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PHTH 564 - ICU > Meds > Flashcards

Meds Flashcards

1
Q

4 types of meds we need to be aware of ?

A
  1. analgesics
  2. sedatives and paralytics
  3. vasopressors and inotropes
  4. anticoagulants
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2
Q

To optimize analgesia, use what kind of pain scale?

A

patient-specific validated pain scale

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3
Q

Infusion goals should be reassessed every __ hours; reduce by ___% if sedation goals are met

A

6;25

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4
Q

Goal in the ICU is to keep pt’s pain intensity rating NRS < __ or BPS < __

A

4;6

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5
Q

BPS scores range from __ (no pain) to __ (max pain)

A

3;12

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6
Q

What are the 3 categories in the BPS?

A
  1. facial expression
  2. upper limb movements
  3. compliance with mechanical ventilation
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7
Q

The critical-care pain observation tool ranges from -

A

0-8

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8
Q

_____ = pain relief; includes opiates, NSAIDS, other oral meds

A

analgesia

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9
Q

______ = blocking sensation, including pain; includes general anesthetic, nerve blocks, numbing agents

A

anesthetic

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10
Q

____ _____ analgesia uses multiple types of analgesia, and works on different levels of the NS

A

multi-modal

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11
Q

_____ blocks pain signals sent from brain to the body and release large amounts of dopamine

A

opioids

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12
Q

3 non-opioid drugs used in the ICU?

A
  1. acetaminophen
  2. NSAIDS
  3. gabapentin or pregabalin
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13
Q

Issues with acetaminophen?

A

caution with liver failure / alcoholism

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14
Q

Issues with NSAIDS?

A

long term use can increase GI / renal bleeding complications

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15
Q

Take note of what with gabapentin or pregabalin?

A
  • for neuropathic pain
  • can sedate
  • monitor renal dysfunction
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16
Q

3 opioid drugs used in ICU?

A
  1. morphine
  2. hydromorphone
  3. fentanyl
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17
Q

Issues with morphine ?

A

drug accumulates in renal failure, itchy skin

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18
Q

Take note of what with hydromoroph / dilaudid?

A
  • 5 x as strong as morphine

- preferred in elderly and renal dyfunction

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19
Q

Take note of what with fentanyl?

A
  • quick onset
  • good for procedural pain
  • 100x as strong as morphine
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20
Q

Opioid side effects in CNS?

A

decreased LOC, delirium

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21
Q

Opioid side effects in resp?

A

depression (decreased drive to breathe, decreased RR)

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22
Q

Opioid side effects in CVS?

A

decrease BP/MAP/HR

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23
Q

Opioid side effects in gut?

A

decreased motility, nausea

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24
Q

Opioid side effects derm?

A

rashes

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25
Q

3 common anti-emetics?

A
  1. dimenhydrinate (gravol)
  2. ondansetron
  3. dexamethasone
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26
Q

4 PT implications with analgesics?

A
  1. consider timing of analgesia with active treatment for optimal pain control
  2. look for trends in analgesia needs with care / movement
  3. be alert for resp side effects
  4. be aware of how our interventions can increase or prevent pain, and consider what we can offer for pain control
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27
Q

Always address ______ sources for sedation

A

underlying

28
Q

3 types of sedation ?

A
  1. Light IV sedation
  2. Daily sedation interruption
  3. Deep IV sedation
29
Q

Current best practice is to _____ sedation

A

minimize (least amount to reach goal)

30
Q

3 common sedatives?

A
  1. benzodiazepines
  2. propofol
  3. dexmedetomidine (Precedex)
31
Q

Most commonly used benzo?

A

midazolam

32
Q

Sedative side effects CNS?

A

decreased LOC; delirium

33
Q

Sedative side effects resp?

A

depression

34
Q

Sedative side effects CVS?

A

decreased BP/MAP/HR

35
Q

_____ may occur as a side effect of propofol

A

arrhythmias

36
Q

PT implications of sedation?

A

consider why the pt is being sedated, and what level (RASS goal) to determine if active treatment/stimulation is appropriate

37
Q

For pt’s with RASS -3/-2 it is appropriate to do AROM and active exercise (T/F)

A

FASLE ; just PROM and sit

38
Q

When are paralytics use (3 instances)

A
  1. endotracheal tube intubation
  2. to allow full mechanical ventilation
  3. to manage increased ICP (lower cerebral O2 consumption)
39
Q

Succinylcholine, rocuronium and cisatracurium are all examples of ______

A

paralytics

40
Q

Paralytics contain no analgesic, anxiolytic or amnesiac properties so pt’s must be adequately sedated (T/F)

A

TRUE

41
Q

There is a prolonged ______ recovery post paralysis

A

motor

42
Q

Acute quadriplegic myopathy syndrome and myositis ossificans are potential side effects of _____

A

paralytics

43
Q

Challenge/stimulation (is/is not) appropriate if the medical goal is full sedation / paralysis

A

IS NOT

44
Q

______ increase the hearts force of contraction, increasing CO

A

inotropes

45
Q

_______ primarily increase systemic vascular resistance via vasoconstriction, increase MAP

A

vasopressors

46
Q

Why use vasopressors or inotropes?

A

to treat hypotension

47
Q

Dopamine is an example of a ______ vasopressor/inotrope

A

mixed

48
Q

________ is used to increase cardiac output through its inotropic/chhronotropic effects in both septic and cardiogenic shock states

A

dobutamine

49
Q

______ has strong vasodilatory effects which are of significant benefit in its with decompensated heart failure

A

dobutamine

50
Q

________ is similar to dobutamine but has a much longer therapeutic effect

A

milrinone

51
Q

4 common vasopressors ?

A
  1. norepinephrine/ epinephrine
  2. phenylephrine
  3. vasopressin
  4. midodrine
52
Q

3 side effects of inotrope s/ vasopressors ?

A
  1. hypoperfusion
  2. cardiac dysrhythmias
  3. myocardial ischemia
  4. inotropes = hypotension post initial vasodilation
53
Q

PT implications of pt on vasopressor/inotrope = consider whether it is appropriate to impose a _____ challenge on a pt requiring vasotropic/inotropic support

A

cardiac

54
Q

List any 3 of the 6 active mobility guidelines for pt on vasopressors/inotropes

A
  1. no increased dose of any vasopressor infusion for at least 2 hrs
  2. no evidence of myocardial ischemia (24 hrs)
  3. no arrhythmia requiring the administration of new antiarrythmic agent (24 hrs)
  4. HR < 75% age predicted max HR at rest
  5. less than 20% variability in BP
  6. pt on low dose inotrope support (usually < 10mcg/kg/min)
55
Q

3 common anticoagulants ?

A
  1. heparin
  2. low molecular weight heparin
  3. warfarin
56
Q

______ (anticoagulant) is used in hospital only

A

heparin

57
Q

What is normal INR?

A

0.9-1.3

58
Q

What is the INR for a pt on anticoagulants?

A

2-3

59
Q

_____ looks at coagulation and clotting time of blood

A

INR

60
Q

Higher INR = increased risk of _____, lower INR = increased risk of _____

A

bleed; clot

61
Q

PT implications of pt on anticoagulants?

A

Be aware of risk of bleed, any restricted activity orders for clots.

62
Q

________ is a sudden and severe change in brain function that causes a person to appear confused or disoriented, typically with a fluctuating course

A

delirium

63
Q

3 features of delirium?

A
  1. acute onset , fluctuating mental state
  2. inattention
  3. disorganized thinking
64
Q

3 subtypes of delirium?

A
  1. hyperactive
  2. hypoactive
  3. mixed
65
Q

3 goals of therapy for delirium?

A
  1. interdisciplinary approach, try non-drug measures first, use anti-psychotics when needed
  2. minimize/eliminate precipitating factors
  3. screen using a validated tool
66
Q

Screening tool used in ICU for delirium?

A

Confusion assessment method for ICU

67
Q

Early mobilization is a non-drug approach for treating delirium (T/F)

A

TRUE

PHTH 564 - ICU (15 decks)

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