Multimodal Pain Control Flashcards
at what temp does the pt have to be to be considered a payable event
at least 36 degrees celsius
two components of multimodal anes
short acting anesthetic agent and opioid sparing techniques
gabapentin is a structural analog of
gaba
gabapentin binds to
vg ca channels
moa of gabapentin
inhibition of excitatory nt release and inhibition of descending pain pathways
gabapentin has no
drug interactions
gabapentin can be used to treat
partial seizures and chronic pain
dose of gabapentin for preemptive analgesia
300-1200 mg
relative contraindications to gabapentin
myasthenia gravis and myoclonus
s/e of gabapentin
abrupt withdrawal in sz patients will cause seizures; pt becomes more somnolent and fatigued
COX catalyzes synthesis of
prostaglandin
COX1 is needed to
maintain homeostasis
many of the symptoms associated with used of nsaids is d/t blocking of
COX1 pathway
COX2 is an _______ form of pain
inducible
_____ inhibition of COX2 helps modulate pain
central
COX2 selective inhibitors have this advantage over nonselectives; what disadvantage?
does not block physiologic processes; possible MI and CVA
nsaid dosage ceiling
does not increase positive effects if you take more, but will increase negative effects
first COX2 selective inhibitor
celebrex or celecoxib
celebrex peaks at
3 hours
acetaminophen does not share this property with nsaids
anti inflammatory
peak po dose of tylenol
1-3 hours
peak iv dose of tylenol
30 mins-1 hour
main moa of tylenol
reduces prostaglandin metabolite
duration of tylenol
6-8 hours
ketorolac moa
non specific nsaid; inhibits PG synthesis
relative CI for ketorolac
cad, cabg, bleeding, renal impairment
ketorolac peak
45-60 mins
ketorolac is a potent analgesic but a moderate
anti inflammatory
ketorolac has no effect on the
biliary tract
ibuprofen moa
non selective cox inhibitor
relative c/t to ibuprofen
nsaid allergy, cabg, bleeding
ibuprofen peak
1-2 hours
ibuprofen is excreted in the
urine and bile
name two short acting anesthetic agents
ketamine and propofol
lidocaine somehow helps with
chronic pain
build up of lidocaine can occur with
liver and renal impairment
safe plasma concentration of lidocain
<5 mcg/mL
we start seeing sz/unconsciousness at what plasma concentration of lidocain
10-15 mcg/mL
nmda stands for
n methyl d aspartate
magnesium is an _____ blocker
nmda receptor
probable moa of mg for pain
potentiation of opioids centrally and peripherally
Mg regulates
ca access into cell, neurotransmission, cell signaling, enzyme function; tldr, hyperpolarizes the cell to decrease excitability
relative c/i to Mg
myasthenia gravis, renal failure
Mg s/e
bradycardia, hpn, diarrhea
mg will decrease ______ dose intraoperatively
fentanyl
s/e of zofran
HA, constipation, qt prolongation
e 1/2 of zofran
4 hours
give zofran when
towards the end of the case
what place in the brain has glucocorticoid receptors
nts
decadron enhances the effects of
5ht3 antagonists and droperidol
moa of decadron
anti inflammatory; inhibition of phospholipase and cytokines; cell stabilization
delay of onset of decardron
2 hours
max dose of tylenol
3000-4000 mg
max dose of ibuprofen
3200 mg
max dose of ketorolac
120 mg
sofa stands for
society of opioid free anesthesia
