analgesics in dentistry

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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

analgesics in dentistry

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