Exam 2 - Multimodals for GETA

Question 1

What enzyme catalyzes the synthesis of prostaglandins?

Answer 1

COX (Cyclooxygenase)

Question 2

This form of COX is responsible for gastric protection, hemostasis, and renal function…

Answer 2

COX-1

Question 3

COX-1 or COX-2?
Ubiquitous, “physiologic”, inhibition is responsible for many adverse effects

Answer 3

COX-1

Question 4

COX-1 or COX-2?
Pathophysiologic, expressed at sites of injury, not protective

Answer 4

COX-2

Question 5

COX-2 is responsible for which symptoms?

Answer 5

Pain, inflammation, and fever

Question 6

What are the three main properties of NSAID drugs?

Answer 6

Analgesic
Anti-inflammatory
Antipyretic

Question 7

Type of NSAID?
Ibuprofen, naproxen, aspirin, acetaminophen, and ketorolac

Answer 7

Non-Specific
Increased gastric irritation with these drugs

Question 8

Celecoxib (Celebrex), Rofecoxib (Vioxx), Valdecoxib (Extra), Parecoxib (Dynastat) are all examples of what?

Answer 8

COX-2 Selective NSAIDs

Question 9

Compare COX-2 selective to Nonspecific NSAIDS

Answer 9

• Comparable analgesia
• No effect on platelets
• Increase in MI and CVA
• Dosage ceiling

Question 10

What was the first COX-2 inhibitor that decreases PG synthesis?

Answer 10

Celecoxib (Celebrex)

Question 11

What is the dosage for Celebrex?

Answer 11

200 to 400 mg PO QD

Question 12

Ofirmev properties?
MOA?
Dosing?

Answer 12

• Analgesic/antipyretic, no anti-inflammatory properties
• Reduces prostaglandin metabolites
• 1000 mg q4-6h, max 4000 mg qd

Question 13

Toradol MOA?

Answer 13

Inhibits PG synthesis by inhibiting both COX-1 and COX-2

Question 14

What are the contraindications for ketorolac?

Answer 14

• Severe renal impairment
• Risk for bleeding
• CAD
• CABG
• Pregnancy
• Decrease dose in elderly
• NSAID allergy

Question 15

Ketorolac properties include:

Answer 15

• Potent analgesic
• Moderate anti-inflammatory
• May potentiate opioid antinociception (increased analgesic effects)

Question 16

Ibuprofen:
MOA
Contraindications
Dose
Peak
Excretion

Answer 16

Question 17

Lidocaine is what type of local anesthetic?

Answer 17

Amide

Question 18

Dosing for lidocaine?

Answer 18

1-2 mg/kg IV initial bolus
1-2 mg/kg/hr drip

Question 19

At what plasma dose of lidocaine do you get analgesia?

Answer 19

1-5 mcg/mL

Question 20

At what plama dose of lidocaine do you get tinnitus, muslce twitching, hypotension, and myocardial depression?

Answer 20

5-10 mcg/mL

Question 21

What happens at a plasma lidocaine dose of 10-15 mcg/mL?
15-25 mcg/mL?
>25 mcg?

Answer 21

10-15 - Seizures and unconciousness
15-25 - Apnea and coma
> 25 - CV depression

Question 22

How does magnesium cause anti-nociceptive effects?

Answer 22

NMDA antagonist - potentiates opioids

Question 23

Magnesium regulates what 4 things?

Answer 23

• Ca access into the cell and actions within the cell
• Neurotransmission
• Cell signaling
• Enzyme function

Question 24

What are the two contraindications to magnesium?

Answer 24

Myasthenia gravis and renal failure

Question 25

What drug was the first 5HT-3 antagonist? Dose? Peds dose?

Answer 25

Ondansetron 4-8 mg IV Peds: 0.1 mg/kg IV

Question 26

MOA of antinausea of corticosteroids?

Answer 26

Unknown... may effect gluccocorticoid receptors in nucleus tractus solitarius Increases effectiveness of 5HT 3 antagonists and droperidol

Question 27

Decadron MOA? Dosing?

Answer 27

Dose: 8-10 mg MOA: Anti-inflammatory - inhibts phospholipase and cytokines and stabilization of the cellular membrane

Question 28

When should decadron be given?

Answer 28

At the start of the case, onset is delayed 2 hours

Question 29

A 50 y/o, 60 kg female patient received a Lidocaine initial dose of 1 mg/kg with a subsequent infusion of 1.5 mg/kg/hour for 1.5 hours. How much total Lidocaine in mgs did she receive prior to PACU?

Answer 29

60kg x 1 mg/kg = 60 mg 60 kg x 1.5 mg/kg = 90 mg (1 hour) (60 kg x 1.5mg/kg = 90 mg)/2 = 45 mg (30 minutes) 60+90+45 = 195 mg

Question 30

What is dexmedetomidine MOA?

Answer 30

Highly selective, specific (pontine locus coeruleus), and potent ⍺2 agonist 7-10x more selective than clonidine

Question 31

Antagonist of dexmedetomidine?

Answer 31

Atipamezole

Question 32

Uses for dexmedetomidine?

Answer 32

- Concious sedation - GETA - TIVA

Question 33

Precedex dosing for TIVA/GETA?

Answer 33

Bolus 0.5 mcg/kg over 10 minutes 0.1 - 1.5 mcg/kg/min infusion

Question 34

Epidural and regional dosing of precedex?

Answer 34

Epidural: 2 mcg/kg Regional: 0.5 mcg/kg with lidocaine

Question 35

Spinal dosing for precedex?

Answer 35

3 mcg as combo 5 mcg with fentanyl 25 mcg alone

Question 36

If dexmedetomidine is available as 200mcg/2 mL, how much dilutent is needed to make 4 mcg/mL?

Answer 36

48 mL

Question 37

Gabapentin MOA?

Answer 37

- Structural analogue of GABA (does not bind to gaba) - Binds voltage gates Ca+ channels - enhancing decending inhibition and inhibiting excitatory neurotransmitter release (glutamate)

Question 38

Gabapentin dosing?

Answer 38

300-1200 mg PO 1-2 hrs pre-op

Question 39

Gabapentin contraindications?

Answer 39

- Myasthenia gravis - Myoclonus - Reduce dose in elderly