Non-opioid Adjuncts

Question 1

Gabapentin mechanism of action

Answer 1

Decrease hyperexcitability of dorsal horn neurons caused by tissue damage

Modulation of calcium-induced release of glutamate centrally in dorsal horn

Activation of descending noradrenergic pathways in the spinal cord and brain

Question 2

gabapentin dose

Answer 2

300-600 mg PO preop

Question 3

gabapentin cautions

Answer 3

Careful in old age and low GFR, morbidly obese, OSA

Question 4

gabapentin is used frequently in

Answer 4

chronic/neuropathic pain

Question 5

gabapentin effect on postoperative sedation

Answer 5

can increase it

Question 6

celebrex mechanism of action

Answer 6

selective COX-2 inhibitor

Question 7

celebrex dose

Answer 7

100-200 mg PO

Question 8

celebrex is associated with an increased risk of

Answer 8

stroke, MI, worsening HTN

Question 9

when to avoid celebrex

Answer 9

in known history of CAD or cerebrovascular disease

Question 10

methocarbamol (robaxin) mechanism of action

Answer 10

Central Acting Skeletal Muscle Relaxant

Depresses the CNS leading to relaxation of the muscles

Question 11

how should methocarbamol be used

Answer 11

as an adjunct

Question 12

can methocarbamol cause sedation

Answer 12

yes

Question 13

methocarbamol dose

Answer 13

1 gram IV slowly over 15-20 min

Question 14

methocarbamol side effects

Answer 14

Can cause hypotension, bradycardia, and convulsions if given rapidly

Question 15

when should methocarbamol be avoided

Answer 15

liver and renal dysfunction

Question 16

ketorolac (toradol) mechanism of action

Answer 16

non-selective Cox 1 and Cox 2 inhibitor

Question 17

how does ketorolac/toradol work

Answer 17

NSAID, inhibits cyclooxygenase, preventing thromboxane synthesis, which is necessary for platelet aggregation, inhibits prostaglandin synthesis

Question 18

ketorolac uses

Answer 18

decrease pain and cramping, postoperative cesarean delivery, orthopedics, laparoscopy

Question 19

ketorolac CNS effects

Answer 19

minimal CNS effects, no respiratory depression or sedation

Question 20

ketorolac cautions

Answer 20

Careful use in elderly, bleeding issues, renal impairment with poor creatinine clearance, ASA allergy, asthma, nasal polyps

Question 21

ketorolac decreases

Answer 21

post-op narcotic use

Question 22

ketorolac dose

Answer 22

15 – 30 mg IV every 6 hours

Question 23

ketorolac onset

Answer 23

10-30 min

Question 24

ketorolac duration

Answer 24

4-6 hours; peaks in 1-2 hours

Question 25

which drug should you always ask the surgeon before administration

Answer 25

toradol/ketorolac

Question 26

Samter’s Triad

Answer 26

asthma, aspirin allergy, nasal polyposis
aspirin-exacerbated respiratory distress

Question 27

ofirmev (IV acetaminophen)

Answer 27

Used to treat mild to moderate pain, and moderate to severe pain with adjunctive opioids

Question 28

side effects of ofirmev (IV acetaminophen)

Answer 28

nausea, vomiting, headache, and insomnia in adults

Question 29

ofirmev onset

Answer 29

15 min

Question 30

ofirmev peak analgesia

Answer 30

~1 hour

Question 31

ofirmev duration

Answer 31

4-6 hours

Question 32

caldolor is

Answer 32

ibuprofen injection

Question 33

caldolor must be _________ prior to use

Answer 33

diluted

Question 34

what can happen if caldolor is not diluted prior to use

Answer 34

can cause hemolysis

Question 35

how should caldolor be administered

Answer 35

NOT via IV bolus or IM injection

Question 36

caldolor adverse reactions

Answer 36

The most common adverse reactions are nausea, flatulence, vomiting, headache, hemorrhage and dizziness (>5%). The most common adverse reactions in pediatric patients are infusion site pain, vomiting, nausea, anemia and headache (≥2%).

Question 37

caldolor dosing

Answer 37

3200 mg/day (400-800 mg/6 hours over 30 minutes)

Question 38

pediatric caldolor dose

Answer 38

400 mg IV q 4-6 hours

Question 39

caldolor is contraindicated in

Answer 39

patients with known hypersensitivity

Question 40

caldolor cautions

Answer 40

CALDOLOR should be used with caution in patients with known cardiovascular (CV) disease or risk factors for CV disease, a history of peptic ulcer disease and/or GI bleeding, liver disease or symptoms of, hypertension, and heart failure.

Question 41

can caldolor be used in pregnancy

Answer 41

avoid use starting at 30 weeks gestation