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CPNP AC flash cards > Pain & Sedation > Flashcards

Pain & Sedation Flashcards

1
Q

No P450 enzyme has developed in kids less than ___ months of age.

A

6 months of age
—impacts metabolism

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2
Q

What type of medication are these:

Morphine, oxycodone, hydromorphone, methadone, and fentanyl.

A

opioids

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3
Q

What type of medication are these:

Tylenol

A

analgesic

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4
Q

What type of medication are these:

Motrin, aspirin, toradol.

A

NSAIDS

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5
Q

What type of medication are these:

topomax and gabapentini

A

antiepileptics

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6
Q

Antiepileptics such as topomax and gabapentin can be used for ______ pain

A

neuropathic pain

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7
Q

What type of medication are these:

ketamine, propofol, dexmedetomidine

A

anesthetics

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8
Q

What type of medication are these:

EMLA, LMX

A

topical anesthetics

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9
Q

What type of medication are these:

injection blocks, caudals, epidurals, inhaled anesthetic agents

A

local anesthetics

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10
Q

Opioids increase the risk for r____d_____, ab____, mi____, and ad_____

A

respiratory depression
abuse
misuse
addiction

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11
Q

Morphine
__-___ minute onset

A

5-10

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12
Q

morphine side effects include v______ and h_____ release leading to i_____

A

vasodilation
histamine
-itching

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13
Q

fentanyl onset is ______

A

immediate

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14
Q

If given too quickly, fentanyl can cause c____ w____ r_____

A

chest wall rigidity

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15
Q

What opioids can be used in children who have P450 3A4 inhibitors?
____ and
________

A

fentanyl and methadone

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16
Q

Methadone has a
____ onset and ____ duration

A

slow onset
long duration

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17
Q

What opioid is good to use in patients with opioid dependence?

A

methadone

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18
Q

Methadone increases the patients risk for q__ _______, to_____, ar_____ and h_______

A

QT prolongation
Torsades
Arrhythmias
Hypotension

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19
Q

Prior to sedating with methadone obtain a baseline _____

A

EKG

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20
Q

Methadone use needs to be w_____. If stopped abruptly, it can cause w____ and s____ in patients

A

weaned
withdrawal and seizures

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21
Q

Hydromorphone onset is about ____ minutes

A

5

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22
Q

Hydromorphone may cause __/_____

A

hypo/hypertension

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23
Q

Opioid habituation and addiction is diagnosed with a?

A

urine drug screen

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24
Q

What drug is indicated for children with opioid dependence?
Me______

A

methadone

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24
Q

Children admitted for opioid addiction should have a _____ withdrawal of the addicted drug.

A

slow withdrawal

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25
Q

What drug is indicated for children with mild to moderate opioid withdrawal?
bupren_____

A

buprenorphine

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26
Q

What drug is indicated for children to prevent opioid use relapse?
naltr______

A

naltrexone

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27
Q

What is the term for adaptation to an opioid?

A

dependence

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28
Q

Dependence s/s include w_____ syndrome with ce______

A

withdrawal syndrome with cessation

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29
Q

What is the term for opioid-compulsive and continued use despite impaired control and harm?

A

addiction

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30
Q

Addiction is associated with opioid c____

A

cravings

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31
Q

Sedation weaning tools include the w___ and N____

A

WAT (withdrawal assessment tool)
-used for infants and children
NAS (neonate scale)

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32
Q

For patients with a WAT score less than 3, the median duration of opioid or benzodiazepine weaning is ____ days

A

6 days

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33
Q

For patients with a WAT score > 3, the median duration of opioid or benzodiazepine weaning is ____ days

A

10 days

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34
Q

What NAS score indicates the need for an infant to receive opioid and/or sedation withdrawal pharmacologic therapy?

A

8 or greater

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35
Q

Abrupt d/c of sedation can lead to di____, di____, ta____, ir____, and hy_____

A

diaphoresis, diarrhea, tachycardia, irritability, hypertension

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36
Q

Kids with > ___ days of sedation are at increased risk for withdrawal

A

5 days
-in these cases, wean slowly

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37
Q

During sedation weaning, ____ doses should be available. Have intermittent doses of mo____ or me_____

A

rescue
morphine, methadone

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38
Q

Analgesics block ______

A

prostaglandins

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39
Q

The most common analgesic is ______.

A

Tylenol

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40
Q

What is the max Tylenol dose? ___ mg/kg/day

A

75 mg/kg/day

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41
Q

Tylenol is rapidly absorbed in the ___ tract and metabolized in the _____

A

GI
liver

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42
Q

Tylenol overdose treatment includes?

A

N-acetylcysteine

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43
Q

What scale assesses for Tylenol toxicity?
Ru____-Ma___ nomogram

A

Rumack-Mathew nomogram

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44
Q

NSAIDs decrease le_____ synthesis and inhibit pr______

A

leukotreine
prostaglandins

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45
Q

The Max Motrin dose is
___ mg /kg/dose or
____ mg/day

A

40 mg/kg/dose
2400 mg/day

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46
Q

Use NSAIDs cautiously in patients with h___ f____ or h____ disorders.

A

hepatic failure or heme disorders

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47
Q

NSAIDs inhibit p____ a____ and can cause g__ b____

A

platelet aggregation
GI bleeds

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48
Q

A___-e____ and A___-d___ are used when pain is unresponsive to narcotics and NSAIDs

A

anti-epileptics and antidepressants

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49
Q

What antiepileptic is indicated for neuro pain or nerve damage?

A

Gabapentin

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50
Q

Gabapentin is indicated for pain that is described as b____, n____, or t_____

A

burning
numb
tingling

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51
Q

What medications are used as adjunctive therapy for use in neuro pain?

A

Tricyclic antidepressants

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52
Q

What TCAs are used as neuro pain adjunct therapy?
nort_____ and desipr_____

A

nortriptyline
desipramine

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53
Q

Atypical antidepressants are indicated for n___ pain and f_____

A

nerve pain and fibromyalgia

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54
Q

What atypical antidepressants can be used in children to treat nerve pain and fibromyalgia?
dul____ and venlaf_____

A

duloxetin
venlafaxine

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55
Q

What medication can treat myofascial pain?
Bac_____

A

baclofen

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56
Q

Haloperidol is used to treat agi____ and irr______

A

agitation and irritability

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57
Q

Haloperidol sedation is _____

A

long

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58
Q

What is a side effect of haloperidol?
Dys______

A

dystonia

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59
Q

Propofol is used for pr____ se_____ and se____ we______

A

procedural sedation
sedation weaning

60
Q

Propofol has a f____ onset and is s____ acting

A

fast onset
short-acting

61
Q

The risk for propofol infusion syndrome increased when propofol is used for > ___-___ hours

A

24-48 hours

62
Q

With long-term therapy, propofol increases the risk for m___ a____

A

metabolic acidosis

63
Q

Propofol side effects include
h____, b____, and b____ at IV site

A

hypotension
bradycardia
burning

64
Q

Ketamine is used for p____ s____ requiring a f____ onset

A

procedural sedation
fast

65
Q

In intubated patients, ketamine can be used c_____

A

continuously

66
Q

Ketamine can lead to h_______, ensure to have s____ available when in use

A

hypersalivation
suction

67
Q

Ketamine induced hypersalivation can lead to o____ or l______

A

obstruction or
laryngospasm

68
Q

Ketamine s/s include a high ___ and ___

A

BP and HR

69
Q

Ketamine emergence phenomena is described as increased ag______ s/p ketamine sedation

A

agitation

70
Q

Ketamine sedation emergence can be treated with m____/v_____: dosage is ___ mg/kg

A

midazolam/versed
1mg/kg

71
Q

Topical anesthetic agents are indicated for m_____ procedure or as an ad_____.
When using topical anesthetics, ensure to p___ a____, and prepare skin about ___ hour before procedure

A

minor procedures or as an adjunct

plan ahead
1 hour before

72
Q

Intradermal anesthetics include l____ i_____ and are indicated for a q____ o_____

A

local injections
quick onset

–For example: lidocaine

73
Q

Regional/Epidural blocks are indicated for children s/p s___ f____, this pain management is used for ____-___ hours

A

spinal fusion
24-48 hours

74
Q

S/p spinal fusion surgery, regional/epidural blocks decrease the need for n___ and increase the patients goal to w_____

A

narcotics
walk

75
Q

Inhaled sedation is indicated for m____ sedation and for d____ procedures

A

moderate
dental

76
Q

Inhaled sedation examples include
intranasal mi____ or dexmato______
-monitor these children very closely

A

midazolam or dexmatomadine

77
Q

Dexmedetomidine dosing is ___ mcg/kg/hr. Bolus dosing is ___ mc/kg

A

1 mcg/kg/hr
0.5 mcg/kg

78
Q

Dexmedetomidine is not an opioid but an a___-2 a____, that is metabolized in the _____

A

alpha-2-agonist
liver

79
Q

Dexmedetomidine s/s include a decrease in ___ and _____.
Patients on Dexmedetomidine are at increased risk for ______

A

HR and BP
acidosis

80
Q

Dexmedetomidine does not decrease _____, this is why is can be used before, during, and after _____

A

RR
extubation

81
Q

Clonidine is a non-narcotic that can be used s/p d_______ use via a c____ p_____

A

Dexmedetomidine
clonidine patch

-prevents Dexmedetomidine habituation

82
Q

Clonidine can lead to a__ b____, h____ and c___ p____

A

AV block, hypotension, chest pain

83
Q

When used with stimulants, clonidine can cause c______ events

A

cardiovascular

84
Q

When used with opioids, benzodiazepines can cause p____ s______

A

profound sedation

85
Q

The benzodiazepam Midazolam is ___ acting and can lead to C____ d_____

A

short
CNS depression

86
Q

Midazolam is good for s____ procedural sedation. Midazolam can be used during v_____

A

short
ventilation

87
Q

Lorazepam is used for acute s____ management

A

seizure

88
Q

Lorazepam toxicity increased when mixed with _____

A

miralax

89
Q

Diazepam is indicated for use in children with m___ t____ and s_____

A

muscle tremors and
spasms

90
Q

If given too quickly, Diazepam may cause h____ and r___ d_____

A

hypotension and respiratory depression

91
Q

According to the State Behavioral Score, the best sedation score to tolerate ventilation is?

A

0

92
Q

According to the State Behavioral Score, a score of 2 indicates?

A

Agitation

93
Q

According to the State Behavioral Score, a score of 3 indicates?

A

unresponsiveness

94
Q

The goal of sedation during mechanical ventilation is for the patient to have a re___ Dr____, some co___, and st_____ re_____

A

respiratory drive
coughing
stimulation response

95
Q

According to the Richmond Agitation Scoring system, the best sedation score to tolerate ventilation is?

A

0

96
Q

According to the Richmond Agitation Scoring system, a score of 4 indicates?

co______

A

combativeness

97
Q

According to the Richmond Agitation Scoring system, a score of 5 indicates?

A

unarousable

98
Q

Pre-sedation assessment Ample mnemonic includes assessment of the patient’s?

A

Allergies
Medications
PMH
Last oral intake
Events leading to illness

99
Q

NPO Guidelines
__ hours for clear liquids
___ hours for breast milk
___ hour for formula
___ hours for solids

A

2
4
6
8

100
Q

For procedural sedation, the patient requires a separate ____

A

consent

101
Q

Minimal sedation provides a_____.
An example of minimal sedation includes i___ m____

A

anxiolysis
inhaled midazolam

102
Q

Moderate sedation provides a d____ c_____, pt should be a____.
An example of a medication that provides moderate sedation includes?

A

depressed consciousness
arousable
ketamine

103
Q

Deep sedation provides either a partial/complete loss of r____. The patient will not be e___ a____.
An example of a medication that provides deep sedation includes?

A

reflexes
easily arousable
propofol

104
Q

What is the only ASA class that NPs are allowed to intubate?

A

ASA class 1 & 2

105
Q

For an ASAa class 3-5 an i____ should intubate

A

intensivist

106
Q

Infants less than 4 weeks of age who require intubation are considered ___ risk and require an i___ to intubate

A

high risk
intensivist to intubate

107
Q

An ASA class of 1 describes a n___ h___ child

A

normal healthy child

108
Q

An ASA class of 2 describes a child with m___ s____ d_____

A

mild systemic disease

109
Q

Malampati scores describe the v___ p____ a_____

A

visual pharynx appearance

110
Q

What malampati scores are considered safe for NPs?

A

1 and 2

111
Q

In what malampati score can you see the uvula, soft palate, and tonsils?

A

1

112
Q

In what malampati score can you see the soft palate and uvula?

A

2

113
Q

In what malampati score can you only see the uvula?

A

3

114
Q

Neuromuscular blockade is reserved for c___ i___ children for the purpose of controlling v_____
*end in

A

critically ill
ventilation

coronium

115
Q

Neuromuscular blockade is indicated for children who are f___ the v_____.

A

fighting the ventilator

116
Q

Neuromuscular blockade allows the ventilator to?

A

take over breathing

117
Q

Neuromuscular blockade is indicated to help provide n_____-_____

A

normothermia

118
Q

Neuromuscular blockade can be given to allow for s____ and a_____ drug h____

A

sedatives and analgesics
drug holidays

119
Q

Use the ______ neuromuscular blockade dosages. Neuromuscular blockade administration should be taken o___ i_____ to determine if the blockade is still needed.

A

lowest

off intermittently

120
Q

Neuromuscular blockade long term sequela include the development of myo____ and loss of re_____

A

myopathies
reflexes

121
Q

While on neuromuscular blockades, the NP should assess that the patient still has?

A

reflexes

122
Q

What is the reversal agent for benzodiazepines?
fl_____

A

Flumazenil

123
Q

When using flumazenil as a reversal agent, keep in mind that you may need to r___ doses

A

repeat

124
Q

Monitor your patient for the development of _____ when administering flumazenil to reverse benzodiazepines

A

seizures

125
Q

What is the reversal agent for opioids?

A

Naloxone

126
Q

Naloxone is ___ acting, patient may need r___ or an i____

A

fast acting
re-dosing
infusion

127
Q

Small doses of naloxone may be indicated to prevent r___ d____ and provide a_____

A

respiratory depression
analgesia

128
Q

When administering Naloxone, monitor your patient for the development of?

A

withdrawal s/s

129
Q

What is the reversal agent for a neuromuscular blockade?
neost______

A

neostigmine

130
Q

When giving neostigmine, ensure to concurrently administer glycopy______ to prevent h_____s____

A

glycopyrrolate to prevent hypersalivation

131
Q

When giving neostigmine, monitor your patient for the development of se_____, lar_____, bro_____, and agi_____

A

seizures
laryngospasms
bronchospasm
agitation

132
Q

Pediatric delirium is described as a disturbance of co____, aw____, inability to f____/t___, and development of be___ i_____

A

consciousness
awareness
focus/think
behavioral issues

133
Q

S/P hospitalization, the risk for pediatric delirium is increased in children less than ___ YOA and m____

A

5 and males

134
Q

What medication increases the risk for pediatric delirium?
B_______

A

benzodiazepines

135
Q

Hyperactive delirium is described as the development of psy___, ag____, and res_____

A

psychosis, agitation, restlessness

136
Q

Hypoactive delirium is described as the development of a wi____, fl____, apa_____ affect

A

withdrawn
flat
apathetic

137
Q

The pediatric confusion assessment is for children less than __ YOA. It assesses for d____

A

5 YOA
delirium

138
Q

Delirium treatment includes the administration of m____, which resets the c____ r_____

A

melatonin
circadian rhythm

139
Q

Treat pediatric delirium psychosis with a____ a____ and h____

A

atypical antipsychotics
—less side effects
Haldol

140
Q

Atypical antipsychotics used for pediatric delirium psychosis include?
ris____
ola_____
ziprasi____

A

risperidone
olanzapine
ziprasidine

141
Q

OSA affects children g____

A

growth

142
Q

OSA is diagnosed with a?

A

sleep study

143
Q

When screening for OSA, assess for en____, an___, and ni___ te____

A

enuresis, anxiety, night terrors

144
Q

Succycholinate May lead to m____ h_____, treat with d_____

A

Malignant hyperthermia
Dantrolene

145
Q

Succycholine is contraindicated in children with a ____ deficiency
—will lead to profound and prolonged ____

A

cholinesterase
Apnea

146
Q

Succsycholine can lead to muscle injury,
Leading to h_____ and a_____

A

Hyperkalemia
Arrhythmias

147
Q

Propofol infusion syndrome
r______
k_____ f_____
h______

A

Rhabdomyolysis
Kidney failure
Hyperkalemia

CPNP AC flash cards (10 decks)

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