- Important issue in dentistry
- often reason patient comes to office
Two components of pain are?
- perception: physical component
- reaction: psychological reaction
_____is usually identified when the body is trying to fight infection.
what happens in pain?
blood rushes to infected area, body temperature increases, inflammation and blood clotting occurs.
The cells responsible for letting the body know there's pain are called?
One way to control pain is to inhibit ________.
Analgesic agents are used to?
two main groups of analgesics?
- Nonopiod: non-narcotic used to treat mild pain and are weaker medications.
- Opioid: narcotic used to treat severe pain and are strong analgesics.
What is an important difference between nonopioid and opioid analgesics?
- site of action.
- Nonopioid act primarily at peripheral nerve endings and Inuit prostaglandin production.
- Opioids act primarily in the central nervous system and depress the CNS response to pain.
Nonopioids Vs Opioids analgesics
- Nonopioids: over the counter, Non-narcotic, analgesic- reduce pain, antipyretic reduces fever, inflammation-reduces inflammation.
- Opioids: need prescription, narcotics, used for severe pain.
More common NSAIDs used in dentistry are?
- ■Aspirin (acetylsalicylic acid)
- ■Tylenol (acetaminophen )
- ■Advil, Motrin (ibuprofen)
- ■Naprosyn (naproxen)
Nonsteroidal antiinflammatory drugs (NSAIDs):
- Nonopioid (Nonnarcotic) Analgesics
- treat pain
Advantages of Aspirin (acetylsalicylic acid)? what group of analgesic?
- ■Reduces inflammation
- ■Lowers body temperature – fights fever
- ■Relieves moderate pain
- ■Prevents blood clotting
- ■Small doses reduce uric acid retention – goutCan potentate effects of certain drugs
Disadvantages of Aspirin (acetylsalicylic acid)?
- ■GI problems in large dosages – bleeding, nausea, vomiting
- ■Prolonged bleeding – exacerbate ulcers
- ■Causes Reye’s syndrome in children – hepatotoxicity and death
- ■Pregnancy – no human studies, but animal studies show birth defects
- ■Drug interaction with Warfarin – blood thinner
- ■Can potentate drug effects like with Methotrexate – used to treat cancer. Combo results in bone marrow depression
- ■Interferes with diuretics
- ■Not recommended for asthmatics – breathing issues
Aspirin + insulin =
increased insulin production. Consult with MD before rx to diabetics
Aspirin + antacids =
decreased aspirin effects
Aspirin + NSAIDs =
increased GI bleeding
Herbs + Aspirin which increase bleeding are:
White willow, dong quai, chamomile, ginseng, ginger, and red clover
advantages of Tylenol (acetaminophen)?
- –Good antipyretic agent (fever reducing)
- –Good analgesic effect
- –Good to use when aspirin is contraindicated in adults and children
- –No GI issues like gastric bleeding
- –Does not affect platelet adhesion
- –Does not affect uric acid No drug interactions
Disadvantages for Tylenol (acetaminophen)?
- No anti-inflammatory action – not considered an NSAID
- Poor antiplatelet
- Is metabolized in liver so can produce hepatotoxicity in certain patients
- If a heavy drinker dose needs to be restricted to 2gm/day
- Drug of choice for folks on Warfarin and peptic ulcer disease
Advantages of Advil, Motrin (ibuprofen)?
- ■Good analgesic, antipyretic and antinflammatory
- ■400mg more affective than aspirin
- ■Drug of choice for dental pain
- ■When combined with Tylenol is as affective as Tylenol with Codeine
- ■ Excreted by kidneys
- ■Higher doses are better than Codeine
- ■Metabolized by liver and excreted by kidneys
Disadvantages Advil, Motrin (ibuprofen)?
- ■Decrease effectiveness of ACE inhibitors, Aspirin, Beta Blockers, Corticosteroids', Cyclosporine, Lithium and loop diuretics
- ■May increase levels of anticoagulants
- ■Not recommended for women who are breast feeding
Advantages of Naprosyn (naproxen)?
- ■Good for mild to moderate pain
- ■Good antipyretic agent
- ■Decreases prostaglandin production
- ■Good antiplatelet agent
Disadvantages of Naprosyn (naproxen)?
- ■Decrease ACE inhibitors – resulting in MI and stroke
- ■Increased GI issues
- ■Increased levels of Lithium, Bisphosphonates, antibiotics and other NSAID
- ■Hepatic issues
When are Opioid analgesics used?
- ■Used when NSAIDs are contraindicated
- ■Used for moderate to severe pain
- ■Bind to receptors in spinal cord and CNS and alter pain perception
- ■Sedation and euphoria
- ■Cough suppression
- ■Control of GI problems such as diarrhea
Common Opioids are?
- ■DepoDur (morphine)
- ■Codeine Sulfate (codeine)
- ■ Combunox, Percocet (oxycodone)
- ■Methadone Hydrochloride (methadone)
Advantages of DepoDur (morphine)?
- ■Great for severe pain
- ■Drug of choice for severe pain of myocardial infarction
- ■Drug of choice for people with severe pain and terminal diseases
- ■Reduces pain perception – best in IV, also comes in pill and liquid form
Disadvantages DepoDur (morphine)?
- ■Respiratory depression
- ■High potential for addiction
- ■Enhances actions of other CNS depressants
- ■Can cause hypotension
- ■Physical and psychological dependence
Advantages Codeine Sulfate (codeine)?
- ■Most commonly used ovoid in dentistry – Tylenol with codeine
- ■Codeine alone is a Schedule II drug but when used in combination is a Schedule III drug
- ■Antitussive – prevents coughing
- ■Good for minor pain
- ■Rapid absorption
- ■Low risk for abuse
Disadvantages Codeine Sulfate (codeine) :
- Overdose results in pinpoint pupils
- Overdose results in respiratory distress and death
- Not recommended for pregnant women
- Not recommended if patient allergic to Opioids
- Side effect of medication is vomiting
Advantages Combunox, Percocet (oxycodone)?
- Treating moderate to severe pain
- Good analgesic
- Reduces pain perception
- Can be combined with NSAIDs
Disadvantages Combunox, Percocet (oxycodone)?
- Not to be prescribed PRN
- May cause CNS depression
- Problems with abuse
- GI upset- abdominal pain
- Respiratory issues
Methadone Hydrochloride (methadone):
- ■Treatment for Narcotic withdrawal and dependence
- ■Effective in cases of Heroin, morphine, and other opioids but not METH
- ■Given for inpatient treatment or during emergency situations – Dr. Drew
- ■Alters pain perception
- ■Not prescribed by DDS
Disadvantages Methadone Hydrochloride (methadone)?
- Cardiovascular issues – arrhythmias, cardiac arrest, fainting
- GI upset
- CNS issues – agitation, hallucination
- Can cause sudden death
- Opioid antagonist
- Used to treat Opioid overdose
- Should be in medical emergency kit
NSAIDs should be avoided by people with?
asthma, cardiovascular or renal diseases –drug interaction
GI issues are associated with?
NSAIDs and Opioids
NSAIDs and Opioids are often used in _____.