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cornelius 2 > post op pain > Flashcards

post op pain Flashcards

(55 cards)

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1
Q

what can make acute pain worse

A

anxiety

increased sympathetic output

poor rest

inadequate oral intake

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2
Q

opioids and non opioids modulate pain..

A

peripherally and centrally

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3
Q

serious side effects of NSAIDS

A

GI toxicity

decreased renal function

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4
Q

absolute contraindications to NSAIDs

A

allergy

pregnancy

erosive or ulcerative conditions of the GI mucosa

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5
Q

relative contraindications to NSAIDs

A

asthma

anticoagulant therapy or hemorrhagic disorders

compromised renal function

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6
Q

COX-2 selective NSAIDs action

A

anti inflammatory, anty pyretic, analgesic

protect normal physiologic processes

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7
Q

why dont we just use COX-2 inhibitors only

A

poor efficacy in third molars

expensive

only one option

increased embolic phenomena

SULFA ALLERGY

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8
Q

how does acetaminophen work

A

probably blocks PG synthesis in CNS

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9
Q

does acetaminophen have anti inflammatory effects n

A

no

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10
Q

recommended daily maximum for tylenol

A

FDA: 4000 mg/day

McNeil Consumer: 3000 mg/day

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11
Q

daily maximum of tylenol for ppl with liver disease

A

2000 mg/day

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12
Q

which opioid receptors are more potent as far as analgesia, resp depression, sedation

A

mu > kappa

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13
Q

rank from most potent to least: hydro, oxygen, codeine

A

oxy > hydro > codeine

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14
Q

how do tylenol and semi synthetic opiate receptors work together

A

synergistically

reduces Amt of opioid needed, tylenol dictates dose/frequence

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15
Q

what converts oral opiates to active metabolites

A

cyp450

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16
Q

codeine active metabolite

A

morphine (effect entirely from metabolite)

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17
Q

hydrocodone active metabolite

A

hydromorphone (effect from parent drug and metabolite)

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18
Q

oxycodone active metabolite

A

oxymorphone (effect almost entirely from parent drug)

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19
Q

how many caucasians are deficient in cyp450

A

4-10%

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20
Q

pentazocine MOA

A

oral agonist-antagonist

analgesic at kappa, antagonist at mu

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21
Q

is pentazocine good for third molars

A

no

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22
Q

tramadol MOA

A

central dual action:

weak binding at mu

inhibit incoming nociceptive impulses

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23
Q

what type of pain is tramadol good for

24
Q

is tramadol better than opioid-tylenol combos

25
how long/what severity is pain for dentoalveolar surgery usally
mild to moderate 3-5 days
26
pre surgical eval for pain
type of surgery, expected pain pre existing medical condiitons/medications patients previous experience
27
why is giving po analgesics prior to surgery a good idea
inhibits PG synthesis lessens nocicpetion during procedure will reduce overall post op analgesic requirement
28
what local anesthetic should you give prior to sx
bupivicaine blocks input to CNS, decreases central hyper excitability, less pain and analgesic intake and 4h and 8 h, easier to maintain pain free state
29
which analgesics better for dental pain
NSAIDs better than opioids (inflammatory)
30
what is NSAID of choice
ibuprofen, nothing is proven to be better or cheaper
31
t/f: NSAIDs have ceiling effect for analgesic properties
true
32
how to chose dose of NSAID
according to contribution of inflammation to the pain experienced
33
dose frequency for non narcotic analgesics
around the clock on fixed schedule regardless of pain severity prn = haphazard drug levels
34
ibuprofen dose and max dose
600 mg q6h 3200 mg
35
tylenol dosage, max dose
650 mg q6h (healthy); 3000 max 500 mg q6h (liver pt); 2000 max
36
breakthrough pain management
small doses of short acting opioid agents if non-opioid regimen is already optimized
37
codeine + acetaminophen brand name, dose
tylenol #2 = 15 tylenol #3 = 30 tylenol #4 = 6-
38
hydrocodone + acetaminophen brand name, dose
norco 5/325
39
oxycodone + acetaminophen brand name, dose
percocet 5/325
40
stepped approach
step one: ibuprofen 600 mg q6h, tylenol 650 mg q6h step two: norco or percocet prn
41
Dr. Kennedy's plan for routine third molars
pre emptive: ibuprofen 600 mg po, ketorolac 30 mg IV local: 2% lido, 0.5% bupivicaine post op: ibuprofen/tylenol q6h for 72 hours, norco one tab prn for severe pain
42
dosing may not exceed ____g morphine equivalent doses
30 mg
43
opioid rx requirements
CDT code and days worth
44
which trimester is best for tx preggo
second
45
what local to use for preggo
lido
46
analgesics for preggo
no NSAIDS tylenol, narcotic w/ OB approval ok
47
chronic opioid users pain management
post op pain is in addition to pain they already have discuss pre op with pt and doctor optimize daily non-opoiod routine tolerance may require increase in opioid dosage
48
rehab ppl pain management
discuss up front use LA, NSAIDs dont rx something they have abused in the past
49
drug rxn that is not anaphylaxis tx
DC drug antihistamines corticosteroids
50
are allergic reactions common with opoids
no but adverse effects are
51
how to avoid adverse effects of opioids
dose reduction opioid rotation manage adverse effects
52
corticosteroids uses in dentistry
topical enteral (po) for trismus/edema tx of non anaphylactic drug allergy
53
contraindications to corticosteroid use
history of chronic infection peptic ulcer dz DM poor wound healers caution w/ simultaneous NSAID use
54
how many adrenal crisises have there been in last 66 yeras
6
55
when to consider stress dose of steroid
20 mg prednisone per day for more than two weeks in the past two months

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