Critical care pharmacology PPT

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Flashcards based on ICU Pharmacology lecture notes.

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51 Terms

1
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What are sedatives used for in the ICU?

Reduce anxiety and agitation, promote sleep, and anterograde amnesia

2
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Name some common Benzodiazepines used in the ICU

Diazepam, Midazolam, Lorazepam

3
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What is an anxiolytic?

Reduces anxiety and causes calm and quietness

4
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What is a sedative?

Decreases activity and calms the patient

5
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What is a hypnotic?

Produces drowsiness and facilitates a state of natural sleep

6
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What is the new goal of sedation?

Sleepy but arousable patient

7
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What was the old goal of sedation?

Completely obtundedand unresponsive patient.

8
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What are some causes of agitation in the ICU?

Pain, anxiety, delirium, fear, sleep deprivation, patient-ventilator interactions, encephalopathy, withdrawal, depression, ICU psychosis

9
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What are the four levels of sedation?

Minimal, Moderate (conscious sedation), Deep, Anesthesia

10
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Describe minimal sedation

Patients can respond to verbal commands, although cognitive function may be impaired

11
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Describe moderate sedation

The patient can perform purposeful response following repeated or painful stimulation

12
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Describe deep sedation

The patient is not easily aroused but can respond to painful stimulation

13
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Describe anesthesia

Patient cannot be aroused, even by painful stimulation

14
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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

15
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Besides Ramsay Sedation Scale, what are some other scales to monitor sedation?

Motor Activity Assessment Scale (MAAS), Sedation-Agitation Scale (SAS), Comfort Scale

16
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Name three common Benzodiazepines

Diazepam (Valium), Midazolam (Versed), Lorazepam (Ativan)

17
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What is a characteristic of Diazepam (Valium)?

Rapid onset of action because of its high lipid solubility

18
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What is a characteristic of Midazolam (Versed)?

Rapid onset of action and short half-life

19
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What is a characteristic of Lorazepam (Ativan)?

Drug of choice for sedating mechanically ventilated patients in the ICU for longer than 24 hours

20
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What is Dexmedetomidine used for?

Used for short-term sedation and analgesia in the ICU.

21
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What is Haloperidol (Haldol) used for?

Specifically used to treat patients demonstrating evidence of extreme agitation and delirium

22
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What is equianalgesic dosing?

A dose of one analgesic that is equivalent in pain-relieving effects to that of another analgesic

23
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What are Barbiturates used for?

Sleep induction, anxiety relief, seizure disorder treatment

24
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What are the properties of Propofol (Diprivan)?

Sedative, anesthetic, amnesic (hypnotic), anticonvulsant

25
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What are some side effects of Propofol?

Respiratory and CV depression

26
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What was the conclusion of the Diprivan vs. Versed sedation studies?

Similar times to sedation, faster wake-up time with Propofol

27
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What is Midazolam (Versed) used for?

Acute seizures, moderate to severe insomnia, for inducing conscious sedation before surgery

28
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What are the extrapyramidal effects of Haldol?

Sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes

29
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What does pain lead to in the ICU?

Pain, catabolism, ileus, ADH release, immune dysregulation, hypercoaguable state

30
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Name some common opioid analgesics

Morphine, Fentanyl

31
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Why is Morphine a preferred agent?

Preferred agent for intermittent therapy because of its longer duration of action

32
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What is a defining trait of Fentanyl?

A synthetic opioid that is approximately 100 to 150 times more potent than morphine

33
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What causes pain in the ICU?

Lines, tubes, underlying illness, interventions, back pain

34
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How are analgesic opioids metabolized?

Metabolized by the liver, excreted in the urine

35
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What is a risk with Morphine?

Potential for histamine release and hypotension

36
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What are some key characteristics of Fentanyl?

Lipid soluble, 100X potency of MSO4, more rapid onset, no histamine release

37
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Why is Demerol not a good analgesic?

Not a good analgesic, potential for abuse, hallucinations

38
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What are some adverse effects of analgesic opioids?

Respiratory depression, hypotension, decreased GI motility, pruritis

39
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As what is Ketamine classified?

NMDA receptor antagonist

40
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What are some effects of dissociative anesthesia?

Analgesia and amnesia with minimal effect on respiratory function

41
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What are some side effects of Ketorolac (Toradol)?

Renal failure, thrombocytopenia, gastritis

42
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How do depolarizing paralytic agents work?

Resemble acetylcholine in their chemical structure

43
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How do non-depolarizing paralytic agents work?

Bind to acetylcholine receptors but cause paralysis by competitively inhibiting the action of acetylcholine

44
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What are paralytics used for?

Facilitate invasive procedures and to prevent movement and ensure the stability of artificial airways

45
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Give an example of a depolarizing agent

Succinylcholine

46
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Give an example of a non-depolarizing agent

Pancuronium, Vecuronium, Atracurium, Cistracurium, Rocuronium

47
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What causes persistent neuromuscular blockade?

Drug accumulation in critically ill patients

48
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What medication should always follow paralytic use?

A patient who receives a paralytic should always receive a sedative

49
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How should neuromuscular blockade be monitored?

Train-of-four (TOF) monitoring

50
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What is the purpose of Neuroleptics?

Modify or treats psychotic behaviors usually by blocking dopamine receptors

51
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What are the properties of Haldol

Anti-psychotic tranquilizer