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BDS3 Oral Surgery > Analgesia > Flashcards

Analgesia Flashcards

1
Q

What drugs can dentists prescribe

A

CHECK DENTAL PRACTITIONERS FORMULARY IN BNF
Aspirin, ibuprofen, diclofenac (NSAIDs), paracetamol, dihydrocodeine, carbamazepine

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2
Q

Arachidonic acid pathway

A

Trauma and infection> breakdown of membrane phospholipids> arachidonic acid

Arachidonic acid broken down to form prostaglandins

These sensitise tissues to other inflammatory products> PAIN

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3
Q

What do prostaglandins do

A

Do not cause pain directly
Sensitise tissues to other inflammatory products
E.g leukotrienes

Prostaglandin production decrease=moderation in pain

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4
Q

Aspirin (acetylsalicylic acid) properties

A

Effective for dental and TMJ pain
Analgesic, antipyretic, anti-inflammatory

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5
Q

Mechanism of action of aspirin

A

Inhibits COX 1+2 (more COX 1)
Therefore reduces production of prostaglandins

COX 1 inhibition reduces platelet aggregation

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6
Q

Analgesic properties of aspirin

A

Work peripherally and centrally
More peripheral
Analgesic action from inhibition of prostaglandin synthesis (from COX inhibition)

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7
Q

Antipyretic properties of aspirin

A

Prevents temp raising effects of interleukin 1 and rise in brain prostaglandin levels
Reduces ELEVATED temp

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8
Q

Anti-inflammatory properties of aspirin

A

Vasodilation, affect capillary permeability
Will reduce redness, swelling and pain at site

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9
Q

Adverse effects of aspirin

A

GIT problems
Hypersensitivity
Overdose- tinnitus, metabolic acidosis
Aspirin burns- mucosal

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10
Q

What is metabolic acidosis

A

Can’t regulate blood pH

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11
Q

When is aspirin completely contraindicated

A

Children and adults under 16, REYES SYNDROME
Previous of active peptic ulceration
Haemophilia
Hypersensitivity to aspirin or any other NSAID

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12
Q

How to avoid aspirin burn

A

Take aspirin with water

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13
Q

Aspirin and anticoagulants

A

Enhances warfarin and other anticoagulants
Increased bleeding tendency (as most warfarin is bound an inactive)

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14
Q

Aspirin and children under 16

A

N.B Breastfeeding
Can cause Reye’s syndrome- up to 50% mortality
fatty degenerative process in liver, swelling in brain

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15
Q

If pt with odontogenic pain has prev or active peptic ulcer disease and requires NSAID (paracetamol ineffective), what do you prescribe?

A

Proton Pump inhibitor (e.g. omeprazole)

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16
Q

Ibuprofen properties

A

NSAID
More commonly used
Long term use recently associated with increased risk of cardiac events
Paeds suspension available

17
Q

Ibuprofen max dose

A

2.4g

18
Q

Ibuprofen side effect

A

GIT discomfort (bleeding, ulceration), hypersensitivity, headaches, dizziness…

19
Q

Caution when prescribing ibuprofen

A

Prev or active peptic ulceration
Elderly
Pregnant …

20
Q

Ibuprofen overdose

A

Nausea, vomiting, tinnitus

Activated charcoal if more than 400mg/kg ingested in last hour (two tablets= 400mg)

21
Q

Paracetamol properties

A

Analgesic
Antipyretic
LITTLE OR NO ANTI-INFLAMMATORY ACTION
No effects on bleeding time
No significant interaction with warfarin
Less irritant to GIT
Suitable for children

22
Q

How does paracetamol work

A

Hyperoxides are produced from metabolism of arachidonic acid by COX
COX then exert positive feedback to stimulate further COX activity
This feedback is blocked by paracetamol

23
Q

What does the positive feedback inhibition action of paracetamol result in

A

Analgesia
Antipyretic action
No reduction of peripheral inflammation

24
Q

Where is main site of action of paracetamol

A

Thalamus

25
Q

Cautions when prescribing paracetamol

A

Hepatic impairment
Renal impairment
Alcohol dependence

26
Q

Side effects of paracetamol

A

Rashes
Blood disorders
Hypotension
Liver damage following overdose

27
Q

Paracetamol dose

A

500mg tablets
Max dose 4g daily (8 tablets)

28
Q

What should always be warned with pts and paracetamol

A

MAX DOSE

29
Q

Trigeminal neuralgia clinical features

A

Severe spasms of pain- electric shock
Usually unilateral
Older population
Trigger spot identifies
Females>males
Periods of remission
Recurrences often greater severity

30
Q

Prescription for trigeminal neuralgia

A

Carbamazepine

Starting dose 100mg once or twice daily
Gradual increase according to response

31
Q

Usual carbamazepine dose

A

200mg 3-4 times daily

32
Q

Opioids

A

Act in spinal cord, dorsal horn pathways
BNF states relatively ineffective in dental pain

33
Q

Dihydrocodeine contraindications

A

Antidepressants MAOIS
Dopaminergics (Parkinson’s)
Never prescribe in raised intracranial pressure/suspected head injury

34
Q

Opioid overdose

A

Naloxone

BDS3 Oral Surgery (2 decks)

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