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BDS 3 - CDS - Oral Surgery > Analgesia in Oral Surgery > Flashcards

Analgesia in Oral Surgery Flashcards

1
Q

what are the main analgesics used by dental practitioners?

A
  • Aspirin (NSAID)
  • Ibuprofen (NSAID)
  • Diclofenac (NSAID)
  • Paracetamol
  • Dihydrocodeine (Opioid)
  • Carbamazepine
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2
Q

what must be taken into consideration when prescribing analgesia for a dental patient?

A
  • mechanism of action, blocks pain receptors? anti-inflammatory? etc
  • doses (BNF)
  • side effects
  • interactions
  • groups of patient to avoid
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3
Q

how are PROSTAGLANDINS involved in causing pain?

A

trauma/infection lead to breakdown of membrane phospholipids producing ARACHIDONIC ACID (broken down to PROSTAGLANDINS).

Prostaglandins sensitise tissues to inflammatory products resulting in pain

[therefore, prostaglandin decreases = control the pain]

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4
Q

what are the 3 main properties of aspirin making it effective?

A
  1. Analgesic
  2. Antipyretic (reduce fever)
  3. Anti-inflammatory
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5
Q

what is the mechanism of action of aspirin? [analgesic action]

A

INHIBITS cyclo-oxygenases, REDUCING production of PROSTAGLANDINS which means less tissue sensitivity to inflammatory products

[less tissue sensitivity = less pain]

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6
Q

how does the ANTIPYRETIC action work in aspirin?

A

aspirin prevents temp rising effects of INTERLEUKIN-1 and rise in PROSTAGLANDIN LEVELS in brain. Causing REDUCED ELEVATED temperature in fever cases.

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7
Q

how does the ANTI-INFLAMMATORY action work in aspirin?

A

reduces production of PROSTAGLANDINS = less tissue sensitivity to inflammatory agents which will reduce and prevent FURTHER inflammation

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8
Q

what are the adverse effects of aspirin?

A
  • git problems (inhibits gastric acid secretion)
  • hypersensitivity
  • overdose (metabolic acidosis)
  • aspirin burns - if left in oral mucosa [scd patients] chemical burn
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9
Q

what groups of patients should AVOID or be CAUTIOUS for aspirin?

A
  • GIT problem patients
  • bleeding abnormalities
  • patients on steroids
  • anticoagulants
  • renal/hepatic impaired patients
  • hypersensitivity to NSAIDs
  • asthma
  • children/u16s
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10
Q

what is the ibuprofen dose?

A

200-400mg orally every 4-6 hours [2.4g MAX 24/HRS]

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11
Q

what are the sideeffects of ibuprofen?

A
  1. GIT discomfort (sometimes bleeding/ulceration)
  2. Hypersensitivity reactions
  3. headaches, dizziness, renal impairment, hepatic damage, blood disorders
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12
Q

what do you do if a patient has an ibuprofen overdose?

A

use activated charcoal

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13
Q

what is the main mode of action of paracetamol?

A

Paracetamol INDIRECTLY inhibits cyclooxygenase (COX) and also reduces prostaglandin preventing pain.

results in:
analgesia
antipyretic action

EXACT MODE OF PARACETAMOL STILL UINCLEAR

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14
Q

what are the main cautions when prescribing paracetamol?

A
  1. hepatic impairment
  2. renal impairment
  3. alcohol dependence
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15
Q

what is the dose of paracetamol?

A

500mg-1000mg (4-6 hourly)

MAX DOSE 4G DAILY (8 TABLETS - 1 TABLET 500MG)

Children: depends on weight/age - see BNF

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16
Q

what does a paracetamol overdose cause in a patient?

A

hepatocellular necrosis -> liver failure -> death

go IMMEDIATELY to hospital

17
Q

what is an opioid analgesic?

A

ACTS IN THE SPINAL CORD (CENTRAL REGULATION OF PAIN)

18
Q

are opioid analgesics effect for dental pain?

A

BNF states that they are relatively ineffective in dental pain

19
Q

what are some problems from opiod analgesics?

A
  • Dependence (psychological and physical) - withdrawal
  • Tolerance (needs progressively more as body adapts to dose)
20
Q

what are side effects of opioid analgesics?

A

effects smooth muscle
- constipation
- urinary & bile retention

most common:
- drowsiness, vomiting, nausea

Larger doses = respiratory depression & hypotension

21
Q

how do opioids affect the CNS?

A

depresses:
1. pain centre (alters awareness/perception of pain)
2. higher centres
3. respiratory centres
4. cough centre

22
Q

how are opioid interactions enhanced?

A

consumption of alcohol - not good

23
Q

what are cautions needed when prescribing opioids?

A
  • hypotension
  • hypothyroidism
  • asthma
  • decreased respiratory reserve
  • pregnancy/breast feeding
24
Q

what is carbamazepine?

A

to treat epilepsy and nerve pain. neuropathic & functional pain - common in dentistry

patients with trigeminal neuralgia?

25
Q

what is trigeminal neuralgia & clinical features?

A

a sudden, severe facial pain, described as sharp, shooting or like an electric shock on the trigeminal nerve

  • trigger spot identified
  • usually unilateral

BDS 3 - CDS - Oral Surgery (8 decks)

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