Multimodal Flashcards

1
Q

Gabapentin (Neurontin)- MOA

A

Binds VG Ca++ channels; inhibits glutamate release in the dorsal horn of the spinal cord

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2
Q

Gabapentin (Neurontin)- Doses

A

300 - 1200 mg prior to OR

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3
Q

Gabapentin (Neurontin)- Side Effects

A

Can exacerbate MG & myoclonus

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4
Q

Gabapentin (Neurontin)- Misc

A

GABA ANALOGUE WITH NO GABANERGIC ACTIVITY

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5
Q

Dexamethasone (Decadron) -MOA

A

Inhibits phosolipase & cytokines; stabilizes membrane

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6
Q

Dexamethasone (Decadron): Dose

A

8-10 mg

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7
Q

Dexamethasone (Decadron): Side Effects

A

Can elicit a vomit reflex if given RIVP; Perineal burning/Itching

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8
Q

Celecoxib (Celebrex)- MOA

A

1st COX-2 specific Inhibitor; decreases PG synthesis (inducible)

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9
Q

Celecoxib (Celebrex)- Doses

A

200 - 400 mg PO QD.
Peak 3 hours

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10
Q

Acetaminophen (Ofirmev): MOA

A

Decreases prostaglandin metabolites

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11
Q

Acetaminophen (Ofirmev): Doses

A

1 Gm IV/PO
Onset: 30 - 60 mins IVOnset: 1 - 3 hours
PO Max: 3 Gm (24 hrs) Duration: 6 - 8 hours

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12
Q

Acetaminophen (Ofirmev): Misc

A

Can have hepatic effects; toxic > 3 Gm/Day

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13
Q

Ketorolac (Toradol): Doses

A

30 or 60 mg IM Q6 hours Elderly: 1/2 dose. Peak: 45 to 60 mins IV

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14
Q

Ketorolac (Toradol): MOA

A

Inhibits COX-1/COX-2; Decreases PG synthesis

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15
Q

Ketorolac (Toradol): S/E

A

Can be extremely renal toxic; 1/2 doses in elderly & renal pts

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16
Q

Ketorolac (Toradol): Misc

A

C/I: Severe renal impairment, significant risk for bleeding, CAD, CABG, pregnancy; decrease dose in. elderly, NSAID allergy

17
Q

Ibuprofen (Caldolor, Neoprofen): MOA

A

Inhibits COX-1/COX-2;

18
Q

Ibuprofen (Caldolor, Neoprofen): Doses

A

200 - 800 mg IV Max: 3200 mg (24 hrs)

19
Q

Ibuprofen (Caldolor, Neoprofen): S/E

A

Allergies to NSAIDs; bleeding, CABG, ulcers

excretion: urine and bile

20
Q

Lidocaine: MOA

A

Amide - Local Anesthetic

21
Q

Lidocaine: Doses

A

1 - 2 mg/kg IV Q 2 - 4 mins

gtt: 1 - 2 mg/kg/hr

terminated 12 - 72 hours

22
Q

Magnesium: MOA

A

NMDA receptor non-competitve antagonist

23
Q

Magnesium: Dose

A

Pre-op: 50 mg IV Intra-op (gtt): 8 mg/kg/hr

Be prepared to treat bradycardia and/or hypotension.

24
Q

Magnesium: S/E

A

C/I in Myasthenia Gravis (MG) and renal failure

25
Magnesium: Misc
SIGNIFICIANTLY DECREASES FENTANYL REQUIRMENTS Limited passage across BBB
26
Cox-1
ubiquitous “physiologic” Inhibition is responsible for many adverse affects "constitutive"
27
COX-2
“pathophysiologic” Expressed at sites of injury Not protective…oncogenic processes Sensitization, “wind-up” Inducible
28
√√√ COX-2 Selective √√√ vs. Nonspecific Inhibitors
Comparable analgesia Lack effects on platelets May be assoc. with ↓ GI effects Possible ↑ in MI and CVA Dosage ceiling ↑ in side effects
29
Types of NSAIDS Non-specific
Ibuprofen, naproxen, aspirin, acetaminophen, ketorolac