control of pain + anxiety

Question 1

what is allodynia

Answer 1

pain from non-painful stimuli

Question 2

what is hyperalgesia

Answer 2

exaggerated response to noxious stimuli

Question 3

2 effects of paracetamol

Answer 3

antipyretic

analgesia

Question 4

risk of paracetamol

Answer 4

liver toxicity in compromised pts

Question 5

risks of NSIADs

Answer 5

gastric ulceration

bleeding

Question 6

pts when NSAIDs are contraindicated

Answer 6

elderly
previous hypersensitivity 
pregnancy/breastfeeding
history of gastrointestinal bleed/ulcer
renal impairment 
hepatic impairment  
coagulation defects 
cardiac impairment 
asthmatics - increased risk of hypersensitivity

Question 7

drug prescribed alongside NSAIDs to offer gastrointestinal protection

Answer 7

proton pump inhibitors - ols

Question 8

drugs developed to have same affects as NSAIDs without side effects

Answer 8

selective COX-2 inhibitors

Question 9

why do NSAIDs cause side effects

Answer 9

not selective - COX1 also inhibited

Question 10

side effects of opioids

Answer 10

nausea/vomiting

respiratory depression

Question 11

example of a weak opioid

Answer 11

codeine or dihydrocodeine

Question 12

example of a strong opioid

Answer 12

morphine

Question 13

why may it be important to give systemic analgesia before LA worn off?

Answer 13

reduce risk of sensitisation

Question 14

where are amino-ester LAs metabolised?

Answer 14

in plasma by pseudocholinesterase

Question 15

where are amino-amide LAs metabolised?

Answer 15

in liver

Question 16

3 general complications of LA

Answer 16

psychogenic
toxic
allergy

Question 17

allergy most likely with what type of LA?

Answer 17

esters

Question 18

3 local complications of LA

Answer 18

soft tissue trauma
nerve trauma - paraesthesisa
intravascular injection - haematoma, systemic effects

Question 19

complications of IDB

Answer 19

injection in medial pterygoid - trismus
deep injection in parotid gland - facial nerve = facial muscle paralysis temporary
electric shock = needle touches IAN

Question 20

medical indications for conscious sedation

Answer 20

mild angina, hypertension, asthma
spasticity, MS, parkinsons
epilepsy

Question 21

why BDZ sedation CI in severe respiratory disease?

Answer 21

sensitive to respiratory depression

Question 22

medical CI to conscious sedation

Answer 22

allergy
systemic disease
resp disease
pregnancy
liver/kidney disese
muscle disease - respiratory depression
obesity - airway control
psychiatric disorders
drug interactions

Question 23

mechanism of action of benzodiazepines

Answer 23

act on GABA receptions - inhibitory action

Question 24

undesirable effects of BDZs

Answer 24

respiratory depression
elimination problems
hyperactivity in elderly - receptors change with age

Question 25

BDZ which injection can cause thrombophlebitis

Answer 25

diazepam (valium) as not water soluble

longer half life than midazolam

Question 26

dosage for flmazenil

Answer 26

200ug originally

100ug/min up to 1mg

Question 27

3 most popular oral sedatives

Answer 27

nitrazepam
diazepam
temazepam

Question 28

instructions for undergoing sedation

Answer 28

light meal no less than 2 hours before
bring a companion 
travel home privately 
take routine meds unless told otherwise
inform if pregnant 
do not drink alcohol that day
do not drive/operate machinery
don't be alone
do not make important decisions

Question 29

why must a chaperone always be present for IV sedation

Answer 29

sexual hallucinations

Question 30

how long must pt stay after last injection of BDZ

Answer 30

1 hour

Question 31

what value is lowest oxygen saturation should be in iv sedation

Answer 31

90% absolute

worried at 94%

Question 32

does nitrous oxide provide any analgesia

Answer 32

yes

Question 33

why may mouth opening be a problem after IDB

Answer 33

haematoma formation in medial pterygoid

antibiotics need prescribing if diagnosed early