Non - Opioid Adjuncts Flashcards
What adverse effects can occur if Robaxin is administered rapidly?
Hypotension, bradycardia, and convulsions
Toradol is a (non-selective/selective) (COX-1/COX-2) inhibitor.
non-selective
COX-1 AND COX-2
Which drug do we always ask the surgeon about before administering?
Toradol (Ketorolac); this is due to bleeding risk
Other name for Samter’s Triad?
Aspirin Exacerbated Respiratory Disease (AERD)
Gabapentin uses:
Used a lot in chronic pain/neuropathic pain
Robaxin dose:
1 gram IV slowly over 15-20 mins;
- used as an adjunct with other meds;
Can cause hypotension, bradycardia, and convulsions if given rapidly
Samter’s Triad is a chronic condition that includes all three triad features (asthma, nasal polyps, ASA allergy) and a sensitivity to ____.
NSAIDS and ASA
Celebrex dose:
100-200 mg PO
Benefits of Toradol:
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.
What is Samter’s Triad?
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).
Toradol duration:
4-6 hrs
Caldolor max dose: (adults and peds)
Max dose:
adults —>; 3200 mg/day (800 mg/6 hrs)
peds <17 yrs old —->; 2400 mg (40 mg/kg)
Gabapentin —-> ; careful when using for which patients?
careful in old age and low GFR, morbidly obese, OSA (all due to sedation effects)
Celebrex s/e:
Careful/avoid use in which patients?
associated with increased risk of stroke and MI, worsening of HTN;
Careful/avoid in known hx of CAD or cerebrovascular disease
Ofirmev dose:
> 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
Ofirmev duration:
4-6 hrs
Celebrex is a (non-selective/selective) (COX-1/COX-2) inhibitor.
Selective COX-2 inhibitor
Gabapentin chemical class:
Gabapentinoid
Toradol
onset:
peak:
10-30 mins;
peaks in 1-2 hrs
What are the triad features of Samter’s Triad?
Asthma
Nasal polyps
ASA allergy
Robaxin —> avoid in which patients?
should probably avoid in liver and renal dysfunction
Gabapentin —> effect on anesthesia:
can increase postoperative sedation
Toradol dose:
Dose in relation to narcotic strength:
15-30 mg IV every 6 hrs
30 mg Toradol IV = ~ 10 mg morphine
Caldolor C/I:
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.
Ofirmev onset:
Peak:
Onset: 15 mins
Peak analgesia: about 1 hr
Gabapentin dose:
300-600 mg PO preop
What every-day symptoms might indicate Samter’s Triad?
May have respiratory reactions to alcohol and impaired sense of smell
Celebrex MOA:
selective COX-2 inhibitor
____must be diluted prior to use;
Infusion without dilution can cause ___ ; It should not be given as an __ bolus or __ injection.
Caldolor;
hemolysis;
IV;
IM
Ofirmev (___)
(IV Acetaminophen)
Ofirmev s/e:
nausea, vomiting, headache, and insomnia in adults.
Methocarbamol (___)
(Robaxin)
Gabapentin (___)
(Neurontin)
Ofirmev; careful when using in which patients?
Hepatic impairment/acute disease,
chronic alcoholism,
chronic malnutrition,
severe hypovolemia,
or severe renal impairment
Toradol uses:
Decrease pain and cramping,
Postop C-section,
Orthopedics,
Laparoscopy
Caldolor —>use caution in these patients:
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
Robaxin MOA:
Central acting skeletal muscle relaxant; Depresses the CNS leading to relaxation of the muscles (used as an adjunct with other medications)
Caldolor (___)
(IV Ibuprofen)
Toradol —> Careful with use in which patients?
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
Toradol (___)
Ketorolac
Toradol MOA:
NSAID, inhibits cyclooxygenase **preventing thromboxane synthesis ** (which is necessary for platelet aggregation), inhibits postaglandin synthesis; Non-selective COX-1 and COX-2 inhibitor
Gabapentin MOA:
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.
Ofirmev uses:
Used to treat mild to moderate pain;
or moderate to severe pain with adjunctive opioids
Robaxin s/e:
Can cause sedation
Can cause hypotension, bradycardia, and convulsions if given rapidly
