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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
What analgesics are used for neuropathic pain?
1. Gabapentin 2. Carbamazepine
26
What non opioid analgesic must be adjusted in renal patients?
Gabapentin
27
What is the caution for the use of carbamazepine?
Many drug interactions
28
What are the 3 sedative drugs that are used?
1. Benzodiazepines 2. Propofol 3. Precedex
29
What are the 3 benzodiazepines that are used for sedation?
1. Diazepam 2. Midazolam 3. Lorazepam
30
What benzodiazepine has prolonged elimination half life?
Diazepam
31
Where is midazolam metabolized and excreted?
Liver; Kidneys
32
Where does midazolams active metabolite accumulate?
In patients with renal impairments
33
What are 2 side effects of midazolam?
1. Respiratory depression 2. Hypotension
34
What are the starting doses for midazolam?
0.02-0.1 mg/kg/hr (continuous infusion)
35
What benzodiazepine can only be used when the patient is intubated?
Midazolam
36
What benzodiazepine is the least lipophilic and has a slower onset of action?
Lorazepam
37
What is lorazepam soluable in?
Propylene glycol
38
At high doses propylene glycol can accumulate and cause what 2 things?
1. Necrosis 2. Lactic acidosis
39
What benzodiazepine has a longer emergence?
Lorazepam
40
What sedative has GABA agonist and may have NMDA blockade?
Propofol
41
What sedative has a quick onset and a short duration?
Propofol
42
True or false: propofol is very lipophilic and can cross the BBB quickly and rapidly
True
43
Long term use of propofol can cause what?
Prolonged emergence
44
What are 4 ADRS of propofol?
1. Hypotension 2. Respiratory depression 3. Increased triglycerides 4. PRIS
45
What are the starting doses of propofol?
5-50 mcg/kg/min
46
What 2 things is PRIS usually associated with?
1. Higher doses (>70 mcg/kg/min) 2. Longer duration (>48 hour infusion)
47
When should you stop propofol and reevaluate your sedation plan?
When TG>500
48
What is the MOA of precedex?
Alpha-2 agonist
49
Precedex promotes anxiolytics and sedation but does not cause what?
Respiration Depression
50
What is Precedex used for?
Light sedation
51
What is Precedex approved for?
Use in non-intubated ICU patients, can be continued following extubation
52
What is the dosing range for Precedex?
0.2-1.5 mcg/kg/hour
53
What sedatives are used to improve outcomes in mechanically ventilated ICU patients?
Propofol and Precedex
54
Patients on Precedex can have a longer time to emergence if they have what organ impaired?
Liver
55
What are the 5 benefits of using Precedex as a sedative?
1. Less delirium 2. Decreased time to extubation 3. Some analgesic properties 4. Opioid sparing 5. No respiratory depression
56
What are benzodiazepines associated with?
1. Longer ICU length of stay 2. Longer time to vent 3. More delirium
57
Propofol compared to benzos is associated with what 2 things?
1. Shorter time to light sedation 2. Shorter time to extubation
58
Precedex compared to benzos is associated with what 3 things?
1. Shorter duration of ventilation 2. Shorter ICU length of stay 3. Less delirium
59
What 2 things is delirium associated with?
1. Increased cognitive impairment 2. Longer length of stay
60
What are 2 ways patients can present with delirium in the ICU?
1. Agitated, hyperactive delirium 2. Lethargic/calm, hypoactive delirium
61
What are 2 things that are considered as hyperactive delirium?
1. Hallucinations 2. Delusions
62
What are 2 things that are associated with hypoactive delirium?
1. Confusion 2. Sedation
63
Most commonly used drug to treat ICU delirium
Haloperidol
64
What are 2 drawbacks that are associated with Haloperidol?
1. EPS 2. QT Prolongation
65
What is the starting dose for the use of haloperidol?
0.5-5 mg IV Q6H
66
What are 2 other antipsychotics that could be used to reduce delirium?
1. Quetiapine 2. Olanzapine
67
What are 3 things to consider for the use of quetiapine?
1. Risk of QT prolongation 2. Shorter t 1/2 3. Better for as needed doses throughout the day
68
What are 3 things to consider for the use of olanzapine?
1. Slightly decreased risk of QT prolongation 2. Longer t 1/2 3. Available as ODT
69
What is done to reduce the incidence and length of delirium?
Early mobilization
70
True or false: prophylactic drugs can be used in ICU patients to help reduce the incidence of delirium
False
71
What are 6 strategies that can be used to decrease the frequency and lessen the severity of delirium?
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
What is the first step in effectively sedating critically ill patients?
Pain management
73
If patients are able to accurately communicate, what should be used for patients to describe their pain?
Self reported pain with a 0-10 numeric rating
74
What are the 2 most valid and reliable scales for monitoring pain in ICU patients?
1. BPS 2. CPOT
75
A BPS score of __ means the patient is in excruciating pain
12
76
What scores on both BPS and CPOT indicate no/minor pain?
BPS: 3-4 CPOT: 0-2
77
What scores on both BPS and CPOT indicate moderate pain?
BPS: 5-7 CPOT: 3-4
78
What should you treat minor/moderate pain with when possible?
Non-opioids
79
What RIKER score shows that the patient is lightly sedated?
3-4
80
What RIKER score shows that the patient is deeply sedated?
1-2
81
What RASS scores shows that the patient is lightly sedated?
0, -1, -2
82
What RASS scores shows that the patient is deeply sedated?
-3,-4,-5

Critically Ill Exam 2 (7 decks)

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