Non-Opioid Dosages

Question 1

Aspirin alternate name:

Answer 1

acetylsalicylic acid (ASA)

Question 2

Aspirin structure:

Answer 2

benzene ring with carboxylic acid group

Question 3

Aspirin MOA:

Answer 3

1. Irreversibly acetylates COX enzymes
2. Prevents the conversion of arachidonic acid to prostaglandins thus attenuating nociceptive response to endogenous mediators of inflammation
3. Inhibiting platelet aggregation for the life of the platelet

Question 4

Aspirin Onset:

Answer 4

30 min

Question 5

Aspirin Duration of action:

Answer 5

4-6 h

Question 6

Aspirin PB:

Answer 6

95%

Question 7

Aspirin metabolism:

Answer 7

Hepatic - active metabolite salicylic acid (salicylate), Renal excretion

Question 8

Aspirin PO dose (daily preventative):

Answer 8

81 mg
Max 4 g/day

Question 9

Aspirin PO dose (analgesia/antipyretic):

Answer 9

325-650 mg Q 4-6 hr
Max 4 g/day

Question 10

Aspirin PO dose (for anti-inflammatory):

Answer 10

1000 mg
Max 4 g/day

Question 11

Aspirin Side Effects:

Answer 11

B – Bleeding
A – Allergic Reaction
K – Kidney Failure
E – Edema

G – GI Bleed

Question 12

Aspirin Contraindications / cautions:

Answer 12

C – Constriction (bronchoconstriction)
H – Heart attack (prevention)
I – Increased temperature (fever treatment)
P – Prostaglandin (decreases production)
S – Stroke (prevention)

1. Inhibits platelet for life (10-14 days)
2. Do not give children (risk for reyes syndrome)
3. Salicylate overdose—tinnitus, metabolic acidosis

Question 13

Toradol alternate name:

Answer 13

Ketorolac

Question 14

Toradol structure:

Answer 14

More COX-1 selective

Question 15

Toradol MOA:

Answer 15

1. Inhibits the COX I & II enzymes (most selective COX-1)
2. Prevents the conversion of arachidonic acid to prostaglandins thus attenuating nociceptive response to endogenous mediators of inflammation

Question 16

Toradol Onset:

Answer 16

10 min

Question 17

Toradol duration of action:

Answer 17

4-6 hr

Question 18

Toradol PB:

Answer 18

95%

Question 19

Toradol Metabolism:

Answer 19

Hepatic glucuronidation, excreted Renally

Question 20

Toradol IV adult dose:

Answer 20

15-30 mg Q 6 hr IV or IM for no more than 5 days

Question 21

Toradol IV kg Dose:

Answer 21

0.5 mg/kg

Question 22

Toradol Side Effects:

Answer 22

B – Bleeding
A – Allergic Reaction
K – Kidney Failure
E – Edema

G – GI Bleed

Question 23

Toradol Contraindications / cautions:

Answer 23

C – Constriction (bronchoconstriction)
H – Heart attack (increased risk)
I – Increased temperature (fever treatment)
P – Prostaglandins
S – Stroke (increased risk)

Question 24

Celecoxib alternate name:

Answer 24

Celebrex

Question 25

Celecoxib Structure:

Answer 25

Acetic acid derivative

Question 26

Celecoxib MOA:

Answer 26

1. Inhibit the action of cyclo-oxygenase (COX) 2. Prevents the conversion of arachidonic acid to prostaglandins thus attenuating nociceptive response to endogenous mediators of inflammation 3. Treatment of mild to moderate post-op pain 4. Analgesic, antipyretic, and anti-inflammatory

Question 27

Celecoxib Onset:

Answer 27

2 h

Question 28

Celecoxib duration of action:

Answer 28

12 h

Question 29

Celecoxib PB:

Answer 29

95%

Question 30

Celecoxib Metabolism:

Answer 30

Hepatic glucuronidation, excreted 50% in feces, 30% Renal

Question 31

Celecoxib PO dose:

Answer 31

< 65 yo = 400 mg > 65 yo = 200 mg

Question 32

Celecoxib Side Effects:

Answer 32

B – Bleeding A – Allergic Reaction K – Kidney Failure E – Edema G – GI Bleed

Question 33

Celecoxib Contraindications / cautions:

Answer 33

C – Constriction (bronchoconstriction) H – Heart attack (increased risk) I – Increased temperature (fever treatment) P – Prostaglandins S – Stroke (increased risk)

Question 34

Acetaminophen alternate name:

Answer 34

Tylenol

Question 35

Acetaminophen structure:

Answer 35

Non-selective COX inhibitor (COX 3?)

Question 36

Acetaminophen MOA:

Answer 36

1. Acts on serotonergic pathways 2. Possible COXIII inhibition 3. Possible endogenous cannabinoid potentiation 4. Anti-pyretic effects from direct inhibition of the hypothalamic heat regulating centers by inhibiting actions of endogenous pyrogens

Question 37

Acetaminophen Onset:

Answer 37

10 min

Question 38

Acetaminophen duration of action:

Answer 38

4-6 hr

Question 39

Acetaminophen PB:

Answer 39

30%

Question 40

Acetaminophen Metabolism:

Answer 40

CYP3A4 (byproduct NAPQI - inactivated by glutathione), Renal

Question 41

Acetaminophen IV dose:

Answer 41

1000 mg over 15 min (max 4g/day)

Question 42

Acetaminophen Peds dose:

Answer 42

10-15 mg/kg (max daily: 75 mg/kg)

Question 43

Acetaminophen Side Effects:

Answer 43

1. Decrease pain 2. No anti-inflammatory effect 3. See C/c for additional

Question 44

Acetaminophen Contraindications / cautions:

Answer 44

1. Treat overdose with acetylcysteine within 8 hours T – Temperature (decreases fever) Y - Yellowing (jaundice) L - Liver damage (with overdose) E – End stage Renal (possible with long term use) N - Nausea O - Opioids: may reduce absorption L - Lush – caution in alcoholics

Question 45

Decadron Alternate name:

Answer 45

Dexamethasone

Question 46

Decadron structure:

Answer 46

Synthetic corticosteroid / glucocorticoid

Question 47

Decadron MOA:

Answer 47

1. Inhibits Phospholipase A2 thus inhibiting arachidonic acid and the entire pathway 2. Prostaglandins are inhibited – decreasing pain and inflammation 3. Leukotrienes are inhibited – ok for brittle asthmatics unlike NSAIDS

Question 48

Decadron Onset:

Answer 48

1-2 h

Question 49

Decadron duration of action:

Answer 49

36-48 h

Question 50

Decadron PB:

Answer 50

75%

Question 51

Decadron Metabolism:

Answer 51

CYP3A4 excreted by the kidneys

Question 52

Decadron IV pain dose:

Answer 52

8-10 mg

Question 53

Decadron IV PONV dose:

Answer 53

4 mg

Question 54

Decadron IV Peds dose:

Answer 54

0.15 mg/kg

Question 55

Decadron Side effects:

Answer 55

1. Increased Glucose levels 2. Weight gain and fluid retention 3. Mood changes 4. Insomnia 5. Increased risk of infections

Question 56

Decadron Contraindications / cautions:

Answer 56

1. Allergy to Decadron 2. May exacerbate hypertension 3. Caution in diabetics 4. Adrenocortical insufficiency or withdrawal if discontinued rapidly 5. Increased risk of perforation/bleeding in patients with GI issues (peptic ulcers, ulcerative colitis, etc.)

Question 57

Magnesium alternate name:

Answer 57

Jokes, there isn't one (sometimes referred to as its chemical compound, magnesium sulfate, magnesium oxide, etc)

Question 58

Magnesium structure:

Answer 58

Elemental

Question 59

Magnesium MOA:

Answer 59

1. Calcium channel and NMDA antagonist 2. Antagonizes hippocampal presynaptic CA++ channels that regulate aspartate and glutamate, preventing central sensitization, inhibiting hyperalgesia and amplifying the analgesic effects of opioids 3. NMDA antagonism is related to magnesium plug that sits within the NMDA channel

Question 60

Magnesium Onset:

Answer 60

30-60 sec

Question 61

Magnesium Duration of action:

Answer 61

30-60 min

Question 62

Magnesium PB:

Answer 62

30%

Question 63

Magnesium Metabolism:

Answer 63

Not metabolized - renally excreted

Question 64

Magnesium IV bolus dose:

Answer 64

30-50 mg/kg (over 15 min)

Question 65

Magnesium IV infusion dose:

Answer 65

10 mg/kg/hr

Question 66

Magnesium Side effects:

Answer 66

1. Hypotension 2. Respiratory depression 3. Decreased DTRs 4. Muscle weakness 5. Flushing

Question 67

Magnesium Contraindications / cautions:

Answer 67

1. Caution in patients with respiratory issues 2. Caution in patients on CCBs 3. CNS depression 4. Caution in Renally impaired patients 5. Caution in patients with Heart block