Non - Opioid Adjuncts

Question 1

What adverse effects can occur if Robaxin is administered rapidly?

Answer 1

Hypotension, bradycardia, and convulsions

Question 2

Toradol is a (non-selective/selective) (COX-1/COX-2) inhibitor.

Answer 2

non-selective
COX-1 AND COX-2

Question 3

Which drug do we always ask the surgeon about before administering?

Answer 3

Toradol (Ketorolac); this is due to bleeding risk

Question 4

Other name for Samter’s Triad?

Answer 4

Aspirin Exacerbated Respiratory Disease (AERD)

Question 5

Gabapentin uses:

Answer 5

Used a lot in chronic pain/neuropathic pain

Question 6

Robaxin dose:

Answer 6

1 gram IV slowly over 15-20 mins;

• used as an adjunct with other meds;
  Can cause hypotension, bradycardia, and convulsions if given rapidly

Question 7

Samter’s Triad is a chronic condition that includes all three triad features (asthma, nasal polyps, ASA allergy) and a sensitivity to ____.

Answer 7

NSAIDS and ASA

Question 8

Celebrex dose:

Answer 8

100-200 mg PO

Question 9

Benefits of Toradol:

Answer 9

Minimal CNS effects,
No respiratory depression or sedation, Decreases narcotic use postop

We use Toradol frequently Make sure your patient has no relative or absolute c/i’s to its use.

Question 10

What is Samter’s Triad?

Answer 10

Chronic condition that includes all three triad features (asthma, nasal polyps, ASA allergy) and sensitivity to NSAIDS and ASA;

causes acute reactions to aspirin and NSAIDS - can be severe and life-threatening; usually diagnoses in adulthood (7-10% of adults).

Question 11

Toradol duration:

Answer 11

4-6 hrs

Question 12

Caldolor max dose: (adults and peds)

Answer 12

Max dose:
adults —>; 3200 mg/day (800 mg/6 hrs)

peds <17 yrs old —->; 2400 mg (40 mg/kg)

Question 13

Gabapentin —-> ; careful when using for which patients?

Answer 13

careful in old age and low GFR, morbidly obese, OSA (all due to sedation effects)

Question 14

Celebrex s/e:
Careful/avoid use in which patients?

Answer 14

associated with increased risk of stroke and MI, worsening of HTN;

Careful/avoid in known hx of CAD or cerebrovascular disease

Question 15

Ofirmev dose:

Answer 15

> 50 kg — 1000 mg IV OVER 15 MINS (in preop); every 6 hrs (or 650 mg Q4 hrs); MAX: 4 grams in 24 hr period;

<50 kg adult —>15 mg/kg every 6 hrs; MAX: 3 grams/day can be given PO in preop

Question 16

Ofirmev duration:

Answer 16

4-6 hrs

Question 17

Celebrex is a (non-selective/selective) (COX-1/COX-2) inhibitor.

Answer 17

Selective COX-2 inhibitor

Question 18

Gabapentin chemical class:

Answer 18

Gabapentinoid

Question 19

Toradol
onset:
peak:

Answer 19

10-30 mins;

peaks in 1-2 hrs

Question 20

What are the triad features of Samter’s Triad?

Answer 20

Asthma

Nasal polyps

ASA allergy

Question 21

Robaxin —> avoid in which patients?

Answer 21

should probably avoid in liver and renal dysfunction

Question 22

Gabapentin —> effect on anesthesia:

Answer 22

can increase postoperative sedation

Question 23

Toradol dose:

Dose in relation to narcotic strength:

Answer 23

15-30 mg IV every 6 hrs

30 mg Toradol IV = ~ 10 mg morphine

Question 24

Caldolor C/I:

Answer 24

Contraindicated in patients with known hypersensitivity (e.g. anaphylactic reactions and serious skin reactions) to ibuprofen or any components of the drug product;

and in patients who have a hx of asthma, urticaria, or other allergic-type reactions after taking ASA or other NSAIDS.

Question 25

Ofirmev onset: Peak:

Answer 25

Onset: 15 mins Peak analgesia: about 1 hr

Question 26

Gabapentin dose:

Answer 26

300-600 mg PO preop

Question 27

What every-day symptoms might indicate Samter's Triad?

Answer 27

May have respiratory reactions to alcohol and impaired sense of smell

Question 28

Celebrex MOA:

Answer 28

**selective COX-2 inhibitor**

Question 29

____must be diluted prior to use; Infusion without dilution can cause ___ ; It should not be given as an __ bolus or __ injection.

Answer 29

Caldolor; hemolysis; IV; IM

Question 30

Ofirmev (___)

Answer 30

(IV Acetaminophen)

Question 31

Ofirmev s/e:

Answer 31

nausea, vomiting, headache, and insomnia in adults.

Question 32

Methocarbamol (___)

Answer 32

(Robaxin)

Question 33

Gabapentin (___)

Answer 33

(Neurontin)

Question 34

Ofirmev; careful when using in which patients?

Answer 34

Hepatic impairment/acute disease, chronic alcoholism, chronic malnutrition, severe hypovolemia, or severe renal impairment

Question 35

Toradol uses:

Answer 35

Decrease pain and cramping, Postop C-section, Orthopedics, Laparoscopy

Question 36

Caldolor --->use caution in these patients:

Answer 36

With known or risk factors for Cardiovascular (CV) disease, a history of peptic ulcer disease and/or GI bleeding, liver disease or symptoms of, hypertension, and heart failure **Avoid use in pregnant women starting at 30 weeks gestation**

Question 37

Robaxin MOA:

Answer 37

Central acting skeletal muscle relaxant; **Depresses the CNS leading to relaxation of the muscles** (used as an adjunct with other medications)

Question 38

Caldolor (___)

Answer 38

(IV Ibuprofen)

Question 39

Toradol ---> Careful with use in which patients?

Answer 39

Elderly (kidney function issues), bleeding issues, renal impairment with poor creatinine clearance, **ASA allergy, asthma, nasal polyps (do not give to these patients)** Renal impairment ASA allergy Poor creatinine clearance Bleeding issues Elderly (kidney function issues) Asthma Nasal Polyps **RAP BEAN**

Question 40

Toradol (___)

Answer 40

Ketorolac

Question 41

Toradol MOA:

Answer 41

NSAID, inhibits cyclooxygenase **preventing thromboxane synthesis ** (which is necessary for platelet aggregation), inhibits postaglandin synthesis; **Non-selective COX-1 and COX-2 inhibitor**

Question 42

Gabapentin MOA:

Answer 42

**Decreases hyperexcitability of dorsal horn neurons** caused by tissue damage via **modulation of Ca++** - induced release of glutamate (inhibits an excitatory pathway) centrally in dorsal horn and activation of **descending noradrenergic pathways** in the spinal cord and brain.

Question 43

Ofirmev uses:

Answer 43

Used to treat mild to moderate pain; or moderate to severe pain with adjunctive opioids

Question 44

Robaxin s/e:

Answer 44

Can cause **sedation** Can cause hypotension, bradycardia, and convulsions **if given rapidly**