Critical care pharmacology PPT

Flashcards based on ICU Pharmacology lecture notes.

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