Multimodal Pain Control

Question 1

at what temp does the pt have to be to be considered a payable event

Answer 1

at least 36 degrees celsius

Question 2

two components of multimodal anes

Answer 2

short acting anesthetic agent and opioid sparing techniques

Question 3

gabapentin is a structural analog of

Answer 3

gaba

Question 4

gabapentin binds to

Answer 4

vg ca channels

Question 5

moa of gabapentin

Answer 5

inhibition of excitatory nt release and inhibition of descending pain pathways

Question 6

gabapentin has no

Answer 6

drug interactions

Question 7

gabapentin can be used to treat

Answer 7

partial seizures and chronic pain

Question 8

dose of gabapentin for preemptive analgesia

Answer 8

300-1200 mg

Question 9

relative contraindications to gabapentin

Answer 9

myasthenia gravis and myoclonus

Question 10

s/e of gabapentin

Answer 10

abrupt withdrawal in sz patients will cause seizures; pt becomes more somnolent and fatigued

Question 11

COX catalyzes synthesis of

Answer 11

prostaglandin

Question 12

COX1 is needed to

Answer 12

maintain homeostasis

Question 13

many of the symptoms associated with used of nsaids is d/t blocking of

Answer 13

COX1 pathway

Question 14

COX2 is an _______ form of pain

Answer 14

inducible

Question 15

_____ inhibition of COX2 helps modulate pain

Answer 15

central

Question 16

COX2 selective inhibitors have this advantage over nonselectives; what disadvantage?

Answer 16

does not block physiologic processes; possible MI and CVA

Question 17

nsaid dosage ceiling

Answer 17

does not increase positive effects if you take more, but will increase negative effects

Question 18

first COX2 selective inhibitor

Answer 18

celebrex or celecoxib

Question 19

celebrex peaks at

Answer 19

3 hours

Question 20

acetaminophen does not share this property with nsaids

Answer 20

anti inflammatory

Question 21

peak po dose of tylenol

Answer 21

1-3 hours

Question 22

peak iv dose of tylenol

Answer 22

30 mins-1 hour

Question 23

main moa of tylenol

Answer 23

reduces prostaglandin metabolite

Question 24

duration of tylenol

Answer 24

6-8 hours

Question 25

ketorolac moa

Answer 25

non specific nsaid; inhibits PG synthesis

Question 26

relative CI for ketorolac

Answer 26

cad, cabg, bleeding, renal impairment

Question 27

ketorolac peak

Answer 27

45-60 mins

Question 28

ketorolac is a potent analgesic but a moderate

Answer 28

anti inflammatory

Question 29

ketorolac has no effect on the

Answer 29

biliary tract

Question 30

ibuprofen moa

Answer 30

non selective cox inhibitor

Question 31

relative c/t to ibuprofen

Answer 31

nsaid allergy, cabg, bleeding

Question 32

ibuprofen peak

Answer 32

1-2 hours

Question 33

ibuprofen is excreted in the

Answer 33

urine and bile

Question 34

name two short acting anesthetic agents

Answer 34

ketamine and propofol

Question 35

lidocaine somehow helps with

Answer 35

chronic pain

Question 36

build up of lidocaine can occur with

Answer 36

liver and renal impairment

Question 37

safe plasma concentration of lidocain

Answer 37

<5 mcg/mL

Question 38

we start seeing sz/unconsciousness at what plasma concentration of lidocain

Answer 38

10-15 mcg/mL

Question 39

nmda stands for

Answer 39

n methyl d aspartate

Question 40

magnesium is an _____ blocker

Answer 40

nmda receptor

Question 41

probable moa of mg for pain

Answer 41

potentiation of opioids centrally and peripherally

Question 42

Mg regulates

Answer 42

ca access into cell, neurotransmission, cell signaling, enzyme function; tldr, hyperpolarizes the cell to decrease excitability

Question 43

relative c/i to Mg

Answer 43

myasthenia gravis, renal failure

Question 44

Mg s/e

Answer 44

bradycardia, hpn, diarrhea

Question 45

mg will decrease ______ dose intraoperatively

Answer 45

fentanyl

Question 46

s/e of zofran

Answer 46

HA, constipation, qt prolongation

Question 47

e 1/2 of zofran

Answer 47

4 hours

Question 48

give zofran when

Answer 48

towards the end of the case

Question 49

what place in the brain has glucocorticoid receptors

Answer 49

nts

Question 50

decadron enhances the effects of

Answer 50

5ht3 antagonists and droperidol

Question 51

moa of decadron

Answer 51

anti inflammatory; inhibition of phospholipase and cytokines; cell stabilization

Question 52

delay of onset of decardron

Answer 52

2 hours

Question 53

max dose of tylenol

Answer 53

3000-4000 mg

Question 54

max dose of ibuprofen

Answer 54

3200 mg

Question 55

max dose of ketorolac

Answer 55

120 mg

Question 56

sofa stands for

Answer 56

society of opioid free anesthesia