Drugs

Question 1

What is the drug class of paracetamol?

Answer 1

COX inhibitor
Antipyretic, analgesia, with no reduction in peripheral inflammation

Question 2

What is the method of action of paracetamol?

Answer 2

COX inhibitor and inhibits synthesis of prostaglandins (these sensitise tissues to inflammatory products = pain)

Question 3

What is the max dose of paracetamol?

Answer 3

4g
2x 500mg tablets 4x daily

Question 4

What is ibuprofen?

Answer 4

NSAID
Analgesia, antipyretic, anti inflammatory

Question 5

What is the method of action of ibuprofen?

Answer 5

Non selective COX inhibitor (enzyme involved in prostaglandin synthesis)

Question 6

What is warfarin?

Answer 6

Anticoagulant

Question 7

When should INR be checked?

Answer 7

Check out<24 hours before procedure (72 hours if pt is stable)
Can treat without interrupting medication if <4

Question 8

What precautions should be taken with patients on warfarin?

Answer 8

Delay treatment if INR >4
Stage treatment with bleeding risk eg half mouth PMPR, stage extractions
Suture and pack

At risk of secondary bleeding later in the day so treat early in the morning

Question 9

Why might a pt on warfarin experience secondary bleeding?

Answer 9

Warfarin does not affect the platelet plug, therefore initial haemostasis may be achieved.
However warfarin affects the coagulation cascade (the conversion of fibrinogen to fibrin)

Question 10

What is the method of action of warfarin?

Answer 10

Vitamin K antagonist inhibiting the synthesis of vitamin K dependant clotting factions 2, 7, 9 and 10 in the liver.

Question 11

After initial dose of warfarin, how long until anti coagulation effects?

Answer 11

2 days (initial state of hypercoagulation therefore pt will be on heparin)

Question 12

What are DOACs?

Answer 12

Eg apixiban
Factor Xa inhibitor
Decreases thrombin generation (indirectly inhibits platelet aggregation)

Question 13

How often are DOACs taken?

Answer 13

Apixaban and dabigatran - 2x daily
Rivaroxaban - morning
Endoxaban - evening

Question 14

What is considered a high risk of post op bleeding complications?

Answer 14

Complex extractions (that will cause large wound or >3 extractions)
Flap raising procedures
Gingival re contouring
Biopsies

Question 15

What are 2 examples of anti platelets?

Answer 15

Aspirin - COX-1 and COX-2 inhibitor, in platelets- inhibits thromboxan synthesis , therefore impairs platelet aggregation
Clopidogrel - inhibits platelet activation and aggregation

Question 16

What are bisphosphonates?

Answer 16

Anti resportive drugs which inhibit osteoclast bone resorption (targets areas of high bone turnover)

Question 17

How does bisphosphonates affect dental treatment?

Answer 17

Risk of developing MRONJ
Exposed, painful areas of exposed necrotic bone eg following extraction
Low risks if taking for <5 years and not on systemic steroids
High risk if taken for >5 years or taking systemic steroids

Question 18

How is MRONJ diagnosed?

Answer 18

Non healing site for 8 weeks - refer to oral surgery/ special care

Question 19

What is max dose of ibuprofen?

Answer 19

2.4 mg
1x 200mg tablet 4x daily