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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
Which benzos have metabolites that accumulate in renal impairment?
1. Diazepam 2. Midazolam 3. Lorazepam (PROPYLENE GLYCOL)
26
What is dosing for Midazolam?
0.02-0.1mg/kg/h
27
What is dosing for Lorazepam?
infusion: 0.01-0.1 mg/kg/h PRN: 0.02-0.06 mg/kg Q2H
28
What does propylene glycol accumulation with high doses of Lorazepam lead to?
1. acute tubular necrosis 2. lactic acidosis
29
What are SEs with benzos?
1. respiratory depression 2. hypotension
30
What sedatives require the patient to be intubated?
1. Midazolam 2. Propofol
31
What is dosing for Propofol?
5-50mcg/kg/min
32
What are SEs of Propofol?
1. severe hypotension 2. respiratory depression 3. increased TGs/ pancreatitis 4. PRIS
33
What is PRIS?
Propofol Infusion Symdrome: life-threatening syndrome resulting in metabolic acidosis, rhabdomyolysis, myocardial failure, fatal arrhythmias, AKI, hyperkalemia, and liver dysfunction
34
What dosage of Propofol is PRIS most associated with?
1. >70mcg/kg/min 2. >48h
35
What is the role of Dexedetomidine PRECEDEX in sedation?
1. light sedation in non-intubated patients 2. associated with less delirium than benzos
36
What are SEs with Dexedetomidine PRECEDEX?
1. hypotension 2. bradycardia
37
What is dosing of Dexedetomidine PRECEDEX?
0.2-1.5 mcg/kg/h
38
What agents are used for ICU delirium?
1. Haloperidol 2. Quetiapine 3. Olanzapine
39
What are SEs with Haloperidol?
1. EPS 2. QTc prolongation 3. fatal arrhythmias
40
What are SEs with atypical antipsychotics?
risk of QTc prolongation
41
How do we prevent ICU delirium?
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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