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Critically Ill Exam 2 > Sedation, Analgesia, And Delirium > Flashcards

Sedation, Analgesia, And Delirium Flashcards

1
Q

What are 4 adverse effects of opioids?

A
  1. Respiratory Depression
  2. Illeus/ GI hypomotility
  3. Hypotension
  4. Decreased level of consciousness
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2
Q

What is the starting dose for the use of morphine?

A

1-4 mg IV every 2-4 hours

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3
Q

What patient population can morphine metabolites accumulate?

A

In patients with impaired renal function

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4
Q

What does morphine have a risk of?

A

Hypotension

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5
Q

What does morphine have the most release of?

A

H1

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6
Q

What is the starting dose for hydromorphone?

A

0.2-0.4 mg IV every 2-4 hours

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7
Q

True or false: Morphine is much more potent than hydromorphone

A

False

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8
Q

What are 2 drawbacks of hydromorphone?

A
  1. Very quick peak
  2. Pronounced Euphoric effects
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9
Q

True or false: fentanyl is very lipophilic

A

True

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10
Q

What is the starting dose for fentanyl?

A

25-100 mcg IV Q1-2H

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11
Q

What are 3 benefits for the use of fentanyl?

A
  1. No significant CV side effects
  2. No H1 release
  3. No active metabolites
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12
Q

What is a drawback with the use of fentanyl?

A

Prolonged sedation effect after turning off the infusion

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13
Q

What opioid analgesic is extremely short acting and goes through plasma esterase hydrolysis?

A

Remifentanil

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14
Q

What opioid analgesic can be used to alleviate postoperative shivering?

A

Meperidine

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15
Q

What opioid analgesic has a high risk of serotonin syndrome when used used with SSRIs and MAOIs?

A

Meperidine

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16
Q

What are 7 non opioid analgesics that can be used?

A
  1. Acetaminophen
  2. Ketorolac
  3. Ketamine
  4. Lidocaine
  5. Bupivacaine
  6. Gabapentin
  7. Carbamazepine
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17
Q

What is Tylenol effective for?

A

Reducing the use of opioids and intensity of pain

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18
Q

What non opioid analgesic is a COX-1 and COX-2 inhibitor?

A

Ketorolac

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19
Q

When can you only use Ketorolac at lower doses?

A

In patients with renal impairment to decrease the risk of renal failure and GI bleed

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20
Q

What can ketamine act as and what does this cause?

A

A sympathomimetic and can cause increased blood pressure and heart rate

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21
Q

What doses of ketamine is used for adjunctive pain control?

A

Low doses

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22
Q

What doses of ketamine are used for sedation?

A

Higher doses

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23
Q

What reactions are more prevalent with higher doses of ketamine?

A

Delirium and hallucinations

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24
Q

What analgesics are used in surgical patients with specific pain sites or for spinal anesthesia?

A

Locally infused anesthetics (lidocaine, bupivacaine)

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25
Q

What analgesics are used for neuropathic pain?

A
  1. Gabapentin
  2. Carbamazepine
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26
Q

What non opioid analgesic must be adjusted in renal patients?

A

Gabapentin

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27
Q

What is the caution for the use of carbamazepine?

A

Many drug interactions

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28
Q

What are the 3 sedative drugs that are used?

A
  1. Benzodiazepines
  2. Propofol
  3. Precedex
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29
Q

What are the 3 benzodiazepines that are used for sedation?

A
  1. Diazepam
  2. Midazolam
  3. Lorazepam
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30
Q

What benzodiazepine has prolonged elimination half life?

A

Diazepam

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31
Q

Where is midazolam metabolized and excreted?

A

Liver; Kidneys

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32
Q

Where does midazolams active metabolite accumulate?

A

In patients with renal impairments

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33
Q

What are 2 side effects of midazolam?

A
  1. Respiratory depression
  2. Hypotension
34
Q

What are the starting doses for midazolam?

A

0.02-0.1 mg/kg/hr (continuous infusion)

35
Q

What benzodiazepine can only be used when the patient is intubated?

A

Midazolam

36
Q

What benzodiazepine is the least lipophilic and has a slower onset of action?

A

Lorazepam

37
Q

What is lorazepam soluable in?

A

Propylene glycol

38
Q

At high doses propylene glycol can accumulate and cause what 2 things?

A
  1. Necrosis
  2. Lactic acidosis
39
Q

What benzodiazepine has a longer emergence?

A

Lorazepam

40
Q

What sedative has GABA agonist and may have NMDA blockade?

A

Propofol

41
Q

What sedative has a quick onset and a short duration?

A

Propofol

42
Q

True or false: propofol is very lipophilic and can cross the BBB quickly and rapidly

A

True

43
Q

Long term use of propofol can cause what?

A

Prolonged emergence

44
Q

What are 4 ADRS of propofol?

A
  1. Hypotension
  2. Respiratory depression
  3. Increased triglycerides
  4. PRIS
45
Q

What are the starting doses of propofol?

A

5-50 mcg/kg/min

46
Q

What 2 things is PRIS usually associated with?

A
  1. Higher doses (>70 mcg/kg/min)
  2. Longer duration (>48 hour infusion)
47
Q

When should you stop propofol and reevaluate your sedation plan?

A

When TG>500

48
Q

What is the MOA of precedex?

A

Alpha-2 agonist

49
Q

Precedex promotes anxiolytics and sedation but does not cause what?

A

Respiration Depression

50
Q

What is Precedex used for?

A

Light sedation

51
Q

What is Precedex approved for?

A

Use in non-intubated ICU patients, can be continued following extubation

52
Q

What is the dosing range for Precedex?

A

0.2-1.5 mcg/kg/hour

53
Q

What sedatives are used to improve outcomes in mechanically ventilated ICU patients?

A

Propofol and Precedex

54
Q

Patients on Precedex can have a longer time to emergence if they have what organ impaired?

A

Liver

55
Q

What are the 5 benefits of using Precedex as a sedative?

A
  1. Less delirium
  2. Decreased time to extubation
  3. Some analgesic properties
  4. Opioid sparing
  5. No respiratory depression
56
Q

What are benzodiazepines associated with?

A
  1. Longer ICU length of stay
  2. Longer time to vent
  3. More delirium
57
Q

Propofol compared to benzos is associated with what 2 things?

A
  1. Shorter time to light sedation
  2. Shorter time to extubation
58
Q

Precedex compared to benzos is associated with what 3 things?

A
  1. Shorter duration of ventilation
  2. Shorter ICU length of stay
  3. Less delirium
59
Q

What 2 things is delirium associated with?

A
  1. Increased cognitive impairment
  2. Longer length of stay
60
Q

What are 2 ways patients can present with delirium in the ICU?

A
  1. Agitated, hyperactive delirium
  2. Lethargic/calm, hypoactive delirium
61
Q

What are 2 things that are considered as hyperactive delirium?

A
  1. Hallucinations
  2. Delusions
62
Q

What are 2 things that are associated with hypoactive delirium?

A
  1. Confusion
  2. Sedation
63
Q

Most commonly used drug to treat ICU delirium

A

Haloperidol

64
Q

What are 2 drawbacks that are associated with Haloperidol?

A
  1. EPS
  2. QT Prolongation
65
Q

What is the starting dose for the use of haloperidol?

A

0.5-5 mg IV Q6H

66
Q

What are 2 other antipsychotics that could be used to reduce delirium?

A
  1. Quetiapine
  2. Olanzapine
67
Q

What are 3 things to consider for the use of quetiapine?

A
  1. Risk of QT prolongation
  2. Shorter t 1/2
  3. Better for as needed doses throughout the day
68
Q

What are 3 things to consider for the use of olanzapine?

A
  1. Slightly decreased risk of QT prolongation
  2. Longer t 1/2
  3. Available as ODT
69
Q

What is done to reduce the incidence and length of delirium?

A

Early mobilization

70
Q

True or false: prophylactic drugs can be used in ICU patients to help reduce the incidence of delirium

A

False

71
Q

What are 6 strategies that can be used to decrease the frequency and lessen the severity of delirium?

A

A. Assess, prevent, and manage pain
B. Both SAT and SBT (spontaneous awakening trials + spontaneous breathing trials)
C. Choice of analgesia and sedation
D. Delirium (same as A)
E. Early mobility and exercise
F. Family engagement

72
Q

What is the first step in effectively sedating critically ill patients?

A

Pain management

73
Q

If patients are able to accurately communicate, what should be used for patients to describe their pain?

A

Self reported pain with a 0-10 numeric rating

74
Q

What are the 2 most valid and reliable scales for monitoring pain in ICU patients?

A
  1. BPS
  2. CPOT
75
Q

A BPS score of __ means the patient is in excruciating pain

A

12

76
Q

What scores on both BPS and CPOT indicate no/minor pain?

A

BPS: 3-4
CPOT: 0-2

77
Q

What scores on both BPS and CPOT indicate moderate pain?

A

BPS: 5-7
CPOT: 3-4

78
Q

What should you treat minor/moderate pain with when possible?

A

Non-opioids

79
Q

What RIKER score shows that the patient is lightly sedated?

A

3-4

80
Q

What RIKER score shows that the patient is deeply sedated?

A

1-2

81
Q

What RASS scores shows that the patient is lightly sedated?

A

0, -1, -2

82
Q

What RASS scores shows that the patient is deeply sedated?

A

-3,-4,-5

Critically Ill Exam 2 (7 decks)

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