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DOH210 S1 > Week Nine: Analgesics and Anti-inflammatory Agents > Flashcards

Week Nine: Analgesics and Anti-inflammatory Agents Flashcards

1
Q

When are analgesics used in dentistry?

A

When the patients pain cannot be removed, reduced or eliminated by appropriate dental treatment.

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2
Q

Analgesics don’t?..

A

Address causes of pain

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3
Q

What is NSAIDs?

A

Nonsteroidal Anti-inflammatory drugs

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4
Q

What are NSAIDS?

A

NSAIDS have anti-inflammatory and analgesic properties.
They are a mediator of inflammation by acting on arachidonic acid pathway, which inhibits production of prostaglandins (mediators and modulators of inflammation)

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5
Q

What do NSAIDS act on?

A

The PNS and CNS

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6
Q

What are NSAIDs effective in treating?

A
  • acute pain and inflammation relating to endodontic, surgical, restorative or periodontal procedures and sometimes temporomandibular joint dysfunction.
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7
Q

NSAIDS are the drug of choice for?

A

Dentistry, regarding pain relief.

  • Aspirin
  • Ibuprofen
  • Naproxen
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8
Q

What is aspirin?

A

Effective analgesic, anti-inflammatory antipyretic and anti-platelet effects

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9
Q

What is the dose range for aspirin?

A

300-900mg, every 4-6 hours (daily maximum 3600mg)

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10
Q

When are aspirins peak blood levels?

A

1-2hours

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11
Q

What is the half life of aspirin?

A

15 minute half life - primary biotransformation in liver.

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12
Q

What are common side effects of aspirin?

A
  • Dyspepsia, nausea & occult bleeding

- Prolonged bleeding time

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13
Q

What can occur after long use of aspirin?

A
  • Higher dose regimens increase risk of GI and renal problems
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14
Q

How is toxicity displayed from aspirin?

A

CNS symptoms

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15
Q

What are the contraindications/precautions of aspirin?

A
  • Children: association with Reyes syndrome
  • Peptic ulcer
  • Compromised liver function
  • Asthma, nasal polyps or chronic allergic disorders
  • Pregnancy
  • Diabetes
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16
Q

What are important drug interaction to note regarding aspirin?

A
  • Alcohol
  • May increase toxicity of methotrexate and valproic acid
  • May decrease the effects of antihypertensive medications (ACE inhibitors, some diuretics, angiotensin II receptor antagonists, oral hypoglycaemic and warfarin)
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17
Q

What is the dose range for ibuprofen?

A

Following dental treatment = 200-600mg every 4-6 hours (daily maximum 2400mg) for a short period of 24 hours.
OTC max dose = 1200mg

18
Q

What produces better analgesia ibuprofen or paracetamol/codeine combinations?

A

Ibuprofen.

19
Q

When is the peak blood level for ibuprofen?

A

0.5-1.5 hours (gel caps have a faster absorption)

20
Q

What are adverse effects of ibuprofen?

A

Gastrointestinal disturbances

Fluid retention

21
Q

What can be an adverse effect after long term use of ibuprofen?

A

Higher dose regimens increase the risk of GI and renal problems.

22
Q

What drug interactions can occur with ibuprofen?

A

Can interfere with antihypertensive medications (ACE inhibitors, some diuretics) - if taken for longer than one week.

23
Q

What is paracetamol also known as?

A

Acetaminophen

24
Q

What does paracetamol do?

A

It is a mediator of inflammation by acting on arachidonic acid pathway

Acts in the CNS to inhibit prostaglandin synthesis and NO synthesis in macrophages

25
Q

What is paracetamol effective in?

A
  • Mild Pain, particularly soft tissue and musculoskeletal origin mild to moderate post treatment pain, severe pain, fever

An alternative to NSAIDs if contraindicated.

26
Q

What is paracetamols dose range?

A

500-1000mg, every 4-6hours (daily maximum 4000mg)

27
Q

When is paracetamols peak in blood levels?

A

0.5-1.5 hrs

28
Q

What is the half life of paracetamol?

A

2-3 hours, primary biotransformation in the liver

29
Q

What is the dosage of paracetamol for children?

A

15mg/kg orally every four hours (daily maximum 90mg/kg up to a total of 4000mg)

30
Q

What can you combine paracetamol with?

A

Opioids for greater analgesia

31
Q

When is paracetamol indicated in comparison to NSAIDs?

A

Paracetamol does not cause the same gastric irritation or the other complications associated with aspirin and other NSAIDs

32
Q

What are adverse effects of paracetamol?

A
  • Liver disease
  • Increased toxicity if taken with alcohol
  • Overdose will produce hepatotoxicity, hypoglycaemia and acute tubular necrosis.
33
Q

What is the MOA of opiods?

A

MOA achieved through activation of opioid receptors inhibiting neuronal activity and subsequently pain transmission. Opioids work on the CNS and PNS.

34
Q

What are interactions/precautions of opioids?

A

MAOIs - potentiation of sedative/depressant effects if used in conjunction with other CNS depressants (sedatives, hypnotics, phenothiazines, anaesthetics and alcohol)

HIGH INCIDENCE OF ADVERSE EFFECTS

35
Q

Name some opioids.

A

Codeine
Morphine
Oxycodone
Tramadol

You should only use opioids as adjunctive analgesics and not as primary analgesics in dentistry

36
Q

How do you manage pain relief with analgesics in dentistry?

A

3 Ds

Diagnosis, Dental Treatment and Drugs

37
Q

How do you manage mild pain in adults?

A
  1. ibuprofen 400mg orally, every four hours (MAX 2400mg in 24hrs)
  2. Aspiring 600-900mg orally, every four hours (MAX 3600mg/24hrs)
  3. If NSAIDs are contraindicated
    Paracetamol 500 - 1000mg orally, every 4hrs (MAX 4g/24HRS)
38
Q

How do you manage moderate pain in adults?

A
  1. Ibuprofen 400 to 600 mg orally, every 4 hours (to a maximum of 2400mg?24hrs) + Paracetamol every four hours (MAX 4g/24hrs)
  2. if NSAIDs contraindicated
    Paracetamol + codeine 1000+60 mg orally, every 4hours (MAX paracetamol = 4g/24hrs)
39
Q

How do you manage severe pain in adults?

A
  1. Ibuprofen 400 to 600 mg orally, every 4 hours (to a maximum of 2400mg?24hrs) + Paracetamol every four hours (MAX 4g/24hrs) + Paracetamol + codeine 1000+60 mg orally, every 4hours (MAX paracetamol = 4g/24hrs)
  2. If NSAIDs contraindicated.
    Paracetamol + codeine 1000+60 mg orally, every 4hours (MAX paracetamol = 4g/24hrs)
40
Q

How do you manage pain in children?

A
  1. Ibuprofen 5-10mg/kg orally, 6-8 hourly (to a maximum daily dose of 2400mg)
  2. paracetamol 15mg/kg orally or rectally, 4-6 hourly (MAX 4g)

DOH210 S1 (15 decks)

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