DHE122 Lecture 5 Chapter 5,6 3/5/18

• Important issue in dentistry 
• often reason patient comes to office

• perception: physical component 
• reaction: psychological reaction

pain

blood rushes to infected area, body temperature increases, inflammation and blood clotting occurs.

prostaglandins

prostaglandin synthesis

control pain

• Nonopiod: non-narcotic used to treat mild pain and are weaker medications.
• Opioid: narcotic used to treat severe pain and are strong 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: over the counter, Non-narcotic, analgesic- reduce pain, antipyretic reduces fever, inflammation-reduces inflammation.
• Opioids: need prescription, narcotics, used for severe pain.

• ■Aspirin (acetylsalicylic acid)
• ■Tylenol (acetaminophen )
• ■Advil, Motrin (ibuprofen)
• ■Naprosyn (naproxen)

• Nonopioid (Nonnarcotic) Analgesics
• treat pain

• ■Advantages:
• ■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
• Nonopioid

• ■Disadvantages:
• ■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

increased insulin production. Consult with MD before rx to diabetics

decreased aspirin effects

increased GI bleeding

White willow, dong quai, chamomile, ginseng, ginger, and red clover

• –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

• 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

• ■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

• ■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

• ■Good for mild to moderate pain
• ■Good antipyretic agent
• ■Decreases prostaglandin production
• ■Good antiplatelet agent

• ■Decrease ACE inhibitors – resulting in MI and stroke
• ■Increased GI issues
• ■Increased levels of Lithium, Bisphosphonates, antibiotics and other NSAID
• ■Hepatic issues

• ■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

• ■DepoDur (morphine)
• ■Codeine Sulfate (codeine)
• ■ Combunox, Percocet (oxycodone)
• ■Methadone Hydrochloride (methadone)

• *Opioids
• ■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

• *Opioids
• ■Respiratory depression
• ■High potential for addiction
• ■Enhances actions of other CNS depressants
• ■Can cause hypotension
• ■Physical and psychological dependence

• *Opioids
• ■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

• *Opioids
• 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

• *Opioids
• Treating moderate to severe pain
• Good analgesic
• Reduces pain perception
• Can be combined with NSAIDs

• *Opioids
• Not to be prescribed PRN
• May cause CNS depression
• Problems with abuse
• GI upset- abdominal pain
• Respiratory issues
• Xerostomia

• *Opioids
• ■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

• *Opioids
• Cardiovascular issues – arrhythmias, cardiac arrest, fainting
• GI upset
• CNS issues – agitation, hallucination
• Can cause sudden death

• *opioids
• Opioid antagonist
• Used to treat Opioid overdose
• Should be in medical emergency kit

asthma, cardiovascular or renal diseases –drug interaction

NSAIDs and Opioids

combination