Exam #4: Non-Opiod Analgesics, Opioid Analgesics, & Adrenocorticosteroids

What are short-acting NSAIDs and what are some examples?

have a shorter half-life meaning the duration of action is less than 6 hours, usually 4-6 hours

ex. ibuprofen (Advil, Motrin) and ketorolac (Toradol)

What are long-acting NSAIDs and what are some examples?

have a longer helf-life meaning the duration of action is greater than 6 hours, usually 6-8 hours

ex. naproxen (Naprosyn), naproxen sodium (Anaprox), and naproxen sodium OTC (Aleve)

How do COX I and COX II drugs work?

by inhibiting COX I and/or COX II enzymes to reduce pain and inflammation

What is an example of a COX II Specific Agent that is for arthritis?

celecoxib (Celebrex)

Which is the most common Opioid used in dentistry today?

codeine

can be combined with acetaminophen for Tylenol #3

What kind of drug do they treat opioid addicts with?

methadone (Dolophine)

What nasal spray can they use to treat opioid overdoses with?

naloxone (Narcan)

What is the most used Adrenocorticosteroid?

prednisone

What is drug tolerance defined as?

need for increasing dose to achieve same effect

rate of development of tolerance depends on strength of agent and frequency of use

Does it help the patient’s post-op pain to take a pain med prior to the procedure?

Yes, it will delay the onset of postsurgical pain

What is the drug of choice for mild to moderate dental pain without contraindications?

NSAIDs

How do opioid analgesics work?

They bind to receptors located in the CNS and spinal cord to alter perception of reaction to pain

Does stimulation of different receptors produce all the same effect or different?

different

Do opioid analgesics help with any anxiety relief in dental pain?

Opioid analgesics are not indicated for tx of dental anxiety, but they can produce sedation and euphoria, which may potentiate their analgesic effect and relieve anxiety

What do the pupils of a drug addict on opioids look? What is that called?

They’re pupils look constricted (miosis)

What are the gastric (GI) issues with the consumption of aspirin?

irritation

dyspepsia (indigestion)

nausea

vomiting

bleeding

ulcers

What drug specifically did we learn about that inhibits prostaglandin synthesis and antipyretic (fever-reducing) effects?

acetylsalicylic acid

aspirin

If a person takes more than 400 mg of an NSAID like Ibuprofen, which effect will this help?

anti inflammatory effect

What are the precautions and advice to give to a patient taking NSAIDs?

take with food to avoid GI adverse effects

persistent use can decrease renal blood flow can cause potential kidney damage

they can cause fluid retention, which has potential to increase BP and cause hypertension

should be avoided for pts with asthma, cardiovascular or renal disease, peptic ulcer, ulcerative colitis, hx of hypersensitivity to aspirin or other NSAIDS

partial agonist or partial antagonist

agonists at some receptors and antagonists at other receptors

mixed opioid

What is the best drug to treat chronic pain for a longer-term basis?

NSAIDs

What organ can APAP/acetaminophen cause damage to if taken too much or often?

liver

What can we say about these drugs…ASA, APAP, and NSAIDs. What can they all do alone that is similar?

They all can have a analgesia (pain reducing) and antipyretic (fever reducing) effect

Why do we watch out advising a person on cardiovascular drugs not to take NSAIDs?

they can elevate the risk of cardiac events and stroke

they can cause fluid retention, which can increase BP and cause hypertension

can affect patients taking diuretics for heart failure

What are some adverse reactions of opiods?

respiratory depression

nausea and emesis

constipation

miosis

hypotension, bradycardia, and syncope

itching and urticaria

allergic reaction (dermatologic in nature) - VERY RARE

additive effects when used with other CNS depressants and MAOIs

What are the two majors signs of addiction?

cravings - intense desire for a drug

loss of control in ability to stop using a drug

Analgesic efficacy varies and depends on the strength of an agent…what are the different strengths of opioids?

Strongest: morphine

Intermediate: oxycodone

Weakest: hydrocodone and codeine

What do they add to the opioid to help with pain relief?

non opiod analgesics, such as acetaminophen and NSAIDs

If there is an addition, does this help reduce the amount of drug needed to help the patient cover pain?

Yes, combining an opioid with a non-opioid medication creates a "synergistic" or additive pain-relieving effect and lowers the total dose of opioid needed to relieve pain

What is Reye’s Syndrome?

caused by giving a child aspirin during a viral illness

condition is life threatening and is associated with hepatotoxicity and encephalopathy (swelling of the brain and liver)

Can a person become addicted to Tylenol #3?

Yes, because it contains an opiod (codeine)

What should you never prescribe to a current or past addict of drugs? 

hydromorphone (Dilaudid)

it is a favorite of addicts because of the strength

What drugs are damaging to the liver? 

aspirin

acetaminophen

What drugs are damaging to the kidneys?

NSAIDs

What can adrenocorticosteroids cause with periodontal disease patients?

delayed wound healing

interfere with the body’s response to inflammation

osteoporosis may reduce bone support for teeth

Would you ever prescribe a steroid to a patient with herpes simplex virus?

They are not usually prescribed for an infectious lesion because suppressing the immune system will worsen the infection

On some occasions, topical corticosteroids may be used for infectious lesions but MUST BE COMBINED WITH AN ANTIVIRAL

When would you prescribe a steroid to a patient?

tx of non-infectious oral lesions (ex. erythema multiforme, lichen planus, pemphigus/pemphigoid)

aphthous stomatitis

TMJ arthritis

oral surgery (reduce post-op edema, trismus, and pain)

pulp procedures

To avoid adrenal crisis, what should you do for patients who have been taking steroids long-term, who may have dental phobia, and for whom the appointment may be stressful?

consult with physician to increase steroid dosage

What kind of medication would be prescribed for an Addison’s disease patient?

adrenocorticosteroids

replacement therapy

What causes an adverse reaction with a adrenocorticosteroid?

prolonged therapy and sufficiently high doses

What is a good medication to treat oral mucositis or aphthous stomatitis?

triamcinolone (used topically)

Where are the adrenal glands and what do they do?

paired glands on top of the kidneys

secrete epinephrine and norepinephrine (from the adrenal medulla)

release adrenocorticosteroids (from the adrenal cortex aka peripheral portion)

What are the two major groups of adrenocorticosteroids?

glucocorticoids

mineralcorticoids

affect CHO metabolism

most common

major one in the body = cortisol (hydrocortisone)

glucocorticoids

affect H₂O and electrolyte composition

mineralocorticoids

What is the reason to prescribe an adrenocorticosteroid?

to control the symptoms and reduce the inflammation or immune response of a disease

What could be the side effects of a corticosteroid inhaler?

xerostomia

oral candidiasis

sore throat

taste alterations

What does an opioid agonist do?

drug has affinity for receptor, binds, and produces effect

What does an opioid antagonist do?

drug has affinity for receptor, binds, but produces no effect, blocks agonist or reduces efficacy of agonist

Which opioid is the prototype which all other opioids are measured against?

morphine

Which non-opioid drug binds irreversibly to platelets and interferes with clotting?

acetylsalicylic acid

aspirin