Multimodal

Question 1

Gabapentin (Neurontin)- MOA

Answer 1

Binds VG Ca++ channels; inhibits glutamate release in the dorsal horn of the spinal cord

Question 2

Gabapentin (Neurontin)- Doses

Answer 2

300 - 1200 mg prior to OR

Question 3

Gabapentin (Neurontin)- Side Effects

Answer 3

Can exacerbate MG & myoclonus

Question 4

Gabapentin (Neurontin)- Misc

Answer 4

GABA ANALOGUE WITH NO GABANERGIC ACTIVITY

Question 5

Dexamethasone (Decadron) -MOA

Answer 5

Inhibits phosolipase & cytokines; stabilizes membrane

Question 6

Dexamethasone (Decadron): Dose

Answer 6

8-10 mg

Question 7

Dexamethasone (Decadron): Side Effects

Answer 7

Can elicit a vomit reflex if given RIVP; Perineal burning/Itching

Question 8

Celecoxib (Celebrex)- MOA

Answer 8

1st COX-2 specific Inhibitor; decreases PG synthesis (inducible)

Question 9

Celecoxib (Celebrex)- Doses

Answer 9

200 - 400 mg PO QD.
Peak 3 hours

Question 10

Acetaminophen (Ofirmev): MOA

Answer 10

Decreases prostaglandin metabolites

Question 11

Acetaminophen (Ofirmev): Doses

Answer 11

1 Gm IV/PO
Onset: 30 - 60 mins IVOnset: 1 - 3 hours
PO Max: 3 Gm (24 hrs) Duration: 6 - 8 hours

Question 12

Acetaminophen (Ofirmev): Misc

Answer 12

Can have hepatic effects; toxic > 3 Gm/Day

Question 13

Ketorolac (Toradol): Doses

Answer 13

30 or 60 mg IM Q6 hours Elderly: 1/2 dose. Peak: 45 to 60 mins IV

Question 14

Ketorolac (Toradol): MOA

Answer 14

Inhibits COX-1/COX-2; Decreases PG synthesis

Question 15

Ketorolac (Toradol): S/E

Answer 15

Can be extremely renal toxic; 1/2 doses in elderly & renal pts

Question 16

Ketorolac (Toradol): Misc

Answer 16

C/I: Severe renal impairment, significant risk for bleeding, CAD, CABG, pregnancy; decrease dose in. elderly, NSAID allergy

Question 17

Ibuprofen (Caldolor, Neoprofen): MOA

Answer 17

Inhibits COX-1/COX-2;

Question 18

Ibuprofen (Caldolor, Neoprofen): Doses

Answer 18

200 - 800 mg IV Max: 3200 mg (24 hrs)

Question 19

Ibuprofen (Caldolor, Neoprofen): S/E

Answer 19

Allergies to NSAIDs; bleeding, CABG, ulcers

excretion: urine and bile

Question 20

Lidocaine: MOA

Answer 20

Amide - Local Anesthetic

Question 21

Lidocaine: Doses

Answer 21

1 - 2 mg/kg IV Q 2 - 4 mins

gtt: 1 - 2 mg/kg/hr

terminated 12 - 72 hours

Question 22

Magnesium: MOA

Answer 22

NMDA receptor non-competitve antagonist

Question 23

Magnesium: Dose

Answer 23

Pre-op: 50 mg IV Intra-op (gtt): 8 mg/kg/hr

Be prepared to treat bradycardia and/or hypotension.

Question 24

Magnesium: S/E

Answer 24

C/I in Myasthenia Gravis (MG) and renal failure

Question 25

Magnesium: Misc

Answer 25

SIGNIFICIANTLY DECREASES FENTANYL REQUIRMENTS

Limited passage across BBB

Question 26

Cox-1

Answer 26

ubiquitous
“physiologic”
Inhibition is responsible for many adverse affects
“constitutive”

Question 27

COX-2

Answer 27

“pathophysiologic”
Expressed at sites of injury
Not protective…oncogenic processes
Sensitization, “wind-up”

Inducible

Question 28

√√√ COX-2 Selective √√√
vs.
Nonspecific Inhibitors

Answer 28

Comparable analgesia
Lack effects on platelets
May be assoc. with ↓ GI effects
Possible ↑ in MI and CVA
Dosage ceiling
↑ in side effects

Question 29

Types of NSAIDS
Non-specific

Answer 29

Ibuprofen, naproxen, aspirin, acetaminophen, ketorolac