Non-Opioid Dosages Flashcards
Aspirin alternate name:
acetylsalicylic acid (ASA)
Aspirin structure:
benzene ring with carboxylic acid group
Aspirin MOA:
- Irreversibly acetylates COX enzymes
- Prevents the conversion of arachidonic acid to prostaglandins thus attenuating nociceptive response to endogenous mediators of inflammation
- Inhibiting platelet aggregation for the life of the platelet
Aspirin Onset:
30 min
Aspirin Duration of action:
4-6 h
Aspirin PB:
95%
Aspirin metabolism:
Hepatic - active metabolite salicylic acid (salicylate), Renal excretion
Aspirin PO dose (daily preventative):
81 mg
Max 4 g/day
Aspirin PO dose (analgesia/antipyretic):
325-650 mg Q 4-6 hr
Max 4 g/day
Aspirin PO dose (for anti-inflammatory):
1000 mg
Max 4 g/day
Aspirin Side Effects:
B – Bleeding
A – Allergic Reaction
K – Kidney Failure
E – Edema
G – GI Bleed
Aspirin Contraindications / cautions:
C – Constriction (bronchoconstriction)
H – Heart attack (prevention)
I – Increased temperature (fever treatment)
P – Prostaglandin (decreases production)
S – Stroke (prevention)
- Inhibits platelet for life (10-14 days)
- Do not give children (risk for reyes syndrome)
- Salicylate overdose—tinnitus, metabolic acidosis
Toradol alternate name:
Ketorolac
Toradol structure:
More COX-1 selective
Toradol MOA:
- Inhibits the COX I & II enzymes (most selective COX-1)
- Prevents the conversion of arachidonic acid to prostaglandins thus attenuating nociceptive response to endogenous mediators of inflammation
Toradol Onset:
10 min
Toradol duration of action:
4-6 hr
Toradol PB:
95%
Toradol Metabolism:
Hepatic glucuronidation, excreted Renally
Toradol IV adult dose:
15-30 mg Q 6 hr IV or IM for no more than 5 days
Toradol IV kg Dose:
0.5 mg/kg
Toradol Side Effects:
B – Bleeding
A – Allergic Reaction
K – Kidney Failure
E – Edema
G – GI Bleed
Toradol Contraindications / cautions:
C – Constriction (bronchoconstriction)
H – Heart attack (increased risk)
I – Increased temperature (fever treatment)
P – Prostaglandins
S – Stroke (increased risk)
Celecoxib alternate name:
Celebrex
Celecoxib Structure:
Acetic acid derivative
Celecoxib MOA:
- Inhibit the action of cyclo-oxygenase (COX)
- Prevents the conversion of arachidonic acid to prostaglandins thus attenuating nociceptive response to endogenous mediators of inflammation
- Treatment of mild to moderate post-op pain
- Analgesic, antipyretic, and anti-inflammatory
Celecoxib Onset:
2 h
Celecoxib duration of action:
12 h
Celecoxib PB:
95%
Celecoxib Metabolism:
Hepatic glucuronidation, excreted 50% in feces, 30% Renal
Celecoxib PO dose:
< 65 yo = 400 mg
> 65 yo = 200 mg
Celecoxib Side Effects:
B – Bleeding
A – Allergic Reaction
K – Kidney Failure
E – Edema
G – GI Bleed
Celecoxib Contraindications / cautions:
C – Constriction (bronchoconstriction)
H – Heart attack (increased risk)
I – Increased temperature (fever treatment)
P – Prostaglandins
S – Stroke (increased risk)
Acetaminophen alternate name:
Tylenol
Acetaminophen structure:
Non-selective COX inhibitor (COX 3?)
Acetaminophen MOA:
- Acts on serotonergic pathways
- Possible COXIII inhibition
- Possible endogenous cannabinoid potentiation
- Anti-pyretic effects from direct inhibition of the hypothalamic heat regulating centers by inhibiting actions of endogenous pyrogens
Acetaminophen Onset:
10 min
Acetaminophen duration of action:
4-6 hr
Acetaminophen PB:
30%
Acetaminophen Metabolism:
CYP3A4 (byproduct NAPQI - inactivated by glutathione), Renal
Acetaminophen IV dose:
1000 mg over 15 min (max 4g/day)
Acetaminophen Peds dose:
10-15 mg/kg (max daily: 75 mg/kg)
Acetaminophen Side Effects:
- Decrease pain
- No anti-inflammatory effect
- See C/c for additional
Acetaminophen Contraindications / cautions:
- Treat overdose with acetylcysteine within 8 hours
T – Temperature (decreases fever)
Y - Yellowing (jaundice)
L - Liver damage (with overdose)
E – End stage Renal (possible with long term use)
N - Nausea
O - Opioids: may reduce absorption
L - Lush – caution in alcoholics
Decadron Alternate name:
Dexamethasone
Decadron structure:
Synthetic corticosteroid / glucocorticoid
Decadron MOA:
- Inhibits Phospholipase A2 thus inhibiting arachidonic acid and the entire pathway
- Prostaglandins are inhibited – decreasing pain and inflammation
- Leukotrienes are inhibited – ok for brittle asthmatics unlike NSAIDS
Decadron Onset:
1-2 h
Decadron duration of action:
36-48 h
Decadron PB:
75%
Decadron Metabolism:
CYP3A4
excreted by the kidneys
Decadron IV pain dose:
8-10 mg
Decadron IV PONV dose:
4 mg
Decadron IV Peds dose:
0.15 mg/kg
Decadron Side effects:
- Increased Glucose levels
- Weight gain and fluid retention
- Mood changes
- Insomnia
- Increased risk of infections
Decadron Contraindications / cautions:
- Allergy to Decadron
- May exacerbate hypertension
- Caution in diabetics
- Adrenocortical insufficiency or withdrawal if discontinued rapidly
- Increased risk of perforation/bleeding in patients with GI issues (peptic ulcers, ulcerative colitis, etc.)
Magnesium alternate name:
Jokes, there isn’t one (sometimes referred to as its chemical compound, magnesium sulfate, magnesium oxide, etc)
Magnesium structure:
Elemental
Magnesium MOA:
- Calcium channel and NMDA antagonist
- Antagonizes hippocampal presynaptic CA++ channels that regulate aspartate and glutamate, preventing central sensitization, inhibiting hyperalgesia and amplifying the analgesic effects of opioids
- NMDA antagonism is related to magnesium plug that sits within the NMDA channel
Magnesium Onset:
30-60 sec
Magnesium Duration of action:
30-60 min
Magnesium PB:
30%
Magnesium Metabolism:
Not metabolized - renally excreted
Magnesium IV bolus dose:
30-50 mg/kg (over 15 min)
Magnesium IV infusion dose:
10 mg/kg/hr
Magnesium Side effects:
- Hypotension
- Respiratory depression
- Decreased DTRs
- Muscle weakness
- Flushing
Magnesium Contraindications / cautions:
- Caution in patients with respiratory issues
- Caution in patients on CCBs
- CNS depression
- Caution in Renally impaired patients
- Caution in patients with Heart block
