Non - Opioid Adjuncts

Question 1

What adverse effects can occur if Robaxin is administered rapidly?

Answer 1

Hypotension, bradycardia, and convulsions

Question 2

Toradol is a (non-selective/selective) (COX-1/COX-2) inhibitor.

Answer 2

non-selective
COX-1 AND COX-2

Question 3

Which drug do we always ask the surgeon about before administering?

Answer 3

Toradol (Ketorolac); this is due to bleeding risk

Question 4

Other name for Samter’s Triad?

Answer 4

Aspirin Exacerbated Respiratory Disease (AERD)

Question 5

Gabapentin uses:

Answer 5

Used a lot in chronic pain/neuropathic pain

Question 6

Robaxin dose:

Answer 6

1 gram IV slowly over 15-20 mins;

• used as an adjunct with other meds;
  Can cause hypotension, bradycardia, and convulsions if given rapidly

Question 7

Samter’s Triad is a chronic condition that includes all three triad features (asthma, nasal polyps, ASA allergy) and a sensitivity to ____.

Answer 7

NSAIDS and ASA

Question 8

Celebrex dose:

Answer 8

100-200 mg PO

Question 9

Benefits of Toradol:

Answer 9

Minimal CNS effects,
No respiratory depression or sedation, Decreases narcotic use postop

We use Toradol frequently Make sure your patient has no relative or absolute c/i’s to its use.

Question 10

What is Samter’s Triad?

Answer 10

Chronic condition that includes all three triad features (asthma, nasal polyps, ASA allergy) and sensitivity to NSAIDS and ASA;

causes acute reactions to aspirin and NSAIDS - can be severe and life-threatening; usually diagnoses in adulthood (7-10% of adults).

Question 11

Toradol duration:

Answer 11

4-6 hrs

Question 12

Caldolor max dose: (adults and peds)

Answer 12

Max dose:
adults —>; 3200 mg/day (800 mg/6 hrs)

peds <17 yrs old —->; 2400 mg (40 mg/kg)

Question 13

Gabapentin —-> ; careful when using for which patients?

Answer 13

careful in old age and low GFR, morbidly obese, OSA (all due to sedation effects)

Question 14

Celebrex s/e:
Careful/avoid use in which patients?

Answer 14

associated with increased risk of stroke and MI, worsening of HTN;

Careful/avoid in known hx of CAD or cerebrovascular disease

Question 15

Ofirmev dose:

Answer 15

> 50 kg — 1000 mg IV OVER 15 MINS (in preop); every 6 hrs (or 650 mg Q4 hrs); MAX: 4 grams in 24 hr period;

<50 kg adult —>15 mg/kg every 6 hrs; MAX: 3 grams/day can be given PO in preop

Question 16

Ofirmev duration:

Answer 16

4-6 hrs

Question 17

Celebrex is a (non-selective/selective) (COX-1/COX-2) inhibitor.

Answer 17

Selective COX-2 inhibitor

Question 18

Gabapentin chemical class:

Answer 18

Gabapentinoid

Question 19

Toradol
onset:
peak:

Answer 19

10-30 mins;

peaks in 1-2 hrs

Question 20

What are the triad features of Samter’s Triad?

Answer 20

Asthma

Nasal polyps

ASA allergy

Question 21

Robaxin —> avoid in which patients?

Answer 21

should probably avoid in liver and renal dysfunction

Question 22

Gabapentin —> effect on anesthesia:

Answer 22

can increase postoperative sedation

Question 23

Toradol dose:

Dose in relation to narcotic strength:

Answer 23

15-30 mg IV every 6 hrs

30 mg Toradol IV = ~ 10 mg morphine

Question 24

Caldolor C/I:

Answer 24

Contraindicated in patients with known hypersensitivity (e.g. anaphylactic reactions and serious skin reactions) to ibuprofen or any components of the drug product;

and in patients who have a hx of asthma, urticaria, or other allergic-type reactions after taking ASA or other NSAIDS.

Question 25

Ofirmev onset:

Peak:

Answer 25

Onset: 15 mins

Peak analgesia: about 1 hr

Question 26

Gabapentin dose:

Answer 26

300-600 mg PO preop

Question 27

What every-day symptoms might indicate Samter’s Triad?

Answer 27

May have respiratory reactions to alcohol and impaired sense of smell

Question 28

Celebrex MOA:

Answer 28

selective COX-2 inhibitor

Question 29

____must be diluted prior to use;
Infusion without dilution can cause ___ ; It should not be given as an __ bolus or __ injection.

Answer 29

Caldolor;
hemolysis;
IV;
IM

Question 30

Ofirmev (___)

Answer 30

(IV Acetaminophen)

Question 31

Ofirmev s/e:

Answer 31

nausea, vomiting, headache, and insomnia in adults.

Question 32

Methocarbamol (___)

Answer 32

(Robaxin)

Question 33

Gabapentin (___)

Answer 33

(Neurontin)

Question 34

Ofirmev; careful when using in which patients?

Answer 34

Hepatic impairment/acute disease,
chronic alcoholism,
chronic malnutrition,
severe hypovolemia,
or severe renal impairment

Question 35

Toradol uses:

Answer 35

Decrease pain and cramping,
Postop C-section,
Orthopedics,
Laparoscopy

Question 36

Caldolor —>use caution in these patients:

Answer 36

With known or risk factors for Cardiovascular (CV) disease,

a history of peptic ulcer disease and/or GI bleeding,

liver disease or symptoms of, hypertension, and heart failure

Avoid use in pregnant women starting at 30 weeks gestation

Question 37

Robaxin MOA:

Answer 37

Central acting skeletal muscle relaxant; Depresses the CNS leading to relaxation of the muscles (used as an adjunct with other medications)

Question 38

Caldolor (___)

Answer 38

(IV Ibuprofen)

Question 39

Toradol —> Careful with use in which patients?

Answer 39

Elderly (kidney function issues), bleeding issues, renal impairment with poor creatinine clearance, ASA allergy, asthma, nasal polyps (do not give to these patients)

Renal impairment
ASA allergy
Poor creatinine clearance

Bleeding issues
Elderly (kidney function issues)
Asthma
Nasal Polyps

RAP BEAN

Question 40

Toradol (___)

Answer 40

Ketorolac

Question 41

Toradol MOA:

Answer 41

NSAID, inhibits cyclooxygenase **preventing thromboxane synthesis ** (which is necessary for platelet aggregation), inhibits postaglandin synthesis; Non-selective COX-1 and COX-2 inhibitor

Question 42

Gabapentin MOA:

Answer 42

Decreases hyperexcitability of dorsal horn neurons caused by tissue damage via modulation of Ca++ - induced release of glutamate (inhibits an excitatory pathway) centrally in dorsal horn and activation of descending noradrenergic pathways in the spinal cord and brain.

Question 43

Ofirmev uses:

Answer 43

Used to treat mild to moderate pain;

or moderate to severe pain with adjunctive opioids

Question 44

Robaxin s/e:

Answer 44

Can cause sedation
Can cause hypotension, bradycardia, and convulsions if given rapidly