7. Odontogenic pain Flashcards
What type of drug is ibuprofen and aspirin?
Non-steroidal anti-inflammatory drugs (NSAIDs).
These have anti-inflammatory activity.
Can you use aspirin in children?
No!
Aspirin is a potent and useful NSAID, but who and when should you avoid it?
- Avoid use in children
- Avoid use in those with aspirin allergy
- Do not prescribe following dental extraction or other minor surgery.
What medications can be used to control pyrexia in children?
Paracetamol or ibuprofen.
Both drugs can be given alternately to control ongoing pyrexia without exceeding the recommended dose or frequency of administration for either drug.
What can an overdose of paracetamol lead to?
Hepatotoxicity
Hepatic damage is sometimes not apparent for 4-6 days and can be fatal.
- caused excessive dose of paracetamol or paracetamol-containing preparations is ingested over a period of hours.
At what dose should you refer someone to A&E if they have had paracetamol overdose?
75 mg/kg or greater, either as a single acute dose of staggered across a 24 hour period.
(Pt who are uncertain about the timing of doses or total amount ingested should also be referred).
What is the therapeutic dose of paracetamol for adults?
8 x 500mg tablets in 24 hours = 4g.
In which patient should you avoid the use of all NSAIDs?
- Pts with a history of hypersensitivity to aspirin or any other NSAID, including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID.
- Pts taking a low dose of aspirin daily.
- Pregnant patients
- Pts with previous or active peptic ulcer disease. However, if NSAIDs are required to provide pain relief in these patients, a proton pump inhibitor can be prescribed in conjunction with the NSAID. (lansoprazole or omeprazole)
- Use with caution in the elderly, pts with allergic disorders, nursing mothers, those taking oral anticoagulants such as warfarin, those with coagulation defects and those with inherited bleeding disorder. NSAIDs might impair renal function and so use with caution in pts with renal, cardiac or hepatic impairment.
In which pts should you use NSAIDs with caution?
- Elderly
- Pts with allergic disorders
- Nursing mothers
- Pts taking oral anticoagulants such as warfarin
- Pt with coagulation defects
- Pts with inherited bleeding disorders
- Renal, cardiac or herpetic impairment as NSAIDs might impair renal function.
Should you prescribe NSAIDs in pts already taking a daily low-dose of aspirin?
Do not prescribe NSAIDs as these can increase the risk of gastro-intestinal side-effects.
In which patients is diclofenac contra-indicated in?
- Ischaemic heart disease
- Cerebrovascular disease
- Peripheral arterial disease
- Mild to severe heart failure
In which patients should diclofenac be used with caution with?
- Pts with a history of cardiac failure
- Left ventricular disfunction
- Hypertension
- Pts with oedema for any other reason
- Pts with other risk factors for cardiac events.
- elderly
- patients with allergic disorders
- nursing mothers
- those taking oral anticoagulants such as warfarin
- those with coagulation defects
- those with an inherited bleeding disorder
- those with renal, cardiac or hepatic impairment
In which patients should diclofenac be avoided?
- Those with hypersensitivity to aspirin or any other NSAID, including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID.
- Pts taking a low dose of aspirin daily.
- Pregnant patients
- Previous or active peptic ulcer disease, unless a proton pump in inhibitor is co-prescribed.
What is the therapeutic dose for paracetamol?
8 x 500mg for adults.
- 2 tablets, 4 times daily.
- Maximum of 4g in 24 hours.
What is the toxic dose for paracetamol?
75mg/kg in any 24 hour period.
What is the therapeutic dose for ibuprofen?
1x400mg tablet, 4 times a day, preferable after food.
1.6g in 24 hours.
In adults, the dose can be increased, if necessary, to a maximum of 2.4g daily.
Initially 300–400 mg 3–4 times a day; maintenance 200–400 mg 3 times a day, increased if necessary up to 600 mg 4 times a day.
How many grams of ibuprofen can you increase the adult dose to if necessary?
2.4g daily.
For patients taking antihypertensive drugs, how many days should you restrict ibuprofen to?
5 days.
How can you advise patients on alternating paracetamol and ibuprofen?
In cases where paracetamol or ibuprofen alone is not effective, both paracetamol and ibuprofen can be given alternately (i.e. ibuprofen can be taken first and then paracetamol 2 hours later, and so on, using the normal daily doses).
How can you prescribe aspirin?
Aspirin Dispersible tablets, 300mg, 2 tablets 4 times daily, preferable after food.
2x 300mg tables, 4 times a day = 2.4g in 24 hours
What is the maximum daily dose of aspirin which can be prescribed to adults and children 16+?
4g
3 tablets (900mg) can be given in one dose (maximum daily dose of 4g).
Do you prescribe aspirin following a dental extraction or other minor surgery?
NO!!!
Why do we not prescribe aspirin to children <16 years?
Do not use in children because, rarely, it can cause Reye’s syndrome.
Who should you avoid giving aspirin to?
- Pts with known allergy to aspirin or hypersensitivity to aspirin or any other NSAID, including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID.
- Avoid use in nursing mothers
- Avoid use in patients with previous or active peptic ulcer disease
Which patients can use aspirin with caution?
- Elderly
- Patients with allergic disorders
- Pregnant women
- Those taking oral anticoagulants such as warfarin
- Those with coagulation defects
- those with an inherited bleeding disorder
- Those with renal, cardiac or hepatic impairment.
How do you prescribe diclofenac?
Diclofenac sodium tablets, 50mg. 1 tablet 3 times daily.
= 150mg in 24 hours.
What can you do if paracetamol alone is not sufficient for tx of odontogenic pain in pts with a history of previous or active peptic ulcer disease?
NSAID (i.e. ibuprofen or diclofenac) is required. Prescribe a proton pump inhibitor (i.e. lansoprazole and omeprazole) in conjunction with the NSAID.
Prescribe the proton pump inhibitor for the duration of the analgesic course to prevent the occurrence of gastric problems.
In patients who have a history of previous or active peptic ulcer disease and require an NSAID for treatment of odontogenic pain, an appropriate 5-day regimen to prevent gastric problems is: (2)
Lansoprazole capsules, 15mg. 1 capsule once daily.
Gastro-resistant omeprazole capsules, 20mg. 1 capsule once daily.
In which patients should lansoprazole and omeprazole be used with caution?
- pts with liver disease
- pregnancy
- breast-feeding
