Week Nine: Analgesics and Anti-inflammatory Agents

Question 1

When are analgesics used in dentistry?

Answer 1

When the patients pain cannot be removed, reduced or eliminated by appropriate dental treatment.

Question 2

Analgesics don’t?..

Answer 2

Address causes of pain

Question 3

What is NSAIDs?

Answer 3

Nonsteroidal Anti-inflammatory drugs

Question 4

What are NSAIDS?

Answer 4

NSAIDS have anti-inflammatory and analgesic properties.
They are a mediator of inflammation by acting on arachidonic acid pathway, which inhibits production of prostaglandins (mediators and modulators of inflammation)

Question 5

What do NSAIDS act on?

Answer 5

The PNS and CNS

Question 6

What are NSAIDs effective in treating?

Answer 6

• acute pain and inflammation relating to endodontic, surgical, restorative or periodontal procedures and sometimes temporomandibular joint dysfunction.

Question 7

NSAIDS are the drug of choice for?

Answer 7

Dentistry, regarding pain relief.

• Aspirin
• Ibuprofen
• Naproxen

Question 8

What is aspirin?

Answer 8

Effective analgesic, anti-inflammatory antipyretic and anti-platelet effects

Question 9

What is the dose range for aspirin?

Answer 9

300-900mg, every 4-6 hours (daily maximum 3600mg)

Question 10

When are aspirins peak blood levels?

Answer 10

1-2hours

Question 11

What is the half life of aspirin?

Answer 11

15 minute half life - primary biotransformation in liver.

Question 12

What are common side effects of aspirin?

Answer 12

• Dyspepsia, nausea & occult bleeding

- Prolonged bleeding time

Question 13

What can occur after long use of aspirin?

Answer 13

• Higher dose regimens increase risk of GI and renal problems

Question 14

How is toxicity displayed from aspirin?

Answer 14

CNS symptoms

Question 15

What are the contraindications/precautions of aspirin?

Answer 15

• Children: association with Reyes syndrome
• Peptic ulcer
• Compromised liver function
• Asthma, nasal polyps or chronic allergic disorders
• Pregnancy
• Diabetes

Question 16

What are important drug interaction to note regarding aspirin?

Answer 16

• Alcohol
• May increase toxicity of methotrexate and valproic acid
• May decrease the effects of antihypertensive medications (ACE inhibitors, some diuretics, angiotensin II receptor antagonists, oral hypoglycaemic and warfarin)

Question 17

What is the dose range for ibuprofen?

Answer 17

Following dental treatment = 200-600mg every 4-6 hours (daily maximum 2400mg) for a short period of 24 hours.
OTC max dose = 1200mg

Question 18

What produces better analgesia ibuprofen or paracetamol/codeine combinations?

Answer 18

Ibuprofen.

Question 19

When is the peak blood level for ibuprofen?

Answer 19

0.5-1.5 hours (gel caps have a faster absorption)

Question 20

What are adverse effects of ibuprofen?

Answer 20

Gastrointestinal disturbances

Fluid retention

Question 21

What can be an adverse effect after long term use of ibuprofen?

Answer 21

Higher dose regimens increase the risk of GI and renal problems.

Question 22

What drug interactions can occur with ibuprofen?

Answer 22

Can interfere with antihypertensive medications (ACE inhibitors, some diuretics) - if taken for longer than one week.

Question 23

What is paracetamol also known as?

Answer 23

Acetaminophen

Question 24

What does paracetamol do?

Answer 24

It is a mediator of inflammation by acting on arachidonic acid pathway

Acts in the CNS to inhibit prostaglandin synthesis and NO synthesis in macrophages

Question 25

What is paracetamol effective in?

Answer 25

- Mild Pain, particularly soft tissue and musculoskeletal origin mild to moderate post treatment pain, severe pain, fever An alternative to NSAIDs if contraindicated.

Question 26

What is paracetamols dose range?

Answer 26

500-1000mg, every 4-6hours (daily maximum 4000mg)

Question 27

When is paracetamols peak in blood levels?

Answer 27

0.5-1.5 hrs

Question 28

What is the half life of paracetamol?

Answer 28

2-3 hours, primary biotransformation in the liver

Question 29

What is the dosage of paracetamol for children?

Answer 29

15mg/kg orally every four hours (daily maximum 90mg/kg up to a total of 4000mg)

Question 30

What can you combine paracetamol with?

Answer 30

Opioids for greater analgesia

Question 31

When is paracetamol indicated in comparison to NSAIDs?

Answer 31

Paracetamol does not cause the same gastric irritation or the other complications associated with aspirin and other NSAIDs

Question 32

What are adverse effects of paracetamol?

Answer 32

- Liver disease - Increased toxicity if taken with alcohol - Overdose will produce hepatotoxicity, hypoglycaemia and acute tubular necrosis.

Question 33

What is the MOA of opiods?

Answer 33

MOA achieved through activation of opioid receptors inhibiting neuronal activity and subsequently pain transmission. Opioids work on the CNS and PNS.

Question 34

What are interactions/precautions of opioids?

Answer 34

MAOIs - potentiation of sedative/depressant effects if used in conjunction with other CNS depressants (sedatives, hypnotics, phenothiazines, anaesthetics and alcohol) HIGH INCIDENCE OF ADVERSE EFFECTS

Question 35

Name some opioids.

Answer 35

Codeine Morphine Oxycodone Tramadol You should only use opioids as adjunctive analgesics and not as primary analgesics in dentistry

Question 36

How do you manage pain relief with analgesics in dentistry?

Answer 36

3 Ds | Diagnosis, Dental Treatment and Drugs

Question 37

How do you manage mild pain in adults?

Answer 37

1. ibuprofen 400mg orally, every four hours (MAX 2400mg in 24hrs) 2. Aspiring 600-900mg orally, every four hours (MAX 3600mg/24hrs) 3. If NSAIDs are contraindicated Paracetamol 500 - 1000mg orally, every 4hrs (MAX 4g/24HRS)

Question 38

How do you manage moderate pain in adults?

Answer 38

1. Ibuprofen 400 to 600 mg orally, every 4 hours (to a maximum of 2400mg?24hrs) + Paracetamol every four hours (MAX 4g/24hrs) 2. if NSAIDs contraindicated Paracetamol + codeine 1000+60 mg orally, every 4hours (MAX paracetamol = 4g/24hrs)

Question 39

How do you manage severe pain in adults?

Answer 39

1. Ibuprofen 400 to 600 mg orally, every 4 hours (to a maximum of 2400mg?24hrs) + Paracetamol every four hours (MAX 4g/24hrs) + Paracetamol + codeine 1000+60 mg orally, every 4hours (MAX paracetamol = 4g/24hrs) 2. If NSAIDs contraindicated. Paracetamol + codeine 1000+60 mg orally, every 4hours (MAX paracetamol = 4g/24hrs)

Question 40

How do you manage pain in children?

Answer 40

1. Ibuprofen 5-10mg/kg orally, 6-8 hourly (to a maximum daily dose of 2400mg) 2. paracetamol 15mg/kg orally or rectally, 4-6 hourly (MAX 4g)