Lecture

Symptomatic/Anti-inflammatory Pharmacology

(Drugs Used in Inflammation)

dr. Agung Nova Mahendra, M.Sc.

Abstract

Pain and inflammation in dentistry has unique features. Pain not only signals tissue injury,
but it also acts as an impediment to most dental procedures, delays resumption of normal
daily activities following dental surgical procedures, and lessens the likelihood of patients
seeking dental procedures in the future. While pain during therapy is usually adequately
controlled by local anesthesia, post-operative pain control is often inadequate, because
of either insufficient relief of pain or unacceptable side-effects, such as nausea, vomiting,
and upper GI tract bleeding. In addition, inadequate control of pain during the immediate
post-operative period may lead to development of hyperalgesia. These considerations
indicate that optimal analgesic and anti-inflammatory therapy for ambulatory dental
patients should be efficacious, with a minimum incidence of side effects.

Clinical Vignette

A male patient, 67 years-old, presents to a dental clinic for treatment of acutely painful
tooth. After a sequence of examinations, the patient was then indicated to have a tooth
extraction procedure because the tooth is non-reparable. To control immediate post-
operative pain, the dentist prescribes an anti-inflammatory drug (mefenamic acid) that
must be taken PO TID or as needed (PRN). Three days later, the patient revisits the clinic
and complaining of nausea and vomiting after taking six doses of this drug in 2 days. The
patient is also under the therapy of antihypertension (hydrochlorothiazide tablets), with
daily baseline systolic blood pressure of + 130 mmHg. He denies history of drug allergy,
gastric, hepatic and renal disease.
Learning Tasks

1. Explain the pharmacokinetics and pharmacodynamics of the drug used in the

management of post-operative pain in this case?
2. Why does this patient exhibit nausea and vomiting? Explain the pathomechanism!
3. What is (are) the potential drug-drug interaction(s) (DDIs) of mefenamic acid and
antihypertensive drugs, such as hydrochlorothiazide?
4. Explain the mechanism of DDIs between NSAIDs and antihypertensive drug!

Reference

Katzung, BG, Trevor AJ. 2015. Basic and Clinical Pharmacology Thirteenth Edition.
McGraw-Hill Education: New York.