Pain Control: Nonopiods and Opiods

perception

physical component – the message of pain that is carried through the nerves

reaction

psychological component – patient’s emotional response to the pain (varies)

Analgesic agent

a drug used to relieve pain

Nonopioid Analgesics MOA

inhibit prostaglandin synthesis

Salicylate example

aspirin

aspirin

inhibits prostaglandins in the hypothalamus, reduced fever, increases vasodilation, and sweating

decrease erythema (redness) and swelling

useful for throbbing pain

NSAIDS MOA

same as aspirin (inhibits prostaglandins)

NSAIDS Contraindications

Increased risk for serious CV events (avoid in pts with CV diseases) Increased risk for serious GI events

NSAIDS examples

ibruprofen (Advil, Motrin)

Naproxem sodium (Anaprox, Aleve)

NSAID used in dentistry

Ketorolac

Acetaminophen (Tylenol)

believed to elevate pain threshold

pregnancy category B

Opioid Analgesics MOA

depress the CNS

Opioid Pharmacokinetics

A – absorbed well by oral administration; absorption can occur via lungs, nose, oral mucosa

D – first-pass metabolism in liver, reducing bioavailability, then bound to plasma proteins and distributed throughout the body

M – metabolized in liver

E – excreted by kidneys via urine

Opioid anlagesics adverse effects

Respiratory Depression

Nausea and Emesis (vomiting)

Miosis (pinpoint pupils)

Opioidi analgesics drug interactions

alcohol or sedative hypnotics

MAOIs

Antihistamines: reduce opioid dosage

opioid agonists

morphine, oxycodone, oxymorphone, hydrocodone, benxhydocodone, benxhydrocodone

codeine

most common opioid agonist in dentistry

mixed agonists

pentazocine: oral

buprenorphine (Buprenex): oral or parenteral

opioid antagonists

naloxone (Narcan Nasal) – pure opioid antagonist; reverses overdose; found in emergency carts

naltrexone (Vivitrol) – used to prevent opioid and alcohol use in addicts; once pt has been opioid-free for one week, they can being maintenance with this

full agonist/reuptake inhibitors

tapentadol (Nucynta) – oral opioid receptor agonist; interacts with MAOIs and should not be given until they have been discontinued for 14 days

tramadol – CNS effects including suicide