Pharmacology Week 3 Ppt Review

Front 1

Pain:

Back 1

• Body's Mechanism for alerting tissue damage

• Protective reflex for self preservation

• Motivation to come to the dental office

• Often a deterrent to dental care

Front 2

Pain:

Some patients come to the DDS when:

Back 2

• They are in pain:

1. Infected tissue = more painful
2. Educate and comfort
3. If comfort fails inform DDS to discuss potential anti-anxiety alternatives

Front 3

Pain Physiology:

Cased by?

Back 3

• Activation of nerve fibers/pain receptors (Nociceptors).

Front 4

Pain Physiology:

Can be activated by?

Back 4

• Mechanically, thermally, chemically, or through injury.

Front 5

Pain Physiology:

Tissue injury releases?

Back 5

• Various substances

Front 6

Pain Physiology:

Various substances tissue injury releases?

Back 6

• Histamine

• Prostaglandins

• Bradykinin

• Leukotrienes

• Serotoni

• Substance P

Front 7

Two Components of Pain:

Back 7

• Reaction

• Perception

Front 8

Two Components of Pain:

Reaction

Back 8

• The psychological component of pain and involves the patient's emotional response. This varies greatly from person to person.

Front 9

Two Components of Pain:

Perception

Back 9

• The physical component of pain that is carried through the nerves and to the brain cortex. This is fairly uniform from person to person.

Front 10

Two Components of Pain:

Back 10

• Acute Pain

• Chronic

Front 11

Two Components of Pain:

Acute Pain

Back 11

• Rapid onset

• More intense

• Short lasting

• Treatment of symptons

Front 12

Two Components of Pain:

Chronic Pain

Back 12

• Slow onset
  
• Less intense

• Long lasting

• Management of symptoms

Front 13

Pain threshold

and

Analgesic Needs

Back 13

• Factors that alter the pain threshold.

Front 14

Pain threshold

Back 14

• What lowers it

• What raises it

Front 15

What lowers it

Back 15

• Pain becomes less bearable

Front 16

What raises it

Back 16

• Pain becomes more bearable

Front 17

What Lowers Pain Threshold?

Threshold = Tolerance

Back 17

• Anxiety

• Sleeplessness

• Tiredness

• Anger

• Fear/Fright

• Depression

• Discomfort
• Pain
• Isolation

Front 18

What Raises Pain Threshold?

Back 18

• Sleep
• Rest
• Diversion
• Empathy
• Specific medications:

Analgesic

Antianxiety agents

Antidepressants

Front 19

How do you measure the analgesic need?

Back 19

• Based on the individual

• Discomfort that requires drug treatment

• Varies by pain threshold

Front 20

Terminology:

Analgesic

Back 20

• Pain reliever

Front 21

Terminology:

Anti-Pyretic

Back 21

• Fever reducer

Front 22

Terminology:

Anti-Inflammatory

Back 22

• Inflammation reducer

Front 23

Terminology:

Opiate

Back 23

• Alkaloids found in the opium poppy (Includes morphine and codeine).

Front 24

Terminology:

Opioid

Back 24

• Drugs that have opiate type action:

Opiates

Semi-synthetics

Synthetic

Endogenous opiods

Front 25

Terminology:

Narcotic

Back 25

• Depressant drugs derived from opium or chemically relation to opium compounds, has addictive properties.

Front 26

Drug Regulation:

Legend Drugs

Back 26

• All prescription drugs (schedule drugs and non-scheduled drugs).

• Regulated by the FDA.

Front 27

Drug Regulation:

Non-legend Drugs

Back 27

• Over the counter medications

• Regulated by the FTC

Front 28

Drug Regulation:

Controlled/Schedule Drugs

Back 28

• The comprehensive Drug Abuse Preventions Act/Controlled Substance Act (1973):

1. Replaced Harrison Narcotics Act of 1914 and established Drug Enforcement Agency (DEA).
2. Divided potentially addictive drugs into 5 categories or schedules.
3. Laws for packaging controlled substances.

Front 29

Cardinal Signs of Inflammation

Back 29

• Calor-Heat
• Rubor-Redness/Erythema
• Dolor-Pain
• Tumor-Swelling

Front 30

Types of Analgesic medications:

Non-opioids (a.k.a. non-narcotics, peripheral acting, antipyretic analgesic, mild analgesics)

Back 30

• Local Anesthetics
• General Anesthetics
• Salicylates
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Acetaminophen (APAP)
• Steroidal Anti-Inflammatory Drugs

Front 31

Types of Analgesic medications:

Opioids (a.k.a. narcotics, central acting, strong analgesics)

Back 31

• Schedule drugs

Front 32

Acetaminophen:

Analgesic effect?

Back 32

• Yes, for mild to moderate pain, equal analgesic effect as aspirin.

Front 33

Acetaminophen:

Anti-Pyretic effect?

Back 33

• Yes

Front 34

Acetaminophen:

Anti-Inflammatory Activity effect?

Back 34

• No

Front 35

Acetaminophen:

MOA

Back 35

• Weak prostaglandin inhibitor in peripheral tissue via cyclo-oxygenase inhibition. Adjusts temperature set-point in hypothalamus in fever.

Front 36

Acetaminophen:

Usual Dose

Back 36

• 325mg-500mg 4 times/day

Front 37

Acetaminophen:

Do NOT exceed

Back 37

• 4 grams/day

Front 38

Acetaminophen:

Drug interactions

Back 38

• Fairly free of.

1. Levels increased by dasatinib, isoniazid, metyrapone, nitric oxide, probenecid, sorafenib.
2. Often combined with other drugs for additive effects.

Front 39

Acetaminophen:

Toxicity

Back 39

• Associate with chronic, high dose and concomitant conditions:

1. Toxic Doses 10 to 15 Grams
2. Hepatotoxicity has been seen with <4 grams/day

Front 40

Acetaminophen:

Alcohol

Back 40

Alcohol can increase hepatic toxicity:

1. Limit to 2 grams/day in moderate drinkers
2. Avoid completely in use with higher alcohol use

Front 41

Salicylates:

Analgesic effect?

Back 41

• Yes

Front 42

Salicylates:

Anti-Pyretic effect?

Back 42

• Yes

Front 43

Salicylates:

Anti-Inflammatory Activity effect?

Back 43

• Yes

Front 44

Salicylates:

MOA

Back 44

• Inhibition of prostaglandin synthesis via cyclooxygenase inhibition

• Fever reduction due to action in hypothalamus

• Irreversible binding to platelets

Front 45

Salicylates:

Medications that include Aspirin

Back 45

• Regular Aspirin & Low-Dose (Baby Aspirin. Dose: 81 mg)

• Enteric Coated Aspirin

• Combination Aspirin

1. Buffer
2. Other analgesics
3. Sedatives
4. Caffeine

Front 46

Salicylates:

Medications that do NOT include Aspirin

Back 46

• Choline, Magnesium Salicylate
• Salsalate
• Diflunisal (Dolobid)
• Pepto-Bismol (Bismuth Subsalicylate)

Front 47

Salicylates:

Adverse Reactions

Associated with?

Most common?

Minimized by?

Bleeding?

When most?

Caution in Children?

Safest analgesic for children & teens?

Especially when?

Hypersensitivity?

Back 47

• Associated with high doses

• GI side effects most common

1. Minimize by taking with food

• Bleeding due to inhibition of platelets

1. Patients may bleed more during treatment

• Caution in children - Rye's Syndrome

1. Acetaminophen is safest analgesic for children or teens, especially if they have influenza or chicken pox

• Hypersensitivity

1. True allergy is uncommon

Front 48

Salicylates:

Drug Interactions

Back 48

• Warfarin

• Probenecid

• Methotrexate

• Sulfonylureas

• Anti-Hypertensives

Front 49

Salicylates:

Drug Interactions - Warfarin

Back 49

• Enhanced anti-coagulation leading to increased risk of bleeding Protein binding displacement and platelet inhibition.

Front 50

Salicylates:

Drug Interactions - Probenecid

Back 50

• A gout medication.

Front 51

Salicylates:

Drug Interactions - Methotrexate

Back 51

• A cancer medication.

Front 52

Salicylates:

Anti-Hypertensives

Back 52

• Decreases effectiveness of CE inhibitors, B-blockers, and thiazide and loop diuretics.

Front 53

NSAIDs:

Analgesic effect?

Back 53

• Yes

Front 54

NSAIDs:

Anti-Pyretic effect?

Back 54

• Yes

Front 55

NSAIDs:

Anti-Inflammatory Activity effect?

Back 55

• Yes

Front 56

NSAIDs:

Ani-Platelet Inhibition?

Back 56

• Reversible

Front 57

NSAIDs:

MOA

Back 57

• Inhibition of prostaglandin synthesis via cyclo-oxygenase inhibition

Front 58

NSAIDs:

Effective pain reliever?

Back 58

• Yes, very

Front 59

NSAIDs Classifications:

Back 59

• Propionic Acid Derivatives
• Acetic Acid Derivatives
• Nonacidic Agent
• Fenamic Acid Derivatives
• Salicylates
• Oxicams

Front 60

NSAIDs Classifications:

Propionic Acid Derivatives approved for?

Back 60

• Pain

Front 61

NSAIDs Classifications:

Fenamic Acid Derivatives approved for?

Back 61

• Pain

Front 62

NSAIDs:

Fenamic Acid Derivatives

Back 62

• Ibuprofen

• Naproxen

• Flurbiprofen

• Ketoprofen

• Oxaprozin

Front 63

NSAIDs Classifications:

Propionic Acid Derivatives - Ibuprofen

Back 63

• May work better for muscle pain (Advil/Motrin)

Front 64

NSAIDs Classifications:

Propionic Acid Derivatives - Naproxen

Back 64

• May work better for joint pain (Aleve)

Front 65

NSAIDs Classifications:

Acetic Acid Derivatives

Back 65

• Indomethacin
• Sulindac
• Tolmetin
• Diclofenac
• Etodolac
• Ketoralac

Front 66

Rest of the NSAIDs:

Non-Acidic

Back 66

• Nabumetone (Relafen)

Front 67

Rest of the NSAIDs:

Fenamic Acid

Back 67

• Meclofenamate; mefenamic acid

Front 68

Rest of the NSAIDs:

Oxicams

Back 68

• Piroxicam, meloxicam

Front 69

Rest of the NSAIDs:

Cox-2 Inhibitor

Back 69

• Celecoxib (Celebrex)

Front 70

NSAIDs Adverse Reactions:

GI

Back 70

• Long term use can promote peptic ulcer. (Inhibition of stomach's protective mechanism)

Front 71

NSAIDs Adverse Reactions:

CNS

Back 71

• Dizziness

Front 72

NSAIDs Adverse Reactions:

Blood Clotting

Back 72

• Decreased

Front 73

NSAIDs Adverse Reactions:

Renal

Back 73

• Renal failure

Front 74

NSAIDs Adverse Reactions:

Hypersensitivity

Back 74

• Rash to anaphylaxis.

Front 75

NSAIDs Adverse Reactions:

Pregnancy

Back 75

• Increase gestation and cause premature closure of the ductus arteriosus.

Front 76

NSAIDs Drug Interactions:

Anticoagulants

Back 76

• Increased bleeding

Front 77

NSAIDs Drug Interactions:

Anti-hypertensives

Back 77

• Reduced effect - Ace Inhibitors, Diuretics, Beta-Blockers

Front 78

NSAIDs Drug Interactions:

Methotrexate

Back 78

• Increased Toxicity

Front 79

NSAIDs Drug Interactions:

Digoxin

Back 79

• Increased Effect/Toxicity

Front 80

NSAIDs Drug Interactions:

Lithium

Back 80

• Increases lithium levels

Front 81

Anti-Gout Agents:

Gout

Back 81

• A metabolic condition with increased uric acid and inflammation causing acute attacks of joint pain (big toe, knee).

Front 82

Anti-Gout Agents:

Treatment

Back 82

• NSAIDs
• Colchicine

Front 83

Anti-Gout Agents:

Prevention

Back 83

• Probenecid
• Allopurinol

Front 84

Anti-Gout Agents:

Prevention - Probenecid

Back 84

• Increases excretion of uric acid (UA).

Front 85

Anti-Gout Agents:

Prevention - Allopurinol

Back 85

• Also a cancer drug, reduces synthesis of UA.

Front 86

Opioid (Narcotic) Analgesics:

Chemical Make-up Image

Back 86

• Morphine
• Codeine

Front 87

Opioid (Narcotic) Analgesics:

Chemical Make-up Image - Morphine

Back 87

Front 88

Opioid (Narcotic) Analgesics:

Chemical Make-up Image - Codeine

Back 88

Front 89

Opioid (Narcotic) Analgesics:

Derived from

Back 89

• The opium poppy plant - Morphine & Codeine.

Front 90

Opioid (Narcotic) Analgesics:

Used since

Back 90

• Ancient times.

Front 91

Opioid (Narcotic) Analgesics:

Obtained from

Back 91

• The seed pod - White latex material that turns brown (black tar heroin).

Front 92

Opioid (Narcotic) Analgesics:

Classified by

Back 92

• Chemical structure (morphine/codeine, methadone, morphinan, meperidine, etc.) and/or efficacy (table 6-1 & 6-2).

Front 93

Opioid (Narcotic) Analgesics:

Classified by - Chemical structure and/or efficacy

Back 93

• Will have higher likelihood of cross-allergy if in same structure group.

Front 94

Opioid Analgesic Mechanism of Action:

Binds to receptors in

Back 94

• The CNS and Spinal Cord

Front 95

Opioid Analgesic Mechanism of Action:

Binds to receptors in the CNS and Spinal Cord

Back 95

• Alters the perception of and reaction to pain.

Front 96

Opioid Analgesic Mechanism of Action:

Opioid receptor discovery aided

Back 96

• By the presence of endogenous substances - Enkephalins, Endorphins, and Dynorphins.

Front 97

Opioid Receptors:

Back 97

• Mu
• Delta
• Sigma
• Epsilon
• Kappa

Front 98

Opioid Receptors:

Mu - Location

Back 98

• In the thalamus, brain stem, and GI tract.

Front 99

Opioid Receptors:

Mu - Function

Back 99

• Analgesia, Respiratory Depression, Euphoria, Emotional Quieting, Sedation, and Constipation.

Front 100

Opioid Receptors:

Mu - Endogenous agonist

Back 100

• Beta-Endorphin

Front 101

Opioid Receptors:

Delta - Location

Back 101

• Brain Stem, spinal cord.

Front 102

Opioid Receptors:

Delta - Function

Back 102

• Spinal analgesia, positive reinforcement

Front 103

Opioid Receptors:

Delta - Endogenous agonist

Back 103

• Enkephalin and Beta-Endorphin

Front 104

Opioid Receptors:

Kappa - Location

Back 104

• On Dorsal Horn of spinal cord and Brain Stem

Front 105

Opioid Receptors:

Kappa - Function

Back 105

• Spinal analgesia, Miosis (pinpoint pupils)

Front 106

Opioid Receptors:

Kappa - Endogenous agonist

Back 106

• Dynorphin

Front 107

Pharmacologic Effects of Opioids:

Analgesia

Back 107

• Raises pain threshold
• Depress reaction to pain

Front 108

Pharmacologic Effects of Opioids:

Sedation/Euphoria

Back 108

• Instruct patient not to drive while taking opioids
• Helps to reduce anxiety

Front 109

Pharmacologic Effects of Opioids:

Cough Suppression

Back 109

• Depression of cough center in medulla

Front 110

Pharmacologic Effects of Opioids:

Gastrointestinal (Constipation)

Back 110

• Increased tone of smooth muscle
• Decreased motility and propulsive contractions

Front 111

Adverse Reactions of Opioids:

Back 111

• Addiction
• Respiratory Depression
• Nausea and Vomiting
• Constipation
• Miosis
• Urinary Retention
• Allergy
• Histamine Release
• CNS effects
• Biliary tract constriction
• Cardiovascular effects
• Pregnancy/Lactation

Front 112

Adverse Reactions of Opioids:

Respiratory Depression

Back 112

• High dose = respiratory failure

Front 113

Adverse Reactions of Opioids:

Nausea and Vomiting

Back 113

• Stimulates CTZ

Front 114

Adverse Reactions of Opioids:

Allergy

Back 114

• Usually rash

Front 115

Adverse Reactions of Opioids:

Histamine Release

Back 115

• Itching, urticaria

Front 116

Adverse Reactions of Opioids:

CNS effects

Back 116

• Sedation, rarely stimulation
• Dysphoria

Front 117

Adverse Reactions of Opioids:

Cardiovascular effects

Back 117

• Hypotension, bradycardia

Front 118

Adverse Reactions of Opioids:

Pregnancy/Lactation

Back 118

• Respiratory depression near term
• Watch breast-fed infant or respiratory depression

Front 119

Adverse Reactions of Opioids:

Tolerance does NOT

Back 119

• Develop to constipation or miosis

Front 120

Drug Interactions:

MAOIs

Back 120

• A class of medication for depression - CNS excitation, hypertension, and hypotension.

Front 121

Drug Interactions:

Alcohol and other CNS depressants

Back 121

• Increased respiratory depression and sedation

Front 122

Drug Interactions:

Avoid for alcoholics

Back 122

• Higher risk of becoming addicted

Front 123

Balanced Approach to Pain Control:

Amount

Back 123

• Enough pain medication to control the pain

Front 124

Balanced Approach to Pain Control:

Acute

Back 124

• Usually what is seen in dental setting
• Definitive treatment in office, most pain managed with NSAID use
• Use of weak opioids, occasionally intermediate if absolutely necessary

Front 125

Balanced Approach to Pain Control:

Chronic

Back 125

• Treatment by pain specialist
• May use combination of therapies/medications including anti-depressants, physical therapy/Tens unit
• Manage these patients with non-opioids in dental setting

Front 126

Balanced Approach to Pain Control:

Tolerance

Back 126

• Will build to pain medications over time

Front 127

Opioid Agonists:

Analgesic action related to activity at the mu and kappa receptors

Back 127

• Morphine
• Oxycodone
• Hydrocodone
• Codeine
• Propoxyphene
• Meperidine
• Hydromorphone
• Methadone
• Fentanyl

Front 128

Opioid Agonists:

Morphine

Back 128

• Strong analgesic

Front 129

Opioid Agonists:

Oxycodone

Back 129

• Intermediate analgesic

Front 130

Opioid Agonists:

Hydrocodone

Back 130

• Weaker analgesic

Front 131

Opioid Agonists:

Codeine

Back 131

• Weaker analgesic

Front 132

Opioid Agonists:

Propoxyphene

Back 132

• No longer on market

Front 133

Opioid Agonists:

Meperidine

Back 133

• Poor choice for PO due to high first pass

Front 134

Opioid Agonists:

Hydromorphone

Back 134

• Severe pain, rarely used in dentistry

Front 135

Opioid Agonists:

Methadone

Back 135

• Used for pain or opioid addiction

Front 136

Opioid Agonists:

Fentanyl

Back 136

• Most commonly used as transdermal patch

Front 137

Characteristics of Various Opioids:

Agonist - Mophine

Back 137

• Route -

1. IV
2. Oral

• Equianalgesic, dose, mg -

1. 10
2. 30

• Onset, min -

1. 5-10
2. 15-60

• Peak effect, min -

1. 10-30
2. 90-120

• Duration of effect, hr -

1. 3-5
2. 4

Front 138

Characteristics of Various Opioids:

Agonist - Codeine

Back 138

• Route -

1. Intramuscular
2. Oral

• Equianalgesic, dose, mg -

1. 120
2. 200

• Onset, min -

1. 10-30
2. 30-45

• Peak effect, min -

1. 90-120
2. 60

• Duration of effect, hr -

1. 4-6
2. 3-4

Front 139

Characteristics of Various Opioids:

Agonist - Hydromorphone

Back 139

• Route -

1. IV
2. Oral

• Equianalgesic, dose, mg -

1. 1.5
2. 7.5

• Onset, min -

1. 5-20
2. 15-30

• Peak effect, min -

1. 15-30
2. 90-120

• Duration of effect, hr -

1. 3-4
2. 4-6

Front 140

Characteristics of Various Opioids:

Agonist - Oxycodone

Back 140

• Route -

1. Oral

• Equianalgesic, dose, mg -

1. 20

• Onset, min -

1. 15-30

• Peak effect, min -

1. 30-60

• Duration of effect, hr -

1. 4-6

Front 141

Characteristics of Various Opioids:

Agonist - Methadone

Back 141

• Route -

1. IV
2. Oral

• Equianalgesic, dose, mg -

1. 10
2. 20

• Onset, min -

1. 10-20
2. 30-60

• Peak effect, min -

1. 60-120
2. 90-120

• Duration of effect, hr -

1. 4-6
2. 4-12

Front 142

Characteristics of Various Opioids:

Agonist - Fentanyl

Back 142

• Route -

1. IV

• Equianalgesic, dose, mg -

1. 0.1

• Onset, min -
• <1
• Peak effect, min -
• 5-7
• Duration of effect, hr -
• 0.75-2+

Front 143

Characteristics of Various Opioids:

Agonist - Oxymophone

Back 143

• Route -

1. IV
2. Oral

• Equianalgesic, dose, mg -

1. 1
2. 10

• Onset, min -

1. 5-10
2. --

• Peak effect, min -

1. 30-60
2. (Meaningful relief: 60)

• Duration of effect, hr -

1. 3-6
2. 4-6

Front 144

Characteristics of Various Opioids:

Agonist - Tramadol

Back 144

• Route -

1. Oral

• Equianalgesic, dose, mg -

1. 100

• Onset, min -

1. 60

• Peak effect, min -

1. 120-180

• Duration of effect, hr -

1. 3-6

Front 145

Clinically Relevant Opioids:

From least to most relevant

Back 145

• Codeine/APAP (Tylenol #2, #3, #4)

- 15 mg/300 mg, 30 mg/300 mg, 60 mg/300 mg

• Hydrocodone/APAP (Vicodin, Lortab)

- 5 mg/300 mg, 7.5 mg/300 mg, 10 mg/300 mg

- 5 mg/325 mg, 7.5 mg/325 mg, 10 mg/325 mg

• Oxycodone/APAP (Percocet)

- 5 mg/325 mg, 7.5 mg/325 mg, 10 mg/325 mg

Front 146

Clinically Relevant Opioids:

Overdose potential

Back 146

• Yes, if also taking other acetaminophen containing prducts

Front 147

Darvocet/Propoxyphene:

On the market?

Back 147

• No

Front 148

Darvocet/Propoxyphene:

Synthetic opioid?

Back 148

• Yes

Front 149

Darvocet/Propoxyphene:

Analgesic efficacy?

Back 149

• Yes, questionable and similar to aspirin

Front 150

Darvocet/Propoxyphene:

Combined with acetaminophen?

Back 150

Yes, be careful of acetaminophen overdose

Front 151

Mixed Opioids

Agonist-Antagonist Opioid

Back 151

• Pentazocine - Only oral form
• Butorphanol (nasal spray)
• Agonist activity at the kappa and delta receptors
• Antagonist activity at the mu receptor

Front 152

Mixed Opioids

Partial Agonist

Back 152

• Partial mu-receptor agonist
• No delta receptor activity
• Buprenorphine (Subutex, Buprenex)
• Used for narcotic withdrawal, schedule III drug

Front 153

Tramadol (Ultram):

Non-Narcotic analgesic

Back 153

• However...is now a controlled substance (August 2014)

Front 154

Tramadol (Ultram):

Used for?

Back 154

• Mild to moderate pain

Front 155

Tramadol (Ultram):

Interesting pharmacology

Back 155

• Mu receptor agonist
• No activity at the delta and kappa receptor
• Serotonin and Norepinephrine re-uptake inhibitor - Modification of ascending pain pathways

Front 156

Tramadol (Ultram):

DDS may prescribe this to?

Back 156

• A suspected "over-user" of schedule drugs

Front 157

Opioid Antagonists:

Naloxone

Back 157

• Blocks the action of opioids at the mu, kappa, and delta receptors
• Only effective parenterally - Why would the use it in po form?
• Drug of choice for opioid overdoses
• Keep in emergency medical kits for dental offices if opioids are used

Front 158

Opioid Antagonists:

Naltrexone

Back 158

• Used to prevent opioid and alcohol use in addicts
• Avoid use of opioids for analgesia if patient is taking naltrexone
• Orally effective

Front 159

Skeletal Muscle Relaxants:

Reduces pain specifically?

Back 159

• No

Front 160

Skeletal Muscle Relaxants:

Reduces muscle spasms?

Back 160

• Yes, can help relax muscle spasms, so effective in treatment of problems such as TMD (formerly TMJ).

Front 161

Skeletal Muscle Relaxants:

Medications

Back 161

• Methocarbamol (Robaxin)
• Carisoprodol (Soma) - Controlled substance!
• Cyclobenzaprine (Flexeril)
• Tizanidine (Zanaflex)
• Baclofen
• Metaxalone (Skelaxin)

Front 162

Addiction:

Usually seen in the dental setting with treatment of naïve patients?

Back 162

• No, usually takes 2 weeks or more of opioid use to establish dependence and possible addiction.

Front 163

Addiction:

Withdrawal symptoms

Back 163

• Will be seen in patients physically dependent on opioids, (including those using for legitimate reasons as well as addicts) when use of drug is discontinued.
• Sweating rhinorrhea, piloerection (goosebumps), irritability, nausea, vomiting, tachycardia, tremors, chills, yawning and lacrimation may be seen.

Front 164

Identification of an addict:

Claims

Back 164

• Low threshold to pain
• Many allergies and that many meds don't work

Front 165

Identification of an addict:

Requests

Back 165

• certain drugs stating they are more effective

Front 166

Identification of an addict:

Actions

Back 166

• Frequently changes dental offices and cancels appointments

Front 167

Identification of an addict:

Complaints

Back 167

• Of pain days after procedure, requesting refills on uncomplicated procedures

Front 168

Identification of an addict:

Complaints - Actions to take

Back 168

• Have patient come in for post-op check if they are still in pain.
• No refills without being seen is a good rule of thumb to make sure everything is healing as it should.