Final topics- Pain management & Analgesic Medications

Question 1

-Pain with a timeframe of less than 4 weeks

-Warning signal

Answer 1

Acute pain

Question 2

-Pain with a timefraine of less than 4-12 weeks

-an “in between pain”

-untreated can lead to chronic

Answer 2

Subacute pain

Question 3

-Pain with timeframe of more than 12 weeks

-may be constant or may come & 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 invovled 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

Considered disorder of pain regulation or neurological “dysfunction” or dysregulation:

Answer 12

Central pain (other 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

These are all examples of:

Answer 14

neuropathic pain

Question 15

-fibromyalgia
-complex regional pain syndrome

These are examples of:

Answer 15

Central pain (other pain)

Question 16

Give some examplesof common non-pharmacotherapy to treat pain:

Answer 16

1. definitive dental treatment (RCT - to take nerve out of tooth or extraction because your getting rid of cause of pain)
2. thermal modalities
3. mouth guards

4 . OT/PT

5. Acupuncture
6. Cognitive behavioral therapy

Question 17

Analgesics include:

Answer 17

Non-opioids (Acetominophen/NSAIDs)

Question 18

Adjunctive/Co-analgesics (pain modulators) include:

Answer 18

1. anti-convulsants
2. anti-depressants

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 & 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

Nonopioid analgesic classifications inlcude:

Answer 23

1. salicylates
2. acetaminophen
3. NSAIDs

Question 24

Brand name tylenol:

Answer 24

acetaminophen (APAP_

Question 25

May inhibit COX pathway & nitric oxide pathway, mediating neurotransmitters in the CNS- inhibiting prostaglandins in the CNS

Answer 25

Acetaminophen

Question 26

What class of drugs are responsible for INHIBITING PROSTAGLANDINS 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 acetopminophen include:

Answer 28

Hepatotoxicity

Question 29

Dosing for acetaminophen:

Answer 29

OTC: Less than 3g/day for adults

Question 30

T/F: it is okay to ingest up to 4g/day of acetaminophen under the direction of a healthcare provider:

Answer 30

True

Question 31

Acetaminophen dose for children & older adults:

Answer 31

2-3g/day dependent on weight

Question 32

Acetaminophen (APAP) should be avoided in patients with:

Answer 32

1. hepatic disease 2. alcoholics (due to increased risk of hepatotoxicity)

Question 33

APAP:

Answer 33

Acetaminophen

Question 34

APAP should be taken with caution for patients also taking:

Answer 34

1. drugs that cause liver toxicity (Leflunomide, Methotrexate, Carbamazepine) 2. Warfarin (but still safe)

Question 35

T/F: For an individual taking warfarin, APAP is safer than NSAIDs

Answer 35

True

Question 36

NSAIDs include:

Answer 36

1. traditional/non-selective/non-aspirin NSAIDS 2. Cox-selective NSAIDs

Question 37

Describe how NSAIDs work in dental pain: 1. tissue injury activates ______ 2. COX2 converts ____ to ____ resulting in pain & inflammation & edema 3. ____ sensitizes and lowers threshold to stimulate nociceptors which initiates transmission of pain to CNS 4. NSAIDs block ____

Answer 37

1. COX2 2. arachidonic acid; PGE2 3. PGE2 4. COX2

Question 38

NSAIDs block:

Answer 38

COX1 & COX2

Question 39

NSAIDs side effects are due to it blocking:

Answer 39

COX1

Question 40

COX1 is involved with:

Answer 40

1. gastric mucosa 2. kidney function 3. platelets

Question 41

COX2 is invovled with:

Answer 41

1. pain 2. inflammation 3. fevere

Question 42

Non-selective NSAIDs and ASA have the following effects

Answer 42

1. anti-inflammatory 2. analgesic 3. anti-pyretic 4. anti-plateley

Question 43

1. Non-selective 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

Non-selective & 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. anti-pyretic

Question 46

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

Answer 46

Selective NSAIDs (COX2 inhibitors)

Question 47

List if the following are selective or non-selective NSAIDs: 1. Celecoxib/Celebrex 2. Ibuprofen/Motrin 3. Meloxicam/Mobic 4. Nabumetone/Relafen 5. Naproxen/Aleve

Answer 47

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

Question 48

Dental pain often includes a ____ component

Answer 48

inflammatory

Question 49

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

Answer 49

Nonselective NSAIDs and COX-2 inhibitors

Question 50

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

Answer 50

Nonselective NSAIDs and COX-2 inhibitors

Question 51

Often used in combination with acetaminophen for dental pain:

Answer 51

Nonselective 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 include:

Answer 53

1. Kidney injury/acute renal failure 2. GI issues 3. Anti-platelet effects 4. Increased risk of CV effects 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 (or direct oral anticoagulants) 2. Blood pressure medications

Question 56

List key drug interactions for NSAIDs:

Answer 56

1. high dose methotrexate 2. lithium

Question 57

Diverse group of drugts 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 commonyl used in chronic ____ pain

Answer 59

neuropathic

Question 60

Common adjuvants/co-analgestics include:

Answer 60

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

Question 61

-amitryptyline -nortriptyline -desimpramine

Answer 61

Tricyclic antidepressants (TCAs)

Question 62

-desvenlafaxine -duloxetine -levomilnacripran -milnacipran -venlafaxine

Answer 62

SNRI

Question 63

-pristiq -cymbalta -fetzima -savella -effexor

Answer 63

SNRI

Question 64

-carbamazepine -gabepentin -iamotrogine -pregabalin -tpiramate -valproic acid

Answer 64

anticonvulsants

Question 65

-tegretol -neurontin -lamictal -lyrica -topamax -depakote/depakene

Answer 65

anticonvulsants