Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS3 ORAL SURGERY > Analgesia in Denistry > Flashcards

Analgesia in Denistry Flashcards

1
Q

What analgesia medications are listed for use under the BNF Dental Practitioners Formulary?

A
  • Aspirin (NSAID)
  • Ibuprofen (NSAID)
  • Diclofenac (NSAID)
  • Paracetamol
  • Dihydrocodeine (Opioid)
  • Carbamazepine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What role do prostaglandins play in a patients pain?

A

They do not cause pain directly BUT they SENSITISE TISSUES TO OTHER INFLAMMATORY PRODUCTS such as leukotrienes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Discuss the pain pathway in terms of the production of prostaglandins:

A
  • trauma and infections lead to breakdown of phospholipid cell membrane
  • causes production of ARACHIDONIC ACID
  • this is broken down to form PROSTAGLANDINS
  • prostaglandins sensitise the tissues to other inflammatory products which results in pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of medication is Aspirin?

A

NSAID analgesic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the properties of aspirin?

A
  1. analgesic
  2. antipyretic
  3. anti-inflammatory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is meant when a medication is described as ‘antipyretic’?

A

Fever reducing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Aspirins mechanism of action?

A

Inhibits cyclo-oxygenases (COX-1 & 2)
- this REDUCES PRODUCTION OF PROSTAGLANDINS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why can aspirin cause damage of the gastric mucosa?

A
  • inhibits production of prostaglandins
  • prostaglandins stimulate the secretion of mucus (which helps to protect the stomach lining from stomach acid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the analgesic properties of aspirin?

A
  • peripheral actions predominate (but central actions also present)
  • analgesic action results from INHIBITION OF PROSTAGLANDIN SYNTHESIS in inflamed tissues (cyclo-oxygenase inhibition)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the antipyretic properties of aspirin?

A
  • prevents the temperature raising effects of interleukin-1 and the rise in brain prostaglandin levels (by inhibiting COX enzymes)
  • reduces elevated temperature in fever !!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the anti-inflammatory properties of aspirin?

A
  • prostaglandins are vasodilators and also affect capillary permeability
  • aspirin prevents prostaglandin production
  • this acts as an anti-inflammatory and will reduce redness & swelling and pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some adverse effects of aspirin?

A
  1. GIT problems
  2. Hypersensitivity
  3. Overdose (tinnitus or metabolic acidosis)
  4. Mucosal aspirin burns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does aspirin cause GIT problems?

A

prevents prostaglandin secretion and prostaglandins:
- inhibit gastric acid secretion
- increase blood flow through gastric mucosa
- help productive of mucin by cells in stomach lining

THEREFOR ASPIRIN PREVENTS ALL OF THIS AND LEADS TO GIT PROBLEMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In which patients must care be taken when prescribing aspirin?

A

Patient with GIT problems
- ulcers
- gastro-oesophageal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why must care be taken when prescribing aspirin to asthmatics?

A

Aspirin can cause hypersensitivity and lead to
- acute bronchospasm/asthma type attacks
- skin rashes/urticaria/angioedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can occur if a patient overdoses on aspirin?

A
  • hyperventilation
  • tinnitus
  • vasodilation & sweating
  • METABOLIC ACIDOSIS***
  • coma (uncommon)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why can mucosal burns occur in patients prescribed aspirin?

A
  • aspirin applied locally to oral mucosa results in chemical burns (patients with impaired swallowing etc)
  • direct effect of salicylic acid
  • aspirin has NO TOPICAL EFFECT

*ensure aspirin is taken with water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In which patient groups should aspirin prescription be avoided/caution?

A
  • peptic ulceration
  • epigastric pain
  • bleeding abnormalities
  • anticoagulants
  • pregnancy/breastfeeding
  • patients on steroids
  • renal/hepatic impairment
  • children/adolescents under 16
  • asthma
  • hypersensitivity to other NSAIDs
  • elderly
  • G6PD-deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does aspirin act on Warfarin/anticoagulant drugs?

A

Aspirin ENHANCES WARFARIN
- displaces warfarin from binding sites on plasma proteins
- increases free warfarin (the majority of warfarin is bound/inactive… if more is released this will become active and increase bleeding tendency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why should aspirin prescription be avoided in pregnant patients?

A

Should be avoided especially in 3rd trimester
- aspirin can cause impairment of platelet function
- leads to haemorrhage, jaundice in baby and can prolong/delay baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is aspirin contraindicated in breastfeeding?

A

Can cause Reye’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why should aspirin be avoided in patients taking steroid medications?

A

Approx. 25% of long term systemic steroid patients will develop an ulcer
- aspirin may result in perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why should aspirin be avoided in renal/hepatic impaired patients?

A
  • aspirin metabolised in liver and excreted mainly in kidneys
  • renal impairment = excretion may be reduced/delayed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is Reye’s Syndrome? What can cause it?

A

Very rare and very serious condition in children under 16 (high mortality rate of 50%)
- fatty degenerative process in liver
- causes profound swelling in brain (causes brain damage & encephalopathy)

ASPIRIN CAN CAUSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why are elderly patients usually more susceptible to drug induced side effects?

A
  • often smaller / have smaller circulating blood volume
  • on other medications
  • have other medical problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What groups of patients is aspirin COMPLETELY CONTRAINDICATED IN?

A
  • children & adolescents under 16 years; breastfeeding mothers
  • previous or active peptic ulceration
  • haemophilia
  • hypersensitivity to aspirin or other NSAID
27
Q

For mild to moderate odontogenic or inflammatory pain, what is the appropriate aspirin prescription?

A

Take two 300mg tablets, 4x daily after food, for 5 days

28
Q

What is the maximum daily dose of aspirin?

A

4g

29
Q

You need to prescribe aspirin to a patient with a history of previous or active peptic ulcer disease, what do you also prescribe? Give the prescription.

A

Proton pump inhibitor
- Lansoprazole 15mg capsules
- 1 capsule per day
- 5 days (same as aspirin)

30
Q

What type of drug is Ibuprofen?

A

NSAID

31
Q

How does Ibuprofen differ from Aspirin?

A
  • less effects on platelets (eg not used therapeutically for this)
  • lower risk of irritation to gastric mucosa
  • paediatric suspension available
32
Q

What is the maximum daily adult dose for Iburpofen?

A

2.4g

33
Q

For mild to moderate odontogenic, post-op or inflammatory pain, what is an appropriate Ibuprofen regimen you might prescribe?

A

One 400mg tablet, 4x daily after food, for 5 days

34
Q

In which patients must you be cautious when prescribing ibuprofen?

A
  • previous or active peptic ulceration
  • elderly
  • pregnancy and lactation
  • renal, cardiac or hepatic impairment
  • history of hypersensitivity to aspirin or other NSAID
  • asthma
  • patient taking other NSAID
  • patient on long term systemic steroid
35
Q

What are some side effects that may be seen in patients taking Ibuprofen?

A
  • GIT discomfort (occasionally bleeding & ulceration)
  • hypersensitivity reactions (rashes/angioedema/bronchospasm)
  • headache
  • dizziness
  • drowsiness
36
Q

What are examples of potential drug interactions that can occur with Ibuprofen?

A
  • ACE inhibitors
  • antibiotics
  • anticoagulants
  • antidepressants
  • corticosteroids
  • diuretics
  • beta blockers
  • calcium channel blockers
  • cyclosporin
  • clopidogrel (antiplatelet)
37
Q

What are the symptoms of Ibuprofen overdose?

A
  • nausea
  • vomiting
  • tinnitus
38
Q

If you suspect that a patient is overdosing on Ibuprofen (more than 400mg/kg in preceding hour), what should you do?

A

Give the patient activated charcoal
- charcoal binds to the ibuprofen preventing it from being absorbed

39
Q

What can paracetamol be used for?

A
  • analgesic
  • antipyretic
40
Q

How does Paracetamol differ from Aspirin or Ibuprofen?

A
  • little or no anti-inflammatory action
  • no effects on bleeding time
  • less irritant to GIT
  • suitable for children
41
Q

What is Paracetamols mode of action?

A
  • central nervous system main site of action
  • inhibits COX by preventing positive feedback of hyperoxides (which are generated from the metabolism of arachidonic acid by COX)
42
Q

Why is Paracetamol more suitable for GIT patients?

A

Paracetamol primarily inhibits COX-2 and has little effect on COX-1
- COX-1 is important for maintaining the protective lining of the stomach & normal function of blood clotting

43
Q

In which patients should the prescription of paracetamol be cautioned?

A
  • hepatic impairment
  • renal impairment
  • alcohol dependence
44
Q

What are the side effects of taking paracetamol?

A

Side effects RARE
- rashes
- blood disorders
- hypotension
- liver damage following overdose

45
Q

What drugs interact with paracetamol?

A
  • anticoagulants (prolonged use of paracetamol possibly enhances anticoagulant effects)
  • cytotoxics
  • domperidone
  • lipid-regulating drugs
  • metoclopramide
46
Q

What would the prescription of Paracetamol for pain be in adults?

A

2x tablets, 4x daily (4-6 hours), for 5 days

47
Q

What is the maximum daily dose of paracetamol in patients?

A

4g

48
Q

Why must you always warn patients of the daily maximum dose of Paracetamol?

A

10-15g (20-30 tablets) or 150mg/kg*** of paracetamol taken within 24 hours can cause severe:
- hepatocellular necrosis
- renal tubular necrosis (less frequent)

49
Q

When is liver damage from paracetamol overdose at its maximum point?

A

3-4 days AFTER ingestion
- leads to liver failure and DEATH

50
Q

How do opioid analgesics work?

A

Act in the spinal cord
- especially in dorsal horn pathways
- central regulation of pain

51
Q

What long-term problems are associated with prescription of opioid medications?

A
  • Dependency (withdrawal of drug will lead to psychological cravings and physical illness)
  • Tolerance (dose needs to be progressively increased)
52
Q

Opioids affect smooth muscle, what can this cause in patients?

A
  • constipation
  • urinary and bile retention
53
Q

What are the side effects of opioids?

A
  • nausea/vomiting/drowsiness
  • dry mouth
  • sweating
  • headache
  • bradycardia
  • rashes
  • palpitations
  • mood changes
54
Q

What can cause an enhanced effect of opioids?

A

alcohol

55
Q

In which patients are opioids contraindicated?

A
  • acute respiratory depression
  • acute alcoholism
  • raised intracranial pressure/head injury
56
Q

In which patients should opioids be cautioned?

A
  • hepatic impairment
  • renal impairment
  • elderly and debilitated
  • convulsive disorders
57
Q

What is a common side effect of Codeine?

A

constipation

58
Q

What dosage would you prescribe when giving Dihydrocodeine?

A

30mg every 4-6 hours as necessary

59
Q

What are the drug interactions of Dihydrocodeine?

A
  • antidepressants
  • dopaminergics (Parkinsonism)
60
Q

Which patients should Dihydrocodeine be cautioned in?

A
  • hypotension
  • asthma
  • pregnancy/lactation
  • renal/hepatic disease
  • elderly
61
Q

If you suspect a patient is experiencing opioid overdose, what is the antidote?

A

NALOXONE

62
Q

For which condition may a dentist prescribe carbamazepine?

A

Trigeminal neuralgia

63
Q

What is the dosage of Carbamazepine to treat trigeminal neuralgia?

A

Starting dose: 100mg once or twice daily
—> increase gradually
Usual dose: 200mg 3-4 times daily, up to 1.6g daily in some patients

BDS3 ORAL SURGERY (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions