Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Critical Care > Analgesia, Sedation, and Delirium > Flashcards

Analgesia, Sedation, and Delirium Flashcards

1
Q

What is the definition of Distress?

A

Pain/suffering affecting the body, a bodily part, or the mind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What were the components of pain?

A
  • Sensory
  • Motor: Defensive posture, withdrawal reflex
  • Autonomic: Tachycardia
  • Affective: Aversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the consequences of unrelieved pain? (Why is pain important?)

A
  • Inadequate sleep
  • Agitation
  • Stress response
    • Increased catecholamines and vasoconstriction
    • Hypercoagulopathy
    • Immunosuppression
    • Persistent catabolism
  • Chronic pain syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the subjective pain assessment?

A

Patient self-report:
* Most reliable & valid indicator
* Evaluate location, characteristics, aggravating/alleviating factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the objective pain assessment?

A
  • Behavorial pain scale (BPS)
  • Critical Care Observation Tool (CPOT) > 3 = mod-severe pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are non-pharmacologic treatments for analgesia?

A
  • Proper positioning
  • Stabilization of fractures
  • Eliminate irritating physical stimulation
  • Application of heat, cold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the pharmacologic treatments of analgesia?

A
  • Opioids
  • Anti-inflammatory
  • Acetaminophen
  • Adjuncts (local anesthetics, neuroleptics, ketamine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are NSAIDs associated with?

A
  • 2-fold increase in risk of renal insufficiency
  • Platelet inhibition
  • GI bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some toxicity risk factors of NSAIDs?

A
  • Hypovolemia
  • Hypoperfusion
  • Elderly
  • Pre-existing RI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ketamine

A
  • NMDA receptor antagonist
  • Dissociative anesthetic
  • Hallucinogenic, PCP-like
  • Opioid sparing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fentanyl

A
  • Most rapid onset and shortest duration
  • Continuous IV preferred
  • Patch formulation:
    • NOT recommended for acute pain (delayed onset)
    • For chronic pain HD stable patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Morphine

A
  • Longer duration than fentanyl (PRN IV administration)
  • Associated with hypotension
  • Active metabolite results in prolonged sedation, especially with renal insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hydromorphone (really potent)

A
  • Similar duration as morphine (PRN IV administration)
  • Lackss clinically significant active metabolites and histamine release
  • Addiction potential
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Meperidine

A
  • Active metabolite causes neuroexcitation (apprehension, tremors, delirium, seizures)
  • Interacts with MAOIs, SSRIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Remifentanil

A
  • Very short duration
  • May be beneficial for patients with neurological injuries (frequent neuro assessment)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the adverse effects of opioids?

A
  • Respiratory depression (non-vent, weaning)
  • Hemodynamic instability-NO MORPHINE
  • CNS effects
  • GI hypomobility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the etiologies of Sedation?

A
  • Anxiety
  • Pain
  • Delirium
  • Drugs/drug withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the deleterious effects of agitation?

A
  • Dysynchrony with the ventilator
  • Increase in oxygen consumption
  • Inadvertent removal of devices, catheters, drains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the non-pharmacologic treatments of sedation?

A
  • Re-orientation
  • Provide comfort
  • Optimize environment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the subjective assessment of sedation?

A
  • Riker Sedation assessment scale (SAS)- Goal 3-4
21
Q

What are the objective assessment of sedation?

A
  • Bispectral Index (BIS)
22
Q

What are some sedatives?

A
  • Benzodiazepines
  • Propofol
  • Dexmedetomidine
  • Ketamine
23
Q

Benzodiazepines

A
  • Diazepam, Lorazepam, Midazolam
  • NOT analgesics
  • Sedative hypnotics and amnesiacs
24
Q

What is the MOA of benzodiazepines?

A

Binds to and enhances inhibitory effect of GABA

25
Q

Diazepam

A
  • Rapid onset & awakening after single doses (PRN IV)
  • Long-acting metabolite
  • For long-term sedation and alcohol withdrawal delirium
26
Q

Lorazepam

A
  • Slower onset
    • less useful w/ acute agitation
    • PRN IV or continuous IV infusion
27
Q

Midazolam

A
  • Rapid onset and short duration
    • Preferred for acute agitation
    • PRN IV or continuous IV infusion
28
Q

What factors can cause accumulation and prolonged sedation of midazolam?

A
  • Obesity
    • Distribution
  • Low albumin
    • Highly protein bound
  • Renal failure
    • Active metabolite eliminated renally
  • CYP inhibitors
    • Macrolides, azoles, and diltiazem
29
Q

Propofol

A
  • NO analgesic properties
  • Rapid onset, short duration
  • Predictable awakening times
  • Emulsion, phospholipid vehicle
    • Hypertryglycemia w/ long term or high dose infusions (check after 2 days)
30
Q

What are the adverse effects of propofol?

A
  • Respiratory depression
  • Hypotension
  • Bradycardia
  • Pain at peripheral IV site
  • Propofol infusion syndrome
31
Q

Dexmedetomidine

A
  • Selective alpha-2 agonist with sedative and opioid sparing effects
  • Rapid onset, short duration
  • NO respiratory depression
32
Q

What are the adverse effects of dexmedetomidine?

A
  • Transient hypertension with rapid administration
  • Bradycardia, hypotension with maintenance infusions
33
Q

Ketamine

A
  • Noncompetitive NMDA receptor antagonist with sedative and opioid sparing effects
  • Rapid onset, short duration
33
Q

What is delirium characterized by?

A
  • Acutely changing or fluctuating mental status
  • Inattention
  • Disorganized thinking
  • Altered level of consciousness
34
Q

What are some modifiable risk factors of delirium?

A
  • Benzodiazepines, blood transfusions
35
Q

Hypoactive delirium

A

Worse prognosis
* calm appearance
* inattention
* obtundation

36
Q

Hyperactive delirium

A
  • Agitation
  • Combative behavior
  • Lack of orientation
  • Progressive confusion
37
Q

What are some causes of delirium?

A
  • ICU environment
  • Alcohol withdrawal
  • Medications
  • Baseline dementia
38
Q

What are some consequences of delirium?

A
  • Strongly associated with cognitive impairment at 3 and 12 months after ICU discharge
  • Moderate association with longer hospital stay and increase costs
39
Q

What are the assessments of delirium in the ICU?

A
  • Clinical history and exam
  • Intensive Care Delirium Screening Checklist (ICDSC)
  • Confusion Assessment Method (CAM-ICU)
40
Q

Intensive Care Delirium Screening Checklist (ICDSC)

A
  • 8 item checklist; score greater than or equal to 4 positive for delirium
  • Bedside screening tool in the ICU based on DSM-IV Criteria
41
Q

What is the non-pharmacological treatment of delirium?

A
  • Sleep promotion
  • Reorientation
  • Optimize environment
  • Early mobilization
42
Q

What are the pharmacological treatment of ICU delirium?

A
  • Neuroleptics
  • Atypical antipsychotics
  • Older antipsychotics
43
Q

What is the MOA of Neuroleptics?

A

Stabilizing effect on cerebral function via antagonizing dopamine mediated transmission at the cerebral synapses, basal ganglia
* Inhibits hallucinations, delusions & unstructured thought patterns
* Diminishes interest in the environment

44
Q

What is the indication of Neuroleptics?

A

ICU-related delirium if patient exhibits harmful behavior to themselves or healthcare professionals

45
Q

Which atypical antipsychotics treat delirium?

A
  • Quetiapine
  • Olanzepine
45
Q

What are the side effects of delirium?

A
  • QT prolongation
  • Extrapyramidal side effects
  • Sedation
46
Q

Alcohol Withdrawal Delirium

A

Unopposed NMDA activation activation due to down regulated GABA receptors

47
Q

What are the treatment options of alcohol withdrawal delirium?

A
  • Benzodiazepines
  • Phenobarbital
  • Propofol
  • Ketamine
  • Dexmedetomidine

Critical Care (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions