Medications Flashcards
4 main categories of medication
- Analgesics
- Sedatives + Paralytics
- Vasopressors and inotropes
- Anticoagulants
3 sources of sub-optimal pain management
- inadequate
- Excessive
- not on schedule
Effect of sup-optimal pain management
- Delayed mobilization
- inability to wean from ventilator
- Poor respiratory state
- +/- use of reversal drugs
- Delirium
Leading to prolonged stay in ICU
4 ways to optimize analgesia
- Follow an interdisceplinary, structured approach to analgesia
- Use a patient-specific validated pain scale
- address underlying source of pain
- Minimiza and be aware of adverse effects
Facial signs of underlying pain
- Brow lower
- Lid tighten
- Eye closure
- Cheek raise
- nose wrinkle
Facial signs of transient pain
- Brow lower
- Lid tighten
- Eye closure
- Cheek raise
- nose wrinkle
- lip raise
- mouth open
Jaw drop
3 pain assessment tools
- Behavioral pain scale
- Critical care pain observation tool
- Wong-Baker FACES pain rating scale
What is the difference between analgesia and anesthetic
Analgesia - pain relief
Anesthetic - blocking sensation including pain
What are types of analgesia
Opiates
NSAIDS
What are types are anesthetic
General anesthetic
Nerve blocks
Numbing agents
What are 3 levels of the nervous system analgesias can effect
- CNS (brain)
- Spinal level
- Peripheral nerve root
At what level does acetaminophen work?
CNS (brain)
At what level do NSAIDS work
Peripheral nerve root
At what level do opioids work
- CNS (brain)
- Spinal level
How do opioids work
- bind to opioid receptors (brain, spinal cord, other organs) and block pain signals sent from brain to the body and release large amounts of dopamine
3 non-opioid drugs used in ICU
- Acetaminophen
- NSAIDS
- Gabepentic or pregabalin
Whic of the non-opioid drugs used in ICU is the quickest acting? Which lasts the longer?
Acetaminophen and NSAIDS both 30mins to 1hour
Gabapentin and pregabalin
Precautions with acetaminophen
Caution with liver failure/alcoholism
Precautions with NSAIDS
Long term use can increase GI/renal/bleeding complications
Precautions with Gabapentin or pregabalin
- Can sedate
- Monitoring with renal dysfunction
Which non-opioid drugs used in ICU is used for neuropathic pain
Gabapentin or pregabalin
Opioids supress drive to ___
breath
3 opioids used in ICU
Morphine
Hydromorphone
Fentanyl
Which of the 3 opioids used in ICU is the strongest?
Fentanyl 100x stronger than morphine (hydromorphone 10x stronger than morphine
Precaution with morphine
Drug accumulates in renal failure - itchy skin
Which what populations is hydromorphone preferred
Elderly and renal dysfunction
What type of pain in fentanyl good for
procedural pain
Opioid side effect in CNS
Decreased LOC, delirium
Opioid side effect in Resp
Depression (decreased drive to breath, decreased RR)
Opioid side effect in CVS
Decreased BP/MAP/HR
Opioid side effect in GI
Decreased gut motility, nausea
Opioid side effect in DERM
rashes
What are anti-emetics
Drugs taken alongside opioids to try and manage nausea
3 common anti-emetics
- Dimenhydrinate (Gravol)
- Ondansetron
- Dexamethasone
Physiotherapy implications of analgesics
- Consider timing of analgesia with active treatment for optimal pain control
- Look for trends in analgesia needs with care/movement
- Be alert for respiratory side effects
- be aware of how our interventions can increase or prevent pain and always consider what we can offer for pain control
What are predisposing factors that may be reason to sedate/paralyze a patient
- Anxiety
- Sleep disorders
- Prior substance abuse
- medical conditions
