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BDS3 Oral Surgery > Analgesia > Flashcards

Analgesia Flashcards

1
Q

what controls pain during dental procedures

A

local anaesthetic

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2
Q

what controls post operative pain

A

systemic analgesic drugs

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3
Q

name some artificial saliva substitutes

A

BioXtra
Saliveze

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4
Q

what are the analgesics in the dental practitioners formulary

A

aspirin
ibuprofen
diclofenac
paracetamol
dihydrocodeine
carbamazepine

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5
Q

what is the pain pathway called

A

arachidonic acid pathway

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6
Q

when is arachidonic acid produced

A

when there is injury to phospholipid cell membrane

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7
Q

what are the two outcomes that can be produced from arachidonic acid

A

prostaglandins or leukotrienes

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8
Q

what occurs when prostaglandins are produced from the arachidonic acid pathway

A

causes pain and inflammation

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9
Q

what occurs when leukotrienes are produced from the arachidonic acid pathway

A

causes bronchoconstriction, asthma attacks and smooth muscle contractions

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10
Q

what sensitises the tissues to other inflammatory products which can cause pain

A

prostaglandins

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11
Q

what is the function of prostaglandins

A

to sensitise the tissues to other inflammatory products such as leukotrienes which causes pain

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12
Q

what type of drug is aspirin

A

NSAID

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13
Q

what are the four properties of aspirin

A

analgesic
antipyretic
anti-inflammatory
metabolic

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14
Q

what is the chemical name for aspirin

A

acetylsalicylic acid

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15
Q

how does aspirin work

A

it inhibits the cyclo-oxygenases and therefore reduces production of prostaglandins

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16
Q

what COX is aspirin more effective at inhibiting

A

COX 1

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17
Q

what occurs when COX 1 is inhibited

A

reduces platelet aggregation and predisposes to damage of the gastric mucosa

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18
Q

where does action of aspirin occur

A

peripherally and centrally

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19
Q

do peripheral or central actions predominate for aspirin

A

peripheral

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20
Q

what are the analgesic properties of aspirin

A

it inhibits the prostaglandin synthesis in inflamed tissue by COX inhibition

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21
Q

what are the antipyretic properties of aspirin

A

prevents temperature raising effects of interleukin-1 and rise in brain prostaglandin level and so reduces elevated temperature

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22
Q

what are the anti-inflammatory properties of aspirin

A

prostaglandins are vasodilators and affect capillary permeability - apirin inhibits this

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23
Q

what are adverse effects of aspirin

A

GIT problems
hypersensitivity
overdose
aspirin burns

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24
Q

how does aspirin cause GIT problems

A

prostaglandins inhibit gastric acid secretion and also increase blood flow to gastric mucosa to help production of mucin by cells in stomach lining

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25
Q

what are hypersensitivity effects of aspirin

A

acute bronchospasm, asthma type attacks
skin rashes/ urticaria/ angioedema

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26
Q

what are effects of an overdose of aspirin

A

hyperventilation
tinnitus, deafness
vasodilation and sweating

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27
Q

what are aspirin related mucosal burns

A

direct effect of salicylic acid - when applied to the mucosa

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28
Q

who do you have to take caution with when prescribing aspirin

A

peptic ulceration
bleeding abnormalities
anitcoagulants
asthma

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29
Q

why should people with peptic ulcerations avoid taking aspirin

A

gastric or duodenal ulcer could result in perforation

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30
Q

why should patients taking anti-coagulant be cautious with taking aspirin

A

aspirin enhances warfarin and other coumarin anticoagulants and displaces warfarin from binding sites on plasma protein which increases free warfarin - increases bleeding

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31
Q

why should aspirin be avoided in pregnant women

A

causes impairment of platelet function which is increased risk of haemorrhage, increased jaundice in the baby and can prolong/ delay labour

32
Q

why should patients on steroids not be taking aspirin

A

patients on long term steroids will develop peptic ulcers - which could result in perforation

33
Q

why should patients with renal/ hepatic impairment avoid aspirin

A

aspirin is metabolised in the liver and excreted in the kidney

34
Q

what might inhibition of prostaglandin synthesis result in

A

sodium retention
reduced renal blood flow
renal failure

35
Q

what are two effects related to the kidney that NSAIDs might have

A

interstitial nephritis and hyperkalaemia

36
Q

what can occur if a breastfeeding mother takes aspirin

A

Reye’s syndrome

37
Q

what is Reye’s syndrome

A

fatty degenerative process in the liver and profound swelling in the brain

38
Q

in what groups of people is aspirin completely contra-indicated

A

children under 16
previous or active peptic ulceration
haemophilia
hypersensitivity to aspirin or NSAIDs

39
Q

what is the prescription of aspirin for odontogenic pain

A

2 x tablets, 4 x daily
300mg

40
Q

what should be prescribed to patients with peptic ulcers with odontogenic pain

A

lansoprazole - proton pump inhibitor

41
Q

what is the prescription for ibuprofen for odontogenic pain

A

1 tablet 4x daily 400mg

42
Q

what is the max dose of ibuprofen for an adult

A

2.4g

43
Q

what are the main side effects of ibuprofen

A

GIT discomfort, bleeding and ulceration
hypersensitivity reactions

44
Q

what are symptoms of ibuprofen overdose

A

nausea
vomiting
tinnitus

45
Q

how is ibuprofen overdose treated

A

activated charcoal followed by symptomatic measures

46
Q

what is paracetamol

A

a simple analgesic without any anti-inflammatory activity

47
Q

does paracetamol interact significantly with warfarin

A

no

48
Q

how does paracetamol work

A

blocks the feedback of hydroperoxides which stimulate COX activity - especially in the brain

49
Q

what is the three modes of action of paracetamol

A

analgesia
antipyretic action
no reduction in peripheral inflammation

50
Q

what is the main site of action of paracetamol

A

thalamus

51
Q

what are three contraindications of paracetamol

A

hepatic impairment
renal impairment
alcohol dependence

52
Q

what is the prescription for paracetamol for odontogenic pain

A

2 tablets 4xdaily 500mg

53
Q

what is the max dose for paracetamol

A

4g daily

54
Q

what are examples of opioid analgesics

A

codeine
dihydrocodeine
fentanyl

55
Q

where do opioid analgesics take their effect

A

they act in the spinal cord in the dorsal horn pathways

56
Q

do opioid analgesics cause peripheral or central regulation of pain

A

central

57
Q

how do opioid analgesics work

A

specific receptors that are closely associated with neuronal pathways that transmit pain to the CNS

58
Q

what are problems with opioids

A

dependence
tolerance
constipation
urinary and bile retention

59
Q

what effects do opioids have on the CNS

A

pain centre
higher centres
respiratory centre
cough centre

60
Q

what is a dental related side effect of opioids

A

dry mouth

61
Q

what are contra-indications of opioids

A

hypotension
hypothyroidism
asthma
decreased respiratory reserve
pregnant

62
Q

what is codeine

A

natural alkaloid found in opium poppy

63
Q

what is the only codeine combination on the dental list

A

dihydrocodeine

64
Q

what are routes of entry for dihydrocodeine

A

subcutaneous
intra muscular
oral

65
Q

what are side effects of dihydrocodeine

A

nausea
constipation
drowsiness

66
Q

what are the main interactions with dihydrocodeine

A

antidepressants
dopaminergics

67
Q

when should you never prescribe dihydrocodeine

A

in raised intra-cranial pressure or suspected head injury

68
Q

is dihydrocodeine effective for dental pain or post-operative dental pain

A

no

69
Q

what occurs in an opioid overdose

A

varying degrees of coma and respiratory depression and pinpoint pupils

70
Q

what is the specific antidote for opioid overdose

A

naloxone

71
Q

what is neuropathic pain in dentistry

A

trigeminal neuralgia
post-herpetic neuralgia

72
Q

what is functional pain in dentistry

A

TMJ or atypical facial pain

73
Q

what is the only neuropathic drug for dental pain we use

A

carbamazepine which is used to control trigeminal neuralgia

74
Q

what drugs can be used to treat trigeminal neuralgia

A

gabapentin
phenytoin
both not on dental list

75
Q

what are features of trigeminal neuralgia

A

severe spasms of pain
unilateral
periods of remission

76
Q

what is the prescription of carbamazepine for trigeminal neuralgia

A

starting dose 100mg 2xdaily
usual dose 200mg 3-4 times daily

BDS3 Oral Surgery (7 decks)

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