Exam 1 - Pain, Agitation, Delirium, Immobility, & Sedation Flashcards
List general analgesia treatments in ICU?
boluses or infusion of opioids, breakthrough PRN opioids
List general sedation treatments in ICU?
propofol, dexmedetomidine, ketamine, PRN boluses of BZDRAs
What is the goal CPOT? Goal BPS?
less than 2; less than 5
Explain the onset, duration, and pearls for morphine?
5-10 min, 3-6 hrs, active metabolite accumulates in renal impairment and can cause histamine release (hypotension, bronchospasm, urticaria)
Explain the onset, duration, and pearls for fentanyl?
seconds, 1-2 hrs, hepatic metabolism and CYP3A4 interactions and tachyphylaxis
Explain the onset, duration, and pearls for hydromorphone?
5 minutes, 2-4 hrs, good for renal impairment and fentanyl tolerance and minimal histamine release, available as PCA
What is the recommendation for hyperalgesia?
switch opioid
List additional options for analgesia in ICU?
acetaminophen, NSAIDs, methadone, gabapentin, ketamine, PCAs
What is the goal RASS score for sedation?
0 to -2
What is the MOA of propofol?
stimulates GABA and inhibits NMDA receptors
What are the AEs of propofol?
respiratory depression, hypotension, bradycardia, hypertriglyceridemia, propofol related infusion syndrome (PRIS)
List the clinical pearls for propofol? (2)
lipid emulsion can provide 1.1 kcal/mL, avoid in egg/sulfite/soybean allergy
What conditions is propofol a first-line agent in? (2)
severe alcohol withdrawal, status epilepticus
What is the MOA of dexmedetomidine?
alpha-2 adrenergic agonist
What are the AEs of dexmedetomidine? (2)
bradycardia, hypotension
List the clinical pearls for dexmedetomidine? (2)
NO RESPIRATORY DEPRESSION, does not work well for deep sedation, risk of withdrawal