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PHARMA-CONFI > Analgesics > Flashcards

Analgesics Flashcards

1
Q

Pain

A

Pain is a PROTECTIVE mechanism

It is based on :
DURATION and
ONSET

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2
Q

Pain in dentistry based on INFLAMMATION

A

SOMATIC : caused by tissue damage the pain receptors NOCIOCEPTORS, cause it
Ex: periodontal, alveolar, or mucosal pain

VISCERAL pain : caused by DEEPER tissues
Ex: pulpal pain, thoracic area, stomach pain

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3
Q

Acute pain
4

A

usually seen in Dentistry-lasts 1 to 7 days

Comes on SUDDENLY and has a LIMITED duration

Caused by damage to tissue, such as bone muscle or organs

Onset is often accompanied by ANXIETY or EMOTIONAL DISTRESS

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4
Q

Chronic pain

A

Last 1-2 weeks

More related to MEDICAL CONDITIONS and long-term illnesses, such as osteoarthritis

It last LONGER than acute pain, and it’s somewhat RESISTANT to medical treatment

Very often attributable to nerve damage

IMPORTANT:
It has SOMATOSENSORY and PSYCHOSOCIAL impacts

IMPORTANT:
In Both acute and chronic pain , perception involves the SAME regions of the brain. That is the CNS.

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5
Q

Dimensions of pain

A

SENSORY : perception of the :
1.location,
2.intensity(mild, moderate, and severe )and
3.quality of pain(stabbing, lancinating, dull, sharp)

AFFECTIVE : reference to the
UNPLEASANTNESS inherent to the pain and the EMOTIONS related to future implications

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6
Q

Points to consider in use of painkillers (analgesics)

A
  1. Eliminate the source of pain if possible

2.Individualized regimens

3.OPTIMIZE dose and frequency before switching

4.Maximize the non-opioid before adding the opioid

  1. Consider LOADING and preoperative dose for nonsteroidal anti-inflammatory drugs(NSAIDS)

6.AVOID chronic use of analgesics

  1. REDUCE the dose in OLDER individuals
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7
Q

Criteria when selecting an analgesic agent

A
  1. Severity of the pain.: mild, moderate,severe- MOST IMPORTANT
  2. age of the patient.: infant child, adult, elderly
  3. Concurrent medication’s.: other medication’s being taken
  4. Pregnancy as all drugs, a pregnant woman, take skin, cross the placenta and enter the foetal circulation.
  5. Medical conditions of the patient including pregnancy.
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8
Q

Pain threshold

A

LOWEST level of the pain a person will detect

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9
Q

For pain severity
WONG BAKER rating scale

A

WONG BAKER faces pain, rating scale

It has 2 groups
1. mild to moderate :
0-no hurts
2- hurts little bit
4-hurts little more

  1. Moderate to severe:
    6-hurts even more
    8-hurts whole lot
    10-hertz worst
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10
Q

Painkillers prescribed on pain severity

A

1-mild to moderate-DOC-acetaminophen

  1. Moderate to severe.DOC-NSAIDs, other than ASA aspirin
  2. If NSAIDs are not enough or contraindicated, we give opioids.
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11
Q

Acetaminophen

A

Safest drug

EVEN if the patient has cirrhosis or liver, disease or chronic alcoholism

Does not affect Cox 1 and Cox 2 so it does NOT have any ANTI-INFLAMMATORY effect

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12
Q

Acetaminophen mechanism of action

A

INHIBITS COX-3

Inhibition of central prostaglandin formation,
inhibits central CNS cyclooxygenase COX-3

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13
Q

Actions of acetaminophen

A

ANALGESIC for mild to moderate pain

ANTIPYRETIC

NO anti-inflammatory action

It does not affect
1. inflammatory response ,
2.platelet functions or the coagulation pathways.
3It has no effect on bleeding time.

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14
Q

Analgesic of choice in elderly and children

A

Acetaminophen

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15
Q

Acetaminophen, acute overdose

A

Most famous side effect is HEPATOTOXICITY, and finally HEPATIC NECROSIS

Long-term use of acetaminophen may lead to RENAL toxicity

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16
Q

Maximum recommended dose of acetaminophen in adults

A

4000 mg per day or 4 g per day

17
Q

Maximum recommended dose of acetaminophen for kids that is less than 12 years of age

A

It’s based on body WEIGHT but about 2.6 g per day.
If you don’t have any patient feet then MRD is equal to 2.6 g per day.

18
Q

Acetaminophen poisoning antidote

A

N-acetylcysteine, NAC

It is the ONLY analgesic other than opioids that has an antidote

19
Q

indications of acetaminophen

A

It is a drug of choice for any patient for mild to moderate pain

20
Q

Best NSAID to Control dental pain after adjustment of orthodontic appliance

A

Acetaminophen

21
Q

Hepatotoxicity risk

A

Chronic consumption of 3 or more drinks per day

may increase the risk of hepatotoxicity

because of

increased P-4 50 mediated conversion of acetaminophen

to reactive, hepatotoxic metabolites

22
Q

Mild to moderate pain

A

Been related to
Dry socket
Simple extraction
Root planning
Reversible pulpitis

23
Q

Moderate to severe pain

A

Irreversible pulpitis
Extensive surgeries
Acute apical abscess
Necrotizing periodontitis
Gingivitis

24
Q

Acetaminophen, side effect

A

Causes Methhaemoglobinaemia in high doses

25
Q

NSAIDs action

A

Analgesic

Antipyretic

Anti-inflammatory

Antiplatelet (sometimes )

26
Q

Aspirin— mechanism of action

A

It inactivates both cyclooxygenase 1 and 2 (COX-1 & COX-2)

27
Q

Actions of aspirin

A

Analgesic

Antipyretic

Anti-inflammatory

Irreversible platelet inhibitor ( by preventing production of thromboxane A2)

Prolonged bleeding

28
Q

Dose of ASA for prophylaxis of myocardial infarction

A

80 mg

Is used for its ANTI PLATELETS for prophylaxis of myocardial infarction in a patient with a history of UNSTABLE ANGINA PECTORIS or with the history of myocardial infarction

It is also used to prescribe to prevent HEART ATTACK and transient ischaemia attack TIA

29
Q

Antiplatelet action

A

Inhibit platelet aggregation

30
Q

Anticoagulant

A

Affect the end result of the coagulation cascade that is Fibrin

Warfarin
Heparin
Factor 10 A
Dabigatran example rivaroxaban

31
Q

The recommended ASA dose during a heart attack

A

160 mg to 162 mg chewable or crushed

32
Q

Analgesic and anti-pyretic of aspirin

A

325 to 650 mg

used for pain but it is not the best choice

33
Q

325 to 650 mg of Aspirin dose is used where else

A

And arthritis as it is a very good anti-inflammatory

34
Q

The antithrombotic effective of Aspirin may be compromised by

A

Ibuprofen

35
Q

The principal site for salicylate metabolism
And excretion

A

Liver

Excretion occurs, mainly via kidney

36
Q

How does the antithrombotic effective aspirin be compromised by ibuprofen?

A

Aspirin 81 mg & ibuprofen ——-do interact

Ibuprofen can interfere with antithrombotic affect of aspirin, but up to four days is OK

37
Q

Aspirin toxicity

Acute

A

Initial symptoms are
1. Respiratory alkalosis with hypercapnia and tachypnea.
2. Nausea and vomiting.
3. Hypokalemia.
4. tinnitus
5. Headache.
6. Dizziness, and confusion.
7. Dehydration.
8. Hyperthermia.
9. Hyperactivity.
10. Haematologic abnormalities.

It can finally progress to coma and respiratory collapse

PHARMA-CONFI (7 decks)

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