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Flashcards based on ICU Pharmacology lecture notes.
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What are sedatives used for in the ICU?
Reduce anxiety and agitation, promote sleep, and anterograde amnesia
Name some common Benzodiazepines used in the ICU
Diazepam, Midazolam, Lorazepam
What is an anxiolytic?
Reduces anxiety and causes calm and quietness
What is a sedative?
Decreases activity and calms the patient
What is a hypnotic?
Produces drowsiness and facilitates a state of natural sleep
What is the new goal of sedation?
Sleepy but arousable patient
What was the old goal of sedation?
Completely obtundedand unresponsive patient.
What are some causes of agitation in the ICU?
Pain, anxiety, delirium, fear, sleep deprivation, patient-ventilator interactions, encephalopathy, withdrawal, depression, ICU psychosis
What are the four levels of sedation?
Minimal, Moderate (conscious sedation), Deep, Anesthesia
Describe minimal sedation
Patients can respond to verbal commands, although cognitive function may be impaired
Describe moderate sedation
The patient can perform purposeful response following repeated or painful stimulation
Describe deep sedation
The patient is not easily aroused but can respond to painful stimulation
Describe anesthesia
Patient cannot be aroused, even by painful stimulation
Describe the Ramsay Sedation Scale (RSS)
A graduated single-category scale where the grade assigned by the observer depends on the patient’s response to stimuli
Besides Ramsay Sedation Scale, what are some other scales to monitor sedation?
Motor Activity Assessment Scale (MAAS), Sedation-Agitation Scale (SAS), Comfort Scale
Name three common Benzodiazepines
Diazepam (Valium), Midazolam (Versed), Lorazepam (Ativan)
What is a characteristic of Diazepam (Valium)?
Rapid onset of action because of its high lipid solubility
What is a characteristic of Midazolam (Versed)?
Rapid onset of action and short half-life
What is a characteristic of Lorazepam (Ativan)?
Drug of choice for sedating mechanically ventilated patients in the ICU for longer than 24 hours
What is Dexmedetomidine used for?
Used for short-term sedation and analgesia in the ICU.
What is Haloperidol (Haldol) used for?
Specifically used to treat patients demonstrating evidence of extreme agitation and delirium
What is equianalgesic dosing?
A dose of one analgesic that is equivalent in pain-relieving effects to that of another analgesic
What are Barbiturates used for?
Sleep induction, anxiety relief, seizure disorder treatment
What are the properties of Propofol (Diprivan)?
Sedative, anesthetic, amnesic (hypnotic), anticonvulsant
What are some side effects of Propofol?
Respiratory and CV depression
What was the conclusion of the Diprivan vs. Versed sedation studies?
Similar times to sedation, faster wake-up time with Propofol
What is Midazolam (Versed) used for?
Acute seizures, moderate to severe insomnia, for inducing conscious sedation before surgery
What are the extrapyramidal effects of Haldol?
Sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes
What does pain lead to in the ICU?
Pain, catabolism, ileus, ADH release, immune dysregulation, hypercoaguable state
Name some common opioid analgesics
Morphine, Fentanyl
Why is Morphine a preferred agent?
Preferred agent for intermittent therapy because of its longer duration of action
What is a defining trait of Fentanyl?
A synthetic opioid that is approximately 100 to 150 times more potent than morphine
What causes pain in the ICU?
Lines, tubes, underlying illness, interventions, back pain
How are analgesic opioids metabolized?
Metabolized by the liver, excreted in the urine
What is a risk with Morphine?
Potential for histamine release and hypotension
What are some key characteristics of Fentanyl?
Lipid soluble, 100X potency of MSO4, more rapid onset, no histamine release
Why is Demerol not a good analgesic?
Not a good analgesic, potential for abuse, hallucinations
What are some adverse effects of analgesic opioids?
Respiratory depression, hypotension, decreased GI motility, pruritis
As what is Ketamine classified?
NMDA receptor antagonist
What are some effects of dissociative anesthesia?
Analgesia and amnesia with minimal effect on respiratory function
What are some side effects of Ketorolac (Toradol)?
Renal failure, thrombocytopenia, gastritis
How do depolarizing paralytic agents work?
Resemble acetylcholine in their chemical structure
How do non-depolarizing paralytic agents work?
Bind to acetylcholine receptors but cause paralysis by competitively inhibiting the action of acetylcholine
What are paralytics used for?
Facilitate invasive procedures and to prevent movement and ensure the stability of artificial airways
Give an example of a depolarizing agent
Succinylcholine
Give an example of a non-depolarizing agent
Pancuronium, Vecuronium, Atracurium, Cistracurium, Rocuronium
What causes persistent neuromuscular blockade?
Drug accumulation in critically ill patients
What medication should always follow paralytic use?
A patient who receives a paralytic should always receive a sedative
How should neuromuscular blockade be monitored?
Train-of-four (TOF) monitoring
What is the purpose of Neuroleptics?
Modify or treats psychotic behaviors usually by blocking dopamine receptors
What are the properties of Haldol
Anti-psychotic tranquilizer