Dental Pain Flashcards

1
Q

What are the two main types of pain?

A

1-Musculoskeletal (somatic, inflammation)2-Visceral

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2
Q

Which 3 groups of neurotransmitters have a direct pain modulation on the brain?

A

1-Opioid narcotics2-Glu, GABA3-Antidepressants (5HT/NE)

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3
Q

What two Neurotransmitters have descending modulation effects in the spinothalamic tract?

A

-Serotonin drugs-Neuropeptides

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4
Q

Which three groups of drugs have an effect on pain in the dorsal horn?

A

1-Local anesthetic2-Opioids3-NSAIDs

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5
Q

Which two drugs affect peripheral nerves to modulate pain?

A

1-Local anesthetic2-Opioids

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6
Q

Which 4 drug groups modulate pain by acting on peripheral nociceptors?

A

1-Local anesthetic2-NSAIDs (COX 1/2 inhib)3-Acetaminophen4-Capsaicin

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7
Q

Arachidonic acid is converted by COX1 into PGE2 and Thromboxane A2 and has side effects in what 4 areas?

A

1-Gastric mucosal barrier2-Renal function3-Platelet Aggregation4-Vasoconstriction

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8
Q

Arachidonic acid is converted by COX2 into Prostaglandins and Prostacyclin and has side effects in what 3 areas?

A

1-Pain, inflammation, fever2-Renal function3-Vasodilation*COX-1 can contribute to this as well

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9
Q

What two drugs are Non-selective COX-1 and COX-2 inhibitors?

A

1-Salicylates (aspirin)2-Ibuprofen-like *Others as well

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10
Q

Which drug is a Selective Cox 2 inhibitor?

A

Celebrex (Celecoxib)

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11
Q

Which drug is NOT and NSAID but in a non-opioid analgesic?

A

Acetaminophen*does not help with inflammation

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12
Q

Salicylates are Cox-1 and Cox-2 inhibitors that are often combined with caffeine, acetaminophen or opioids for mild-moderate somatic pain. What are 3 dose dependent effects of these drugs?

A

1-Analgesia (600 mg)2-Antiinflammation (1 gm)3-Antipyretic (300-600 mg)*4 hour duration

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13
Q

What are the 4 side effects of salicylates?

A

1-G.I. Irritation and erosion2-Reyes syndrome in children (Cold/flu)3-Anti-clotting (lasts 1-2 weeks)4-RInging in ears (tinnitis, at higher doses)

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14
Q

Ibuprofen is a cox-1 and cox-2 inhibitor that is often a little better for mild-moderate pain and has what 3 effects?

A

1-Analgesia (400 mg)2-Anti-inflammation (800 mg)3-Antipyretic (400 mg)*4 hour duration

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15
Q

What are 3 side effects of ibuprofen?

A

1-GI ulcers (less than aspirin)2-Anti-clotting (less than aspirin)3-Cardiovascular effects

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16
Q

Which Ibuprofen-like drug is more potent and has lower doses (50 mg/Capsule)?

A

Ketoprofen (Orudis)

17
Q

Which Ibuprofen-like drug is longer-lasting and slower acting?

A

Naproxen (Naprosyn)*Aleve is also one of the longer lasting ones

18
Q

Which drug has the same analgesic potency as ibuprofen, lacks GI and anti-clotting action, has been linked with CV side effects and is a Cox-2 selective antagonist?

A

Celecoxib (Celebrex)*Rx only

19
Q

Which drug is a potent non-selective NSAID used for arthritis but is not a common analgesic due to its side effects?

A

Indomethacin*good for inflammation

20
Q

Which alternate drug preferentially inhibits Cox-2 over Cox-1 resulting in less GI problems?

A

Meloxicam

21
Q

Which drug is related to salicylates and is good for bone pain?

A

Diflunisal (Dolobid)*Oral surgeons use frequently

22
Q

Which drug is not a Cox 1 or 2 inhibitor, is not an anti-inflammatory and has a mysterious mechanism (COX 3/Serotonin?)?

A

Acetaminophen

23
Q

Though acetaminophen does not achieve the same analgesia or anti-inflammation that aspirin can, what are 5 advantages to it?

A

1-Good antipyretic2-Stable in solution (for kids)3-No GI problem4-No effect on clotting5-No Reye’s syndrome

24
Q

What is the main serious side effect of acetaminophen?

A

Liver toxin in high doses*Do not use in those with compromised livers

25
Q

What are 6 situations in which you should be cautious or not use NSAIDs?

A

1-Patients on anticoagulants2-Hemophiliac3-Ulcers4-Already taking high doses (arthritis and other inflammatory disease)5-Child (aspirin danger)6-History of allergies

26
Q

What group of drugs is used for mild to severe somatic and visceral pain and is antitussive as well as antidiarrheal?

A

Opioid Narcotics

27
Q

What is the most potent narcotic group?

A

Fentanyl

28
Q

What are the two main narcotic types?

A

1-Morphine (more potent group)2-Codeine (less potent group)

29
Q

What are 4 common codeine type narcotics?

A

1-Lortab (30 mg)2-Vicodin (30 mg)3-Oxycontin (20 mg)4-Percodan (20 mg)

30
Q

What are two common Morphine type narcotics?

A

1-Dilaudid (1.5 mg)2-Numorphan (1 mg)

31
Q

Which other narcotic drug is used for moderate to strong pain?

A

Meperidine (Demerol)

32
Q

Which 3 other narcotic drug are used to discourage abuse?

A

1-Pentazocine/Talwin (agonist/antagonist)2-Methadone (long acting, minimizes withdrawl)3-Buprenorphine/Suboxone (agonist/antagonist)

33
Q

Acting on mu receptors, what are the 4 main side effects of opioids?

A

1-Respiratory depression (decreased pulmonary reflex)2-Constipation3-Sedation/synergistic with other CNS depressants4-Euphoria/dependence/addiction

34
Q

What is the main treatment for opioid overdose?

A

-Inject/mist of the mu antagonist naloxone (narcan)

35
Q

What are the 3 first line treatments for managing neuropathic/chronic pain?

A

1-Gabapentin (antiseizure-lyrica)2-Duloxetine (antidepressant)3-Nortriptyline (antidepressant)

36
Q

Which schedule 4 drug is a next-line treatment for neuropathic/chronic pain management?

A

Tramadol (ultram)