Nonopioid Analgesics

Question 1

APAP

Answer 1

Acetaminophen
MOA: works close to the cox pathway? Might be a cox-3 pathway, but not sure at this time. Analgesic and antipyretic, no anti-inflammatory properties
PK: metab in liver, N-acetyl-benzoquinoneimine depletes glutathione (antioxidant)  liver failure
PD:
Dosing:
T1/2: 325-650 mg q4-6 hour, max 4 g/24 hours, if hepatic impairment/ETOH max 2 g/24 hours
Anesthetic Considerations: multimodal pain management

Question 2

ALL NSAIDs

Answer 2

• Are acids, prevent the binding of arachidonic acid to the COX (cyclooxygenase) enzyme, which inhibits the biosynthesis of prostaglandins
• Are metabolized by the liver, eliminated by renal/biliary
• Nonselective agents IMPEDE maintenance of renal fn, mucosal protection of the GI tract, production of thromboxane A2 – plt aggregator (aka nonselective NSAIDs can make you prone to bleeding)
• COX2 inhib cause mediation of pain/inflammation/fever without the other SEs above.

Question 3

Ibuprofen

Answer 3

Ibuprofen
Are acids, prevent the binding of arachidonic acid to the COX (cyclooxygenase) enzyme, which inhibits the biosynthesis of prostaglandins
PK:
PD: Nonselective agents IMPEDE maintenance of renal fn, mucosal protection of the GI tract, production of thromboxane A2 – plt aggregator (aka nonselective NSAIDs can make you prone to bleeding)
Dosing: 400-800 mg q6-8hr
T1/2:
Anesthetic Considerations: multimodal pain management

Question 4

ketorolac (Toradol)

Answer 4

Ketoralac (nonselective NSAID)
PK:
PD: decreases GFR, reversible in healthy pts
Dosing: 15 mg IV or IM q6hr
T1/2: 6 hrs
Anesthetic Considerations: multimodal pain management

Question 5

Celecoxib

Answer 5

Celecoxib
PK: selective COX2-inhibitor
PD: less GI toxicity, not prone to bleeds (prone to MI/↑ CV risk bc not blocking plt aggregators)
Dosing: 400 mg PO preop, 200 mg BID x 5days postop
T1/2:
Anesthetic Considerations: multimodal pain management