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BDS3 CDS Oral Surgery > 3. Analgesia in Oral Surgery > Flashcards

3. Analgesia in Oral Surgery Flashcards

1
Q

What inflammatory mediators cause pain ?

A

Leukotrienes.

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2
Q

What is the function of prostaglandin ?

A

Formed in any tissue injury - sensitises tissue to other inflammatory products, recruits inflammatory cells.

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3
Q

What are three examples of non-opioid analgesics used in dentistry ?

A

Paracetamol, aspirin and ibruprofen.

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4
Q

What type of drug is aspirin ?

A

NSAID.

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5
Q

How do NSAIDs work ?

A

Inhibits cyclo-oxygenases (COX1 and COX2) which inhibits production of prostaglandins - preventing inflammatory response and pain.

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6
Q

What are contraindications for aspirin ?

A

Patients with PUD.
Patients with GORD.
Care with asthma and allergies.
Haemophilia.
Warfarinised patients - enhanced effect.
Pregnancy - third trimester.
Patients on steroids - risk of stomach ulcer.
Hepatic impairment - metabolised here.
With other NSAIDs.
G6PD deficiency - acute haemolytic anaemia - risk of haemorrhage.
Children.

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7
Q

What are signs of aspirin hypersensitivity ?

A

Respiratory issues.
Angioedema.
Skin rashes.

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8
Q

What are signs of aspirin overdose ?

A

Hyperventilation.
Tinnitus.
Deafness.
Vasodilation.
Sweating.
Metabolic acidosis.
Coma.

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9
Q

What is an adverse effect of aspirin which can be seen in the mouth ?

A

Mucosal burns - contains salicylic acid and has no topical effect.

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10
Q

If aspirin required in patient with gastric issues, what should it be prescribed with ?

A

Lansoprazole capsule.

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11
Q

What can be the side effects of giving children under 16 aspirin ?

A

Reye’s syndrome - 50% mortality rate.
Causes encephalopathy and liver damage.

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12
Q

What is the maximum dose for ibuprofen ?

A

400mg up to 4x a day - 2.4mg max a day.

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13
Q

What is the maximum dose for ibuprofen ?

A

400mg up to 4x a day - 2.4g max a day.

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14
Q

What 6 analgesics can be prescribed by a dentist ?

A

Aspirin NSAID.
Ibuprofen NSAID.
Diclofenac NSAID.
Paracetamol.
Dihydrocodenie (opioid).
Carbamazepine.

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15
Q

What are 3 properties of aspirin ?

A

Analgesic, antipyretic, anti-inflammatory.

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16
Q

Describe the analgesic properties of aspirin.

A

Peripheral action predominate.
Analgesic action results from inhibition of prostaglandin synthesis in inflamed tissue (COX1 and COX2 inhibition).

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17
Q

Describe the antipyretic properties of aspirin.

A

Prevent temperature rising effects of IL-1 and rise in brain prostaglandin levels so reduces elevated temperature in fever.

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18
Q

Describe anti-inflammatory properties of aspirin.

A

Prostaglandins are vasodilators and affect permeability.
Reduced prostaglandins so reduction in redness, swelling and pain in site of injury due to reduced permeability.

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19
Q

Explain how aspirin has a negative effect on patients with GIT problems.

A

Prostaglandins (PGE2 and PGI2) - inhibit gastric acid secretion, increase blood flow through mucosa, help production of mucin by cells in stomach lining as cytoprotective action.

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20
Q

Where is aspirin metabolised and excreted from mainly ?

A

Metabolised in liver.
Excreted in kidney.

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21
Q

What are the 4 groups which aspirin is completely contraindicated ?

A

Children <16 years old or breast feeding mothers.
Previous or active peptic ulceration - risk of perforation.
Haemophilia - enhanced affect.
Hypersensitivity to aspirin or other NSAIDs.

22
Q

What is the dosage for aspirin for odontogenic pain ?

A

5 day regime - 2x 300mg tablets x 4 daily, preferably after food.

23
Q

For patients who have history of GI problems, what dosage of lansoprazole be prescribed for odontogenic pain ?

A

5 day regime - 15mg tablet x 1 daily.

24
Q

Aspirin vs. ibuprofen - which is a bigger irritant to gastric mucosa ?

A

Aspirin.

25
Q

Aspirin vs. ibruprofen - which has a bigger anti-platelet effect ?

A

Aspirin.

26
Q

What is the maximum adult dose for ibuprofen ?

A

2.4g daily.

27
Q

Ibruprofen - when should caution be given when prescribing ?

A

Previous or active peptic ulceration.
Elderly.
Pregnancy and lactation.
Renal, cardiac or hepatic impairment.
Previous hypersensitivity reaction to ibuprofen or NSAIDs.
Asthma.
Patients taking other NSAIDs.
Patients on long term systemic steroids.

28
Q

What are 3 symptoms of ibuprofen overdose ?

A

Nausea, vomiting, tinnitus.

29
Q

What should be given to patient experiencing ibuprofen overdose (>400mg/kg within 1 hour) ?

A

Activated charcoal and symptomatic relief.

30
Q

Describe the mode of action for paracetamol.

A

Hydroperoxides are generated from metabolism of arachidonic acid by COX and exert positive feedback to stimulate COX activity - feedback blocked by paracetamol, indirectly inhibiting COX.

Works centrally - in thalamus - (more so than peripherally).

31
Q

What are the 2 properties of paracetamol ?

A

Analgesia, antipyretic action.
No reduction in peripheral inflammation.

32
Q

Why does paracetamol not cause gastric irritation ?

A

Has no effect on peripheral prostaglandins.

33
Q

What dosage of paracetamol should be used in odontogenic pain ?

A

2x 500mg tablets 4x daily.
Maximum daily dose is 4g so 8 tablets.

34
Q

What does paracetamol overdose cause ?

A

Hepatocellular necrosis and renal tubular necrosis.

35
Q

Where do opioid analgesics act ?

A

Dorsal horn pathways in spinal cord - central pain regulation.

36
Q

What are common problems associated with opioid medication ?

A

Dependence.
Tolerance.
Smooth muscle effects - constipation, urinary and bile retention.

37
Q

What are side effects of opioid medication ?

A

Dry mouth.
Sweating.
Facial flushing.
Headache.
Vertigo.
Bradycardia.
Hallucinations.
Mood changes.

38
Q

What is the main interaction of opioid medication ?

A

Alcohol - enhanced effects.

39
Q

For what medical conditions should caution be taken when prescribing opioid medication ?

A

Hypotension.
Hypothyroidism.
Asthma.
Decreased respiratory rate.
Pregnancy and breast feeding.
Hepatic impairment - reduced dose.
Renal impairment - reduced dose.
Elderly and debilitated - reduced dose.
Convulsive disorders.
Dependence.

40
Q

What are the 3 contraindications for opioid prescription ?

A

Acute respiratory depression.
Acute alcoholism.
Raised intracranial pressure/head injury.

41
Q

What combination of dihydrocodeine and NSAIDs/paracetamol should be used together ?

A

8mg codeine : 500mg paracetamol.

42
Q

What is the oral dosage of dihydrocodeine ?

A

30mg every 4-6 hours as necessary.

43
Q

What are the three main side effects of dihydrocodeine ?

A

Nausea/vomiting.
Constipation.
Drowsiness.

44
Q

What are the 2 drug interactions of dihydrocodeine ?

A

MAOIs antidepressants.
Dopaminergics for Parkinsons.

45
Q

What is the antidote for opioid overdose ?

A

Naloxone.

46
Q

What should be prescribed for neuropathic/functional pain ?

A

Carbamazepine.

47
Q

What are two types of dental neuropathic pain ?

A

Post-herpetic neuralgia and trigeminal neuralgia.

48
Q

What two types of dental functional pain ?

A

TMJ and atypical facial pain.

49
Q

What is the proprietary brand of carbamazepine ?

A

Tegretol.

50
Q

What is the proprietary brand of carbamazepine ?

A

Tegretol.

51
Q

What are three drugs which can be used to treat trigeminal neuralgia ?

A

Gabapentin.
Phenytoin.
Carbamazepine.

52
Q

What carbamazepine dosage routine should be prescribed for trigeminal neuralgia ?

A

100mg 1-2x daily increasing gradually to 200mg 2-4x daily.

BDS3 CDS Oral Surgery (4 decks)

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