Non-opioid Pain Agents Flashcards
What is the trade name of gabapentin?
Neurontin
What drug class is gabapentin under?
gabapentinoid
What are the mechanisms of action of gabapentin?
- 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
Gabapentin Dosing
300-600 mg PO preop
How early would you give gabapentin in preop?
30-60 min before surgery
When should you have careful consideration when administering gabapentin?
- old age
- low GFR
- morbidly obese
- OSA
Gabapentin is used a lot for what types of pain?
- chronic pain
- neuropathic pain
As an anesthesia provider, what side effect would you consider after gabapentin administration?
can increase postop sedation
What drug class is celebrex under?
selective COX-2 inhibitor
Celebrex Dosing
100-200 mg PO
Celebrex is associated with increased risk of _________, _________, and ______________
- stroke
- MI
- worsening of HTN
Celebrex should be avoided or carefully used in patients with history of?
- CAD
- cerebrovascular disease
What is the trade name of methocarbamol?
Robaxin
What is methocarbamol and how does it work?
- central acting skeletal muscle relaxant
- depresses the CNS leading to relaxation of the muscles
T/F: methocarbamol cannot be used in conjunction with any other medications
false
methocarbamol can be used as an adjunct with other medications
Methocarbamol Dosing
1 gram IV slowly over 15-20 min
What are the potential side effects of methocarbamol?
- hypotension
- bradycardia
- convulsions if given rapidly
In what cases should we avoid methocarbamol?
liver and renal dysfunction
T/F: methocarbamol does not cause sedation in patients
false
methocarbamol can cause sedation
What is the trade name of ketorolac?
Toradol
What drug class does ketorolac fall under?
Non-selective Cox 1 and Cox 2 inhibitor (NSAID)
What is the mechanism of action of ketorolac?
- inhibits cyclooxygenase
- prevents thromboxane synthesis (which is necessary for platelet aggregation)
- inhibits prostaglandin synthesis
How much toradol is equivalent to 10 mg of morphine?
30 mg toradol = 10 mg morphine
What is ketorolac used for?
- decrease pain and cramping
- postop C section
- orthopedics
- laproscopy
T/F: ketorolac may cause sedation and respiratory depression
false
ketorolac has minimal CNS effects
What cases should we carefully use ketorolac?
- elderly
- bleeding issues
- renal impairment with poor creatinine clearance
- ASA allergy
- asthma
- nasal polyps
What is a benefit of using toradol intraoperatively?
decreases narcotic use postop
Toradol Dosing
15-30 mg IV q6h
Toradol onset, peak, and duration
Onset: 10-30 min
Peak: 1-2 hours
Duration: 4-6 hours
T/F: toradol is used frequently in anesthesia
true
Since we use toradol so frequently, what should we ensure in each of our patients?
that they have no relative or absolute contraindication to its use
When administering ketorolac during surgery, what should you do?
- ALWAYS ask the surgeon before administering!!!
- may increase bleeding
What does Samter’s Triad include?
- asthma
- nasal polyposis
- aspirin allergy
What is Samter’s Triad also called?
Aspirin Exacerbated Respiratory Disease (AERD)
What is Samter’s triad?
chronic condition that includes all three triad features and sensitvity to NSAIDS and ASA
What are some signs that a patient may have AERD?
- repsiratory reactions to alcohol
- impaired sense of smell
In AERD, patient will have acute reactions to ________ and _________ which can be severe and life threatening
aspirin and NSAIDS
When is AERD usually diagnosed?
in adulthood (7-10% of adults)
How does Samter’s Triad present?
looks like bronchospastic asthma attack
What is Ofirmev?
- IV actaminophen
- non-opioid alternative or in combination with other drugs
When would we be careful to use Ofirmev?
- hepatic impairment/acute disease
- chronic alcoholism
- chronic malnutrition
- severe hypovolemia
- severe renal impairment
Ofirmev Dosing for > 50 kg patient
1000mg IV over 15 min q6h
OR
650 mg q4h PO acetaminophen
- max of 4 grams in 24 hr
Ofirmev Dosing in < 50 kg patient
15mg/kg q6h
- max of 3 grams in 24 hr
T/F: PO acetaminophen can be given in preop as part of ERAS protocol
true
What is Ofirmev used for?
- treat mild to moderate pain
- treat moderate to severe pain with adjunctive opioids
- ERAS protocol
What are the most common side effects of Ofirmev?
- N/V
- headache
- insomnia
Why is Ofirmev used sparingly and PO acetaminophen in preop used instead?
Ofirmev is expensive $$$
Ofirmev onset, peak, and duration
Onset: 15 min
Peak: 1 hour
Duration: 4-6 hours
What is Caldolor?
IV ibuprofen
How should Caldolor be prepared?
must be diluted before use!!! may cause hemolysis if not diluted
How should Caldolor be administered?
- IV infusion
- should NOT be given as an IV bolus or IM injection
What are the most common side effects of Caldolor?
- nausea
- flatulence
- vomiting
- headache
- hemorrhage
- dizziness
- infusion site pain
Caldolor Max Dose
3200 mg/day
Caldolor Dosing
400-800 mg over 30 min q6h
Caldolor pediatric (12-17 yo) dosing
400 mg IV q4-6 hours
When is Caldolor contraindicated?
- known hypersensitivity to ibuprofen or any components of the drug product
- asthma/urticaria/allergic type reaction safter taking aspirin or other NSAIDS
When should we carefully administer Caldolor?
- known CV disease or risk factors for CV disease
- peptic ulcer disease
- GI bleeding
- liver disease
- hypertension/heart failure
How many weeks gestation should we begin to avoid administration of Caldolor?
avoid use at 30 weeks gestation
What is the generic name for Celebrex?
celecoxib
What is the trade name for pregabalin?
Lyrica
