Opioid lecture part 3

Question 1

What is one of the most frequently prescribed opioids in dentistry the is not used as sole agent, aka it is used in combination products with acetaminophen or aspirin

Answer 1

codeine

Question 2

codeine has what percentage the potency of morphine?

Answer 2

one-sixth

10 mg morphine = 60 mg codeine

Question 3

What is the optimum dose of codeine?

Answer 3

60 mg is optimum dose

- If exceed 60 mg, no greater analgesic effect, but more side effects

Question 4

Which is better orally, codeine or morphine

Answer 4

Oral morphine is poorly absorbed, so we use codeine, given orally, instead

Question 5

In dentistry, codeine is used in combination preparations with?

Answer 5

1. aspirin

2. acetaminophen

Question 6

T or F, codeine is not good for severe pain

Answer 6

True (use oxycodone)

Question 7

What is the drug of choice for cough suppression?

Answer 7

codeine

Question 8

Adverse reactions to codeine

Answer 8

• Nausea
• Dizziness
• Excitability
• Constipation
• Allergy = skin rash, asthmatic-type reaction

Question 9

codeine dosing

Answer 9

15-60 mg every 4-6 hours when pain is present

Question 10

Codeine containing preparations are identified by numbers that reflect the mg concentration. give examples

Answer 10

#1 = 8 mg (OTC in Canada, not in US)
#2 = 15 mg
#3 = 30 mg
#4 = 60 mg

Question 11

Popular codeine preparations:

Answer 11

1. Tylenol with codeine (#1,2,3,4) –> C-III/C-IV
   
   • acetaminophen 300 mg
   • Most widely prescribed codeine product by dentists is Tylenol #3
2. Fiorinal w codeine (#1,2,3)
   - relief of complex tension (muscle contraction) headache - C-III

Question 12

What is the most widely prescribed codeine product by dentists

Answer 12

Tylenol #3

Question 13

T or F, Hydrocodone is 2 times less potent than codeine

Answer 13

False, 3 times more potent than codeine

Question 14

Drug examples of hydrocodone with acetaminophen

Answer 14

1. Vicodin (5/500 mg or 7.5/500 mg)

2. Lorcet/Lortab (5/500 mg; 7.5/500 mg)

Question 15

Describe the dosing for Norco and why it might be good

Answer 15

10 mg hydrocodone with 325 mg acetaminophen

- uses lower dose of acetaminophen in alignment with new FDA recommendations to reduce risk for acute liver damage

Question 16

dihydrocodeine’s efficacy/potency is what compared to codeine?

Answer 16

The same

Question 17

T or F, dihydrocodeine is no more effective than Tylenol #3

Answer 17

True

Question 18

Drug example for dihydrocodeine

Answer 18

Synalgos DC

• dihydrocodeine = 16 mg
• aspirin 356.4 mg (avoid if aspirin allergy)
• caffeine 30 mg

Question 19

T or F, oxycodone is less potent than morphine

Answer 19

False, it is AS potent as morphine

• More potent than codeine
• Highly addictive

Question 20

Oxycodone is what schedule of drugs

Answer 20

Schedule II - used in dentistry in combo products for severe pain

Question 21

Drug examples for oxycodone

Answer 21

1. Percocet (oxycodone 5 mg; acetaminophen 325 mg)
2. Tylox (oxycodone 5 mg; acetaminophen 325 mg)
3. Percodan (oxycodone 5 mg; aspirin 325 mg)
4. Roxicet (oxycodone 5 mg; aspirin 325 mg) *Drug seekers ask by name

Question 22

Combunox includes how much of oxycodone and ibuprofen

Answer 22

oxycodone 5 mg with ibuprofen 400 mg

Question 23

Combunox could be used for what?

Answer 23

Short term management of acute, moderate-to-severe dental pain
- Used for 3-5 days only

Question 24

fentanyl is how potent in comparison to morphine

Answer 24

100 times more potent than morphine

- 500 times more potent than meperidine

Question 25

How is fentanyl used in dentistry

Answer 25

for conscious sedation only | - IV, transdermal, lollipop

Question 26

How long is tramadol used for?

Answer 26

Use for less than or equal to 5 days for acute dental pain

Question 27

tramadol binds to what receptors?

Answer 27

mu opiate receptors in CNS, which inhibits ascending pain pathways, altering perception of and response to pain.

Question 28

tramadol inhibits the repute of what?

Answer 28

norepinephrine and serotonin | - also modulates ascending pathway

Question 29

dosing of tramadol

Answer 29

immediate release given 50-100 mg every 4 to 6 hours, not to exceed 400 mg/day = titrate up

Question 30

T or F, tramadol is not associated with seizures

Answer 30

False, is

Question 31

tramadol can be used with what other non-opioid in a combo product

Answer 31

acetaminophen - acetaminophen 325 mg and tramadol 37.5 mg - use for less than or equal to 5 days for post-op dental pain

Question 32

dosing of Ultracet

Answer 32

2 tablets every 4-6 hours (maximum 8 tablets per day) | - acetaminophen dictates totally maximum daily dose

Question 33

Describe ketorolac (Toradol) as its classification and use

Answer 33

NSAID Provides analgesia at the opioid level Indicated for moderate to severe dental pain Short term use < 5 days

Question 34

Limite opioid use to what? for what reasons?

Answer 34

limit use to 3-5 days (acute pain only) | - Write for limited quantities due to the potential for addiction

Question 35

Which opiate agent is the most widely used for the management of dental pain

Answer 35

hydrocodone with acetaminophen (Vicodin or Lorcet)

Question 36

Of the codeine preparations, which is the most widely prescribed in dentistry

Answer 36

Tylenol #3

Question 37

T or F, oxycodone with acetaminophen is used to treat the more severe degrees of pain

Answer 37

True

Question 38

meperidine (Demerol) is useful for patients with a history of what?

Answer 38

codeine allergy

Question 39

T or F, morphine and hydromorphone are indicated as analgesics in any dental situation

Answer 39

False, NOT indicated

Question 40

T or F, whenever possible, an opiate agent is preferred to an NSAID for pain management because of its potency

Answer 40

False, Whenever possible, an NSAID is preferred to a opiate agent for pain management - Opiates do not reduce inflammation, which is the most common etiology for dental pain

Question 41

T or F, ALL opiates will cause nausea in most patients

Answer 41

True

Question 42

T or F, Constipation is usually not a common complaint with patients on opiate drugs

Answer 42

False, Constipation is another common complaint for patients on opiate drugs

Question 43

Ranking opiates by potency

Answer 43

1. fentanyl - 100 times more potent than morphine 2. Morphine = oxycodone 3. meperidine 4. hydrocodone = 3x more potent than codeine 5. codeine = 1/6 the potency of morphine 6. dihydrocodeine = codeine