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Oral Surgery > Analgesia in Oral Surgery (c) > Flashcards

Analgesia in Oral Surgery (c) Flashcards

1
Q

When should systemic analgesics be started?

A

systemic analgesics should be started before the local anaesthetic wears off

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2
Q

What analgesics are contained within the Dental Practitioner’s Formulary?

A

analgesics in the Dental Practitioner’s Formulary:

  • aspirin (NSAID)
  • ibuprofen (NSAID)
  • diclofenac (NSAID)
  • paracetamol
  • dihydrocodeine (opoid)
  • carbamazepine
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3
Q

What do the following drugs have in common?:

  • aspirin
  • ibuprofen
  • diclofenac
A

aspirin, ibuprofen and diclofenac are all NSAIDs

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4
Q

Is paracetamol an NSAID?

A

no, paracetamol is not an NSAID

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5
Q

What type of drug is dihydrocodeine?

A

dihydrocodeine is an opioid

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6
Q

Aspirin has X anti-inflammatory properties to paracetamol

A

X - superior

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7
Q

Aspirin is less commonly used in dentistry now, X is more commonly used

A

X - ibuprofen

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8
Q

Can aspirin be bought over the counter?

A

yes, aspirin can be bought over the counter

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9
Q

What properties does aspirin have?

A

aspirin has the following properties:

  • analgesic
  • antipyretic
  • anti-inflammatory
  • anti-platelet
  • metabolic
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10
Q

What is acetylsalicylic acid also known as?

A

acetylsalicylic acid = aspirin

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11
Q

Trauma and infection lead to the breakdown of membrane X, producing arachidonic acid

A

X - phospholipids

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12
Q

Trauma and infection lead to the breakdown of membrane phospholipids, producing what?

A

trauma and infection lead to the breakdown of membrane phospholipids, producing arachidonic acid

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13
Q

What can arachidonic acid be broken down to form?

A

arachidonic acid can be broken down to form prostaglandins

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14
Q

What can be broken down to form prostaglandins?

A

arachidonic acid can be broken down to form prostaglandins

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15
Q

Arachidonic acid can be broken down to form X, which sensitise tissues to other inflammatory products which which results in pain

A

X - prostaglandins

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16
Q

Do prostaglandins directly cause pain?

A

no, prostaglandins do not directly cause pain

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17
Q

Prostaglandins do not directly cause pain but they sensitise tissues to other X such as leukotrienes

A

X - inflammatory products

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18
Q

What will happen if prostaglandin production decreases?

A

if prostaglandin production decreases then this will moderate pain

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19
Q

What does aspirin reduce the production of?

A

aspirin reduces the production of prostaglandins

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20
Q

Aspirin reduces the production of prostaglandins and inhibits X

A

X - COX 1 and 2 (cyclo-oxygenases 1 and 2)

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21
Q

Is aspirin more effective at inhibiting COX 1 or 2?

A

aspirin is more effective at reducing COX 1

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22
Q

X inhibition by aspirin reduces platelet aggregation and predisposes to damage of the gastric mucosa

A

X - COX-1

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23
Q

Aspirin is mainly a X acting agent

A

X - peripherally

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24
Q

The analgesic action of NSAIDs is exerted both peripherally and X

A

X - centrally

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25
Q

The analgesic action of aspirin results from inhibition of prostaglandin synthesis in X

A

X - inflamed tissues

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26
Q

Aspirin prevents the temperature X effects of interleukin-1

A

X - rising

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27
Q

Aspirin prevents the temperature rising effects of X

A

X - interleukin 1

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28
Q

Aspirin prevents the temperature raising effects of interleukin-1 and the rise in brain X levels

A

X - prostaglandin

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29
Q

How does aspirin reduce elevated temperature in fever?

A

aspirin reduces elevated temperature in a fever by preventing:

  • temperature raising effects of interleukin-1
  • the rise in brain prostaglandin levels
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30
Q

Does aspirin reduce normal body temperature?

A

no, aspirin does not reduce normal body temperature

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31
Q

Prostaglandins are X so therefore affect capillary permeability

A

X - vasodilators

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32
Q

Is aspirin a good anti-inflammatory?

A

yes, aspirin is a good anti-inflammatory and will reduce redness and swelling as well as pain at the site of injury

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33
Q

What does aspirin do to basal metabolic rate?

A

aspirin increases basal metabolic rate

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34
Q

What does aspirin do to blood sugar?

A

aspirin decreases blood sugar

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35
Q

What are adverse effects of aspirin?

A

aspirin - adverse effects:

  • GIT problems
  • hypersensitivity
  • overdose
    • tinnitus
    • metabolic acidosis
  • aspirin burns (mucosal)
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36
Q

Where are most GIT problems caused from aspirin found?

A

most GIT problems caused by aspirin are found on the mucosal lining of the stomach

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37
Q

Prostaglandins X blood flow through the gastric mucosa

A

X - increase

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38
Q

Prostaglandins help production of X by cells in the stomach lining (cytoprotective action)

A

X - mucin

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39
Q

Patients with what types of GIT problems should care be taken with when giving aspirin?

A

GIT problems to be careful of when using aspirin:

  • ulcers
  • gastro-oesophageal reflux
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40
Q

What are hypersensitivity reactions that may occur due to the use of aspirin?

A

aspirin - possible hypersensitivity reactions:

  • acute bronchospasm/asthma type attacks
  • minor skin rashes
  • other allergies
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41
Q

When prescribing aspirin, what condition should you be being mindful of (thinking about hypersensitivity)?

A

take care when prescribing aspirin to asthmatics

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42
Q

What can happen in aspirin overdose?

A

adverse effects of aspirin overdose:

  • hyperventilation
  • tinnitus/deafness
  • vasodilation and sweating
  • metabolic acidosis (can be life threatening)
  • coma (uncommon)
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43
Q

Aspirin can casue mucosal burns due to the direct effect of X

A

X - salicylic acid

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44
Q

If aspirin is applied locally to oral mucosa, what does it result in?

A

if aspirin is applied locally to oral mucosa, it results in chemical burns

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45
Q

Does aspirin have a topical effect?

A

no, aspirin does not have a topical effect

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46
Q

What should aspirin be taken with?

A

aspirin should be taken with water

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47
Q

What general groups of people should you apply caution or implement avoidance with when prescribing aspirin?

A

aspirin - groups to avoid/be cautious of:

  • peptic ulceration
  • epigastric pain
  • bleeding abnormalities
  • anticoagulants
  • pregnancy/breastfeeding
  • patients on steroids
  • renal/hepatic impairment
  • children and adolescents under 16 years old
  • asthma
  • hypersensitivity to other NSAIDs
  • taking other NSAIDs
  • elderly
  • G6PD-deficiency
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48
Q

Why should aspirin be avoided in patients with peptic ulceration?

A

aspirin should be avoided in patients with peptic ulceration as their gastric or duodenal ulcer could perforate

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49
Q

Aspirin X warfarin and other coumarin anticoagulants

A

X - enhances

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50
Q

How does aspirin enhance warfarin and other coumarin anticoagulants?

A

aspirin enhances warfarin and other coumarin anticoagulants as it displaces warfarin from binding sites on plasma proteins

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51
Q

Aspirin X free warfarin in patients on warfarin

A

X - increases

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52
Q

The majority of warfarin is X (inactive)

A

X - bound

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53
Q

The majority of warfarin is bound (X)

A

X - inactive

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54
Q

The majority of warfarin is bound (inactive). If more is released then this will become active, X bleeding tendency

A

X - increasing

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55
Q

Aspirin should be avoided in pregnancy (especially in the X trimester) and lactation

A

X - 3rd

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56
Q

Why shoudl aspirin especially be avoided in the 3rd trimester of pregnancy?

A

aspirin should especially be avoided in the 3rd trimester of pregnancy as this is near the time of delivery and may cause impairment of platelet function

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57
Q

Why is aspirin contraindicated in breastfeeding?

A

aspirin is contraindicated in breastfeeding as it has been known to cause Reye’s syndrome

58
Q

Why should patients on steroids not be prescribed aspirin?

A

patients on steroids should not be prescribed aspirin as approximately 25% of patient on steroids long term will develop a peptic ulcer. If this ulcer is undiagnosed, aspirin may result in a perforation

59
Q

Where is aspirin metabolism carried out?

A

aspirin metabolism is carried out in the liver

60
Q

Where is aspirin mainly excreted from?

A

aspirin is mainly excreted from the kidney

61
Q

What can be said about aspirin excretion if there is renal impairment?

A

if there is renal impairment, aspirin excretion may be reduced or delayed

62
Q

Prostaglandins X and PGI2 are powerful vasodilators synthesised in the renal medulla and glomeruli and are involved in the control of renal blood flow and excretion of salt and water

A

X - PGE2

63
Q

Prostaglandins PGE2 and PGI2 are powerful X synthesised in the renal medulla and glomeruli respectively and are inolved in the control of renal blood flow and excretion of salt and water

A

X - vasodilators

64
Q

What may inhibition of renal prostaglandins synthesis may result in?

A

inhibition of renal prostaglandin synthesis may result in:

  • sodium retention
  • reduced renal blood flow
  • renal failure
65
Q

What is prolonged analgesic abuse over a period of years associated with?

A

prolonged analgesic abuse over a period of years is associated with papillary necrosis and chronic renal failure

66
Q

What is Reye’s syndrome?

A

Reye’s syndrome is a fatty degenerative process in the liver

67
Q

Reye’s syndrome leads to profound X in the brain

A

X - swelling

68
Q

Are NSAIDs completely ocntraindicated in asthmatics?

A

no, NSAIDs are not completely contraindicated in asthmatics as some asthmatics have no problem with them

69
Q

Is aspirin a contraindication in patients with a history of hypersensitivity to aspirin or another NSAID?

A

yes, aspirin is a contraindication in patients with a history of hypersensitivity to aspirin or other NSAIDs

70
Q

What can be said about the risk of side effects when NSAIDs are taken in combination?

A

when NSAIDs are taken in combination, there is an increased risk of side effects

71
Q

Elderly patients are X susceptible to drug induced side effects in general

A

X - more

72
Q

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

A

elderly patients are more susceptible to drug induced side effects in general as they often:

  • have a smaller circulating blood volume
  • are smaller in size
  • are on other medications
  • have other medical problems
73
Q

Wha are individuals with G6PD-deficiency susceptible to developing?

A

individuals with G6PD-deficiency are susceptible to developing acute haemolytic anaemia on taking a number of common drugs

74
Q

Aspirin carries a possible risk of X in some G6PD-deficient individuals

A

X - haemolysis

75
Q

In what groups of people is aspirin definitely contraindicated?

A

aspirin is CONTRAINDICATED in the following groups:

  • children and adolescents under 16 years old (Reye’s syndrome)
  • breastfeeding mothers (Reye’s syndrome)
  • previous or active peptic ulceration
  • haemophilia
  • hypersensitivity to aspirin or any other NSAID
76
Q

What is long term use of ibuprofen associated with an increased risk of?

A

long term use of ibuprofen is associated with an increased risk of cardiac events

77
Q

Is ibuprofen an NSAID?

A

yes, ibuprofen is an NSAID

78
Q

Ibuprofen has X of an effect on platelets compared to aspirin

A

X - less

79
Q

Ibuprofen is an irritant to gastric mucosa, but has a X risk than aspirin

A

X - lower

80
Q

What is the maximum dose of ibuprofen in adults?

A

the maximum dose of ibuprofen in adults is 2.4g

81
Q

What groups should you give caution to when prescribing ibuprofen?

A

give caution when prescribing ibuprofen to the following groups:

  • previous or active peptic ulceration
  • elderly
  • pregnancy and lactation
  • renal, cardiac or hepatic impairment
  • history of hypersensitivity to aspirin and other NSAIDs
  • asthma
  • patients taking other NSAIDs
  • patients on long term systemic steroids
82
Q

What are some side effects of ibuprofen?

A

ibuprofen side effects:

  • GIT discomfort, occasionally bleeding and ulceration
  • hypersensitivity reactions such as rashes, angioedema and bronchospasm
  • others:
    • headache
    • dizziness
    • nervousness
    • depression
    • drowsiness
    • insomnia
    • vertigo
    • hearing disturbance/tinnitus
    • photosensitivity
    • haematuria
    • blood disorders
    • fluid retention
    • renal impairment
    • hepatic damage
    • pancreatitis
    • eye changes
    • Stevens-Johnson syndrome
83
Q

What are symptoms of ibuprofen overdose?

A

symptoms of ibuprofen overdose:

  • nausea
  • vomiting
  • tinnitus (more serious toxicity very uncommon)
84
Q

What is indicated if more than 400mg/kg of ibuprofen has been ingested within the preceding hour?

A

activated charcoal followed by symtomatic measures are indicated if more than 400mg/kg of ibuprofen has been ingested within the preceding hour

85
Q

What do NSAIDs inhibit?

A

NSAIDs inhibit cyclo-oxygenases

86
Q

NSAIDs inhibit cyclo-oxygenases and so reduce X (which sensitise the tissues to other inflammatory mediators, resulting in pain)

A

X - prostaglandins

87
Q

COX1 is the cyclo-oxygenase predominantly responsible for catalysing the reaction that produces prostaglandins associated with what?

A

COX1 is the cyclo-oxygenase predominantly responsbile for catalysing the reaction that produces prostaglandins associated with:

  • platelet aggregation
  • protection of the gastric mucosa
88
Q

COX2 is the enzyme responsible for the generation of most of what?

A

COX2 is the enzyme responsible for the generation of most of the inflammatory prostaglandins

89
Q

What do the actions of the formed prostaglandins depend on?

A

the actions of the formed prostaglandins depends on:

  • the pathological situation
  • whether they are formed by COX1 or COX2
  • whether they are formed in excessive amounts
90
Q

Should you use more than one oral NSAID at a time?

A

no, you should not use more than one oral NSAID at a time

91
Q

What is an example of a selective COX2 inhibitor?

A

celecoxib (celebrex) is a selective COX2 inhibitor

92
Q

What patients may COX2 selectives be chosen to manage dental pain in?

A

COX2 selectives should be chosen to manage dental pain only in patients at a high risk of gastric or duodenal ulceration (e.g. those with a history of a peptic ulcer)

93
Q

Do highly selective COX2 inhibitors have an effect on platelet aggregation?

A

no, highly selective COX2 inhibitors do not have an effect on platelet aggregation

94
Q

What is the name of a simple analgesic without the anti-inflammatory activity?

A

paracetamol is a simple analgesic without the anti-inflammatory activity

95
Q

What drug is also known as acetaminophen?

A

acetaminophen = paracetamol

96
Q

X are generated from the metabolism of arachidonic acid by COX and exert a positive feedback to stimulate COX activity

A

X - hydroperoxides

97
Q

Hydroperoxides are generated from the metabolism of arachidonic acid by COX and exert a positive feedbak to stimulate COX activity. This feedback is blocked by X, thus indriectly inhibiting COX (especially in the brain)

A

X - paracetamol

98
Q

A small component of the analgesic action of all NSAIDs is the reduction of X in the pain pain pathways of the CNS (such as the thalamus) - this is the main site of action of paracetamol

A

X - prostaglandins

99
Q

What is the main action of paracetamol?

A

the main action of paracetamol is the reduction of prostaglandins in the pain pathways of the central nervous system (such as in the thalamus)

100
Q

Since paracetamol does not appear to have much effect on peripheral prostaglandins, there is little/no X irritation

A

X - gastric mucosal

101
Q

Is there gastric mucosal irritation with paracetamol?

A

there is little/no gastric mucosal irritation with paracetamol

102
Q

Why is paracetamol considered a “safe analgesic”?

A

paracetamol is considered a “safe analgesic” as there is little/no gastric mucosal irritation

103
Q

What groups of people should you be cautious of when prescribing paracetamol?

A

cautions when prescribing paracetamol to the following groups:

  • hepatic impairment
  • renal impairment
  • alcohol dependence
104
Q

Side effects of paracetamol are rare, but what are possible side effects?

A

possible side effects with paracetamol:

  • rashes
  • blood disorders
  • hypotension reported on infusion
  • liver damage (and, less frequently, kidney damage) following overdose
105
Q

What does paracetamol have interactions with?

A

paracetamol interactions:

  • anticoagulants (prolonged regular use of paracetamol possibly enhances the anticoagulant effects of the coumarins)
  • cytotoxics
  • domeperidone
  • lipid-regulating drugs
  • metoclopramide
106
Q

What warning should you always give patients with regards to paracetamol?

A

with regards to paracetamol, always warn patients about the maximum dose and emphasise that they should not exceed this

107
Q

As little as 10-15g (20-30 tablets) or 150mg/kg of paracetamol taken within 24 hours may cause severe X and, less frequently, renal tubular necrosis

A

X - hepatocellular necrosis

108
Q

What should you do with patients who have taken an overdose of paracetamol?

A

if a patient has taken an overdose of paracetamol, you should transfer them to hospital immediately

109
Q

What can be said about the early symptoms of paracetamol overdose?

A

there is a lack of significant early symptoms of paracetamol overdose

110
Q

Does co-codamol contain paracetamol?

A

yes, co-codamol contains paracetamol

111
Q

Does co-proxamol contain paracetamol?

A

yes, co-proxamol contains paracetamol

112
Q

What opioid analgesic are dentists allowed to prescribe?

A

dentists can prescribe dihydrocodeine, whcih is an opioid analgesic

113
Q

Where do opioid analgesics act?

A

opioid analgesics act in the spinal cord

114
Q

What is the term used for both naturally occurring and synthetic molecules that produce their effects by combining with opioid receptors?

A

opioids is the term used for both naturally occurring and synthetic molecules that produce their effects by combining with opioid receptors

115
Q

Are opioid analgesics effective in dental pain?

A

opioids analgesics are relatively ineffective in dental pain

116
Q

What is opioid dependence?

A

opioid dependence is when a patient has withdrawal of the drug and this will lead to psychological cravings and the patient will also be physically ill

117
Q

What is opioid tolerance?

A

opioid tolerance is when an increased dose of the drug is needed to be given to achieve the same effects

118
Q

What effects do opioids have on smooth muscle?

A

effects of opioids on smooth muscle:

  • constipation (can occur after a few doses of dihydrocodeine)
  • urinary and bile retention
119
Q

What do opioid analgesics depress?

A

opioid analgesics have a CNS effect and depress:

  • pain centre (alters awareness/perception of pain)
  • higher centres
  • respiratory centre
  • cough centre
  • vasomotor
120
Q

What do CNS effects do opioid analgesics stimulate?

A

opioid analgesics ahve CNS effects and stimulate:

  • vomiting centre (dihydrocodeine often causes nausea and vomiting which limits its value in dental pain)
  • salivary centre
  • pupillary constriction
121
Q

What are the most common side effects of opioids?

A

most common side effects of opioids:

  • nausea
  • vomiting
  • drowsiness
122
Q

What side effects can large doses of opioids produce?

A

large doses of opioids can produce respiratory depression and hypotension

123
Q

What substance can enhance the effects of opioids?

A

the effects of opioids are enhanced by alcohol

124
Q

What should you be cautious of when prescribing opioids?

A

cautions with opioids:

  • hypotension
  • hypothyroidism
  • asthma
  • decreased respiratory reserve
  • prostatic hyperplasia
  • pregnancy/breastfeeding
  • hepatic impairment
  • renal impairment
  • elderly and debilitated (reduced dose)
  • convulsive disorders
  • dependence
125
Q

What are contraindications of opioids?

A

contraindications of opioids:

  • acute respiratory depression
  • acute alcoholism
  • riased intracranial pressure/head injury
126
Q

What is the only codeine combination on the Dental Practitioner’s Formulary?

A

the only codeine combination on the Dental Practitioner’s Formulary is dihydrocodeine

127
Q

What is the potency of dihydrocodeine similar to?

A

the potency of dihydrocodeine is similar to codeine

128
Q

What are the routes of dihydrocodeine?

A

dihydrocodeine routes:

  • subcutaneous (controlled drug)
  • intramuscular (controlled drug)
  • oral (not controlled)
129
Q

What are drug interactions to be aware of when prescribing dihydrocodeine?

A

dihydrocodeine interactions:

  • antidepressants
  • dopaminergics
130
Q

Can opioids be prescribed when there is raised intracranial pressure or suspected head injury?

A

no, opioids cannot be prescribed when there is rasied intracranial pressure or suspected head injury

131
Q

What can be said about the value of dihydrocodeine for dental pain?

A

dihydrocodeine is of little value for dental pain

132
Q

Is dihydrocodeine effective for post-operative dental pain?

A

no, dihydrocodeine is not effective for post-operative dental pain

133
Q

What are examples of functional pain?

A

functional pain:

  • TMJ pain
  • atypical facial pain
134
Q

What is the only drug presently on the dental list for neuropathic and functional pain?

A

the only drug at present on the dental list for neuropathic and functional pain is carbamazepine

135
Q

What drug can be used to control trigeminal neuralgia?

A

carbamazepine can be used to control trigeminal neuralgia

136
Q

What are clinical features of trigeminal neuralgia?

A

clinical features of trigeminal neuralgia:

  • severe spasms of pain (electric shock)
  • lasting seconds
  • usually unilateral
  • trigger spot identified
  • periods of remission
  • recurrences often greater severity
137
Q

What age group does trigeminal neuralgia tend to happen in?

A

trigeminal neuralgia tends to happen in older age groups

138
Q

Does trigeminal neuralgia tend to happen more in males or females?

A

trigeminal neuralgia tends to happen more in females than males

139
Q

What are side effects of carbamazepine?

A

side effects of carbamazepine:

  • dizziness
  • ataxia
  • drowsiness
  • leucopenia and other blood disorders
140
Q

What are contraindications for carbamazepine?

A

carbamazepine contraindications:

  • AV conduction abnormalities (unless paced)
  • history of bone marrow depression
  • porphyria
141
Q

What should you be cautious of when prescribing carbamazepine?

A

carbamazepine cautions:

  • hepatic/renal/cardiac disease
  • skin reactions
  • history of haematological reactiosn to other drugs
  • glaucoma
  • pregnancy/breastfeeding
  • avoid abrupt withdrawal

Oral Surgery (9 decks)

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