What are the NSAIDS we discussed? some toxicity about each?
Acetaminophen =20-30% opioid sparing; liver damage at high doses
Non-selective COX1/2 Inibitors = 30-50% opioid sparing and decreased opioid-associated PONV, but has GI effects, bone healing, hypersensitivity, asthma, renal insufficiency, and bleeding
Coxibs = COX2 selective but increased incidence of thrombus/stroke/MI
What is Gabapentin? How dies it work? Effects?
Binds to Voltage sensitive calcium channels
20-62% opioid sparing effect
Decreases vomiting, pruritis, and urinary retention from opioids
Effects - Somnolence, dizziness, HA, balance problems, Peripheral edema, sweating, dry mouth, N/V
What is Pregabalin? How does it work?
Binds to Voltage-sensitive Ca channels
25-30% opioid sparing effect but unclear if decreased opioid-related adverse effects
Effects: somnolence, dizziness, visual disturbances
Ketamine as an analgesic: mechanism, opioid-sparing effects, side effects, uses
NMDA receptor antagonist
30-5% opioid sparing effects - unclear if decreased related adverse effects
Used in low doses for chronic pain management
Side Effects: Dysphoria, Hallucination, vivid unpleasant dreams, dizziness, blurred vision etc BUT all are UNLIKELY at LOW doses for which is is used for chronic pain management
What is Clonidine and how is it used? EffectS?
Centrally actiing Alpha-2 agonist
25% opioid sparing effect and decreases Nausea associated with opioids
Side Effects: Intra-op and post-op Hypotension
What is Dexmedetimidine? How does it work/what does it do? Effects?
Centrally acting Alpha2 Agonist
30% opioid sparing effect and decreases Nausea and Itching associated with opioids
Side Effects: Intra-op and Post-op Bradycardia
How is dexamethasone used in pain management? What can it cause?
Glucocorticoid used and has 10% opioid sparing effect
Decreases PONV assoc with opioids
GOOD FOR BONE PAIN especially with Metastases!!!
Side Effects: Mild hyperglycemia, impaired wound healing and increased infection (although unlikely with single dose)