Week Nine: Analgesics and Anti-inflammatory Agents Flashcards
When are analgesics used in dentistry?
When the patients pain cannot be removed, reduced or eliminated by appropriate dental treatment.
Analgesics don’t?..
Address causes of pain
What is NSAIDs?
Nonsteroidal Anti-inflammatory drugs
What are NSAIDS?
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)
What do NSAIDS act on?
The PNS and CNS
What are NSAIDs effective in treating?
- acute pain and inflammation relating to endodontic, surgical, restorative or periodontal procedures and sometimes temporomandibular joint dysfunction.
NSAIDS are the drug of choice for?
Dentistry, regarding pain relief.
- Aspirin
- Ibuprofen
- Naproxen
What is aspirin?
Effective analgesic, anti-inflammatory antipyretic and anti-platelet effects
What is the dose range for aspirin?
300-900mg, every 4-6 hours (daily maximum 3600mg)
When are aspirins peak blood levels?
1-2hours
What is the half life of aspirin?
15 minute half life - primary biotransformation in liver.
What are common side effects of aspirin?
- Dyspepsia, nausea & occult bleeding
- Prolonged bleeding time
What can occur after long use of aspirin?
- Higher dose regimens increase risk of GI and renal problems
How is toxicity displayed from aspirin?
CNS symptoms
What are the contraindications/precautions of aspirin?
- Children: association with Reyes syndrome
- Peptic ulcer
- Compromised liver function
- Asthma, nasal polyps or chronic allergic disorders
- Pregnancy
- Diabetes
What are important drug interaction to note regarding aspirin?
- 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)
What is the dose range for ibuprofen?
Following dental treatment = 200-600mg every 4-6 hours (daily maximum 2400mg) for a short period of 24 hours.
OTC max dose = 1200mg
What produces better analgesia ibuprofen or paracetamol/codeine combinations?
Ibuprofen.
When is the peak blood level for ibuprofen?
0.5-1.5 hours (gel caps have a faster absorption)
What are adverse effects of ibuprofen?
Gastrointestinal disturbances
Fluid retention
What can be an adverse effect after long term use of ibuprofen?
Higher dose regimens increase the risk of GI and renal problems.
What drug interactions can occur with ibuprofen?
Can interfere with antihypertensive medications (ACE inhibitors, some diuretics) - if taken for longer than one week.
What is paracetamol also known as?
Acetaminophen
What does paracetamol do?
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
What is paracetamol effective in?
- Mild Pain, particularly soft tissue and musculoskeletal origin mild to moderate post treatment pain, severe pain, fever
An alternative to NSAIDs if contraindicated.
What is paracetamols dose range?
500-1000mg, every 4-6hours (daily maximum 4000mg)
When is paracetamols peak in blood levels?
0.5-1.5 hrs
What is the half life of paracetamol?
2-3 hours, primary biotransformation in the liver
What is the dosage of paracetamol for children?
15mg/kg orally every four hours (daily maximum 90mg/kg up to a total of 4000mg)
What can you combine paracetamol with?
Opioids for greater analgesia
When is paracetamol indicated in comparison to NSAIDs?
Paracetamol does not cause the same gastric irritation or the other complications associated with aspirin and other NSAIDs
What are adverse effects of paracetamol?
- Liver disease
- Increased toxicity if taken with alcohol
- Overdose will produce hepatotoxicity, hypoglycaemia and acute tubular necrosis.
What is the MOA of opiods?
MOA achieved through activation of opioid receptors inhibiting neuronal activity and subsequently pain transmission. Opioids work on the CNS and PNS.
What are interactions/precautions of opioids?
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
Name some opioids.
Codeine
Morphine
Oxycodone
Tramadol
You should only use opioids as adjunctive analgesics and not as primary analgesics in dentistry
How do you manage pain relief with analgesics in dentistry?
3 Ds
Diagnosis, Dental Treatment and Drugs
How do you manage mild pain in adults?
- ibuprofen 400mg orally, every four hours (MAX 2400mg in 24hrs)
- Aspiring 600-900mg orally, every four hours (MAX 3600mg/24hrs)
- If NSAIDs are contraindicated
Paracetamol 500 - 1000mg orally, every 4hrs (MAX 4g/24HRS)
How do you manage moderate pain in adults?
- Ibuprofen 400 to 600 mg orally, every 4 hours (to a maximum of 2400mg?24hrs) + Paracetamol every four hours (MAX 4g/24hrs)
- if NSAIDs contraindicated
Paracetamol + codeine 1000+60 mg orally, every 4hours (MAX paracetamol = 4g/24hrs)
How do you manage severe pain in adults?
- 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)
- If NSAIDs contraindicated.
Paracetamol + codeine 1000+60 mg orally, every 4hours (MAX paracetamol = 4g/24hrs)
How do you manage pain in children?
- Ibuprofen 5-10mg/kg orally, 6-8 hourly (to a maximum daily dose of 2400mg)
- paracetamol 15mg/kg orally or rectally, 4-6 hourly (MAX 4g)
