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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
T/F: ketorolac may cause sedation and respiratory depression
false ketorolac has minimal CNS effects
24
What cases should we carefully use ketorolac?
- elderly - bleeding issues - renal impairment with poor creatinine clearance - ASA allergy - asthma - nasal polyps
25
What is a benefit of using toradol intraoperatively?
decreases narcotic use postop
26
Toradol Dosing
15-30 mg IV q6h
27
Toradol onset, peak, and duration
Onset: 10-30 min Peak: 1-2 hours Duration: 4-6 hours
28
T/F: toradol is used frequently in anesthesia
true
29
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
30
When administering ketorolac during surgery, what should you do?
- ALWAYS ask the surgeon before administering!!! - may increase bleeding
31
What does Samter's Triad include?
- asthma - nasal polyposis - aspirin allergy
32
What is Samter's Triad also called?
Aspirin Exacerbated Respiratory Disease (AERD)
33
What is Samter's triad?
chronic condition that includes all three triad features and sensitvity to NSAIDS and ASA
34
What are some signs that a patient may have AERD?
- repsiratory reactions to alcohol - impaired sense of smell
35
In AERD, patient will have acute reactions to ________ and _________ which can be severe and life threatening
aspirin and NSAIDS
36
When is AERD usually diagnosed?
in adulthood (7-10% of adults)
37
How does Samter's Triad present?
looks like bronchospastic asthma attack
38
What is Ofirmev?
- IV actaminophen - non-opioid alternative or in combination with other drugs
39
When would we be careful to use Ofirmev?
- hepatic impairment/acute disease - chronic alcoholism - chronic malnutrition - severe hypovolemia - severe renal impairment
40
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
41
Ofirmev Dosing in < 50 kg patient
15mg/kg q6h - max of 3 grams in 24 hr
42
T/F: PO acetaminophen can be given in preop as part of ERAS protocol
true
43
What is Ofirmev used for?
- treat mild to moderate pain - treat moderate to severe pain with adjunctive opioids - ERAS protocol
44
What are the most common side effects of Ofirmev?
- N/V - headache - insomnia
45
Why is Ofirmev used sparingly and PO acetaminophen in preop used instead?
Ofirmev is expensive $$$
46
Ofirmev onset, peak, and duration
Onset: 15 min Peak: 1 hour Duration: 4-6 hours
47
What is Caldolor?
IV ibuprofen
48
How should Caldolor be prepared?
must be diluted before use!!! may cause hemolysis if not diluted
49
How should Caldolor be administered?
- IV infusion - should NOT be given as an IV bolus or IM injection
50
What are the most common side effects of Caldolor?
- nausea - flatulence - vomiting - headache - hemorrhage - dizziness - infusion site pain
51
Caldolor Max Dose
3200 mg/day
52
Caldolor Dosing
400-800 mg over 30 min q6h
53
Caldolor pediatric (12-17 yo) dosing
400 mg IV q4-6 hours
54
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
55
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
56
How many weeks gestation should we begin to avoid administration of Caldolor?
avoid use at 30 weeks gestation
57
What is the generic name for Celebrex?
celecoxib
58
What is the trade name for pregabalin?
Lyrica
59

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