Chapter 5 Flashcards
Why is tooth extraction considered a “pain standard”?
Tooth extraction is considered a “pain standard” because it serves as a benchmark for comparing dental pain in clinical studies
How are prostaglandins important for maintaining homeostasis? How are they important in the pain response?
Prostaglandins help maintain homeostasis by regulating various physiological functions such as inflammation, blood flow, and the formation of blood clots. In the pain response, prostaglandins are produced at sites of tissue damage or infection, triggering inflammation and pain signals
What is the prostaglandin synthesis pathway? Which enzymes are involved in the pathway and what reactions do they catalyze?
The prostaglandin synthesis pathway begins with phospholipids being converted into arachidonic acid, which is then acted upon by cyclooxygenase (COX) enzymes to produce prostaglandins. COX-1 and COX-2 are the key enzymes involved in this process
What categories of nonnarcotic drugs exist?
Categories of nonnarcotic drugs include N
SAIDs (Nonsteroidal Anti-Inflammatory Drugs),
salicylates (such as aspirin), and
acetaminophen
What is the mechanism by which salicylates work?
Salicylates, such as aspirin, irreversibly inhibit COX enzymes, thereby reducing the production of prostaglandins, which are responsible for pain, fever, and inflammation
What are the pharmacologic effects of salicylates?
Salicylates relieve pain, reduce fever, decrease inflammation, and reduce clotting. They are primarily administered orally
What are the pharmacokinetics of salicylates?
Salicylates are rapidly absorbed in the stomach and small intestine, bind to plasma proteins, metabolize in the liver through zero-order kinetics, and are excreted via the kidneys
What are the adverse reactions associated with the use of salicylates?
Adverse reactions include
gastrointestinal distress,
bleeding problems,
Reye’s syndrome,
hepatotoxicity,
nephritis,
teratogenicity,
allergic reactions,
and toxicity from overdose (e.g., headache, dizziness, nausea, and vision problems)
What types of drug interactions are associated with salicylates?
Salicylates can interact with antihypertensives, warfarin, probenecid, methotrexate, sulfonylureas, and certain herbs like ginseng, dong quai, and ginger. They can also interact with diseases such as hemophilia
What are the potential doses of salicylates?
For adults, salicylates are taken PRN for pain at 325-650 mg every 4-6 hours, 3000-4000 mg daily for arthritis, or 81 mg daily for heart attack prevention
What is the mechanism by which NSAIDs work? How are NSAIDs different from one another with regard to their mechanism of action?
Most NSAIDs work by reversibly inhibiting COX-1 and COX-2 enzymes, reducing prostaglandin synthesis. Some NSAIDs, like celecoxib (Celebrex®), specifically inhibit COX-2 without affecting platelet clumping
What are the pharmacologic effects of NSAIDs?
NSAIDs reduce pain, fever, and inflammation and decrease blood clotting
What are the pharmacokinetics of NSAIDs?
NSAIDs are absorbed in the stomach and small intestine, have a high plasma protein binding rate (~95%), metabolized in the liver, and are excreted through the kidneys
What are the adverse reactions associated with the use of NSAIDs?
Adverse reactions include ulceration, sedation, convulsions, cardiovascular effects, renal issues, oral issues and allergic reactions (especially cross-allergies with salicylates)
What types of drug interactions are associated with NSAIDs?
NSAIDs can interact with antihypertensives, methotrexate, lithium, digoxin, and patients with asthma
What are the potential doses of different NSAIDs? How do the intervals of administration differ for each?
ibuprofen is taken at 200-400 mg every 4-6 hours for pain relief (OTC) and 400-800 mg every 6-8 hours (prescription).
Naproxyn is taken at 220 mg every 8-12 hours, up to 3 pills in 24 hours.
Meloxicam is used at lower doses for COX-2 inhibition
What is the mechanism by which acetaminophen works?
Acetaminophen works by inhibiting the COX enzyme (competitive), mainly in the brain, which helps reduce pain and fever but has little to no anti-inflammatory effects
What are the pharmacologic effects of acetaminophen?
Acetaminophen is effective in reducing pain and fever but does not significantly reduce inflammation
What are the pharmacokinetics of acetaminophen?
Acetaminophen is absorbed in the small intestine, DISTRIBUTION: dissolves in blood, metabolized in the liver via glucuronidation, and excreted by the kidneys/renal
What are the adverse reactions associated with the use of acetaminophen?
Adverse reactions include liver and kidney toxicity, methemoglobinemia, nausea, vomiting, and renal necrosis
What types of drug interactions are associated with acetaminophen?
Acetaminophen can interact with alcohol, increasing the risk of liver damage
What is gout?
Gout is a type of arthritis caused by the accumulation of uric acid crystals in the joints, leading to inflammation and pain
How is gout treated preventatively? In case of acute attacks?
Preventative treatments for gout include allopurinol and probenecid. In case of acute attacks, NSAIDs and colchicine are used
What are the adverse abortive effects of gout medications?
NSAIDS and colchicine can cause gastrointestinal distress
What are the different types of NSAIDS used for?
Meloxicam- Arthritis
Naproxyn- Arthritis, gout and mod/sev pain
Ibuprofen- Fever, Sympotms of Arthritis and mild to mod pain
Celebrex- Does not inhibit platelet clumping, only for certain patient and has no dental application.
Which NSAID should not be used in during different trimesters within a pregnancy ?
Ibuprofen should not be used during the last trimester
Naproxyn should not be used during the 1st trimester, increases bleeding.
