How Opioids Affect Pain Perception

Opioids decrease pain transmission to the brain by causing activation of the descending
nerve fibers coming from the periaqueductal gray within the midbrain and raphe nuclei
within the medulla that control the endogenous opioid containing interneurons within
the dorsal horn of the spinal cord.
In addition, opioids directly inhibit afferent nerve transmission by binding to mu-opioid
receptors presynaptically and postsynaptically within the dorsal horn of the spinal cord.
As a result of these various effects, the ascending pathways for pain stimuli are
decreased thereby providing pain relief for the patient.
Patients who shouldnt take opioids
1. Depressed nervous system
a. Acute Alcoholics
2. Respiratory Depression
3. Oxycodone allergy
4. Diarrhoea (due to poisoning or pseudomembranous candidiasis)
5. Lactation
a. MIMS 2016
Characteristics Which Differentiate Opioids

Adverse effects:
1. Nausea and Vomiting
2. Hypotension
3. Itch
4. Bronchospasm
5. Constipation
6. Sedation
How tolerance affect the treatment of patient with opioids
Tolerance is due to long term use (days to weeks) and is reversible over a similar tiem frame
No tolerance: miosis
Moderate tolerance:
o Constipation
o Emesis
o Anagesia
o Sedation
Rapid Tolerance
o Euphoria
Warnings required for a patient taking analgesics containing Doxylamine Succinate
1.
2.
3.
4.

Dizziness
Drowziness
Dry mouth
Extreme: allergic reaction

Explain Why Glucocorticoids are Useful in Txing Inflammation

List 4 adverse effects pts may Experience Taking Glucocorticoids

1.
2.
3.
4.

Skin atrophy
Delayed healing
Bruising
Taste disturbances

What Long Term Effects May Dentists Encounter

1.
2.
3.
4.

Increased risk of caries

Increased risk of oral thrush
Taste disturbances
Immunosuppression

Precautions when stopping

Step down dosing as endogoneous levels of cortisol need to restore to a normal level.
(there is decreased ACTH)

Functions of Prostaglandins
1.
2.
3.
4.

Platelet aggregation and relaxation

Vasodilation
Increase vessel permeability
Increase nociception of pain
a. Resp, Uterus, GI; contraction/relaxation

Enzymes for Prostaglandin Synthesis

1. Phospholipase A2
2. COX
NSAID Caution
1. Asthma (10%)
2. ACE inbitors (pril)
3. ARB (sartan)
4. Diuretic (-semide, -thiazide, -actone)
5. Anticoagulants
6. SSRI
7. Corticosteroids
Serious Affects of Guianine Analogues
Renal impairment
Headaches
Confusions

Hallucinations
Convulsions
Topical creams - Irritant to the mucosa

Differentiate Azoles Based on Drug Interaction

Competitive inhibition of liver oxidative metabolism via rapid reversible binding to CYP450
system enzymes.
Triazoles: prevent the metabolism of other drugs and clearance can lead to toxic levels. Can
lead to QT elongation.
This is only fluconazole (dont rx).
Common Adverse B-Lactams
Class A:
Diarrhea
Thrush
Clostridium Dificile
Class B:
Hypersensitivity
Rash
Why time is important:
Short half life wide therapeutic window.
What
1.
2.
3.
4.

factors affect antibiotic use:

What bacteria aacts on ve/+ve
Site they act on
Bacteriostatic/cidal
Broad/narrow spectrum

Common Problems with Antibiotic Therapy:

Drug interactions: contraceptive and anticoagulants
GI imbalance
Suppurative Saliva Gland:
Stimulate saliva
Drain
Warm Compress
o 450mg IV/po q8h for 10 days
o 2g IV q6h then 500mg po q6h for 10 daays
o 600mg IV q8h then swap to clindamycin for 10 days
If spreading too far refer to hospital.