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Sedation 2009
Willet MCPHS Spring 2009
| Question | Answer |
|---|---|
| Opiods | analgesia, respiratory depression, No amnesia, no sedation, constipation, Nausea, |
| benzo's | no analgesia, respiratory depression, amnesia, sedation, delirum , decrease BP, tolerance, |
| propofol | no analgesia, respiratory depression, amenesia, sedation, decreases blood pressure and heart rate, decrease ICP, increases TG's & risk of pancreatitis |
| dexmedtomidine (precedex) | analgesic (lower opiod dose), no repiratory depression, no amnesia, sedation, transient hypertension with bolus, hypotension and bradycardia with infusion |
| morphine (ms contin, avinza,kadian) | histamine relase, decreases BP, don't use if patient is unstable, hypotensive, or has renal or hepatic failure. Good choice for someone with hypertension and doesn't need very fast acute pain relief. |
| hydromorphone Dilaudid | choose if the paitent is unstable. Don't choose if patient has renal or hepatic failure |
| fentanyl Duragesic or sublimaze | good in renal dysfucntion and when need fast pain relief, it is given as drip because short DOA |
| what is the reversal agent for opiods | naloxone (narcan) |
| what is the reversla agen for propylene glycol | fomepizole (antizol) |
| what is the reversal agent for benzos | flumaemil (romazicon) |
| which drugs lack amnesia | precedex and opiods |
| which drugs are short acting for sedative (do good for daily awakenings) | propofol(15 mins) midazolam (2 hours) both are infused |
| which drugs for sedation have quick onset (good for acute sedation) | midazolam (1-5 minutes) Propofol (1-2 mins) |
| which drugs are in propylene glycol | lorazepam and diazepam |
| which drugs has nich in neuro patients and decrease ICP also in lipid emulsion and should not be used in HYPOtensive patients | propofol |
| which drug has nich in cardio thoraci paitents | dexmedtomidine precedex |
| used to facilitate intubation, very shortacting, can cause malignant hyperthermia, hyperkalemia, and NMS (neurolyptic malignant syndrome) | succinylcholine (depolorizing) |
| reversal agents for non depolarizing NMB | pyridostigmine (mestinon) or Neostigmine (prostigmin) |
| which NMB do you use in ESRD or Hepatic dysfunction | cisatracurium |
| which NMB has no vagolytic or histamine release therefor no effect on BP | vecuronium |
| which NMBA has a long DOA | pancuronium |
| which NMB has an active metabolite that could cause seizures | atracurium |
| what is the goal for the SAS riker sedation agitation scale | 3 or 4 |
| what is the goal for the RAAS richmond agitation sedation scale | -2 to -3 |
| what is the BIS This is the only objective way to measure sedation | bispectral index and your goal is <40. useful when somebody is on a paralytic mostly in general anesthesia but increase in ICU |
| when is the CAM-ICU scale used | it is used to test for 4 phases delirium. fluctuation in mental status, inattention, disorganized thinking, altered level of consciousness (lethargy) ahve delirium if 3 or more are present |
| 1st line drug for delirum is | haloperidol (haldol) it is a sedative that has 20 min onset given intermitent bolus but cause no respiratory depression |
| 2nd line drugs for delirum given when have risk for TdP or QT prolongation EPS or PD | use zyprexa |
| what are the sign associated with hypoactive delirium | depression, slurred speech, lethargy, apathy, altered sleep patterns, and flat affect |
| what is agitation | anxiety plus motor component |
| what are some reason people get sedation in the ICU | #1 pain, agitation, anxiety, sleep, help with ventilation, improve care, provide amnesia |
Created by:
lainylaina