analgesics in dentistry
TRANSCRIPT
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PRESENTED BY:ROJI GAUTAMROLL.NO:16
ANALGESICS IN DENTISTRY
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Contents
Pain classificationIntroduction to analgesicsClassificationSome drugsContraindicationWHO ladder of painConclusionReferences
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PAIN
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Pain clasification
Nociceptive
Neuropathic
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Introduction
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A drug that selectively relieves pain by acting in CNS or on peripheral pain mechanisms, without significantly altering consciousness
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Classification of opioids
1. Natural opium alkaloids :morphine ,codeine
2. Semisynthetic opiates: diacetylmorphine(heroin) , pholcodeine
3. Synthetic opioids: pethidine(meperidine) ,fentanyl ,methadone, dextropropoxyphene ,tramadol
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MORPHINE
Principal alkaloid
Pharmacological action:
Analgesic: dull,poorly localized viceral pain is better relieved than sharply defined somatic pain
Nonciceptive pain >neuretic pain
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Sedation : drowsiness
Mood and subjective effects: calming effect,loss of apprehension,mental clouding,and inability to concentrate occurs
Respiratory effects:depress respiratory center death in poisoining is due to respiratory failure
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Temperature regulating center: depressed, hypothermia occur in cold surrounding
Vasomotor:depressed at higher doses and contributes to fall in BP
B. CVS:vasodilation due to histamine release depression of
vasomotor system direct action decreasing
tone to blood vessel
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GIT: constipation
Administration:tabletsDosage 15-30mg 12hour
ADVERSE EFFECTS Sedation,mental clouding,lethargy xerostomia idiosyncracy and allergy apnoea acute morphing poisoining
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PRECAUTION AND CONTRAINDICATION
Infant and adult more susceptible to respiratory distress
Dangerous in respiratory insufficiency Bronchial asthma:can precipitate attack
by histamine release Head injury Hypotensive an hypovolumic state Undiagnosed acute abdominal pain Elderly male Hypothyroidism,liver and kidney disease
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Newer analgesics
methyldihydrmorphinoe, or metopon a new member of morphine
Mepiridine, or demerol and metadone or amedone
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CODEINE
Occurs naturally in opium
Less potent than morphine
Low affinity for opoids receptor
Good activity by oral route
Constipation is a potent side affects so has been used to control diarrhoea
Abuse liability is low
Can relieve mild to moderate pain
Relief of post extration pain
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Diacetyl morphine
More lipid soluble: enters brain more rapidly but duration of action is similar to morphine
More euphorient and highly addicting
Banned in most country except U.K
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PETHIDINE
Reacts with opoids receptor and its action are blocked by naloxone
Used as preanaesthetic medication
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NSAIDs
Aspirin: pharmacological action: 1. analgesic,
antipyretic , antiinflammatory action
Adverse effects: gastricdisorder, hypersensitivity,
antiinflammatory dose,acute salicylate poisoiningAction: inhibit prostaglandin synthesis by cyclo-
oxygenase pathway
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Precaution and contraindication:
Sensitive to it and in peptic ulcer,bleeding tendencies
In children suffering from chicken pox and influenza
Diabetics Chronic liver disease Stopped 1 week before elective surgery Pregnancy Breastfeeding mother High dose in g-6-pd deficient individuals
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use
Toothache, for headache ( including mild migrane)
Dose :0.3-0.6g 6-8 hourly
Pharmakokinetic: absorbed from stomach and small intestine
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nimesulide
Most completely absorbed orally
99% plasma protein bound
Extensively metabolized and excreated in urine
Adverse effect:
gastrointestinal(epigastric,heartburn,nausea,loose motion,), dermatological (rash,pruritis), and central(somnolence,dizziness)
Use:
Sinusitis,ear nose throat disorder, dental surgery
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Diclofenac sodium
Analgesic,antipyretic and anti inflammatory drug
MOA: Inhibit prostaglandin synthesis USE: To manage post operative pain muscuoskeletal pain temporomandibular
joint Contraindication:caution to be taken with
hepatic or renal dysfunction SIDE EFFECT: Nausea,headache,dizziness
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Ibuprofen
Mild to moderate nociceptive pain
Administration in tablet and liquid form
Tablet 200-400mg Liquid 20-40mg
Side effects: GI bleed and ulcer,MI,dermatitis ,stroke
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Indomethacin
Relieves only inflammatory and tissue injury related pain
Orally absorbed
Gastrointestinal and CNS effects
Use:psoriatic arthritis, acute gout
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PARACETAMOL
It raises pain threshold but has weak peripheral antiinflammatory component
Well absorbed orally
Metabolism occurs mainly by conjugation with glucoronic acid and sulphate : conjugates are rapidly excreted in urine
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acute paracetamol poisoining Occur in children who has low hepatic
glucoronide conjugating ability
If large dose >150mg/kg or >10g is taken
Manifestation: nausea, vomiting,abdominal pain and liver tendernss
after12-18 hours centrilobular hepatic necrosis occur with renal tubular necrosis and hyoglycemia may progress to coma
jaundice occur after 2 hours
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Treatment of acute paracetamol poisoining Early- vomitting is induced Activated charchoal Is given to
reduce absorption Specific: N-acetylcysteine 150mg/kg
i.v over 5 min
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SIDE EFFECTS
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Combination
Combination of aspirin and paracetamol is additive and a ceiling analgesic affect is obtained when total amount of aspirin +paracetamol is ~1000mg
Combination of paracetamol is also used with other NSAIDs like ibuprofen,diclofen,etc
Combination should be used for short period of time
The objective of using combination is to use low dose of drug
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WHO LADDER OF PAIN
Basic principle : analgesia which is an appropriate for the degree of pain should be prescribed and to increase until pain is controlled
If pain is severe or remains poorly controlled strong opoids should be prescribed
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Mild pain:non opoids e.g paracetamol 1 g 6 hourly
Moderate pain:weak opoids e.g codeine 60mg 6 hourly is added
Severe pain:strong opoids
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Non opoid analgesic for patient with dental pain Intolerable to aspirin may be able to
tolerate acetamphinol
Caution should be taken to assure that cross intolerance is not present
Ibuprofen increase probabitity of cross intolerance
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Conclusion
The basis purpose of analgesic is to relieve pain however misuse of the drug is also found
Analgesic should not be used for long period(i.e more than 3 days)
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References
ESSENTIAL OF MEDICAL PHARMACOLOGY K.D tripathi 6th edition
DAVIDSON PRINCIPLE AND PRACTICE OF MEDICINE 21st edition
BURKET’s ORAL MEDICINE 11TH edition
NM DENT J 1994 WINTER Cage TW
Dent clin NORTH Am 1984 Deuben RR
Twenty-ninth annual session of amerian college of physician herris isbell,lexington
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Newer NSAIDs
This group of drug has provided the data involving 3rd molar extraction has provided sore clinical data