Ibuprofen & Acetaminophen For Dental Article Study

User Generated

Oebaoeba10

Health Medical

Florida South Western University

Description

Analgesic Combinations Pharmacology.pdf

After carefully reading the assigned article, please write a two to three paragraph summary of the article's contents. The summary may not exceed three paragraphs and/or 500 words. The idea of the summary is to prepare a report that would quickly inform your dental office co-workers of the clinically important facts contained in the article. The goal is to be brief and discuss the clinically significant points only.
The summary must be submitted in Word Doc. using Calbri (body) Font size 11, with 1.5 Line and Paragraph spacing.

Rubric

Journal Article Summary - 2018

Journal Article Summary - 2018

CriteriaRatingsPts

This criterion is linked to a Learning OutcomeSpelling and Grammar - One point deduction for each spelling/grammatical error.

10.0 pts

This criterion is linked to a Learning OutcomeContent - The extent to which the salient information in the article is covered.

75.0 pts

This criterion is linked to a Learning OutcomeLength - completed within two to three paragraphs and under 500 words.

15.0 pts

This criterion is linked to a Learning OutcomeSubmit Assignment by Due Date5 point deduction for each day assignment is late.

0.0 pts

Total Points: 100.0

Unformatted Attachment Preview

Pharmacology Combination ibuprofen and acetaminophen analgesic products for dental pain management Thomas A. Viola, RPh, CCP C ombination analgesic products have been the mainstay of treatment of moderate to severe dental pain for many years. Formulations containing both an opioid analgesic, such as oxycodone, and a non-opioid analgesic, such as acetaminophen, are widely used in dentistry and have demonstrated greater efficacy in providing pain relief than either ingredient used individually.1 However, since an opioid analgesic ingredient may increase the risk of adverse effects such as central nervous system depression, respiratory depression, and gastrointestinal upset, combination analgesic products that contain only non-opioid ingredients are attractive alternatives. Non-opioid analgesics useful in the treatment of dental pain include acetaminophen (Tylenol) and nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen). Many patients believe that since these agents are available without a prescription, they are inferior to analgesics available only by prescription in their ability to relieve dental pain. However, many studies have concluded that the opposite is true.2,3 In addition, recent studies have demonstrated the potential advantages of a product which combines these 2 ingredients.4-6 Acetaminophen is often referred to as APAP, an acronym for its chemical name (N-acetyl-p-aminophenol), or as paracetamol outside the United States. It has analgesic and antipyretic activity that is equivalent to that of aspirin, but very weak antiinflammatory effects when compared with aspirin or NSAIDs. Although acetaminophen is not a true anti-inflammatory drug, it can be effective in treating pain resulting from inflammation. While its exact mechanism of action is not fully understood, it is thought that acetaminophen, like aspirin and the NSAIDs, inhibits prostaglandin synthesis. However, there is evidence that acetaminophen may be much more active in the central nervous system as a result of multiple unknown mechanisms of action.7 For patients in whom aspirin and NSAIDs are contraindicated, acetaminophen is usually the drug of choice. The most serious adverse effect associated with the use of acetaminophen is drug-induced hepatotoxicity due to acute or chronic overdose of the drug. When used as monotherapy, acetaminophen has been shown to be a superior analgesic for the relief of postoperative pain.2 Acetaminophen at a 1000 mg dose has been shown to be more effective than placebo in reducing pain after third molar extractions.8 However, especially at high doses, acetaminophen’s analgesic effect is limited in the treatment of moderate to severe postoperative pain resulting from other types of dental procedures.2,9 Acetaminophen has long been considered the “safe” analgesic because it produces few side effects at typical adult doses, though studies have demonstrated some clinically significant drug interactions and adverse drug reactions. It has been shown 14 November/December 2013 General Dentistry that at high doses acetaminophen may interact with warfarin, resulting in a significantly higher internationalized normal ratio (INR).10 In addition, while it is well known that acetaminophen may cause acute liver toxicity in supratherapeutic doses, even high therapeutic doses of acetaminophen may still result in subclinical liver injury.11,12 This information suggests that acetaminophen’s analgesic effect would be optimized and its potential for producing adverse reactions and drug interactions minimized if it were used in lower doses. This would perhaps be possible in combination with another analgesic, such as an NSAID.13 Such a combination would improve analgesic efficacy without increasing the risk of adverse drug reactions. NSAIDs themselves have long been considered first line therapy in the treatment of dental pain. NSAIDs inhibit the formation of cyclooxygenase-2 (COX-II), the enzyme responsible for the production of certain prostaglandins which, in turn, produce pain, fever, and inflammation. Unfortunately, NSAIDs also inhibit the formation of cyclooxygenase-1 (COX-I), the enzyme responsible for the production of other prostaglandins which are responsible for numerous beneficial effects, such as the production of the gastrointestinal mucous lining, regulation of normal platelet activity, bronchodilation, and maintenance of adequate blood flow to the kidneys. As in the case with acetaminophen, the therapeutic and adverse effects of NSAIDs are dose-related, and the use of lower doses in a combination product would be considered advantageous.13,14 There is no definitive evidence to support the conclusion that one NSAID is superior to another in its ability to relieve dental pain. Studies have demonstrated that NSAIDs are equally efficacious compared to acetaminophen and acetaminophen/codeine in reducing pain after dental surgery.15,16 There is a substantial amount of evidence which shows that the NSAID ibuprofen, at 200 mg and 400 mg doses, is an effective pain reliever, equal or superior to acetaminophen in treating postoperative dental pain.3 Numerous studies comparing ibuprofen to placebo found that ibuprofen provided greater pain relief in patients with moderate to severe postoperative dental pain and with similar adverse effects.3 Monotherapy with ibuprofen has been shown to be equal or superior to monotherapy with acetaminophen in the management of dental pain.3 However, because monotherapies may provide incomplete pain relief, combinations of these 2 analgesics have been researched extensively.13,14 Acetaminophen and ibuprofen have similar yet different mechanisms of action, so a combination of the 2 agents may offer a synergistic approach to pain relief.13 Although there is as yet no nonprescription analgesic product available in the US that combines acetaminophen with ibuprofen, studies have compared combinations of acetaminophen with various NSAIDs.4 www.agd.org Published with permission by the Academy of General Dentistry. © Copyright 2013 by the Academy of General Dentistry. All rights reserved. For printed and electronic reprints of this article for distribution, please contact rhondab@fosterprinting.com. Historically, the therapeutic superiority of the combination of acetaminophen and ibuprofen over either drug alone was controversial, but current evidence now suggests that a combination of acetaminophen and ibuprofen may offer superior analgesia compared with either monotherapy.17 In a 2010 study by Mehlisch et al, concurrent ibuprofen and acetaminophen appeared to provide significantly better analgesic efficacy compared with ibuprofen or acetaminophen alone for acute postoperative dental pain in adolescents and adults.5 Daniels et al found that a single-tablet combination of ibuprofen (200 mg)/acetaminophen (500 mg) provided highly effective analgesia that was comparable with or superior to other combination analgesics currently indicated for strong pain.6 In another 2010 study by Mehlisch et al, ibuprofen (200 mg)/acetaminophen (500 mg) and ibuprofen (400 mg)/ acetaminophen (1000 mg) were significantly more effective than comparable doses of ibuprofen or acetaminophen alone in treating moderate to severe acute dental pain and were significantly more effective than placebo in providing sustained pain relief.18 Several nonprescription combination analgesics contain caffeine. While caffeine is not thought to possess any analgesic properties on its own, in combination with traditional analgesics such as acetaminophen, ibuprofen, and aspirin, it is believed to enhance analgesic efficacy. Studies have demonstrated that the addition of caffeine to these analgesics provided an increase in the number of patients who experienced improved pain relief.19 As a result, a combination analgesic containing acetaminophen and ibuprofen that contains caffeine as an adjunct may improve the efficacy of the product. Such acetaminophen and ibuprofen combination products would not be without risks. It has been reported that among elderly patients requiring analgesic/anti-inflammatory treatment, use of a combination of acetaminophen and an NSAID increased the risk of GI bleeding compared with either agent alone.20 Additionally, a recent warning by the FDA notified health care professionals and patients that acetaminophen has been associated with a risk of Stevens-Johnson syndrome, and toxic epidermal necrolysis.21 The use of NSAIDs has also been associated with the risk of these rare but serious skin reactions, so a product which combines both of these ingredients may theoretically increase this risk.22 Combining 2 analgesic agents with similar yet different mechanisms of action may offer a synergistic approach to providing dental pain relief while minimizing adverse effects. Recent studies have consistently demonstrated that a combination analgesic containing acetaminophen and ibuprofen is more effective in treating dental pain than the individual ingredients when administered alone. Author information In addition to his daily practice in the pharmacy profession, Mr. Viola is also an educator, published author, and professional speaker in the fields of dentistry, dental hygiene, and dental assisting. References 1. Gaskell H, Derry S, Moore RA, McQuay HJ. Single dose oral oxycodone and oxycodone plus paracetamol (acetaminophen) for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009;(3):CD002763. 2. Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev. 2008;8(4):CD004602. 3. Derry C, Derry S, Moore RA, McQuay HJ. Single dose oral ibuprofen for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009;8(3):CD001548. 4. Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110(4):1170-1179. 5. Mehlisch DR; Aspley S, Daniels SE, Bandy DP. Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: a randomized, double-blind, placebo-controlled, parallel-group, singledose, two-center, modified factorial study. Clin Ther. 2010;32(5):882-895. 6. Daniels SE, Goulder MA, Aspley S, Reader S. A randomised, five-parallel-group, placebo-controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single-tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain. 2011;152(3):632-642. 7. Smith HS. Potential analgesic mechanisms of acetaminophen. Pain Physician. 2009; 12(1):269-280. 8. Weil K, Hooper L, Afzal Z, et al. Paracetamol for pain relief after surgical removal of lower wisdom teeth. Cochrane Database Syst Rev. 2007;18(3):CD004487. 9. Skoglund JA, Skjelbred P, Fyllingen G. Analgesic efficacy of acetaminophen 1000 mg, acetaminophen 2000 mg, and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg versus placebo in acute postoperative pain. Pharmacotherapy. 1991;11(5):364-369. 10. Parra D, Beckey NP, Stevens GR. The effect of acetaminophen on the international normalized ratio in patients stabilized on warfarin therapy. Pharmacotherapy. 2007;27(5): 675-683. 11. Daly FF, O’Malley GF, Heard K, Bogdan GM, Dart RC. Prospective evaluation of repeated supratherapeutic acetaminophen (paracetamol) ingestion. Ann Emerg Med. 2004; 44(4):393-398. 12. Arundel C, Lewis JH. Drug-induced liver disease in 2006. Curr Opin Gastronterol. 2007; 23(3):244-254. 13. Altman RD. A rationale for combining acetaminophen and NSAIDs for mild-to-moderate pain. Clin Exp Rheumatol. 2004;22(1):110-117. 14. Dionne R. Additive analgesia without opioid side effects. Compendium. 2000;21(7): 572-574, 576-577. 15. Mehlisch D, Frakes L, Cavaliere MB, Gelman M. Double-blind parallel comparison of single oral doses of ketoprofen, codeine, and placebo in patients with moderate to severe dental pain. J Clin Pharmacol. 1984;24(11-12):486-492. 16. Mehlisch DR, Jasper RD, Brown P, Korn SH, McCarroll K, Murakami AA. Comparative study of ibuprofen lysine and acetaminophen in patients with postoperative dental pain. Clin Ther. 1995;17(5):852-860. 17. Mehlisch DR, Sollecito WA, Helfrick JF, et al. Multicenter clinical trial of ibuprofen and acetaminophen in the treatment of postoperative dental pain. J Am Dent Assoc. 1990; 121(2):257-263. 18. Mehlisch DR, Aspley S, Daniels SE, Southerden KA, Christensen KS. A single-tablet fixed-dose combination of racemic ibuprofen/paracetamol in the management of moderate to severe postoperative dental pain in adult and adolescent patients: a multicenter, two-stage, randomized, double-blind, parallel-group, placebo-controlled, factorial study. Clin Ther. 2010;32(6):1033-1049. 19. Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database Syst Rev. 2012;3:CD009281. 20. Rahme E, Barkun A, Nedjar H, Gaugris S, Watson D. Hospitalizations for upper and lower GI events associated with traditional NSAIDs and acetaminophen among the elderly in Quebec, Canada. Am J Gastroenterol. 2008;103(4):872-882. 21. U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA warns of rare but serious skin reactions with the pain reliever/fever reducer acetaminophen. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm363041.htm. Accessed September 11, 2013. 22. Kasemsarn P, Kulthanan K, Tuchinda P, Dhana N, Jongjarearnprasert K. Cutaneous reactions to non-steroidal anti-inflammatory drugs. J Drugs Dermatol. 2011;10(10): 1160-1167. www.agd.org General Dentistry November/December 2013 15
Purchase answer to see full attachment
User generated content is uploaded by users for the purposes of learning and should be used following Studypool's honor code & terms of service.

Explanation & Answer

Here is the solution. Let me know if you need edits. Feel free to invite me in the future. Cheers!😀

Running head: JOURNAL ARTICLE SUMMARY

1

Journal Article Summary
Author’s Name
Institutional Affiliation
Date

JOURNAL ARTICLE SUMMARY

2
Journal Article Summary

A mixture of analgesics products has been applied in the treatment of severe and moderate
dental ache. The combination of the analgesics may comprise of opioid or may lack opioid elements. The
analgesics components assist in pain relief to individuals who have dental pain. Analgesics that contain
elements of opioid may cause side effects such as depression of the central ...


Anonymous
Excellent resource! Really helped me get the gist of things.

Studypool
4.7
Trustpilot
4.5
Sitejabber
4.4

Similar Content

Related Tags