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BDS3 Oral Surgery > Analgesia > Flashcards

Analgesia Flashcards

1
Q

what are the 6 main analgesics used in dentistry

A

aspirin
paracetamol
ibuprofen
diclofenac
dihydrocodeine
carbamazepine

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2
Q

briefly describe the pain pathway

A

tissue injury sees release of arachidonic acid which goes on to stimulate 2 pathways
1 - cyclooxygenase pathway concerning COX1 and COX2 , sees production of prostaglandins and thromboxane
2 - 5-lipooxygenase pathways , sees production of leukotrienes

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3
Q

function of prostaglandins

A

sensitise tissues to inflammatory products which cause pain and inflammation

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4
Q

what is the positive feedback mechanism assosciated with the cyclooxygenase pathway

A

hydroperoxides are generated from arachidonic acid metabolism and they have a positive feedback mechanism on stimulating COX production
i.e stimulating prostaglandin production

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5
Q

why might a mucosal burn occur if aspirin is placed topically

A

due to its salicylic acid content
should only be taken orally

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6
Q

how does aspirin work

A

works by inhibiting the cyclooxygenase pathway therefore decreasing prostaglandin production and therefore decreasing pain

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7
Q

how does ibuprofen work

A

works by inhibiting the cyclooxygenase pathway in the peripheries
decrease in prostaglandin production therefore also decrease in pain

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8
Q

why can NSAIDS such as ibuprofen cause GIT irritation

A

their mode of action sees decreased prostaglandin production
in the stomach prostaglandins
- inhibit gastric acid secretion
- increase blood flow in gastric mucosa
- aid mucin production by stomach cells

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9
Q

Groups to be cautious about prescribing ibuprofen to

A
  • GIT issues , elderly, pregnant, lactating, renal impariment, hepatic impairment, asthmatics, hypersensitivity to any NSAID, taking other NSAIDs, taking long term systemic steroids
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10
Q

why should you be cautious prescribing ibuprofen to the elderly

A
  • elderly - other medications and problems , more susceptible to side effects
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11
Q

why should you be cautious prescribing ibuprofen to pregnant women

A
  • pregnancy - particularly 3rd trimester, can potentially cause a decrease in platelets so increased haemmhorage risk and increased risk of jaundice in the baby
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12
Q

why should you be cautious prescribing ibuprofen to women who are breastfeeding

A

risk of reyes syndrome - very rare

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13
Q

why should you be cautious prescribing ibuprofen to people with a renal or hepatic impairment

A

renal - ibuprofen excreted via kidneys
hepatic - ibuprofen metabolised in liver

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14
Q

side effects of ibuprofen

A

GIT discomfort, headache, ulceration , dizziness, hypersensitivity reactions e.g rash, bronchospasm, drowsiness

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15
Q

symptoms of ibuprofen overdose

A

nausea, vomiting, rarely - tinnitus (ringing within ears) sign of serious toxicity

treatment = activated charcoal

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16
Q

drug interactions with ibuprofen

A

many - check BNF
includes - antidepressants, antibiotics, anti coagulants, ACE inhibitors, corticosteroids, clopidogrel

17
Q

what is ibuprofen and its properties

A

ibuprofen is an NSAID with anti - inflammatory, anti pyretic and analgesic properties

18
Q

what is paracetamol and its properties

A

paracetamol is a simple analgesic and anti pyretic
NO anti inflammatory properties
also known as acetaminophen

19
Q

paracetamol mode of action

A

blocks positive feedback mechanism of hydroperoxides on COX activity therefore decreasing prostaglandin actvivity
main target is in CNS e.g thalamus unlike NSAIDS which target peripheries

20
Q

what 3 groups should you be cautious about prescribing paracetamol to

A

hepatic impairment - metabolised in liver
renal impairment - excreted in kidneys
alcohol dependent - excess alcohol in combination with paracetamol risks damaging liver

21
Q

drug interactions of paracetamol

A

consult BNF
include lipid regulating drugs, cytotoxics, anti coagulants if prolonged paracetamol use

22
Q

when would a paracetamol overdose become apparent

A

not till 3-4 days post overdose
cause is hepatic necrosis which takes this long to fully show

23
Q

problems with opioid analgesics

A

dependence - psychological cravings and physically ill
tolerance - to achieve same therapeutic effect over time dose needs to be progressively increased
CNS effects - depresses pain , respiratory and cough centres
effect on smooth muscle - constipation , urinary and bile retention

24
Q

what opioid analgesic is available in the dental practitioners formulary

A

dihydrocodeine
BNF states it is not thought to be effective at treating post op dental pain

25
Q

contraindications for prescribing opioid analgesics

A

acute respiratory depression
acute alcoholism
raised intracranial pressure/ head injury

26
Q

carbamazepine - what is it and why would it be used dentally

A

anticonvulsant medication used to treat neuropathic and functional pain such as trigeminal neuralgia

BDS3 Oral Surgery (5 decks)

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