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D2: 622 Oral Surgery > Pain Management and Wound Healing > Flashcards

Pain Management and Wound Healing Flashcards

1
Q
  1. Highly variable and depends on patient’s preoperative frame of mind
  2. Spending enough time discussing post op course helps greatly
  3. Usually not severe and can be managed with mild analgesics in most patients
  4. Peak pain 12 hours after extraction then diminishes rapidly
  5. Pain from extraction rarely persists longer than 2 days
A

Characteristics of Post op pain

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2
Q
  1. First dose of analgesic should be taken before anesthetic wears off
  2. This will avoid sharp, intense pain
  3. This helps control pain with milder meds
  4. Post op pain is harder to beat if administration of analgesics is delayed
A

Post op pain tips

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3
Q

Pain that occurs within the normal course of a disease or condition or as the result of surgery for which controlled substances may be prescribed for no more than 3 months

A

Acute Pain

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4
Q

Non-malignant pain that goes beyond the normal course of a disease or condition.

Controlled substances may be prescribed for a period greater than 3 months

A

Chronic Pain

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5
Q

MME

A

Morphine milligram equivalent

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6
Q

Drugs listed in the Drug Control Act of the Code of Virginia in Schedules II through IV

A

Controlled Substance

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7
Q

The electronic system within thhe department of health professions that monitor the dispensing of certain controlled substances

A

Prescription Monitoring Program

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8
Q

What is the goal for managing postprocedural dental pain or pain from limited pathological conditions

A

Minimize or Limit the pain

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9
Q

What might happen if you don’t tell the patient that the goal is not to fully eliminate pain

A

They may self prescribe

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10
Q

These drugs work peripherally, interfering with prostaglandin synthesis

A

Non-narcotics

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11
Q

What is a good alternative if a patient cannot tolerate aspirin

A

acetaminophen

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12
Q

What is the primary disadvantage of aspirin

A

potential for postop bleeding

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13
Q

What is the DOC for mild to moderate pain after tooth extraction

A

NSAIDs

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14
Q

Adult Dosage and Max Daily Dosage for Tylenol

A

500-1000 mg q4h

MAX: 4000 mg

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15
Q

Adult Dosage and Max Daily Dosage for Aspirin

A

500-1000 mg q4h

MAX: 4000 mg

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16
Q

Adult Dosage and Max Daily Dosage for Diflunisal

A

500 mg q8h

MAX: 1500 mg

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17
Q

Adult Dosage and Max Daily Dosage for Ibuprofen

A

200-800 q4-6h

MAX: 3200 mg

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18
Q

Most commonly used drugs of this class are codeine and the codeine congeners like oxycodone, hydrocodone, dihyrocodeine

A

Centrally Acting Analgesics

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19
Q

Opiods are rarely used alone…what are they typically paired with

A

Aspirin, Tylenol, or Advil

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20
Q

1 Codeine

A

7.5 mg

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21
Q

2 Codeine

A

15 mg

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22
Q

3 Codeine

A

30 mg

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23
Q

4 Codeine

A

60 mg

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24
Q

Dosage of Oral Codeine

A

30 mg q4h

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25
Q

Dosage of Oxycodone

A

5 mg q4h

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26
Q

Dosage of Hydrocodone

A

5 mg q4h

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27
Q

Dosage of Dihydrocodone

A

30 mg q4h

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28
Q

Dosage of pentazocine

A

50 mg q4h

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29
Q

Dosage of Meperidine

A

100 mg q4h

30
Q

If pairing Aspirin with Codeine, how much aspirin is prescribed

A

325 mg

31
Q

How much Tylenol is prescribed when paired with ceodeine

A

Phenopehn: 325
Codeine: 300
Darvocet N1000: 650

32
Q

What government agency controls Narcotic Analgesics?

A

DEA

33
Q

What do you need to write a script for Narcotics?

A

DEA permit and number

34
Q

In 2014 more Virginians died from Opioid overdoses than…..

A

Car accidents

35
Q

What percent of fatal drug overdoses are due to opioids?

A

61%

36
Q

With over 52,000 deaths in 2015, what was the leading cause of accidental death in the USA

A

Drug OD

37
Q

Of the 52,000 deaths, how many of them were due to opioids

A

13,000

38
Q

In 2012, how many opioid prescriptions were written in the USA

A

259 million

39
Q

What percent of heroin users used opioids as a gateway

A

80%

40
Q

Why do people move from Opioids to heroin?

A

Heroin is cheaper and easier to get

41
Q

What subpopulation is at an especially high risk for opioid OD

A

12-17 year old adolescents

42
Q

Where do most teens get their hands on opioids?

A

They are given to them by relatives

43
Q

Why are women at a higher risk for opioid dependence than men

A

More likely to have chronic pain

May become dependant on Rx drugs more quickly then men

44
Q

Between 1999 and 2010, the number of narcotic pain med OD’s for men increased 237% for men……what was the increase for women?

A

400%

45
Q

How much have fatal heroin OD’s among women increased from 2010-2013

A

Tripled

46
Q

What Virginia laws apply to prescribing narcotics for dentists

A

none

47
Q
  1. Perform a health history and physical examination appropriate to the complaint
  2. Query the Prescription Monitoring Program
  3. Conduct an assessment of the patient’s history and risk of substance abuse
A

Things that need to be done before prescribing a narcotic analgesic

48
Q
  1. Description of the pain
  2. Presumptive diagnosis for the origin of the pain
  3. An examination appropriate to the complaint
  4. Treatment plan
  5. The medication prescribed (date, type, dosage, strength, and quant)
A

Information to be included in patient records

49
Q

If an opioid is considered, what type should it be

A

Short acting
Lowest effective dose
Fewest number of days
Max 7 days

50
Q

Careful and thorough documentation must be maintained if prescription is higher than ________

A

50 MME/day

51
Q

What is the threshold dose that requires referral to a pain management physician

A

120 MME/day

52
Q
  1. Patient be evaluated again, and decision to prescribe again documented
  2. Check patient’s prescription history in the Prescription Monitoring Program
A

Steps required if a new prescription is required beyond initial 7 days

53
Q

Rx for Mild PO Pain

A

Ibuprofen
200-400 mg q4-6
prn (as needed)

54
Q

Rx for Moderate PO Pain

A

Ibuprofen 400-600 mg q6h for 24 hrs

Then:
Ibuprofen 400 mg
q4-6h prn

55
Q

Moderate to Severe Pain

A

Ibuprofen 400-600 mg + APAP 500 mg every 6 hours for 24 hours

Then:
Ibuprofen 400 mg + APAP 500 mg every 6 h prn

56
Q

Severe Acute Post-Op Pain

A

Ibuprofen 400-600 mg + APAP 325 mg hydrocodone 5mg q6h for 24-48 hrs

Then:
Ibuprofen 400-600 mg + APAP 500 mg q6h prn

57
Q

What is APAP?

A

acetyl-para-aminophenol

(Tylenol and Oxycodone) 325mg/5mg

58
Q

What is the max dose for APAP

A

3000 mg

59
Q

What is Viviprofen

A

Rescue med in case patient experiences breakthrough pain

60
Q

What is the max dose of Ibuprofen (Daily). Who can prescribe a higher dose?

A

2400 mg

Physician for osteoarthritis

61
Q

What is a long acting local anesthetics

A

Marcaine

62
Q

What is the Rx for preemptive analgesics

A

600 mg Ibuprofen 1 hour before surgery

63
Q
  1. Dexamethasone IV

2. Medrol Pack

A

Corticosteroids

64
Q

These have unlimited efficacy in providing pain relief

A

Opioids

65
Q

As doses of opioids increase, so does their effectiveness at reducing pain, why not just up the dosage?

A

Because SE’s and toxicity also icrease

66
Q

Opioids are identical in their analgesic efficacy at _______ doses

A

equipotent

67
Q

What is considered to be the conventional standard for relief of moderately sever pain

A

Morphine:

10 mg IM
30 mg Oral

68
Q

What are the multipliers for equipotent (to morphine) doses of Hydromorphone
Codeine
Hydrocodeine
Oxycodone

A

Hydromorphone: 4 (30/4 = 7.5 mg)

Codeine: 0.15 (30/0.15 = 180-200 mg)

Hydrocodone: 1 (30/1 = 30 mg)

Oxycodone: 1.5 (30/1.5 = 20 mg)

69
Q

Formula for DME

A

Daily Morphine Equivalents = (Strength x Multiplier x Quantity)/Days

70
Q

For our purposes:

Who prescribes for acute pain, and who prescribes for chronic pain

A 
Dentist = Acute
Doc = Chronic

D2: 622 Oral Surgery (7 decks)

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