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BODC exodontia yr 2 > intro to analgesia and pain contro (inc children) > Flashcards

intro to analgesia and pain contro (inc children) Flashcards

1
Q

types of pain

A

acute

chronic

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2
Q

cause of pain

A

inflammatory
neuropathic
vascualr

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3
Q

removal of pain peripherally

A

remove cause
antiinflammatoy and pain killers
LA

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4
Q

pain managment methods (alternative pain managments)

A 
remove the cause
medication
regional anesthesia 
nerve blocks
physcical methods (physiotherapy, manipulation, acupuncture)
pyscolgoical (Relaxation, hypnosis)
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5
Q

trauma leads to

A
  • release of phospholipase A2
  • causes phospholipids to form arachidonic acid
  • this can set off pathway of production, resulting in inflammatory mediator substances
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6
Q

what do sterioids do

A

block inflammatory pain

prevent arachnoic acid pathway

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7
Q

other alternatives to steroids

A

NSAIDS

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8
Q

what do NSAIDS

A

inhibit production of prostaglandins therefore reducing pain swelling and inflammtion

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9
Q

what does the other pathway in pain (not prostaglandin priduction) produce

A

5- lipoxygerase eventurally leading to cytokines interlukins, TNF a ect

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10
Q

what can blocking inflamamtion do (- side effects)

A

inflammation

  • bronchoconstriction
  • airway obstruction
  • cell infiltration
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11
Q

what do prostaglandins do

A
  • increase vascular permeability (swelling)
  • inflammation
  • contract smooth muscle
  • increased hyperalgesia in sensory afferent nerve fibres
  • reduce gastric acidiy
  • inhibit platelet adhesion (clotting)
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12
Q

what does COX do (cyclo-oxygenases)

A

Catalyse the conversion of arachnidonic acid to biologically active prostaglandins (pain and inflammation) by cyclooxygenases and peroxidase activity

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13
Q

active prostaglandins physiological function

A
  • protection of the GIT tract
  • renal homeostasis (kidney)
  • uterine function
  • embryo implantation and labour
  • regulation of the sleep wake cycle and body temperature
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14
Q

COx 1, where its found and what it does

A

Found in most tissues
- particularly in platelets, stomach and kidney
Responsible for
- production of prostaglandins
- important for responses to circulating hormones
- maintenance of gastric mucosal integrity and platelet function
- synthesises prostaglandins responsible for physiological funcitons including GIT protection

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15
Q

how to inhibit cox 1

A

classic NSAIDs

can also inhibit cox 2

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16
Q

results of inhibting cox 1

A
  • inhibition reduces the ability of the stomach to protect itself from its acidic contents
  • results in greater erosion and ulceration
17
Q

when does cox 2 occur and what does it do

A

when you have an inflammatory repsonce

- responsible for the biosynthesis of some of the inflammatory prostaglandins

18
Q

analgesics in DPF

A
  • aspirin tablets dispersible
  • diclofenac sodium tablets
  • dihydrocodeine tablets 30mg
  • ibuprofen tablets
  • ibuprofen oral suspension sugar free
  • paracetamol oral suspension
  • paracetamol tablets
  • paracetamol tablets soluble
19
Q

NSAIDS in pregnancy

A

avoid

  • risk of haemorrhage
  • closure of ductus arterisus
  • pulmonary hypertension of newborn
  • delayed labour
  • increased duration of labour
  • increased blood loss in labour
20
Q

prescribing drugs for children

A 
Prescribe according to weight
1st month
up to a year
-	8th adult dose
1-5 years
-	quarter dose
6-12
-	half dose

After 12 you are considered adult in doses

21
Q

action of paracatamol

A
  • Cox 1/2 ? maybe 3
  • TRPA – 1 receptors ?
  • Central actions?
22
Q

dose of paracetamol

A
  • 500mg-1g QDS /4-6 hourly
  • no more than 4g in 24 hours
    Under 50 kg
  • should only be having one tablet 500mg
    Multiple preparations available
  • tablets
  • capsules
  • elixir (sugar free or sugar)
23
Q

antidote for paracetamol

A

acetyl cystenine

20-30 is OD

24
Q

overdose parecetamol symptoms

A
  • nausea
  • vomiting
  • typically wont feel anything for 24 hours, but may be fatal
  • refer to A/E asap
25
Q

ibuprofen doses

A

200 to 400mg TDS (3x a day

  • no more than 2.4 g in 24 hours
  • can have bigger doses than normal as can be prescribed (but not recommended outsie hospital
26
Q

side effects of ibuprofen

A

1) Asthma potentiation
2) GI ulceration/bleed (lowest risk NSAID)
- worse with other NSAIDs
- sig in elderly
3) antithrombo-embolic efficacy (inc bleeding time)
4) risk of thrombotic events – MI
- ibuprofen/diclofenac worst
- naproxen best

27
Q

diclofenac use

A

Good efficacy in inflamm pain

  • anti pyretic
  • major side effect/interactions (anticoagulants, harmorrhagic disorders, GI, asthma)
  • similar profile to ibuprofen
28
Q

dose of diclofenac

A
  • 75-150mg daily in divided doses
29
Q

what do proton pump inhibitors do

A

protect stomach from acture bleed
Suppresses stomach acid secretion by specific inhibition of the H+/K+ ATPase system found in the secretory surface of gastric parietal cells

30
Q

what are PPIs used fro

A

treat symptoms of gastroesophageal reflux disease (GORD) and other conditions causes by excess stomach acid
- used to promote healing

31
Q

what are Opioids

A

Naturally occurring alkaloids

32
Q

when are opiods likely to be used

A

if NSAIDS contra indicated

  • warfarin
  • GI symtpoms
33
Q

codeien

A

weak opiiod
active at Mu receptor
dose with paracetamol usually about 8mg

34
Q

co codamol use and dose

A

mainly used if NSAIDS contr indicated
Paracetamol and codeine mixture
- dose 1-2 tables 4-6 hourly Max 8 a day

35
Q

writing prescriptions - what is needed

A
  • name
  • address
  • DOB
  • drug name
  • dose
  • preparation (syrup, capsule, tablet, sugar free ect
  • frequency
  • duration
  • length of drug course

BODC exodontia yr 2 (25 decks)

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