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PHM 703- Critical Care > Pain Management: Sedation > Flashcards

Pain Management: Sedation Flashcards

1
Q

What should you NOT use for sedation?

A

BZD drips

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2
Q

If agitation isn’t controlled by opioids, what are your options?

A

Propofol, Precedex, ketamine, PRN boluses of BZDs

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3
Q

Ideal RASS score for sedation

A

0 to -2

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4
Q

RASS score: 0

A

alert and calm

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5
Q

RASS score: -1

A

not fully alert, but has sustained awakening to voice for ≥10 seconds

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6
Q

RASS score: -2

A

briefly awakens with eye contact to voice for <10 seconds

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7
Q

Ideal SAS score for sedation

A

3-4

4: calm and cooperative; awakens easily and follows commands
3: difficult to arouse, awakens to verbal stimuli or gentle shaking, but drifts off again, follows simple commands

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8
Q

Propofol: onset

A

<1 minute

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9
Q

Propofol: duration

A

10-15 minutes; rapid hepatic and extra hepatic CL

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10
Q

Propofol: benefits

A

First-line agent for severe alcohol withdrawal, SE

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11
Q

Propofol: drawbacks

A

NO ANALGESIC PROPERTIES

Long-term administration can lead to saturation of peripheral tissues

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12
Q

Propofol: PK/PD

A

Hypnotic, anxiolytic, amnestic, and anticonvulsant effects

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13
Q

Propofol: ADEs

A

Respiratory depression: use with caution or only in intubated patients

Hypotension, bradycardia, decreased CO, hypertriglyceridemia, PRIS with higher doses and longer duration

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14
Q

Propofol: clinical pearls

A

Lipid emulsion provides 1.1kcal/ml of nutrition
Avoid in patients with egg, sulfite, soybean allergies

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15
Q

Propofol: monitoring

A

BP, HR, TGs, anion gap/lactate, and CK when using >48 hours

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16
Q

Precedex: benefits

A

Used in procedural sedation and sedation for mechanical ventilation not lasting >24 hours

No respiratory depression
Effects similar to naturally-occurring sleep
Opioid-sparing effects
Useful as adjunct therapy for alcohol withdrawal

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17
Q

Precedex: drawbacks

A

Don’t use as monotherapy in alcohol withdrawal

Risk of hypotension
RASS score of -3 or less is unlikely (heavy sedation)
Risk of withdrawal with prolonged use
Case reports of drug-induced fever

18
Q

Precedex: PK/PD

A

Sedative and analgesic properties

19
Q

Precedex: ADEs

A

Bradycardia, hypotension

20
Q

Precedex: pearls

A

Alpha-2 adrenergic agonist
Don’t use in RASS score more than -3

21
Q

Midazolam: onset

A

2-5 minutes

22
Q

Midazolam: duration

A

1-2 hours

23
Q

Midazolam: dosing

A

Bolus: 2-4mg
Infusion: 1-4 mg/hr

24
Q

Midazolam: pearls

A

Lipophilic
Active metabolites
Accumulates in renal impairment
Primary use for status epilepticus

25
Q

Lorazepam: onset

A

5-20 minutes

26
Q

Lorazepam: duration

A

2-4 hours

27
Q

Lorazepam: dosing

A

Bolus: 1-2mg
Infusion: 0.5-4mg/hr

28
Q

Lorazepam: pearls

A

Propylene glycol acidosis → propylene glycol is the diluent → metabolic acidosis
Can use in renal/hepatic failure

29
Q

Diazepam: onset

A

5-10 minutes

30
Q

Diazepam: duration

A

44-100 hours as the half-life

31
Q

Diazepam: dosing

A

5-15mg TID

32
Q

Diazepam: pearls

A

Active metabolites
Can taper off quickly
Standing doses used in alcohol withdrawal

33
Q

BZDs drawbacks in sedation

A

Increased risk of delirium
Increased time on a ventilator
Increased length of ICU stay

DON’T GIVE WHEN A PATIENT IS AGITATED

34
Q

BZDs are reserved first-line for what situations?

A

Reserve first line in: status epilepticus, extreme alcohol withdrawal symptoms, severe ARDS requiring deep sedation

35
Q

Ketamine: onset

A

IV: within 30 seconds

IM: 3-4 minutes (anesthetic), 10-15 minutes (analgesia)

36
Q

Ketamine: duration

A

IV: 5-10 minutes, recovery 1-2 hours

IM: 12-25 minutes (anesthetic), 15-30 minutes for analgesia, recovery 3-4 hours

37
Q

Ketamine: dosing

A

Dose-dependent effects

38
Q

Ketamine: benefits

A

Favorable hemodynamic
Bronchodilator effects
Opioid-sparing effects

Don’t need to intubate the patient to administer

39
Q

Ketamine PO bioavailability

A

20-30% PO bioavailability

40
Q

Ketamine ADEs

A

Emergence reaction (pretreat with BZD or propofol)
Agitations, hallucinations
Oral secretions
Tachycardia
HTN

PHM 703- Critical Care (14 decks)

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