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Top Drawer > Non-opioid Pain Agents > Flashcards

Non-opioid Pain Agents Flashcards

1
Q

What is the trade name of gabapentin?

A

Neurontin

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2
Q

What drug class is gabapentin under?

A

gabapentinoid

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3
Q

What are the mechanisms of action of gabapentin?

A
  • decrease hyperexcitability of dorsal horn neurons caused by tissue damage
  • modulation of calcium-induced release of glutamate centrally in dorsal horn
  • activation of descending nonadrenergic pathways in spinal cord and brain
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4
Q

Gabapentin Dosing

A

300-600 mg PO preop

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5
Q

How early would you give gabapentin in preop?

A

30-60 min before surgery

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6
Q

When should you have careful consideration when administering gabapentin?

A
  • old age
  • low GFR
  • morbidly obese
  • OSA
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7
Q

Gabapentin is used a lot for what types of pain?

A
  • chronic pain
  • neuropathic pain
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8
Q

As an anesthesia provider, what side effect would you consider after gabapentin administration?

A

can increase postop sedation

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9
Q

What drug class is celebrex under?

A

selective COX-2 inhibitor

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10
Q

Celebrex Dosing

A

100-200 mg PO

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11
Q

Celebrex is associated with increased risk of _________, _________, and ______________

A
  • stroke
  • MI
  • worsening of HTN
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12
Q

Celebrex should be avoided or carefully used in patients with history of?

A
  • CAD
  • cerebrovascular disease
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13
Q

What is the trade name of methocarbamol?

A

Robaxin

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14
Q

What is methocarbamol and how does it work?

A
  • central acting skeletal muscle relaxant
  • depresses the CNS leading to relaxation of the muscles
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15
Q

T/F: methocarbamol cannot be used in conjunction with any other medications

A

false
methocarbamol can be used as an adjunct with other medications

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16
Q

Methocarbamol Dosing

A

1 gram IV slowly over 15-20 min

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17
Q

What are the potential side effects of methocarbamol?

A
  • hypotension
  • bradycardia
  • convulsions if given rapidly
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18
Q

In what cases should we avoid methocarbamol?

A

liver and renal dysfunction

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19
Q

T/F: methocarbamol does not cause sedation in patients

A

false
methocarbamol can cause sedation

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20
Q

What is the trade name of ketorolac?

A

Toradol

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20
Q

What drug class does ketorolac fall under?

A

Non-selective Cox 1 and Cox 2 inhibitor (NSAID)

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21
Q

What is the mechanism of action of ketorolac?

A
  • inhibits cyclooxygenase
  • prevents thromboxane synthesis (which is necessary for platelet aggregation)
  • inhibits prostaglandin synthesis
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21
Q

How much toradol is equivalent to 10 mg of morphine?

A

30 mg toradol = 10 mg morphine

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22
Q

What is ketorolac used for?

A
  • decrease pain and cramping
  • postop C section
  • orthopedics
  • laproscopy
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23
Q

T/F: ketorolac may cause sedation and respiratory depression

A

false
ketorolac has minimal CNS effects

24
Q

What cases should we carefully use ketorolac?

A
  • elderly
  • bleeding issues
  • renal impairment with poor creatinine clearance
  • ASA allergy
  • asthma
  • nasal polyps
25
Q

What is a benefit of using toradol intraoperatively?

A

decreases narcotic use postop

26
Q

Toradol Dosing

A

15-30 mg IV q6h

27
Q

Toradol onset, peak, and duration

A

Onset: 10-30 min
Peak: 1-2 hours
Duration: 4-6 hours

28
Q

T/F: toradol is used frequently in anesthesia

A

true

29
Q

Since we use toradol so frequently, what should we ensure in each of our patients?

A

that they have no relative or absolute contraindication to its use

30
Q

When administering ketorolac during surgery, what should you do?

A
  • ALWAYS ask the surgeon before administering!!!
  • may increase bleeding
31
Q

What does Samter’s Triad include?

A
  • asthma
  • nasal polyposis
  • aspirin allergy
32
Q

What is Samter’s Triad also called?

A

Aspirin Exacerbated Respiratory Disease (AERD)

33
Q

What is Samter’s triad?

A

chronic condition that includes all three triad features and sensitvity to NSAIDS and ASA

34
Q

What are some signs that a patient may have AERD?

A
  • repsiratory reactions to alcohol
  • impaired sense of smell
35
Q

In AERD, patient will have acute reactions to ________ and _________ which can be severe and life threatening

A

aspirin and NSAIDS

36
Q

When is AERD usually diagnosed?

A

in adulthood (7-10% of adults)

37
Q

How does Samter’s Triad present?

A

looks like bronchospastic asthma attack

38
Q

What is Ofirmev?

A
  • IV actaminophen
  • non-opioid alternative or in combination with other drugs
39
Q

When would we be careful to use Ofirmev?

A
  • hepatic impairment/acute disease
  • chronic alcoholism
  • chronic malnutrition
  • severe hypovolemia
  • severe renal impairment
40
Q

Ofirmev Dosing for > 50 kg patient

A

1000mg IV over 15 min q6h
OR
650 mg q4h PO acetaminophen
- max of 4 grams in 24 hr

41
Q

Ofirmev Dosing in < 50 kg patient

A

15mg/kg q6h
- max of 3 grams in 24 hr

42
Q

T/F: PO acetaminophen can be given in preop as part of ERAS protocol

A

true

43
Q

What is Ofirmev used for?

A
  • treat mild to moderate pain
  • treat moderate to severe pain with adjunctive opioids
  • ERAS protocol
44
Q

What are the most common side effects of Ofirmev?

A
  • N/V
  • headache
  • insomnia
45
Q

Why is Ofirmev used sparingly and PO acetaminophen in preop used instead?

A

Ofirmev is expensive $$$

46
Q

Ofirmev onset, peak, and duration

A

Onset: 15 min
Peak: 1 hour
Duration: 4-6 hours

47
Q

What is Caldolor?

A

IV ibuprofen

48
Q

How should Caldolor be prepared?

A

must be diluted before use!!! may cause hemolysis if not diluted

49
Q

How should Caldolor be administered?

A
  • IV infusion
  • should NOT be given as an IV bolus or IM injection
50
Q

What are the most common side effects of Caldolor?

A
  • nausea
  • flatulence
  • vomiting
  • headache
  • hemorrhage
  • dizziness
  • infusion site pain
51
Q

Caldolor Max Dose

A

3200 mg/day

52
Q

Caldolor Dosing

A

400-800 mg over 30 min q6h

53
Q

Caldolor pediatric (12-17 yo) dosing

A

400 mg IV q4-6 hours

54
Q

When is Caldolor contraindicated?

A
  • known hypersensitivity to ibuprofen or any components of the drug product
  • asthma/urticaria/allergic type reaction safter taking aspirin or other NSAIDS
55
Q

When should we carefully administer Caldolor?

A
  • known CV disease or risk factors for CV disease
  • peptic ulcer disease
  • GI bleeding
  • liver disease
  • hypertension/heart failure
56
Q

How many weeks gestation should we begin to avoid administration of Caldolor?

A

avoid use at 30 weeks gestation

57
Q

What is the generic name for Celebrex?

A

celecoxib

58
Q

What is the trade name for pregabalin?

A

Lyrica

59
Q
A

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