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BDS3 - Oral Surgery > Analgesia Part 1 > Flashcards

Analgesia Part 1 Flashcards

1
Q

What are 5 analgesia considerations?

A
  1. Think postoperative analgesia
  2. Start systemic analgesia before the LA wears off
  3. Sell the prescription to obtain optimal response
  4. Use LA more
  5. Watch for risk groups
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2
Q

Where can you find more information about the drugs that dentists can prescribe?

A

BNF, dental practitioners formulary and SDCEP.

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3
Q

What group of drugs does aspirin belong to?

A

NSAIDS.

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4
Q

How are prostaglandins produced to create pain?

A

Trauma and infection lead to the breakdown of membrane and phospholipids producing arachidonic acid. Arachidonic acid can be broken down to form prostaglandins. Prostaglandins sensitise the tissues to other inflammatory products which results in pain. Prostaglandins do not cause pain directly but they sensitise the tissues to other inflammatory products such as leukotrienes. So, if prostaglandin production decreases this will moderate the pain.

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5
Q

What is the mechanism of action for aspirin?

A

Aspirin reduces production of prostaglandins. It inhibits cyclo-oxygenases (COX 1 and 2). It is more effective at inhibiting COX 1. COX 1 inhibition reduces platelet aggregation and predisposes to damage of the gastric mucosa.

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6
Q

How does aspirin create an analgesic effect?

A

Analgesic action of NSAIDs is exerted both peripherally and centrally. Peripheral actions predominate. The analgesic action results from inhibition of prostaglandins synthesis in inflamed tissues (cyclo-oxygenase inhibition).

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7
Q

How does aspirin have antipyretic properties?

A

Aspirin prevents the temperature raising effects of interleukin-1 and the rise in brain prostaglandin levels and so reduces elevated temperature in fever, doesn’t reduce normal temperature.

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8
Q

How does aspirin have anti-inflammatory properties?

A

Prostaglandins are vasodilators and as such also affect capillary permeability. 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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9
Q

What are the metabolic effects of aspirin?

A

BMR (basal metabolic rate) increase
Platelets
Prothrombin
Decrease blood sugar.

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10
Q

What are adverse effects of aspirin?

A

GIT problems
Hypersensitivity
Overdose= tinnitus, metabolic acidosis
Aspirin burns (mucosal).

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11
Q

How can aspirin negatively effect the GIT?

A

Mostly on mucosal lining of the stomach
Prostaglandins (PGE2 and PGI2) inhibit gastric secretion, increase blood flow through the gastric mucosa and help the production of mucin by cells in the stomach lining (cytoprotective action). Most patients taking aspirin will suffer some blood loss from the GIT (not detectable macroscopically and is asymptomatic).

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12
Q

What side effects can you get from as aspirin overdose?

A 
Hyperventilation
Tinnitus
Deafness
Vasodilation and swelling
Metabolic acidosis
Coma.
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13
Q

What are some adverse hypersensitivity reactions that you can get from taking aspirin?

A

Acute bronchospasm/asthma type attacks
Minor skin rashes
Other skin allergies
TAKE CARE WHEN PRESCRIBING TO ASTHMATICS.

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14
Q

Why must you ensure that the patient takes aspirin with water?

A

You can get mucosal burns from the direct effect of salicylic acid. Aspirin applied locally to oral mucosa results in chemical burns- it has NO topical effect.

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15
Q

What groups of patients should you take caution with when prescribing aspirin?

A 
Peptic ulceration
Epigastic pain
Bleeding abnormalities
Anticoagulants
Pregnancy/breast feeding
Patients on steroids (increase aspirin side effects and about 25% of patients taking steroids will have a peptic ulcer)
Renal/hepatic impairment
Children under 26
Asthma
Hypersensitivity to other NSAIDs (includes those that have has asthma attacks, angiooedema, urticaria or rhinitis that has been precipitated by any NSAID)
Taking other NSAIDS
Elderly
G6PD- deficiency.
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16
Q

Why should you avoid giving peptic ulceration patients aspirin?

A

Gastric or duodenal ulcer could result in perforation.

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17
Q

Why should we avoid giving anticoagulant patients warfarin?

A

Aspirin enhances warfarin and other coumarin anticoagulants. It displaces warfarin from binding sites on plasma and increases free warfarin. The majority of warfarin in bound (inactive). If more is released this will become active increasing bleeding tendency.

18
Q

Why should we avoid giving pregnant women aspirin?

A

Especially during the third trimester as this is nearer the delivery and may cause impairment of platelet function. This might result in an increased risk of haemorrhage, jaundice in the baby and can prolong labour. It is contraindicated in breastfeeding (might cause Reye’s syndrome).

19
Q

Why should we avoid giving patients with renal or a hepatic impairment aspirin?

A

Aspirin metabolism in liver and excretion mainly in the kidney. If renal impairment excretion might be delayed. Not a complete contraindication but administer with care/reduce dose and avoid if renal or hepatic impairment severe.

20
Q

How does aspirin cause nephrotoxicity?

A

Prostaglandins PGE2 and PGI2 are powerful vasodilators synthesised in the renal medulla and glomeruli respectively, and are involved in the control of renal blood flow and excretion of salt and water. Inhibition of renal prostaglandin synthesis may result in: sodium retention, reduced renal blood flow and renal failure. NSAIDs over time may cause nephritis and hyperkalcaemia. Prolonged analgesic abuse over a period of years is associated with papillary necrosis and chronic renal failure.

21
Q

Why should be not prescribe aspirin to children under age 16?

A

It can cause Reye’s syndrome.

22
Q

What is Reye’s syndrome?

A

Very serious up to 50% mortality. Fatty degenerative process in liver (and kidney but to a lesser extent). There is a profound swelling in the brain
Clinically- nausea, vomiting and lethargy initially then later seizures/coma.

23
Q

What is encepalophy?

A

“Encephalopathy” means damage or disease that affects the brain. It happens when there’s been a change in the way your brain works or a change in your body that affects your brain. Those changes lead to an altered mental state, leaving you confused and not acting like you usually do.

24
Q

What is miosis?

A

Excessive constriction of the pupil of the eye.

25
Q

Why should you avoid taking several NSAIDs together?

A

Increases the risk of side effects. The combination of an NSAID may increase the risk of GIT side effects and should only be used in absolutely necessary and monitored the patient closely.

26
Q

Why should you avoid giving aspirin to an elderly patient?

A

They are more susceptible to drug induced side effects in general. They are often smaller and have a smaller circulating blood volume. They are often on other medications and have other medical problems.

27
Q

Why should you avoid giving aspirin to a patient with G6PD deficiency?

A

Glucose 6 phosphate dehydrogenase deficiency is prevalent in individuals originating from: most parts of africa, asia, oceania and southern europe. Individuals with this deficiency are susceptible to developing acute haemolytic anaemia on taking a number of common drugs. Aspirin carries a possible risk of haemolysis in some G6PD individuals (acceptable up to a dose of at least 1g daily in most G6PD deficient individuals).

28
Q

What 4 groups of patients can YOU NOT prescribe aspirin to?

A
  1. children under 16
  2. previous or active peptic ulceration
  3. haemophilia
  4. hypersensitivity to aspirin or any other NSAID.
29
Q

What is the dose of aspirin that you can give to a patient experiencing mild to moderate odontogenic or inflammatory pain?

A

40 tablets, 2 tablets four times a day preferably after food

Aspirin 300mg.

30
Q

What strength of aspirin is for analgesia and to thin the blood?

A

Analgesia- 300mg

Blood thinner- 75mg.

31
Q

What two drugs can you give with an NSAID being prescribed for odontogenic pain and the patient has active peptic ulcer disease or a previous episode?

A

Lansoprazole 15mg and omeprazole 20mg g/r capsules.

32
Q

What is the dose for lansoprazole and omeprazole?

A

Lanzoprazole 15mg, give 5 capsules, once daily

Omeprazole 20mg, 5 capsules, one capsule a day.

33
Q

What are the differences in properties between aspirin and ibuprofen?

A

Ibuprofen is less effective on platelets
Ibuprofen is an irritant to gastric mucosa but has a lower risk
Ibuprofen ma cause bronchospasm (take care in asthmatics but not completely contraindicated)
Popular as post op analgesia following oral surgery
Comes in a paediatric suspension.

34
Q

What is the dose of ibuprofen given to an adult patient as a post op drug or for inflammatory pain?

A

20 tablets, take one tablet four times a day, preferably after food.

35
Q

What is the max dose of ibuprofen for adults?

A

2.4g.

36
Q

What groups of patients do you have to be careful when prescribing ibuprofen?

A 
Previous or active peptic ulceration
Elderly
Pregnancy and lactation
Renal/hepatic or cardiac impairment
Hypersensitivity history to NSAIDs
Asthma
Patients taking other NSAIDs
Patients on long term steroids.
37
Q

What are some side effects of ibuprofen?

A

GIT discomfort, occasionally bleeding and ulceration
Hypersensitivity reactions eg rashes, angioedema and bronchospasm
Headache, dizziness, hearing disturbances, vertigo etc (more in the lecture).

38
Q

Name some drugs that have a potential drug interaction with ibuprofen?

A 
ACE inhibitors
Analgesics
Beta blockers
Clonidine
Antibiotics
Anticoagulants
Antidepressants
Diuretics (more on lecture).
39
Q

What are symptoms of an ibuprofen overdose?

A

Nausea, vomiting and tinnitus (more serious toxicity very uncommon).

40
Q

What can be given to patients that have had an ibuprofen overdose?

A

Activated charcoal followed by symptomatic measures are indicated if more than 400mg/kg has been ingested within the preceding hour.

41
Q

What other useful information is included in the SDCEP guidance and the BNF?

A

Mean weights for prescribing drugs to children

New interactions of drugs are displayed in bold.

BDS3 - Oral Surgery (7 decks)

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