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Critically Ill > Sedation, Analgesia, Delirium > Flashcards

Sedation, Analgesia, Delirium Flashcards

1
Q

What are SEs with opioid analgesics?

A
  1. respiratory depression
  2. hypotension- hemodynamic instabilities
  3. decreased level of consciousness
  4. constipation
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2
Q

What is a typical and high dose of Morphine?

A

typical: 1-4mg
high dose: 10mg

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3
Q

How much Hydropmorphone is equivalent to 10mg IV Morphine?

A

1.5mg

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4
Q

What is a typical and high dose of Hydromorphone?

A

typical: 0.2-0.4
high dose: 4mg

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5
Q

What is a typical and high dose of Fentanyl?

A

typical: 25-100mcg IV
High dose: 200mcg+

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6
Q

How much Fentanyl is equivalent to 10mg Morphine?

A

200 mcg

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7
Q

Which IV opioid is most likely to cause hypotension?

A

Morphie

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8
Q

What IV opioid has active metabolites that accumulate with renal dysfunction?

A

Morphine

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9
Q

What are the options for non-opioid analgesics?

A
  1. Acetaminophen
  2. Ketolorac (Toradol)
  3. Ketamine
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10
Q

What opioid is only used for post-operative shivering?

A

Meperidine DEMEROL

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11
Q

What are risks with Meperidine DEMEROL?

A
  1. neurotoxic metabolite-induced delirium, tremor, seizures
  2. high risk of serotonin syndromes with SSRIs and MAOIs
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12
Q

Why is Ketamine for sedation not the best option in patients with high BP/HR?

A

can act as a sympathomimetic and lead to increased BP and HR

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13
Q

What are the options for treatment of neuropathic pain?

A
  1. Gabapentin NEURONTIN
  2. Carbamazepine TEGRETOL
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14
Q

What is the dosing for APAP?

A

650-1000mg Q6H prn mild pain

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15
Q

What is dosing for Ketorolac?

A

15-30mg IV Q6H max. 5 days

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16
Q

What patients should Ketorolac be used with caution in?

A

increased risk of GI bleed or renal impairment

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17
Q

What is dosing for Ketamine as an analgesic?

A

0.5mg/kg IV x 1,
then 0.05-0.25 mcg/kg.h

18
Q

What is dosing for ketamine for sedation?

A

2.5 mg/kg/h

19
Q

What reactions are at increased risk of occurring when using sedation doses of ketamine?

A

emergence delirium and hallucinations

20
Q

What agents are locally infused anesthetics?

A
  1. Bupivacaine
  2. Lidocaine
21
Q

What is dosing for Gabapentin?

A

100mg PO TID
max 3600mg (requires renal adjustment)

22
Q

What is dosing for Carbamazepine?

A

50-100mg PO TID
max dose 1200mg

23
Q

What kind of benzo dosing is associated with increased delirium?

A

PRN bolus dosing

24
Q

All benzos are metabolized by what?

A

liver; reduced clearance in hepatic patients

25
Q

Which benzos have metabolites that accumulate in renal impairment?

A
  1. Diazepam
  2. Midazolam
  3. Lorazepam (PROPYLENE GLYCOL)
26
Q

What is dosing for Midazolam?

A

0.02-0.1mg/kg/h

27
Q

What is dosing for Lorazepam?

A

infusion: 0.01-0.1 mg/kg/h
PRN: 0.02-0.06 mg/kg Q2H

28
Q

What does propylene glycol accumulation with high doses of Lorazepam lead to?

A
  1. acute tubular necrosis
  2. lactic acidosis
29
Q

What are SEs with benzos?

A
  1. respiratory depression
  2. hypotension
30
Q

What sedatives require the patient to be intubated?

A
  1. Midazolam
  2. Propofol
31
Q

What is dosing for Propofol?

A

5-50mcg/kg/min

32
Q

What are SEs of Propofol?

A
  1. severe hypotension
  2. respiratory depression
  3. increased TGs/ pancreatitis
  4. PRIS
33
Q

What is PRIS?

A

Propofol Infusion Symdrome:
life-threatening syndrome resulting in metabolic acidosis, rhabdomyolysis, myocardial failure, fatal arrhythmias, AKI, hyperkalemia, and liver dysfunction

34
Q

What dosage of Propofol is PRIS most associated with?

A
  1. > 70mcg/kg/min
  2. > 48h
35
Q

What is the role of Dexedetomidine PRECEDEX in sedation?

A
  1. light sedation in non-intubated patients
  2. associated with less delirium than benzos
36
Q

What are SEs with Dexedetomidine PRECEDEX?

A
  1. hypotension
  2. bradycardia
37
Q

What is dosing of Dexedetomidine PRECEDEX?

A

0.2-1.5 mcg/kg/h

38
Q

What agents are used for ICU delirium?

A
  1. Haloperidol
  2. Quetiapine
  3. Olanzapine
39
Q

What are SEs with Haloperidol?

A
  1. EPS
  2. QTc prolongation
  3. fatal arrhythmias
40
Q

What are SEs with atypical antipsychotics?

A

risk of QTc prolongation

41
Q

How do we prevent ICU delirium?

A

Assess, prevent, manage pain
Both SAT and SBT (sedation vacay)
Choice of analgesia and sedation
Delirium assess, prevent, manage
Early mobility
Family engagement

Critically Ill (20 decks)

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