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Anesthesia Pharmacology > Multimodal > Flashcards

Multimodal Flashcards

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1
Q

The emphasis on Multimodal anesthesia for general anesthesia includes these two aspects:

A

Short acting anesthetic agents and opioid sparing

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2
Q

Nonopioid alternatives for the treatment of pain

A

PT/OT, Massage, acupuncture, behavioral, topical medications, cold/heat, exercise, weight loss, diet/nutrition, yoga/taichi, TENS, OTC meds, interventional pain management, nonopioid anesthesia

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3
Q

Acetaminophen doses (preop, intraop, postop)

A
  • preop: 1000mg PO
  • intraop: Ofirmev 1g IV
  • postop: 1000mg PO tid
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4
Q

Which multimodal drugs can be given preop to reduce pain

A
  • acetaminophen 1000mg PO
  • gabapentin 300mg PO
  • celebrex 100-200mg PO
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5
Q

Which multimodal drugs can be given intraop to reduce pain

A
  • Ofirmev 1g IV
  • Maintain GA with VA
  • Ketamine
  • Magnesium 30-60mg/kg (max 6g) over 1 hr
  • lidocaine 1mg/kg over 1 hr
  • Ondansetron
  • Decadron
  • Ketorolac
  • Ibuprofen 200-800mg IV over 30min
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6
Q

Which multimodal drugs can be used for pain post-op

A
  • Acetaminophen 1g tid
  • Mag supplement 400-600mg bid
  • gabapentin 300mg tid
  • Celebrex or advil TID (as permitted by surgeon)
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7
Q

MOA for gabapentin

A

structural analogue of GABA, binds to vg-CA++ channels
- enhances descending inhibition
- inhibits excitatory neurotrasmitter release

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8
Q

Is gabapentin protein bound?

A

no, <3%

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9
Q

Is gabapentin lipid or water soluble

A

lipid

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10
Q

What are uses of gabapentin

A
  • partial seizures
  • chronic pain syndromes: diabetic neuropathy, post-herpetic neuralgia, reflex sympathetic dystrophy, phantom limb pain, fibromyalgia
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11
Q

For gabapentin to treat pain, it must be given ________

A

prior to surgery, 1-2hrs, only works for preemptive analgesia

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12
Q

When is gabapentin contraindicated

A

MG and myoclonus

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13
Q

what are s/e of gabapentin?

A
  • somnolence
  • ataxia
  • fatigue
  • vertigo
  • GI disturbance, constipation
  • seizure if abrupt withdrawal
  • weight gain
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14
Q

MOA of NSAIDs

A

COX1/2 inhibition, inhibits synthesis of prostaglandins

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15
Q

Which COX is constitutive

A

COX-1

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16
Q

Which COX is inducible

A

COX-2

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17
Q

What is COX-2 responsible for

A

pain, inflammation, fever

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18
Q

What is COX-1 responsible for

A

gastric protection, hemostasis, renal function

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19
Q

3 uses of NSAIDs includes

A
  • analgesic
  • anti-inflammatory
  • anti-pyretic
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20
Q

Which NSAIDs are non-specific

A
  • ibuprofen
  • naproxen
  • ASA
  • acetaminophen (?)
  • ketorolac
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21
Q

Which NSAIDs are COX-2 selective

A
  • Celecoxib (Celebrex)
  • rofecoxib (Vioxx) : banned in US
  • valdecoxib (Bextra) : banned in US
  • parecoxib (Dynastat): banned in US
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22
Q

COX-2 selective NSAIDs compared to nonspecific

A
  • comparable analgesia
  • lack of effect on platelets
  • less GI effects
  • increased MI and CVA risk
  • dosage-ceiling
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23
Q

Celebrex dosage

Study These Flashcards
A

200-400mg PO qday

24
Q

celebrex peak time

25
MAO of acetaminophen
reduces prostaglandin metabolites
26
max dose of acetaminophen per day
4g
27
peak time of acetaminophen
PO= 1-3hrs IV= 30min- 1hr
28
duration of action of acetaminophen
6-8hrs
29
ketorolac (Toradol) MOA
inhibits PG synthesis by inhibiting COX1 and 2
30
C/I of ketorolac (Toradol)
- severe renal impairment - significant risk for bleeding - CAD/CABG - pregnancy - NSAID allergy - decrease dose in elderly
31
ketorolac (Toradol) peak timing
45-60min IV, give during emergence
32
keotolac (Toradol) dose
15-30mg IV q6hr; max 60-120mg qDay half dose in elderly
33
Lidocaine dose
1-2mg/kg IV (initial bolus) over 2-4min 1-2mg/kg/hr drip terminate 12-72hrs
34
what should be carefully monitored when using lidocaine for analgesia
cardiac, hepatic and renal function
35
Plasma lidocaine concentrations and effects
- 1-5mcg/ml = analgesia - 5-10mcg/ml = circumoral numbness, tinnitus, skeletal muscle twitching, systemic hypotension, myocardial depression - 10-15 mcg/ml= seizure, unconsciousness - 15-25 mcg/ml= apnea, coma - >25mcg/ml = cardiovascular depression
36
Magnesium MOA in analgesia
- anti-nociceptive effects - N-methyl-D-aspartate (NMDA) receptor antagonist probably potentiates opioids centrally and peripherally
37
Magnesium helps regulate
- Ca++ access into cell and actions within cell - neurotransmission - cell signaling - enzyme function
38
Magnesium has ____ passage across BBB
limited
39
Magnesium use for analgesia is C/I in
MG and renal failure
40
Magnesium doses for analgesia
preop: 50mg/kg IV intraop: 8mg/kg/hr IV
41
magnesium use as analgesic can cause
bradycardia and hypotension
42
side effects of ondansetron (zofran)
QT prolongation (give slowly to prevent) HA, constipation
43
ondansetron (zofran) E1/2time
4hrs
44
Ondansetron (zofran) dose
adult: 4-8mg IV ped: 0.1mg/kg IV
45
Corticosteroid MOA in analgesia
MOA unknown: - glucocorticoid receptors in nucleus tractus solitarius (a cluster of neurons located in the brainstem, specifically in the dorsal medulla oblongata. It plays a crucial role in processing and integrating sensory information from various organs) - increase effectiveness of 5HT3 antagonists and droperidol -anti-inflammatory; inhibition of phospholipase and cytokines and stabilization of cellular membrane
46
dexamethasone (Decadron) dosing
8-10mg IV
47
dexamethasone (Decadron) onset
delayed; 2 hrs, efficacy persists for 24hrs
48
What is adverse effects of dexamethasone (Decadron)
perineal burning/itching if given rapidly
49
dexamethasone (Decadron) is useful as an adjunct with ________ because it increases duration
nerve blocks, both when given IV or in the block
50
Dexmedetomidine (Precedex) MOA
highly selective, specific (pontine locus coeruleus), potent, and full a2 adrenergic agonist.
51
clonidine is a ______ a2 agonist
partial
52
precedex is ______ selective than clonidine
7-10x more selective
53
What is the antagonist to dexmedetomidine (Precedex)
Atipamezole
54
dexmedetomidine (precedex) uses
- conscious sedation: calmness, easily rousable, preserves spontaneous ventilation (high dose can collapse upper airway), amnesia not assured - GETA: tracheal intubation, decreased perioperative opioid requirements - TIVA: depression of ventilation, use LMA or ETT
55
dexmedetomidine (precedex) E1/2time
2-3hrs
56
CV side effects of dexmedetomidine (Precedex) include
hypotension, bradycardia
57
dexmedetomidine (precedex) dosage
- TIVA/GETA: 0.5-1 mcg/kg bolus, 0.1-1.5mcg/kg/hr infusion. - sedation: 0.2-0.7mcg/kg/hr IV - IV regional: 0.5mcg/kg with lidocaine - Neuraxial: spinal= 3mcg, 5mcg with fent 25mcg epidural= 2mcg/kg

Anesthesia Pharmacology (11 decks)

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