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Oral Surgery BDS3 > Analgesia in Oral Surgery > Flashcards

Analgesia in Oral Surgery Flashcards

1
Q

what drugs can we prescribe for pain in dentistry

A

aspirin
ibuprofen
diclofenac
dihydrocodeine
carbamazepine
paracetamol

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2
Q

what is the arachidonic pathway of pain

A

trauma and infection lead to breakdown of membrane phospholipids producing arachidonic acid
this can be broken down to form prostaglandins
these sensitise tissues to other inflammatory products which results in pain

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3
Q

what is the action of prostaglandins

A

sensitise tissues to other inflammatory products such as leukotrienes

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4
Q

what are the properties of aspirin

A

analgesic
antipyretic
antiinflammatory
metabolic

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5
Q

what is the mechanism of action of aspirin

A

inhibits COX1 and COX2 to reduce production of prostaglandins

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6
Q

what does COX1 inhibition do

A

reduce platelet aggregation

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7
Q

what is the analgesic action of aspirin

A

peripheral action predominates
results from inhibition of prostaglandin synthesis in inflamed tissues

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8
Q

what is the antipyretic properties of aspirin

A

prevents the temperature raising effects of IL1 and rise in brain prostaglandin levels so reduces elevated temperature in fever

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9
Q

what is the antiinflammatory action of aspirin

A

as they inhibit production of prostaglandins (which are vasodilators) they can reduce redness and swelling

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10
Q

what are the adverse effects of aspirin

A

GIT problems
hypersensitive
overdose - tinnitus, metabolic acidosis
aspirin burns - mucosal

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11
Q

how does aspirin cause GIT problems

A

as prostaglandins inhibit gastric acid secretion and increase blood flow through gastric mucosa and help production of mucin cells
aspirin stops this by inhibiting prostaglandin secretion

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12
Q

what hypersensitivity reactions can occur due to aspirin

A

acute bronchospasm/asthma attacks
skin rashes/urticaria

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13
Q

what would overdose of aspirin present as

A

hyperventilation
tinnitus, deafness
vasodilation and sweating
metabolic acidosis
coma

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14
Q

how does aspirin cause mucosal burns

A

due to salicylic acid

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15
Q

how do you prevent mucosal aspirin burns

A

make sure aspirin is taken with water

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16
Q

what are the groups to avoid when prescribing aspirin

A

peptic ulcers
epigastric pain
bleeding abnormalities
anticoagulants
pregnant/breast feeding
patients on steroids
renal/hepatic impairment
under 16s
asthma
allergies to other NSAIDs
taking other NSAIDs
elderly

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17
Q

why should people on anticoagulants avoid aspirin

A

it enhances warfarin and other coumarin anticoagulants as it displaces warfarin from binding sites of plasma proteins and increases free warfarin

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18
Q

why should pregnant people not take aspirin

A

increased risk of haemorrhage
increased risk of jaundice in baby
prolong/delay labour

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19
Q

why should patients on steroids avoid taking aspirin

A

25% of steroid patients will develop peptic ulcer
aspirin can result in perforation of the ulcer

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20
Q

where is aspirin metabolised and excreted

A

metabolised in liver
excreted in kidney

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21
Q

with regards to the kidneys, what might inhibition of renal prostaglandin result in

A

sodium retention
reduced renal blood flow
renal failure

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22
Q

what is reye’s syndrome

A

fatty degenerative process in liver causing profound swelling in the brain

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23
Q

when is aspirin completely contraindicated

A

children and adolescents under 16
previous or active peptic ulceration
haemophilia
hypersensitivity to aspirin or any other NSAID

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24
Q

what is the prescription for aspirin

A

aspirin dispersible tablets 300mg
two tablets four times daily, preferably after food for five days

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25
Q

what is the prescription for ibuprofen

A

ibuprofen tablets 400mg
20 tablets
take one tablet four times daily, preferably after food for five days

26
Q

what is the max dose of ibuprofen

A

2.4g

27
Q

when do you take caution when prescribing ibuprofen

A

previous or active peptic ulceration
elderly
pregnancy and lactation
renal, cardiac or hepatic impairment
history of hypersensitivity to aspirin and NSAIDs
ashtma
patient taking other NSAIDs
patient on long term systemic steroids

28
Q

what are the side effects of ibuprofen

A

GIT discomfort, bleeding and ulceration
hypersensitivity reactions

29
Q

name some potential drug interactions for ibuprofen

A

ACE inhibitors
beta blockers
antibiotics
anticoagulants

30
Q

what are the symptoms of an ibuprofen overdose

A

nausea
vomiting
tinnitus

31
Q

what do you do if more than 400mg/kg has been ingested within preceding hour

A

activated charcoal followed by symptomatic measures

32
Q

what are the affects of paracetamol

A

analgesic
antipyretic
little or no antiinflammatory action
less irritable to GIT
no effects on bleeding time
does not interact with warfarin
suitable for children

33
Q

what is the mode of action of paracetamol

A

inhibit positive feedback of hydroperoxides which inhibits COX

34
Q

what does the mode of action of paracetamol result in

A

analgesia
antipyretic action
no reduction in peripheral inflammation

35
Q

what is the main site of action of paracetamol

A

thalamus

36
Q

why does paracetamol not have an affect on gastric mucosa

A

it does not appear to have much effect on peripheral prostaglandins

37
Q

what are the cautions when prescribing paracetamol

A

hepatic impairment
renal impairment
alcohol dependence

38
Q

what are paracetamol side effects

A

rashes
blood disorders
hypotension reported on infusion
liver damage following overdose

39
Q

what drug interactions does paracetamol have

A

anticoagulants
cytotoxics
domperidone
lipid regulating drugs
metoclopramide

40
Q

what is the prescription for paracetamol

A

paracetamol tablets 500mg
40 tablets
2 tablets four times daily for five days

41
Q

what is the max dose of paracetamol

A

4g daily (8 tablets)

42
Q

how much paracetamol would cause an overdose

A

150mg/kg

43
Q

where does opioid analgesia work

A

in spinal cord in dorsal horn pathways

44
Q

how do opioids work

A

via specific receptors which are associated with neuronal pathways that transmit pain to CNS

45
Q

what is the dependence issue with opioids

A

withdrawal will lead to psychological cravings and patient will be physically ill

46
Q

what is the tolerance issue with opioids

A

dose of drug needs to be progressively increased

47
Q

what are the effects of opioids on smooth muscle

A

constipation
urinary and bile retention

48
Q

what are the cns effects of opioids

A

depresses:
- pain centre
- higher centres
- respiratory centre
- cough centre

49
Q

what are the most common side effects of opioids

A

nausea
vomiting
drowsiness

sometimes produce respiratory depression and hypotension

50
Q

what are the cautions with opioids

A

hypotension
hypothyroidism
asthma
decreased respiratory reserve
pregnancy/breastfeeding
may cause coma in hepatic impairment
renal impairment
elderly
convulsive disorders
dependence

51
Q

what are the contraindications to opioids

A

acute respiratory depression
acute alcoholism
raised intracranial pressure

52
Q

what is the only codeine on the dental list

A

dihydrocodeine

53
Q

what is the dose of dihydrocodeine

A

30mg every four to six hours as necessary

54
Q

what are the side effects of dihydrocodeine

A

nausea/vomiting
constipation
drowsiness

55
Q

what are the interactions of dihydrocodeine

A

antidepressants
dopaminergics

56
Q

when would you never prescribe dihydrocodeine

A

raised intracranial pressure/suspected head injury

57
Q

when would you use dihydrocodeine

A

moderate to severe pain but it is of little value for dental pain

58
Q

what is the antidote for opioid overdose

A

naloxone

59
Q

what drug is used for neuropathic pain

A

carbamazepine

60
Q

what are the clinical features of trigeminal neuralgia

A

severe spasms of pain
usually unilateral
older age group
trigger spot identified
females more than males
periods of remission
recurrences often greater severity

Oral Surgery BDS3 (8 decks)

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