pain control in endo II Flashcards
inflammation
1) can be cause by non living things
2) not always conjunct with infection
3) not fixed with antibiotics if no infection 4)
infection
1) organisms invade tissue
2) ALWAYS associated with inflammation
each tooth nerves
1) 2700
2) that only react as pain
number needed to treat
1) NNT is the proportion of patients with at least 50% pain relief after 4-6 hours
2) compared with a placebo
3) randomized clinical trials
bigger NNT
1) are less effective
2) closer to 1 is better
placebo effect
1) 60-77% of the drug effect is due to placebo
2) smaller pills and colorful pills seem to induce the effect
arachidonic acid
1) lipogeneses or cyclooxygenase pathway
- steroids block both
- COX inhib blocks cyclooxygenase pathway
COX1 or COX2
1) COX1 gets you more mucus, which is good, but MORE platelet clotting is bad
2) COX2 is mostly taken off the market
- heart attack and stroke
NSAID drug interactions
1)monitor prothrombin time and concurrent use of aspirin
2) lithium toxicity
3) hypertension medication
4) warfarin (oral antibiotics)
5) digoxin
6) methotrexate
- RENAL CLEARANCE REDUCED
7) phenytoin
NSAID and kidney function
1) prostaglandins increase blood flow to kidney
2) NSAIDS slow blood flow, making it toxic
3) kidney sees that as low BP, secretes renin
4) BP goes up
5) but if you take the antihypertensive agents, you can cause acute renal failure
acetaminophen
1) use if they have GI, kidney problems
2) BUT can cause liver problems
- do not use in liver failure patients
cannabinoid receptors
1) acetaminophen affects signaling of these
Cochrane review
1) 35 cochrane analyses
2) 45,000 patients in 350 studies
NNT >50%
1) ibuprofen 400mg/ APAP 1000mg is 1.5
2) ibuprofen 600 mg - 800 mg is 1.7
3) oxycodone 10 mg/ APAP 650 mg is 2.3
4) codeine 60 mg / APAP 650 is 3.9
5) codeine 60 mg is 21
dosage of ibuprofen
1) use the dose about 400-800 mg each 6 hours
2) 600/800 mg is 80% with NNT > 50%
