non opioids and adjuvants

Question 1

tramadol

Answer 1

adjuvant
centrally acting analgesic
bind weakly to mu opiois receptors and inhibit reuptake of norepi and serotonin
mod-severe
usually no SE: drowsy, dizzy, HA, n, constipation, resp depression, seizures with other CNS depressants (rare)

Question 2

gabapentin, preglabin

Answer 2

adjuvant
anticonvulsant
spontaneously suppress neuronal firing
compliment opioids, neuropathic pain
SE: drowsy, dizzy, visual problems, can only be partially reversed with Naloxone, use Narcan!

Question 3

aspirin

Answer 3

NSAID
salicylate poisoning/toxicity (acute = n/v, seizures, cerebral edema; chronic = n/v, tinnitus, hearing loss)
reye’s syndrome

Question 4

ketorolac

Answer 4

NSAID
most potent (IM/IV, sometimes PO)
acute mod-severe (post op, <5 days), decrease pain + inflam, similar to morphine w/o resp depression
SE: GI ulcer and higher risk of renal dysfunction (especially if decreased renal function at baseline or are dehydrated)

Question 5

acetaminophen

Answer 5

NSAID - not true
unknown moa
decreased prostaglandin synthesis in CNS
no anti inflam!
mild-mod pain and fever (antipyretic)
ceiling effect
SE not common with normal dose unlike other NSAIDs, acute hepatic necrosis, liver failure with chronic-long term use, mild nephropathy, jaundice, increased LFTs, creatinine levels
4g/24 hrs (hydrocodone, oxycodone)
antidote = acetylcysteine
OH: chronic users <2g/day, increased risk of liver toxicity
IV: manage pain with less opioid use, less SE (paralytic ileus and resp depression); for acute, post op, usually with opioids