Oral analgesics for acute pain

Question 1

acute pain

Answer 1

1) pain provoked by disease or injury
2) >3 mo is chronic
3) acute orofacial pain is protopathic pain
- pathological conditions and underlying disease
4) pain can be due to hard tissues and soft tissue conditions
- trauma or infection

Question 2

purpose of pain

Answer 2

1) acute pain is protective warning of tissue damage
2) persistent pain is also protective
3) chronic pain is no associated with ongoing tissue damage
- disruptive
4) invokes withdrawal, avoidance, and escape

Question 3

nociception

Answer 3

1) damage to tissue which can be central or peripheral in brain and spinal cord
- noxious stimuli that brain interprets as pain
2) a delta
- myelinated
- physiologic pain, epicritic, acute
3) c-fibers
- unmyelinated
- protopathic, pathologic pain, dull aching

Question 4

neuropathic pain

Answer 4

1) superficial burning
2) deep pressing
3) touch, pressure, heat, cold
4) phantom pain, TN

Question 5

nociceptive pain

Answer 5

1) spontaneous pain

Question 6

pain mechanisms - central

Answer 6

1) longer than 3 months, same pain, refer

Question 7

allogeneic substances

Answer 7

1) adenosime, ATP, serotonin, histamine, bradykinin
2) substance p
3) glutamate
- released by a delta and ?

Question 8

analgesic

Answer 8

1) no pain is felt
2) drugs that alleviate pain without major impairment to other sensory modalities
- opioids
- non opioid
- analgesics to treat specific pain syndromes

Question 9

NSAIDS

Answer 9

1) anti-inflammatory
2) antipyretic
3) analgesic by prostaglandin inhibition

Question 10

adverse effects of NSAIDs

Answer 10

1) GI irritation and bleeding
2) platelet dysfunction
3) precautions
- asthma, pregnancy, advanced age
- vaso and broncho constrictors
- affects fetal development in 3rd trimester

Question 11

non opioid analgesic

Answer 11

1) NSAIDs
2) acetaminophen

Question 12

opioids

Answer 12

1) moderate to severe acute pain
2) oxycodone, hydrocodone, codeine
- usually combined with acetaminophen
3) agonists of opioid receptors
4) no analgesic ceiling
5) black box warning for addiction abuse
6) sedation, dizziness, nausea, vomiting, pruritus, sweating, constipation, and respiratory depression
7) interactions with P450 3A4 inhibitors

Question 13

codeine

Answer 13

1) morphine x0.10
2) delta receptors need spinal admin to cross BBB
3) most are mu receptive
4) kappa is less respiratory depression

Question 14

hydrocodone

Answer 14

1) 0.75x morphine

Question 15

oxycodone

Answer 15

1) 1.5 morphine

Question 16

naloxone

Answer 16

1) mu receptor antagonist
2) duration of action is shorter than duration of opioid

Question 17

order of prescribing

Answer 17

1) ibuprofen
- mild to moderate
2) acetaminophen
- with ibuprofen for moderate to severe
- 600 ibuprofen, 500 acetaminophen every 6 hrs
3) opioids
- severe

Question 18

DEA

Answer 18

1) diverting or turning aside from a course or purpose
2) prevent non medical abuse of CPDs
3) addiction
- substance use disorder
4) tolerance
- more drug to get same effect
5) withdrawal
- suddenly decreased physiological effect?