Week 7: Non-Opiate Pain Control

Question 1

Prednisone

1. Mechanism

Answer 1

1. Corticosteroid: reduce inflammation by decreasing production of inflammatory mediators and phospholipase A2 inhibition

Question 2

Dexamethasone

1. Mechanism
2. Use

Answer 2

1. Corticosteroid: reduce inflammation by decreasing production of inflammatory mediators and phospholipase A2 inhibition
2. To decrease pain, decrease concurrent opioid use, decrease frequency of analgesic dose, shorter PACU stay due to decreased pain and PONV

Question 3

General NSAIDs

1. Mechanism of action
2. CV and platelet side effects
3. GI SE
4. Renal SE
5. Pulmonary SE

Answer 3

1. Inhibit the biosynthesis of prostaglandin by blocking arachidonic acid from binding to COX enzymes (decreases prostaglandin and thromboxane A2 production)
2. Blockade of COX1 = decreases platelet aggregation; Disruption of COX2 = decreased production of thromboxane and prostaglandin 12 -> MI, HTN
3. Upper GI complications
4. Decreased Na+ excretion and decreased GFR
5. Increased risk for anaphylaxis in asthma due to prostaglandin inhibition

Question 4

Celebrex

1. Mechanism of Action
2. Key points

Answer 4

1. Selective Cox-2 inhibitor

2. Only -coxib available due to CV effects and increased risk of MI; No Cox-2 on platelets so no effect on them

Question 5

Capsaicin

1. Mechanism of action
2. Use

Answer 5

1. TRPV channel agonist

2. Herpetic neuropathic pain