Opioid lecture part 3 Flashcards
What is one of the most frequently prescribed opioids in dentistry the is not used as sole agent, aka it is used in combination products with acetaminophen or aspirin
codeine
codeine has what percentage the potency of morphine?
one-sixth
10 mg morphine = 60 mg codeine
What is the optimum dose of codeine?
60 mg is optimum dose
- If exceed 60 mg, no greater analgesic effect, but more side effects
Which is better orally, codeine or morphine
Oral morphine is poorly absorbed, so we use codeine, given orally, instead
In dentistry, codeine is used in combination preparations with?
- aspirin
2. acetaminophen
T or F, codeine is not good for severe pain
True (use oxycodone)
What is the drug of choice for cough suppression?
codeine
Adverse reactions to codeine
- Nausea
- Dizziness
- Excitability
- Constipation
- Allergy = skin rash, asthmatic-type reaction
codeine dosing
15-60 mg every 4-6 hours when pain is present
Codeine containing preparations are identified by numbers that reflect the mg concentration. give examples
#1 = 8 mg (OTC in Canada, not in US) #2 = 15 mg #3 = 30 mg #4 = 60 mg
Popular codeine preparations:
- Tylenol with codeine (#1,2,3,4) –> C-III/C-IV
- acetaminophen 300 mg
- Most widely prescribed codeine product by dentists is Tylenol #3
- Fiorinal w codeine (#1,2,3)
- relief of complex tension (muscle contraction) headache - C-III
What is the most widely prescribed codeine product by dentists
Tylenol #3
T or F, Hydrocodone is 2 times less potent than codeine
False, 3 times more potent than codeine
Drug examples of hydrocodone with acetaminophen
- Vicodin (5/500 mg or 7.5/500 mg)
2. Lorcet/Lortab (5/500 mg; 7.5/500 mg)
Describe the dosing for Norco and why it might be good
10 mg hydrocodone with 325 mg acetaminophen
- uses lower dose of acetaminophen in alignment with new FDA recommendations to reduce risk for acute liver damage
dihydrocodeine’s efficacy/potency is what compared to codeine?
The same
T or F, dihydrocodeine is no more effective than Tylenol #3
True
Drug example for dihydrocodeine
Synalgos DC
- dihydrocodeine = 16 mg
- aspirin 356.4 mg (avoid if aspirin allergy)
- caffeine 30 mg
T or F, oxycodone is less potent than morphine
False, it is AS potent as morphine
- More potent than codeine
- Highly addictive
Oxycodone is what schedule of drugs
Schedule II - used in dentistry in combo products for severe pain
Drug examples for oxycodone
- Percocet (oxycodone 5 mg; acetaminophen 325 mg)
- Tylox (oxycodone 5 mg; acetaminophen 325 mg)
- Percodan (oxycodone 5 mg; aspirin 325 mg)
- Roxicet (oxycodone 5 mg; aspirin 325 mg) *Drug seekers ask by name
Combunox includes how much of oxycodone and ibuprofen
oxycodone 5 mg with ibuprofen 400 mg
Combunox could be used for what?
Short term management of acute, moderate-to-severe dental pain
- Used for 3-5 days only
fentanyl is how potent in comparison to morphine
100 times more potent than morphine
- 500 times more potent than meperidine
How is fentanyl used in dentistry
for conscious sedation only
- IV, transdermal, lollipop
How long is tramadol used for?
Use for less than or equal to 5 days for acute dental pain
tramadol binds to what receptors?
mu opiate receptors in CNS, which inhibits ascending pain pathways, altering perception of and response to pain.
tramadol inhibits the repute of what?
norepinephrine and serotonin
- also modulates ascending pathway
dosing of tramadol
immediate release given 50-100 mg every 4 to 6 hours, not to exceed 400 mg/day = titrate up
T or F, tramadol is not associated with seizures
False, is
tramadol can be used with what other non-opioid in a combo product
acetaminophen
- acetaminophen 325 mg and tramadol 37.5 mg
- use for less than or equal to 5 days for post-op dental pain
dosing of Ultracet
2 tablets every 4-6 hours (maximum 8 tablets per day)
- acetaminophen dictates totally maximum daily dose
Describe ketorolac (Toradol) as its classification and use
NSAID
Provides analgesia at the opioid level
Indicated for moderate to severe dental pain
Short term use < 5 days
Limite opioid use to what? for what reasons?
limit use to 3-5 days (acute pain only)
- Write for limited quantities due to the potential for addiction
Which opiate agent is the most widely used for the management of dental pain
hydrocodone with acetaminophen (Vicodin or Lorcet)
Of the codeine preparations, which is the most widely prescribed in dentistry
Tylenol #3
T or F, oxycodone with acetaminophen is used to treat the more severe degrees of pain
True
meperidine (Demerol) is useful for patients with a history of what?
codeine allergy
T or F, morphine and hydromorphone are indicated as analgesics in any dental situation
False, NOT indicated
T or F, whenever possible, an opiate agent is preferred to an NSAID for pain management because of its potency
False, Whenever possible, an NSAID is preferred to a opiate agent for pain management
- Opiates do not reduce inflammation, which is the most common etiology for dental pain
T or F, ALL opiates will cause nausea in most patients
True
T or F, Constipation is usually not a common complaint with patients on opiate drugs
False, Constipation is another common complaint for patients on opiate drugs
Ranking opiates by potency
- fentanyl - 100 times more potent than morphine
- Morphine = oxycodone
- meperidine
- hydrocodone = 3x more potent than codeine
- codeine = 1/6 the potency of morphine
- dihydrocodeine = codeine
