer 5

1. somatic
2. visceral

Question 6

Pain of the skin, muscles, joints, bones or teeth

Answer 6

Somatic pain (nociceptive)

Question 7

Dental pain is considered:

Answer 7

Somatic pain (nociceptive)

Question 8

Pain of the internal organs

Answer 8

Visceral pain (nociceptive)

Question 9

Fibers involved with dental pain:

Answer 9

A-fibers & C-fibers

Question 10

Pain caused by damage or disease directly affecting the nervous system that may be described as shooting, burning, tingling or numbness:

Answer 10

Neuropathic pain

Question 11

Pain that is often evoked by a non-painful stimuli such as touch:

Answer 11

Allodynia (seen in neuropathic pain)

Question 12

Considerd disorder of pain regulation or neurological “dysfunction” or dysregulation

Answer 12

Central pain

Question 13

Pain that arises with no evidence of structural abnormalities, lab abnormalities, or disease process:

Answer 13

Central pain

Question 14

Diabetic neuropathy, shingles, multiple sclerosis are all examples of:

Answer 14

Neuropathic pain

Question 15

Fibromyalgia and complex regional pain syndrome are examples of:

Answer 15

Central pain (Other pain)

Question 16

Give some examples of common non-pharmacotherapy to treat pain:

Answer 16

1. definitive dental treatment (extraction/RCT bc you’re getting rid of the pain cause)
2. Thermal modalities (ice/heat)
3. Mouth guards
4. OT/PT
5. Acupuncture
6. Cognitive behavioral therapy

Question 17

Analgesics include:

Answer 17

Non-opioids
(acetaminophen/NSAIDs)

Question 18

Adjunvtives/ Co-analgesics (pain modulators) include:

Answer 18

1. Anticonvulsants
2. Antidepressants

Question 19

opioids/opioid-like agents include:

Answer 19

1. morphine
2. hydrocodone
3. oxycodone
4. tramadol

Question 20

Realistic pain goal:

Answer 20

Reduce pain and improve function

30-50% reduction

Question 21

T/F: You may not be able to eliminate acute pain until the underlying cause is treated/healed

Answer 21

True

Question 22

What is our drug of choice for treating pain?

Answer 22

Non-opioids

Question 23

Non-opioid analgesic classifications include:

Answer 23

1. Salicylates
2. Acetaminophen (APAP)
3. NDSAIDs

Question 24

Brand name Tylenol:

Answer 24

Acetaminophen (APAP)

Question 25

May inhibit COX pathway and nitric oxide pathway, editing neurotransmitters in the CNS- INHIBITING PROSTAGLANDINS IN THE CNS:

Answer 25

Acetominophen

Question 26

What class of drugs are responsible for INHIBITING PROSTGLANDINS IN THE CNS?

Answer 26

Acetaminophen (Tylenol)

Question 27

Drug that possesses NO significant systemic anti-inflammatory activity along with NO anti platelet activity (No increased bleeding risk)

Answer 27

Acetaminophen (Tylenol)

Question 28

Adverse effects of acetaminophen include:

Answer 28

Hepatotoxicity

Question 29

Dosing for acetaminophen:

Answer 29

Less than 3g/day for adults

Question 30

T/F: Its okay to ingest up to 4gm/day of acetaminophen under direction from healthcare provider

Answer 30

true

Question 31

Acetominophen dose for children and older adults

Answer 31

2-3gm/day dependent on weight

Question 32

Acetominophen (APAP) should be avoided in patients with:

Answer 32

1. Hepatic disease 2. Alcoholics (due to increased risk for hepatotoxicity)

Question 33

APAP:

Answer 33

Acetominophen

Question 34

APAP should taken with caution for people also taking:

Answer 34

1. Drugs that cause liver toxicity (leflunomide, methotrexate, carbamazeimpe) 2. Warfarin (but still safe)

Question 35

T/F: for an individual on warfarin, APAP is safer than NSAIDs

Answer 35

True

Question 36

NSAIDs include:

Answer 36

1. Tradition/Non-selective/non-aspirin NSAIDs 2. Cox-selective NSAIDs

Question 37

Describe how NSAIDs work in dental: 1. Tissue injury activates: 2. COX 2 converts ___ to __ resulting in pain & inflammation & edema 3. ____ sensitizes and lowers threshold to stimulate nociceptors which initiation transmission of pain to CNS 4. NSAIDs block:

Answer 37

1. COX 2 2. arachidonic acid to PGE2 3.PGE2 4. COX2

Question 38

NSAIDs block:

Answer 38

COX 2 & COX 1

Question 39

NSAIDs side effects are due to it blocking:

Answer 39

COX 1

Question 40

COX 1 involved with:

Answer 40

1. Gastric mucosa 2. Kidney function 3. Platelets

Question 41

COX 2 involved with:

Answer 41

1. Pain 2. Inflammation 3. Fever

Question 42

Non-selective NSAIDs and ASA have the following effects:

Answer 42

1. anti-inflammatory 2. Analgesic 3. Antipyretic 4. Antiplatelet

Question 43

1. Nonselective inhibition of COX-1 and COX-2 2. Inhibition of biosynthesis of prostaglandins 3. Reduced number of pain impulses received by CNS 4. Decrease in fever

Answer 43

NON-selective NSAIDs and ASA

Question 44

Selective &NON-selective NSAIDs and ASA act ____ for pain

Answer 44

peripherally

Question 45

Selective NSAIDs have the following effects:

Answer 45

1. Anti-inflammatory 2. Analgesic 3. Antipyretic

Question 46

1. Selectively inhibits COX-2 isoenzyme at the site of inflammation 2. Inhibits prostaglandin synthesis 3. Decrease the number of pain impulses received by the CNS 4. Decrease in fever 5. Acts peripherally for pain

Answer 46

Selective NSAIDs

Question 47

List if the following are Selective or Non-selective NSAIDs: 1. Celcoxib/Celebrex: 2. Ibuprofen/Motfin 3. Meloxicam/Mobic 4. Nabumeton/Relafen 5. Naproxen/Aleve

Answer 47

1. SELECTIVE 2. NS 3. NS 4.NS 5. NS

Question 48

Dental pain often includes an:

Answer 48

inflammatory component

Question 49

- Often considered the first line in dental pain for moderate pain

Answer 49

Non-selective NSAIDs and Cox-2 inhibitors

Question 50

- Preop use 24 hours before the appointment decreases post-op edema and hastens healing time:

Answer 50

Non-selective NSAIDs and Cox-2 inhibitors

Question 51

Often used in combination with acetaminophen for dental pain:

Answer 51

Non-selective NSAIDs and Cox-2 inhibitors

Question 52

Non-aspirin NSAID blackbox warnings include:

Answer 52

1. GI risk 2. CV risk 3. CABG surgery

Question 53

Key NSAID adverse effects:

Answer 53

1. kidney injury/acute renal failure 2. GI issues 3. Anti-platelet effects 4. Increased risk of CV events 5. Fluid retention/edema- worsens HTN & HF

Question 54

What medication should be given for a pregnant lady in her 3rd trimester?

Answer 54

Acetaminophen (NSAIDS contraindicated)

Question 55

List Key drug interactions for ASA/NSAIDS:

Answer 55

1. Warfarin (ora direct oral anticoagulants) 2. Blood pressure meds

Question 56

List key drug interactions for NSAIDs:

Answer 56

1. High dose methotrexate 2. Lithium

Question 57

Diverse group of drugs with individual characteristics that are useful in the management of pain but aren't typically considered analgesics

Answer 57

Adjuvants/Co-analgesics

Question 58

Give some examples of adjuvants/co-analgesics:

Answer 58

1. Anticonvulsants 2. Antidepressants 3. Local anesthetics 4. Corticosteroids

Question 59

Most anticonvulsants and antidepressants are commonly used in chronic, _____ pain

Answer 59

Neuropathics

Question 60

Common adjuvants/co-analgesics:

Answer 60

1. Tricyclic antidepressants (TCAs) 2. SNRIs 3. Anticonvulsants 4. Local anesthetics 5. Corticosteroids

Question 61

- Amitriptyline - Nortriptykine - Desimpramine

Answer 61

Tricyclic antidepressants (TCAs)

Question 62

- Desvenlafaxine - Duloxetine - Levomilnacipran - Milnacipran - Venlafaxine

Answer 62

SNRI

Question 63

- Prisiq - Cymbalta - Fetzia -Savella - Effexor

Answer 63

SNRI

Question 64

- Carbamazepine - Gabapentin - Iamotrogine - Pregabalin - Topiramate - Valproic acid

Answer 64

Anti-convulsants

Question 65

- Tegretol -Neurontin - Lamictal - Lyrica - Topamax - Depakote/ Depakene

Answer 65

Anticonvulstants