Thera Test 4 Sedation And Analgesia

Front 1

what are the 1st line opioids for analgesia

Back 1

morphine
hydromorphone
fentanyl

Front 2

what are the equivalent doses of morphine, hydromorphone, fentanyl

Back 2

morphine: 10mg
hydromorphone 1.5mg
fentanyl: 0.1mg

Front 3

what is the main SE of morphine

Back 3

histamine release (avoid in hemodynamically unstable patients)

Front 4

what is the man SE of fentanyl

Back 4

muscle rigidity @ high doses

Front 5

Jen is in pain and requires a IVP dose of morphine every 30 minutes what should be done

Back 5

if pt needs IVP doses more often than 2 hrs give CONTINUOUS INFUSION OF OPIOID

Front 6

what can be done to treat the Respiratory/CNS depression when patients use opioids for pain

Back 6

naloxone 0.4mg as needed
-dilute to 10ml in 0.9% NaCl and give in 0.5ml increments

Front 7

what can be done to prevent/manage physical dependence to opioids

Back 7

daily analgesic interruption
systematic titration

Front 8

what is PCA by proxy

Back 8

when family members are administering the PCA for the pt this can lead to OD

Front 9

which opioids should be avoided

Back 9

meperidine
codeine
mixed opioid agonist-antagonist

Front 10

what are the AE of meperidine

Back 10

neuroexcitation
seizures
accumulates with repetitive dosing and can lead to renal insufficiency

Front 11

what are the mixed opioid agonist-antagonist

Back 11

nalbuphine
butorphenol
buprenorphine

-may elicit withdrawal symptoms

Front 12

what are the NSAIDS used for treatment of pain

Back 12

ketorlac
ibuprofen
naproxen

Front 13

what are the AE of NSAIDS

Back 13

GI bleed
renal impairment
platelet inhibition

Front 14

what are the APAP used in pain use

Back 14

IV - ofirmev
PO - tylenol

Front 15

what are the AE of APAP drugs

Back 15

liver toxicity - therefore avoid in cirrhosis patients or those with history of chronic alcohol abuse

Front 16

what is the preferred method of administering opioids

Back 16

IV Push or continuous infusion instead of giving on a "as needed basis"

Front 17

what is the preferred opioid for analgesia in acute distress

Back 17

fentanyl

Front 18

what is the preferred opioid for hemodynamic or renal insufficiency

Back 18

fentanyl or hydromorphone

Front 19

what is the preferred opioid for scheduled intermittent therapy

Back 19

morphine or hydromorphone

Front 20

delerium is anxiety or agitation

Back 20

agitation

Front 21

pain is anxiety or agitation

Back 21

agitation

Front 22

hypoxia/hypotension/hypoglycemia are anxiety or agitation

Back 22

agitation

Front 23

drug AE are anxiety or agitation

Back 23

agitation

Front 24

sleep deprivation are anxiety or agitation

Back 24

anxiety

Front 25

what are the consequences of Anxiety/Agitation

Back 25

removal of therapeutic devices
PTSD/unpleasant recall
increased O2 consumption
ventilator dysynchrony

Front 26

deep sedation is typically for

Back 26

severe respiratory failure

Front 27

light sedation is typically for

Back 27

to prevent mild anxiety or agitation

Front 28

what are the drug options for sedation

Back 28

BZD - midazolam, lorazepam, diazepam
Propofol
Dexmedetomidine

Front 29

what are the properties of BZDs in general

Back 29

sedative and hypnotic activity
promote anterograde amnesia

Front 30

how is midazolam eliminated

Back 30

renally

Front 31

what sedative can't be given to patient suffering from renal failure

Back 31

midazolam (renally eliminated)

Front 32

what is the preferred agent for intermitten dosing in ongoing sedation

Back 32

lorazepam

Front 33

what are the SE of lorazepam

Back 33

due to its PEG vehicle
-renal insufficiency, lactic acidosis, hyperosmolar state
-this occurs with prolonged infusions or high doses

Front 34

what is the preferred agent when rapid awakening is needed

Back 34

propofol

Front 35

what are the properties of propofol

Back 35

promotes amnesia
rapid onset short duration

Front 36

at high doses propofol acts as a
at low doses propofol acts as a

Back 36

high doses - general anesthetic
low doses - sedative/hypnotic

Front 37

Jane is suffering from pain due to increase intraocular pressure what agent can be used for sedation

Back 37

propfol - can treat high intraocular pressure

Front 38

what sedative can also manage refractory SE

Back 38

propofol

Front 39

what sedative requires dedicated IV catheter

Back 39

propofol

Front 40

what are the SE of Propofol

Back 40

Respiratory depression
Cardiovascular depression
Hypertriglyceridemia
Propofol infusion syndrome

Front 41

what are signs of Propofol Infusion Syndrome

Back 41

metabolic acidosis
cardiact arrest
dislipidemia
acute renal failure
rhabdomyolysis
hypotension

Front 42

what dose of propofol is associated with Propofol Infusion Syndrome

Back 42

>5mg/kg/hr for a duration of 48 hrs

Front 43

what sedative has analgesia properties

Back 43

Dexmedetomidine

Front 44

what sedative has anxiolysis

Back 44

dexmedetomidine

Front 45

what is Dexmedetomidine FDA approved for

Back 45

sedation of initially mechanically ventilated patients during treatment in the ICU for < 24 hrs

Front 46

what are the SE of Dexmedetomidine

Back 46

hypotension
dry mouth
bradycardia

Front 47

what sedative doesn't have respiratory depression

Back 47

dexmedetomidine

Front 48

what sedative can be used to fascilitate weaning off of ventilator

Back 48

dexmedetomidine

Front 49

if patient has ACUTE AGITATION what should you give them

Back 49

Midazolam 2-5 mg IVP q 5-15 min until event controlled

Front 50

for short term sedation < 24 hrs what are you options

Back 50

propofol
midazolam
dexmedetomidine

Front 51

for intermediate sedation (24-72 hrs) what are your options

Back 51

propofol
lorazepam
midazolam

Front 52

for long term sedation (>72 hrs) what are your options

Back 52

lorazepam