What is the most widely used route of administration for morphine?
What is the structure of morphine and why is it important?
Piperidine ring structure - 6 sided
Needed to bind to opiate mu receptor
What is the most widely abused drug by hospital personnel?
No miosis - unlike morphine
How is meperidine (Demerol) used in dentistry?
IV sedation (conscious sedation)
Orally for moderate to severe pain
What is one of the most frequently prescribed opioids in dentistry, and how is it used?
codeine - used in combination products with acetaminophen or aspirin because of the many GI side effects
What is the optimum dose of codeine?
60 mg - if exceed 60 mg, no greater analgesic effect but more side effects
How does codeine compare to morphine?
1/6th its potency
10mg morphine = 60 mg of codeine
Oral morphine is poorly absorbed, so instead we use?
codeine given orally
In dentistry we use codeine in combination preparations with?
What is codeine indicated for?
Moderate to moderately severe pain
Not good for severe pain (use oxycodone)
What is the drug of choice for cough suppression?
How does the codeine dosing work?
codeine containing preparations are identified by numbers that reflect the mg concentration:
- #1 - 8 mg (not sold in US)
- #2 - 15 mg
- #3 - 30 mg
- #4 - 60 mg
What is the most widely prescribed codeine product by dentists?
codeine (30mg)/ acetaminophen (300mg)
What opioid is 3 times more powerful than codeine?
Hydrocodone is prepared with acetaminophen, what are examples of these drugs?
What drug uses acetaminophen in alignment with new FDA recommendations to reduce risk for acute liver damage and combines it with 10 mg hydrocodone?
Norco - stronger opiate dose, baseline acetaminophen dose
Is hydrocodone prepared with ibuprofen?
- Vicoprofen, Ibudone, Reprexain
- Constant ibuprofen dose - 200mg
What opioid has the same efficacy/potency as codeine?
dihydrocodiene (Synalgos DC)
no more effective than Tylenol #3
Which drug is highly addictive, as potent as morphine and used in dentistry in combo products for severe pain?
oxycodone (schedule II)
What are the drug examples of oxycodone?
- Percocet - 5/325 (acetaminophen)
- Tylox - 5/325 (same as Percocet, diff name)
Which drug should you be cautious about patients asking specifically for by name?
Roxicet - extended release tablet, with concentrated core that people would get high on
What is oxycodone 5mg with ibuprofen 400 mg called?
Combunox - a short term management of acute, moderate-to-severe dental pain
What drug is 100 times more potent than morphine? And what is it used for?
fentanyl - in dentistry used for conscious sedation only (IV, transdermal, lollipop)
What is the most potent opiate used in dentistry?
fentanyl - conscious sedation
What is the opiate that is not scheduled by the DEA?
What does tramadol do?
- binds to mu opiate receptors in CNS, which inhibit ascending pathways
- Inhibits the reuptake of norepinephrine and serotonin
- Also associated with seizures
- Only use for up to 5 days
What is a brand name for tramadol?
What is Ultracet?
acetaminophen and tramadol
What NSAID provides analgesia at the opioid level?
- Most patients are better managed with ____?
- Start with _______ preparations?
- Only prescribe stronger opioids for ______ periods of time, then switch.
- Prescribe _______ quantities without ______.
- Prescribe only if the patients has _______.
- If pain persists, ________?
- If patient demands more drugs?
- Chronic pain is managed ________?