Pain, Agitation, and Delirium

Question 1

Fentanyl

Answer 1

Preferred in hemodynamically unstable, less histamine release, 0.5-3 mcg/kg/h or 25-1000 mcg IVP q30-60min

Question 2

Morphine

Answer 2

1-10 mg/h or 2-4 mg IVP q1-2h; avoid high dose prolonge use in renal pts

Question 3

Hydromorphone

Answer 3

0.5-3 mg/h, 0.2-0.6 mg IVP q1-2h

Question 4

Etiology of Agitation

Answer 4

Sepsis, renal/liver failure, hypoxia, PA, CNS infections, hypoglycemia, electrolyte imbalances, sleep deprivation

Question 5

Sedation Strategy

Answer 5

Light level preferred, consider daily sedation interruptions, benzo/non-benzo

Question 6

Propofol Dosage

Answer 6

5-50 mcg/kg/min, central line preferred, provides 1.1 kcal?mL;

Question 7

Propofol Monitor

Answer 7

serum zinc (may dec), serum TGs (may inc) w/ prolonged infusion

Question 8

Propofol Infusion Syndrome

Answer 8

May result in severe metabolic acidosis, dysrhythmias, CV collapse, rhabdo

Question 9

Dexmedetomidine

Answer 9

Indication: sedation or delirium 1 mcg/kg over 10 min, followed by 0.2-0.7 mcg/kg/h, doses up to 1.5 mcg/kg/h used;

Question 10

Midazolam Sedation

Answer 10

Dose: 0.02-0.1 mg/kg/h; active metabolite may accumulate in renal

Question 11

Lorazepam Sedation

Answer 11

Dose: 0.01-0.1 mg/kg/h or 1-4 mg IV q4-6h

Question 12

Drugs that May Cause Delirium

Answer 12

Benzos, CCS, DA agonist, H2 blockers, anti-ACh, B-blockers, metoclopramide, cefepime (low CrCl)

Question 13

Haloperidol

Answer 13

LD: 1-2 mg slow IVP, double dose q15-20min till desired effect; MD: 25% of total LD enterally q6h; QTc

Question 14

Olanzapine

Answer 14

Dose: 2.4-10 mg IM or enteral daily