Oral Surgery - Analgesia
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What is the mechanism of action of aspirin?
It inhibits cycle-oxygenase, reduces the production of prostaglandins
What cyclo-oxygenase is aspirin more effective at inhibiting and what is the effect of this?
COX1 This reduces platelet aggregation Predisposes to damage of gastric mucosa
What is the analgesic affect of aspirin
The peripheral action is predominate, it reduces prostaglandin synthesis in inflamed tissues Reducing pain
What is the anti-pyretic affect of aspirin
It prevents the temperature rising affects of interleukin-1 and the rise in brain prostaglandin levels It reduces the elevated temperature in fever
What is the third affect of aspirin, analgesic, anti-pyretic and ….
Anti inflammatory Will reduce redness and swelling Aswell as pain a the site of the injury
What three affects do prostaglandins have on the gastric intestinal mucosa
Inhibit gastric acid secretion Increase blood flow through the gastric mucosa Help production of mucins by cells in the stomach lining
What is the function of gastric mucins
Gastric mucins are components that protect the gastric epithelium from the itch concentrations of Acid in the stomach lumen and from auto digestion by pepsin
What are three symptoms a patient may experience following an aspirin overdose
Hyperventilation Deafness Vasodilation and sweating
What component of aspirin causes the mucosal burn and why does this happen.
Aspirin applied to locally to the oral mucosa results in a chemical burn, this is a direct result of the salicylic acid. Aspirin has no topica affect
Why should aspirin not b given to someone taking warfarin/ anticoagulants
Aspirin enhances warfarin and other anticoagulants Displaces warfarin from binding sites on plasma proteins, increases the free warfarin. The majority of warfarin is bound( inactive). If more is realised this will become active increasing bleeding tendency.
What are thee complications that taking aspirin during pregnancy?
Increased risk of haemorrhage Increased risk of jaundice in the baby Can potentially prolong Labour
Where is aspirin metabolised and where is it excreted
Aspirin is metabolised in the liver and excreted by the kidney
Where are PGE2 and PGI1 synthesised
PGE2 - Renal medulla PG1 - glomerulus
What are three affects of inhibition of renal prostaglandins
Sodium retention Reduced renal blood flow Renal failure
Aspirin is contraindicated in children under 16s years and breastfeeding, what condition is this aiming to prevent
Reyes Sydrome Fatty degerative process in the liver and profound encephalopathy in the brain
What is the best way to find out if someone with asthma can take NSAIDS
Ask the patient if they have any hypersensitivity to NSAIDs before or if they have any adverse affects when taking them before
Why are elderly people in the list of groups to avoid when prescribing NSAIDS
They have a smaller blood volume, they tend to be on other medications and often have other medical issues Elderly people are most susceptible to drugs induced side affects in general
What is G6PD deficiecy and what does it make them susceptible to
Glucose 6-phosphonate deficiency - they are at risk of developing acute haemolytic anamia
Where is G6PD most popular
Most common in individuals orgingating from parts of Asia.Africa/ oceana and southern Europe’s
What are the 4 groups that NSAIDS are completely contraidnacted in?
Children under 16years; breastfeeding Previous or active peptic ulceration Haemophilia Hypersensitivity to aspirin or any other NSAID
When prescribing aspirin for mild to moderate odontogenic what is the dosage
300mg 2 tablets 4 times a day
What is the maximum dosage of aspirin
4grams
If a patient has a hypersensitivity to aspirin or any other NSAID what can be prescribed, what groups would you be wary of when prescribing these?
Lansoprazole 15mg 1 capsule 1 daily Gastro-resistant omeprazole 20mg 1 capsule 1 daily Be wary of patients with liver diease, pregnancy or breast feeding
What is the maximum adult dose for ibuprofen
2.4 grams