Analgesia- Dental Therapeutics-1.txt

  1. What drugs are in the propel IC acid category
    • Ibuprofen, naproxen, naproxen sodium OTC, prescription naproxen sodium
    • Drugs that end in -en
  2. What drugs are considered acetic acids
    Ketorolac, diclofinac sodium, etodolac, drugs that end in -ac
  3. What drugs are in the salicylate category
    Diflunisal, other drugs that end in -sal
  4. What is the adult dose naproxen sodium
    OTC 400 stat 220 mg q 8-12 hrs

    Prescription strength 550 stat 275 mg q 6-8 hrs
  5. What is the maximum daily dose of naproxen sodium
    • OTC 660 mg
    • Prescription 1650 mg
  6. What is the adult dose for naproxen?
    500 stat 250 mg q 6-8 hrs
  7. What is the maximum daily dose for naproxen?
    1500 mg
  8. What is the adult dose for ibuprofen?
    400-600 q 4-6 hrs
  9. What is the maximum daily dose of ibuprofen
    • 3200 mg prescription
    • 1200 mg OTC
  10. What is the adult daily dose of ketorolac?
    20 mg stat 10 mg q 4-6 hrs
  11. what is the maximum dose of ketorolac daily?
    40 mg
  12. What is maximum daily dose of etodolac
    1200 mg
  13. What is the adult daily dose of etodolac?
    200-400 q 6-8 hrs
  14. What is the maximum daily dose of diclofinac?
    50 mg q 5-6 hrs
  15. What is the adult dose of diclofinac?
    50 mg q 6 hrs
  16. What is the maximum daily dose of diflunisal?
    1500 mg
  17. What is the adult dose of diflunisal?
    1000 stat 500 mg q 8 hrs
  18. What category is ketorolac in?
    Acetic acid
  19. What category is etdolac in?
    Acetic acid
  20. What category is diclofinac in?
    Acetic acid
  21. What category is ibuprofen in?
    Proprionic aicd
  22. What category is naproxen in?
    Proprionic acid
  23. What category is naproxen sodium in
    Proprionic acid
  24. What category is diflunisal in?
  25. Is mixing NSAIDs with narcotics synergistic or additive?
  26. Is mixing NSAIDs with acetaminophen additive or synergistic
  27. What are the general prescribing guidelines with NSAIDs
    • 1. NSAIDs can be mixed with narcotics or acetaminophen for additional effects
    • 2. Avoid NSAID NSAID combo ( platelets and GI problems)
    • 3. If NSAID failure switch chemical classes
  28. What are the general rules for prescribing NSAIDs in the clinics
    • Start with 600-800 mg ibuprofen qid
    • - schedule dose for opiod sparing
    • - APAP synergistic
    • 2. Inadequate response switch categories
    • 3. Ketorolac produces highest pain relief
    • - screen for GI and renal problems
  29. What are the adverse effects of NSAIDs
    • - risk of ulcers and GI complications
    • Platelet aggregation- reversible inhibitor
    • Nephrotoxicity-decrease GFR
    • CNS
  30. If a patient develops asthmatic symptoms from taking a specific NSAID is his mechanistic or structurally mediated
  31. If a pt develops a hypersensitivity to a single drug then is it structural or mechanistic
  32. How are patients treated with a mechanism mediated hypersensitivity to NSAIDs... Asthmatic rxn
    Do not use NSAIDs use narcotic plus apap
  33. What drugs lie in the phenanthrenes?
    • Morphin
    • Codeine
    • Oxycodone
    • Hydrocodone
    • Nalbuphine
    • Hydromorphone
  34. What drugs lie in the phenylpiperidines?
    • Meperidine
    • Fentanyl
    • Alfentanil
    • Sufentanil
    • Remifentanil
  35. What drugs lie in the phenylheptylamines?
    • Methadone
    • Propoxyphene
  36. What rules for prescribing nsaids to the elderly
    • -Use short half life NSAID ibuprofen
    • - higher risk of GI Bleed
    • -- higher in elderly females, age increase, increase w previous GI bleed, increase prednisone use
    • - consider APAP #3 q 4-6 hrs 1 tablet
  37. How many mg of hydrocodone equals40 mg of codeine
    5 mg
  38. How many mg of Oxycodone equals 40 mg of codeine
    2.5 mg
  39. How many mg of meperidine equals 40 mg of codeine
    50 mg
  40. How do you manage a patient with a pseudoallergy to an opiod
    • Use half the dose of a more potent oral agent
    • Consider adding diphephenhydramine
  41. What is the regimen for minimizing risk of pseudoallergy
    • - use a nonopoiod analgesic first
    • - decrease opiod dose if tolerated
    • - administer oral rather than parenteral
    • - use low dose of more potent opiod
    • - premed with diphenhydramine 25 mg 30 min before opiod use
  42. Which drugs are more common to have a pseudoallergy
    Low potency like meperidine and codein
  43. What are the symptoms of pseudoallergy
    Hypotension, flushing, pruritis, sweating
  44. List major adverse effects of opioids?
    • Nausea computing increased by vestibular stimulation
    • - constipation- no tolerance built up
    • - miosis- no tolerance to constricted pupils
    • - histamine release- doesn't indicate allergic rxn
    • - respiratory depression- tolerance builds quickly
  45. What is the prescribing regimen of codeine?
    30 mg codeine with 300 mg tylenol 1-2 tabs q 3-4 prn pain take qith food/ milk

    Max 14/24 hrs
  46. What is the prescribing regimen for hydrocodone?
    5/500 APAP q 4-6 hrs prn pain take with food or milk
  47. What is the prescribing regimen of Oxycodone?
    5/500 APAP q 4-6 hrs take with food or milk

    Max dose 8/24 hrs
  48. What patients should never be prescribed NSAIDs?
    • - Patients with moderate renal failure
    • - patients already taking an NSAID
    • - patients taking warfarin
    • - patients with a recent peptic ulcer disease
  49. What is the pediatric dose for APAP
    10 mg/kg q 4-6 hrs 65 mg/kg max
  50. What is the pediatric dose of ibuprofen
    5-10mg/kg q4-6hrs 300 mg max
  51. What is the pediatric dose for codeine
    0.5 mg/kg q 4 hrs 120mg max
  52. What is the pediatric dose for hydrocodone
    0.1-0.2 mg/kg
  53. What are the precautions associated with codeine
    Impaired ventilation, asthma, high intracranial pressure
  54. What are the precautions associated with hydrocodone
    Most addictive schedule 3, health care workers are most at risk for problems
  55. What are the precautions associated with meperidine
    Normeperidine can accumulate with repeated dosing causing seizures AVOID MAOIs
  56. What are the precautions associated with Oxycodone
    Causes euphoria and is a schedule 2 substance
  57. If a patient presents with gastritis or alcohol use how should they be managed?
    Use etodolac or cox2 use prophylactic for GI irritation
  58. How should patients with hepatic disease be managed
    Avoid diclofinac or oxicams
  59. How should patients on warfarin be managed
    Avoid all NSAIDs may try cox2 or diflunisal
  60. What is the controversy surrounding use of ketorolac
    Has tons of side effects but good for substance abuse patients because of high peak pain relief
  61. What is the max dose of apap acute and chronic
    • Acute 4000mg/day
    • Chronic without monitoring 2600mg/day
  62. What are he potential toxicities associated with overuse of APAP
    Doses above2765 mg daily increase INR in patients on warfarin

    Toxicityis increased by fasting or alcohol consumption
  63. What is the mechanism of tramadol?
    Binds mu receptors and inhibits serotonin and NE reuptake
  64. What are the uses for tramadol
    • CANNOT prescribe for people with opioid dependent history
    • CANNOT prescribe for patients allergic to codeine
    • - rescue med for bad gut and patients with neuropathic ain
Card Set
Analgesia- Dental Therapeutics-1.txt
Baker Analgesia Test #2