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level: Analgesics and pain

Questions and Answers List

level questions: Analgesics and pain

QuestionAnswer
Nociceptive painCaused by stimulation of peripheral nerve fibres responding to stimulus near or exceeding harmful intensity
Neuropathic painCaused by abnormal somatosensory activity due to damage or disease affecting the PNS or CNS
Psychogenic painNo apparent organic basis for pain
WHO pain ladder1. non opoid e.g. paracetamol, 2. weak opoid e.g. code+non opoidine 3. srong opoid e.g. morphine +non opoid
What beneficial side effect can ibu or para haveAntipyretic
Paracetamol facts 4Analgesic- inhibits PGs, antipyretic useful for dental , not anti inflam. little interactions/adverse affects
Para dosingfor >50 kg 2 tablets 1g every 4-6 hours max 8 daily usually for 5 days post op
NSAIDs and COXCOX1- protects gastric mucosa, COX-2 inducible inflammatory and renal
Why are NSAIDs good for dental painReduced inflamm. e.g. pulpitis
Common NSAIDs used and noteIbuprofen, diclofenac and aspirin
Ibuprofen dosingIbu tablets 400mg 1 tablet to be taken four times a day after food max daily dose is 2.4g a day i.e. 800 mg three times a day
Ibu dosing for childrenTablets 200mg or in supsension 100ml/5ml
Diclofenac dosing for moderate inflammatroy or post op painDiclofenac sodium tablets 50mg 1 tablet to be taken three times a day pref. after food not for children
NSAID drug interactionsInc. bleeding risk by aspirin antiplatelet anticoag. and increased risk of bleeding wiht SSRIs
NSAID in peptic ulcer casePrescribe a PPI e.g. lansoprazole once daily during NSAID
Weak opoids in dentistryNo anti-inflamm and relatively inneffective and have adverse affects
Weak opoids in dentistry dosing (less appropriate)Codeine phosphate 30mg tablets 1 to 2 tablets taken 4 times a day max 240 mg daily- can be given IM but not reccomended
Co-codamolCodeine phosphate and paracetamol
Co-dyrmadolDihydrocodeine and paracetamol
Co-codaprinCodeine phosphate plus aspirin
TramacetTramadol plus paracetamol
Codafen continusCodeine phosphate and ibuprofen
Amount of paracetamol per kg to refer to A&E75 mg/kg
What is the toxic intermediate of paracetamol shortened toNAPQI
What is tramadolOpoid analgesic and enhances 5HT indicated for moderate to severe pain see side effects dose is 50-100 mg every 4 hours max dose 400mg a day
(generally not in dental setting) Strong opiates e.g. morphine, fentanyl, oxycodone and pethidinepethidine 50 mg orally 50-150mg every 4 hrs max dose daily 450
What can be used to treat atypical facial painTricyclic antidepressant
Trigeminal neuralgia treatment can be withAntiepileptics e.g. gabapentin and carbamazepine
Adjunct medication in various facial painsAnxiolytics e.g. diazeapam
Chronic and oral facial pain may be due toAtypical/idiopathic, TMJ dysfunc.
Acute oral problems e.g. acute herpetic gingivostomatitis, apthous ulceration, erythema multiforme may be treated betterTopically e.g. benzydamine hydrochloride 0.15% oral rinse or spray15mls or 4-8 spraysused every 1.5 to 3 hrs
What is important to be aware of in some patients when prescribingAddicts, liver and kidney disease patiets
prescribing to childrenNSAIDs okay not aspirin prescribe by weight or age