*MAGA (Exam II) Flashcards
What are the components of today’s Multimodal practice?
- Preoperative Fluid
- Carbohydrate Loading
- Short Acting Anesthetic Agents
- Opioid Sparing
- Temperature Management
- Cerebral/neuromuscular
S2
What are Nonopioid Alternatives for the treatment of pain?
This is a list
- PT & OT
- Massage Therapy
- Acupuncture
- Chiropractic Care
- Osteopathic Manipulative Treatment (OMT)
- Behavioral Interventions
- Topical Treatments and Medications
- Cold & Heat
- Exercise
- Weight Loss
- Diet and Nutrition
- Yoga & Tai Chi
- TENS
- OTC Medications
- Interventional Pain Management
- Nonopioid Anesthesia
S11
What refers to the anesthetic technique of using medications to provide anesthesia and post-operative pain relief in a way that does not require opioids?
Nonopioid Anesthesia
S11
What is the pain response pathway? (5)
(this was in the pain pathway slide set too)
S17
What is the MOA of Gabapentin?
GABA analogue
(not act like GABA)
Binds voltage gated Ca++ channels:
enhances descending inhibition
inhibits excitatory neurotransmitter release
S25*
Is Gabapentin lipid soluble?
What percentage protein-binding occurs?
What’s it’s E 1/2 time?
- Yes, Lipid soluble
- 0% protein-bound
- Brief E 1/2 time – need redosing required
S25
Does Gabapentin have any drug-drug interactions?
No drug interactions
S25
What are indicated uses for gabapentin?
- Seizures
- Neuropathic pain
- Chronic pain syndromes.
S26
Regarding Gabapentin’s preemptive analgesia, What 3 studies/ procedures is it used in?
- Spine surgeries
- Orthopedic procedures
- Major abdominal procedures.
S27
What is the PO dose of preemptive Gabapentin?
When should we give it?
300-1200mg PO
1-2 hrs prior to OR
start slow then build up
S27
For Preemptive Gabapentin, what patient population is it contraindicated for?
- MG and Myoclonus patients
- Reduce dose in elderly patients
S27
What are Gabapentin’s side effects?
Think ↑GABA effects
- Somnolence
- fatigue
- ataxia
- vertigo
- GI disturbances: constipation
- abrupt withdrawal in seizure pts (when Gaba is used as an antiepiliptic) –> causing seizures
- wt gain
S29
Evidenced based slide
What evidence based conclusion was found with the study “Efficacy of preoperative gabapentin in spinal surgery: a meta-analysis of randomized controlled trials”
despite of 10 RCTs and low sample size, Gabapentin is:
* effective in reducing post operative opioid consumption
* it also lessen the side effects after spinal surgery
* lower dose should be given to elderly
S30
What are the effects of NSAIDs?
- Decrease activation of peripheral nociceptors
- No addictive potential
- Preemptive analgesia
- Absence of ventilatory depression
- Less nausea and vomiting
- Absence of cognitive effects
- Long duration of action
S32
What enzyme catalyzes the synthesis of prostaglandins?
COX (Cyclooxygenase)
S33
This form of COX is responsible for gastric protection, hemostasis, and renal function…
COX-1
S33
COX-1 or COX-2?
Ubiquitous, “physiologic”, inhibition of this enzyme is responsible for many adverse effects.
COX-1
S33
COX-1 or COX-2?
Pathophysiologic, expressed at sites of injury, not protective.
COX-2
S33
COX-2 propagation is responsible for which symptoms?
Pain, inflammation, and fever
S33
What are the three main properties of NSAID drugs?
Analgesic
Anti-inflammatory
Antipyretic
S34
Are the following drugs non-specific or COX-2 selective?
–Ibuprofen, naproxen, aspirin, and ketorolac–
What gastric symptomology would be seen with administration of these drugs?
Non-Specific
Increased gastric irritation with these drugs
S34
Celecoxib (Celebrex), Rofecoxib (Vioxx), Valdecoxib (Extra), Parecoxib (Dynastat) are all examples of what?
COX-2 Selective NSAIDs
S34
Do COX-2 selective NSAIDs effect platelets?
No
S35
Because COX-2 selective NSAIDs have no effect on platelets, this would increase the chance of what pathology?
Clotting (think MI and CVA)
S35
COX-2 selective and nonspecific inhibitors have _____________ analgesia
Comparable
S35
What was the first COX-2 inhibitor that decreases PG synthesis?
Celecoxib (Celebrex)
S36
What is the dosage for Celebrex?
200 to 400 mg PO QD
S36
Celebrex reaches its peak in…
3 hours
S36