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LO 9/10 Flashcards

Analgesics (40 cards)

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1
Q

Describe pain

A
  1. Individuals are very uniform in the perception of pain and variable in reaction to it
  2. The pain threshold is raised by sleep, sympathy, activities and analgesics
  3. The dental health care provider must be able to recognize and evaluate a patient’s need for medication
  4. According to a recent study, older patients are more sensitive to pain.
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2
Q

What are important differences between nonopioid and opioid analgesics?

A
  1. The site of action (PNS Vs CNS)
  2. The mechanism of action - Nonopioid analgesics inhibit prostaglandin synthesis; Opioids affect the response to pain by depressing the CNS
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3
Q

Describe Non-Opioid (non-narcotic) Analgesics

A
  1. Mech of action: inhibit PG synthesis
  2. Site of action: peripheral nervous system
  3. Effective against mild to moderate pain
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4
Q

What are the 3 groups of Non-Opioid (non-narcotic) Analgesics?

A
  1. Salicylates
  2. Non-steroidal anti-inflammatory drugs(NSAIDs)
  3. Acetaminophen
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5
Q

Describe the medical uses for Salicylates (e.g. Aspirin/ASA)

A
  1. Prevention of second degree myocardial infarction
  2. Prevention of stroke (> 55yr)
  3. Rheumatic fever/arthritis
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6
Q

What are the pharmacological effects of Salicylates

A
  1. analgesics - decrease pain
  2. antipyretic - decrease fever
  3. anti-inflammatory - dec swelling
  4. anti-platelets – irreversible for the lifetime of platelets (approx 7 days)
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7
Q

What are the adverse reactions of Salicylates

A
  1. GI irritation - acidic
  2. Increase bleeding - interferes with clotting mechanism by reducing platelet adhesiveness
  3. Reye’s syndrome - brain damage in children with viral infections
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8
Q

What is the Aspirin hypersensitivity triad?

A

Aspirin hypersensitivity, asthma, and nasal polyps often occur together – need to be cautious with patients known to have asthma

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9
Q

What are the contraindications for Salicylates?

A
  1. Crohn’s or peptic ulcers (due to acidity
  2. NSAIDS allergy due to cross allergenicity
  3. Tx of pyrexia in children
  4. Pregnancy and nursing
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10
Q

How should you treat toxicity of Salicylates?

A
  1. Induce emesis (vomiting) and call 911
  2. Activated charcoal (at the hospital)
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11
Q

What drugs do Salicylates interact with?

A
  1. warfarin (fatal)
  2. Many anti-hypertensives
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12
Q

List some examples of Non-steroidal anti-inflammatory drugs(NSAIDs)

A
  1. ibuprofen – Advil, Motrin (short lasting)
  2. naproxen (long lasting) loading dose required
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13
Q

What are the medical uses for Non-steroidal anti-inflammatory drugs(NSAIDs)?

A
  1. Rheumatoid and Osteoarthritis
  2. headaches
  3. menstrual pain
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14
Q

What are the pharmacological effects of NSAIDs?

A
  1. Analgesics - decrease pain
  2. Antipyretic - decrease fever
  3. Anti-inflammatory - decrease swelling
  4. Anti-platelets - (reversible) the effect remains only as long as the drug is present in the blood
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15
Q

What are the adverse reactions, cautions, and contraindications for taking NSAIDs?

A

Adverse Reactions
1. GI irritation -acidic
2. Oral effects: ulcerative stomatitis, gingival ulcerations, dry mouth

Caution
1. Cardiovascular disease - could be taking meds that interact
2. Asthma

Contraindications
1. Crohn’s, ulcerative colitis, peptic ulcers
2. Renal function impairment
3. Aspirin allergy
4. Pregnancy

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16
Q

What is the maximum dose of NSAIDs and what should you do in the case of toxicity?

A
  1. Max dose - 2.4g (=6 tabs, 400mg each)
  2. Toxicity - induce emesis (vomiting) and call 911
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17
Q

What drugs interact with NSAIDs?

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A
  1. Digoxin toxicity
  2. Li toxicity
  3. Anti-hypertensives
  4. NSAIDs will increase methotrexate toxicity (chemo treatment)
  5. Must never use NSAIDs and corticosteroids med, will lead to peptic ulcer (acidity on acidity)
18
Q

What are the medical uses for Acetaminophen (e.g. Tylenol)

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A
  1. Headache
  2. Cold/fever
19
Q

What are the pharmacological effects and adverse reactions of Acetaminophen?

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A

Pharm effects
1. Analgesics
2. Antipyretic

Adverse reactions
1. Hepatic necrosis and toxicity
2. Nephrotoxicity

20
Q

What are the contraindications for taking acetaminophen?

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A
  1. Liver disease
  2. Alcoholism (3 drinks per day)
21
Q

What drugs do Acetaminophen interact with?

22
Q

What is the maximum dose of Acetaminophen and what should you do in case of toxicity?

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A
  1. Max dose - 4g (=8 tabs 500mg each)
  2. Induce emesis (vomiting) and call 911
  3. At hospital, gastric lavage (stomach pump) and Acetylcysteine (antidote)
23
Q

What drugs are best for dental pain?

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A
  1. Dental pain is considered mild to moderate
  2. NSAID plus acetaminophen is sufficient for dental pain (endo, 8s ext). For best results: MUST be pre-op or the latest before LA injection.
24
Q

Describe opioid analgesics

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A
  1. Central action and CNS depression
  2. Effective against moderate to severe pain relief (chronic pain, major surgeries, trauma..etc. NOT DENTAL PAIN)
25
What are the pharmacological effects of opioid analgesics?
1. Analgesics - decreases pain 2. Sedative - increases sleepiness 3. Euphoria 4. Cough Depressant 5. GI effects: anticholinergic - e.g. Imodium: Tx of diarrhea
26
List the routes of administration for opioid analgesics
1. Oral 2. Spray 3. IV injection Important 1. cross placenta - not safe for pregnancy 2. cross BBB Blood Brain Barrier
27
List the adverse reactions of opioid analgesics
1. Respiratory Depression ( dec resp rate) 2. GI nausea/emesis 3. Miosis (pin point pupils) **addict alert** 4. Urinary retention anticholinergic effects 5. CNS dep (occasional stimulation) 6. CVS - decrease heart rate, decrease blood pressure - syncope (fainting) 7. histamine release 8. Pregnancy: increase labour - Fetus: resp dep, withdrawal symptoms 9. Allergic reactions - cross allergenicity w/in each chemical group
28
What drugs do opioid analgesics interact with?
1. EtOH - Alcohol 2. Other CNS depressants
29
What is the treatment for Opioid Analgesic toxicity/OD?
OD Tx: naloxone ( Narcan); antidote
30
How can you ID an opioid addict?
1. "Shopping" for specific drugs 2. Inconsistent story 3. Fake pain - e.g. first it's on the right side, then it's on the left
31
What are the 3 ways to classify opioids?
1. Mechanism of action 2. Chemical Structure 3. Efficacy
32
What are the 3 mechanisms of action of opioids?
1. Agonist - morphine/codeine 2. Antagonist - Naloxone (Narcan) 3. Partial - pentazocine
33
Why is it important to understand the chemical structure of opioids?
1. Cross allergenicity for opioids with similar structures 2. E.g. Morphine and codeine belong to the same chemical structure group
34
List the efficacy levels of opioids with examples
1. Strong - morphine & Fentanyl 2. pentazocine 3. codeine
35
__________ is oxycodone + acetaminophen
Percocet
36
__________ is oxycodone + aspirin
Percodan
37
oxycontin = ___________
oxycodone
38
How much codeine is in each level of Tylenol?
1. T1 - 7.5mg (8mg) 2. T2 - 15mg 3. T3 - 30mg 4. T4 - 60mg
39
What are the treatment plan implications of opioids?
1. Chronic narcotic use accelerates liver enzymes causing faster metabolism - will shorten the effective time of LA 2. Watch for opioids toxicity 3. Must avoid opioids in pts with liver/kidney dysfunction - they won’t be able to metabolize properly 4. Consent?
40
Describe dental treatment of the alcoholic patient
1. Most alcoholic patients have poor oral hygiene 2. Check for sweet musty breath and painless bilateral hypertrophy of parotid glands 3. Liver Cirrhosis 4. Bleeding tendencies with higher INR 5. Oral complications include: glossitis, loss of tongue papillae, angular/labial cheilosis, and Candida infection 6. Higher risk for oral squamous cell carcinoma 7. LA dose reductions may be necessary because of diminished liver function

Pharmacology (15 decks)

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