Non-opioid Adjuncts Flashcards
Gabapentin mechanism of action
Decrease hyperexcitability of dorsal horn neurons caused by tissue damage
Modulation of calcium-induced release of glutamate centrally in dorsal horn
Activation of descending noradrenergic pathways in the spinal cord and brain
gabapentin dose
300-600 mg PO preop
gabapentin cautions
Careful in old age and low GFR, morbidly obese, OSA
gabapentin is used frequently in
chronic/neuropathic pain
gabapentin effect on postoperative sedation
can increase it
celebrex mechanism of action
selective COX-2 inhibitor
celebrex dose
100-200 mg PO
celebrex is associated with an increased risk of
stroke, MI, worsening HTN
when to avoid celebrex
in known history of CAD or cerebrovascular disease
methocarbamol (robaxin) mechanism of action
Central Acting Skeletal Muscle Relaxant
Depresses the CNS leading to relaxation of the muscles
how should methocarbamol be used
as an adjunct
can methocarbamol cause sedation
yes
methocarbamol dose
1 gram IV slowly over 15-20 min
methocarbamol side effects
Can cause hypotension, bradycardia, and convulsions if given rapidly
when should methocarbamol be avoided
liver and renal dysfunction
ketorolac (toradol) mechanism of action
non-selective Cox 1 and Cox 2 inhibitor
how does ketorolac/toradol work
NSAID, inhibits cyclooxygenase, preventing thromboxane synthesis, which is necessary for platelet aggregation, inhibits prostaglandin synthesis
ketorolac uses
decrease pain and cramping, postoperative cesarean delivery, orthopedics, laparoscopy
ketorolac CNS effects
minimal CNS effects, no respiratory depression or sedation
ketorolac cautions
Careful use in elderly, bleeding issues, renal impairment with poor creatinine clearance, ASA allergy, asthma, nasal polyps
ketorolac decreases
post-op narcotic use
ketorolac dose
15 – 30 mg IV every 6 hours
ketorolac onset
10-30 min
ketorolac duration
4-6 hours; peaks in 1-2 hours
which drug should you always ask the surgeon before administration
toradol/ketorolac
Samter’s Triad
asthma, aspirin allergy, nasal polyposis
aspirin-exacerbated respiratory distress
ofirmev (IV acetaminophen)
Used to treat mild to moderate pain, and moderate to severe pain with adjunctive opioids
side effects of ofirmev (IV acetaminophen)
nausea, vomiting, headache, and insomnia in adults
ofirmev onset
15 min
ofirmev peak analgesia
~1 hour
ofirmev duration
4-6 hours
caldolor is
ibuprofen injection
caldolor must be _________ prior to use
diluted
what can happen if caldolor is not diluted prior to use
can cause hemolysis
how should caldolor be administered
NOT via IV bolus or IM injection
caldolor adverse reactions
The most common adverse reactions are nausea, flatulence, vomiting, headache, hemorrhage and dizziness (>5%). The most common adverse reactions in pediatric patients are infusion site pain, vomiting, nausea, anemia and headache (≥2%).
caldolor dosing
3200 mg/day (400-800 mg/6 hours over 30 minutes)
pediatric caldolor dose
400 mg IV q 4-6 hours
caldolor is contraindicated in
patients with known hypersensitivity
caldolor cautions
CALDOLOR should be used with caution in patients with known cardiovascular (CV) disease or risk factors for CV disease, a history of peptic ulcer disease and/or GI bleeding, liver disease or symptoms of, hypertension, and heart failure.
can caldolor be used in pregnancy
avoid use starting at 30 weeks gestation
