Analgesia

Question 1

What analgesia are useful in control of dental pain?

Answer 1

• Ibuprofen
• Paracetamol
• Aspirin (less common now)

Question 2

What are the side effects of aspirin?

Answer 2

1. GIT problems (acute loss of protective function- mucins)
2. Hypersensitivity (acute brconchospasms, rashes)
3. Overdose - tinnitus, metabolic acidosis
4. Aspirin burns (mucosal)

Question 3

What groups should be AVOIDED in prescription of aspirin?

Answer 3

1. Peptic ulcers
2. Bleeding disorders
3. Anticoagulants (Warfarin)
4. Breastfeeding/ pregnant
5. <16 yrs
6. Hypersensitive to other NSAIDs

Question 4

What groups should be CAUTIONED in prescription of aspirin/ ibuprofen?

Answer 4

1. Pt on steroids (potential to develop peptic ulcer)
2. Renal/ hepatic
3. Asthma (ask if taken before and if problems)

Question 5

What is Reye’s Syndrome and how may it be induced?

Answer 5

Fatty degenerative process in liver

• Profound brain swelling
• Nausea, vomitting, lethergy
• Seizures, coma
• MORTALITY

<16yrs taking aspirin may induce/ via breast feeding = AVOID!!

Question 6

What is an appropriate regime for ASPIRIN for odontogenic pain in an adult?

Answer 6

5 day course

300mg (2 tablets x4 daily)

Question 7

Other than odontogenic pain, what is another indication for aspirin?

Answer 7

Thrombotic prophylaxis

• Straight after iscahemic event = dingle dose 300mg
• Maintenance = 75mg daily

Question 8

What is an appropriate regime for IBUPROFEN for odontogenic pain in an adult?

Answer 8

5 day course

400mg (1 tablet x4 daily after food)

Question 9

What is the maximum dose of ibuprofen?

Answer 9

2.4g in adults

Question 10

What are the side effects of ibuprofen?

Answer 10

1. GIT discomfort, bleeding, ulceration
2. Hypersensitivity
3. Other = dizzy, anxiety, depression, drowsiness, insomnia etc.

Question 11

What are the signs of ibuprofen over dose?

Answer 11

• Nausea
• Vomitting
• Tinnitus

Question 12

Explain COX-1 and COX-2

Answer 12

• COX-1 = produces prostaglandins responsible for platelet aggregation & protection of gastric mucosa
• COX-2 = responsible for generation of inflammatory prostaglandins

==> Aspirin blocks COX-1 more (150x)

Question 13

What are the effects of aspirin and ibuprofen?

Answer 13

1. Analgesic
2. Antipyretic
3. Anti-inflammatory
4. Metabolic
5. Platelet aggregation

Question 14

What are the effects of paracetamol?

Answer 14

1. Analgesic
2. Antipyretic
3. No effect on bleeding time/ platelet aggregation
4. No anti-inflammatory action
5. Less GIT irritant
6. No warfarin interaction

Question 15

What is paracetamol’s mode of action?

Answer 15

Blocks feedback of COX
Main site = CNS

Exact mode unclear

Question 16

What groups should be CAUTIONED in prescription of paracetamol?

Answer 16

1. Hepatic impairment
2. Renal impairment
3. Alcohol dependence

Question 17

What are the associated side effects of PARACETAMOL?

Answer 17

Rare

1. Rashes
2. Blood disorders
3. Hypotension
4. Liver damage following overdose

Question 18

What is an appropriate regime for PARACETAMOL for odontogenic pain in an adult?

Answer 18

5 day course

500mg (2 tablets x4 daily)

Question 19

What are the signs of paracetamol over dose?

Answer 19

1. Anorexia, nausea, vomiting
2. Persistent abdominal pain
3. Liver damage = jaundice, renal failure, haemorrhage, hypoglycaemia, encephalopy, death

Question 20

What drug in the DPF in the BNF is ineffective at regulating odontogenic pain?

Answer 20

Dihydrocodeine

• Acts on CNS –> alters awareness/ perception of pain