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BDS3 Oral Surgery > Analgesia > Flashcards

Analgesia Flashcards

1
Q

How does trauma and infection lead to pain?

A
  • trauma and infection lead to the breakdown of membrane phospholipids
  • this produces arachidonic acid
  • Arachidonic acid can be broken down to form prostaglandins
  • prostaglandins sensitise tissues to other inflammatory products resulting in pain
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2
Q

Arachidonic acid produces Leukotrienes when broken down, what does this result in?

A
  • bronchoconstriction
  • smooth muscle contraction
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3
Q

What products are formed from the Cyclooxygenase pathway?

A

Prostaglandins
protacyclin
thromboxane

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4
Q

what does thromboxane cause?

A

platelet aggregation

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5
Q

What are the properties of aspirin?

A
  • analgesic
  • anti-inflammatory
  • antipyretic
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6
Q

Outline the mechanism of action for aspirin

A
  • inhibits cycle-oxygenases COX 1 and COX 2
  • thus reduces production of prostaglandins
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7
Q

Aspirin is more effective at inhibiting COX-1 than COX-2. What does this mean?

A

COX-1 inhibition reduces platelet aggregation
- predisposes to damage of the gastric mucosa

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8
Q

What are aspirin’s analgesic properties?

A

It is an NSAID so its analgesic action is exerted both peripherally and centrally
- mostly peripheral
- analgesic action results from inhibition of prostaglandin synthesis in inflamed tissues

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9
Q

outline the antipyretic properties of aspirin

A
  • prevents temperature raising effects of interleukin-1
  • thus reduces elevated temperature in fever
  • does not reduce normal temperature
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10
Q

Outline the anti-inflammatory properties of aspirin

A
  • prostaglandins are vasodilators
  • therefore affect capillary permeability
  • aspirin reduces redness, swelling and pain at injury site
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11
Q

What are the possible adverse effects of aspirin?

A
  • mucosal aspirin burns
  • GIT problems
  • hypersensitivity
  • overdose
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12
Q

Why can aspirin lead to GIT problems?

A

prostaglandins PGE and PGI2:
- inhibit gastric acid secretion
- increase blood flow through gastric mucosa
- help production of mucin by cells in stomach lining
- can lead to ulcers and gastro-oesophageal reflux

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13
Q

Why can aspirin cause mucosal burns?

A
  • contains salicylic acid
  • chemical burns occur when applied locally to oral mucosa
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14
Q

What groups should be avoided or approached with caution when prescribing aspirin?

A
  • peptic ulceration
  • bleeding disorders
  • patients on anticoagulants
  • pregnant or breast feeding women
  • patients on steroids
  • asthma patients
  • hypersensitivity with NSAIDs
  • u16s
  • elderly
  • Taking other NSAIDs
  • renal impairment
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15
Q

When is aspirin completely contraindicated?

A
  • under 16s
  • patients with previous or active peptic ulceration
  • patients with haemophilia
  • patients with hypersensitivity to aspirin or other NSAIDs
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16
Q

Give 2 ways in which ibuprofen differs in effect from aspirin

A
  • less effects on platelets
  • irritant to gastric mucosa lesser than with aspirin
17
Q

What is the maximum adult dose for ibuprofen?

A

2.4g

18
Q

What is the treatment for ibruprofen overdose?

A

activated charcoal

19
Q

Outline the mode of action for paracetamol

A
  • hydroperoxides are generated from metabolism of arachidonic acid by COX, which then exerts a passive feedback stimulating COX activity
  • feedback blocked by paracetamol, indirectly inhibiting COX
20
Q

What properties does paracetamol have?

A
  • analgesic
  • antipyretic
21
Q

Where is the main site of action of paracetamol?

A

the thalamus of the brain

22
Q

When would you take caution for prescribing paracetamol?

A

patients with:
- hepatic impairment
- renal impairment
- alcohol dependence

23
Q

What are the potential side effects of paracetamol?

A
  • rashes
  • blood disorders
  • liver damage
24
Q

What are the potential side effects of paracetamol?

A
  • rashes
  • blood disorders
  • liver damage
25
Q

What are the potential drug interactions of paracetamol?

A
  • anti-coagulants (prolonged used may enhance anticoagulant effects of the coumarins)
  • cytotocics
  • lipid-regulating drugs
  • domperidone
  • metoclopramide
26
Q

What is the maximum daily adult dose for paracetamol?

A

4g

27
Q

How the opioid analgesics work?

A
  • act in spinal cord
  • central regulation of pain
28
Q

Outline possible downsides of opiods

A
  • dependence
  • tolerance
  • constipation
  • urinary and bile retention
29
Q

What are the side effects of opioids?

A
  • nausea
  • vomiting
  • drowsiness
  • respiratory depression and hypotension in larger doses
  • dry mouth
  • sweating
  • bradycardia
  • rashes
  • palpitations
  • hallucinations
  • mood changes
  • tachycardia
  • mood changes
30
Q

Which patients should be prescribed opioids with extra caution?

A
  • hypotention
  • asthma
  • pregnant/breast feeding
  • hypothyroidism
31
Q

When are opioids completely contraindicated?

A
  • acute respiratory depression
  • acute alcoholism
  • raised inter cranial pressure/head injury
32
Q

What are the features of trigeminal neuralgia?

A
  • severe spasms of pain: electric shock which lasts seconds
  • usually unilateral
  • older-age group
  • periods of remission
  • trigger spot identified
  • more common in females
33
Q

What is used to treat trigeminal neuralgia?

A

Carbamazepine 100 or 200mg 1-2x daily, dose may be increased gradually according to response

BDS3 Oral Surgery (7 decks)

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