Opiods

Question 1

available on DNF

-effective?

Answer 1

dihydrocodeine

INEFFECTIVE FOR DENTAL PAIN

Question 2

how do opiods work

Answer 2

-Act in the spinal cord
- especially in the dorsal horn pathways
associated with paleo-spinothalamic pathway
-Have important supraspinal actions
- periaqueductal grey matter
- nucleus reticularis paragigantocellularis
- raphe magnus nucleus

Question 3

issues with opiods
-what can they cause
Methdone issues

Answer 3

tolerance
dependance
-cause - constipation/urinary retention
-methadone - high sugar=caries
if sugar free=injectable

Question 4

what systems can opiods depress

Answer 4

1. Pain centre (alters awareness/perception of pain)
2. Higher centres
3. Respiratory centre
4. Cough centre
5. Vasomotor

Question 5

what centres can opiods excite

Answer 5

Vomiting centre (dihydrocodeine often causes nausea and
vomiting which limits its value in dental pain )
2. Salivary centre
3. Pupillary constriction

Question 6

name some opiod side eff

Answer 6

Difficulty with micturition - Postural Hypotension

• Ureteric or Biliary spasm - Hypothermia
• Dry mouth - Hallucinations
• Sweating - Dysphoria
• Facial flushing - Mood changes
• Headache - Dependence
• Vertigo - Miosis
• Bradycardia - Decreased libido or potency
• Tachycardia - Rashes/Urticaria/Pruritis
• Palpitations

Question 7

opiod contra ind

Answer 7

Hypotension

• Hypothyroidism
• Asthma
• Decreased respiratory reserve
• Prostatic hypertrophy
• renal impariment
• Pregnancy/Breast-feeding

Question 8

complete contraind to opiods

Answer 8

Acute respiratory depression

• Acute alcoholism
• Raised intracranial pressure/head injury