Term
| short term inadequate sedation and analgesia |
|
Definition
| increased stress response (increased O2 needs, persistent catabolism, immunosuppression) |
|
|
Term
| long term inadequate sedation and analgesia |
|
Definition
| PTSD, traumatic flashbacks, depression |
|
|
Term
|
Definition
| increased duration of mechanical ventilation nand longer ICU stay; increased risk of DVTs and VAP; Inability to communicate |
|
|
Term
| Used in ventilated patients for pain evaluation |
|
Definition
| Critical-Care Pain Observation Tool (CPOT) and Behavior Pain Scale (BPS) |
|
|
Term
| mainstay of pharmacologic pain management in the ICU |
|
Definition
|
|
Term
| desirable properties of an opioid for ICU use |
|
Definition
| rapid onset, easy Titratable, lack active metabolites, readily available |
|
|
Term
| continuous IV infusion or Patient Controlled Analgesia (PCA) |
|
Definition
| morphine, hydromorphone, fentanyl |
|
|
Term
|
Definition
| morphine, hydromorphone, oxycodone |
|
|
Term
| hydrophilic, prolonged duration of action, accumulation of active metabolites, promotion of histamine release causing vasodilation and hypotension |
|
Definition
|
|
Term
|
Definition
| not recommended in patients with renal dysfunction or hemodynamic instability |
|
|
Term
|
Definition
|
|
Term
| ten times more potent than morphine, does not induce histamine release, inactive metabolites |
|
Definition
|
|
Term
|
Definition
| safe in patients with hemodynamic instability or renal dysfunction |
|
|
Term
| highly lipophilic, fast acting -->rapid titration; short duration of action; no active metabolite, safe in renal dysfunction |
|
Definition
|
|
Term
|
Definition
| little effect on cardiovascular system, can be used in hemodynamically unstable patients |
|
|
Term
| tachyphylaxis in fentanyl |
|
Definition
| occurs in chronic exposure, increase dose or switch to another agent |
|
|
Term
|
Definition
| centrally mediated, dose dependent decrease in both respiratory rate and tidal volume, clinically significant hypoxemia is uncommon--- caution in chronic hypercapnic patients ** |
|
|
Term
|
Definition
| mild decrease in blood pressure and heart rate, usually well tolerated (except in patients with hypovolemia or heart failure) |
|
|
Term
|
Definition
| reduced peristalsis leading to impaired tolerance to enteral feedings and ileus |
|
|
Term
| opioid sparing, no effect on respiration; inhibits platelet aggregation and renal prostaglandin synthesis |
|
Definition
| Ketorolac (available PO and IV) |
|
|
Term
| opioid sparing, no effect on respiration; inhibits platelet aggregation and renal prostaglandin synthesis |
|
Definition
| Ketorolac (available PO and IV) |
|
|
Term
| gabapentin and carbamazepine are preferred in combination with opioids |
|
Definition
| provides synergistic effects, monitor sedation, enteral route only |
|
|
Term
|
Definition
| Prefer non-benzodiazepine over benzodiazepines: decreased delirium, decreased LOS, decreased mechanical ventilation time |
|
|
Term
| tool for assessing sedation |
|
Definition
|
|
Term
| global CNS depression through GABA activation and NMDA receptor blockade |
|
Definition
|
|
Term
|
Definition
| caution in patients with hypovolemic hypotension, seizure disorders and increased intracranial pressure |
|
|
Term
| global CNS depression through GABA activation and NMDA receptor blockade |
|
Definition
|
|
Term
|
Definition
| caution in patients with hypovolemic hypotension, seizure disorders and increased intracranial pressure |
|
|
Term
| frequently following a bolus dose of propofol and more pronounced in elderly, heart failure and hypovolemic patients |
|
Definition
|
|
Term
|
Definition
| in a 10% lipid emulsion (check triglycerides every 72 hours) |
|
|
Term
| Propofol Related Infusion Syndrome (PRIS) |
|
Definition
| rare but lethal reaction; associated with prolonged high dose infusions, high mortality even when the drug is discontinued |
|
|
Term
| characterized by: abrupt onset of dysrhythmia, metabolic acidosis, hyperkalemia, hyperlipidemia, rhabdomyolysis or myoglobinuria, renal failure |
|
Definition
| Propofol Related Infusion Syndrome (PRIS) |
|
|
Term
| highly selective alpha1- adrenergic agonist (8x more selective than clonidine) |
|
Definition
| Dexmedetomidine (Precedex) |
|
|
Term
| Dexmedetomidine (Precedex) |
|
Definition
| sedation without respiratory depression; great for sedation during weaning from mechanical ventilation |
|
|
Term
| Dexmedetomidine-- short duration of action (~60 minutes) |
|
Definition
| due to its "calming" effect, used commonly for agitation in the ICU; manufacturer recommends against use >24 hours |
|
|
Term
| withdrawal of Dexmedetomidine |
|
Definition
| hypertension, nervousness, agitation and headache; should not be stopped abruptly |
|
|
Term
| adverse effects of dexmedetomidine |
|
Definition
| hypotension, bradycardia, sympathetic rebound |
|
|
Term
| all agents are lipid soluble thus accumulate in the CNS with continued use; special caution in patients with renal failure |
|
Definition
|
|
Term
|
Definition
| Midazolam, Lorazepam, Diazepam |
|
|
Term
| Benzodiazepines Adverse Effects |
|
Definition
| Respiratory depression, hypotension, excessive sedation |
|
|
Term
| used in IV solutions of lorazepam and diazepam to enhance drug solubility |
|
Definition
|
|
Term
| Propylene glycol symptoms of toxicity |
|
Definition
| agitation, metabolic acidosis, hypotension and seizures |
|
|
Term
| benzodiazepine withdrawal |
|
Definition
| agitation, disorientation, hallucination and seizure |
|
|
Term
| benzodiazepine withdrawal |
|
Definition
| agitation, disorientation, hallucination and seizure |
|
|
Term
| prolonged duration of action of benzos due to inhibition of metabolism |
|
Definition
| erythromycin, fluconazole, diltiazem, verapamil and omeprazole |
|
|
Term
| antagonism of sedative effects |
|
Definition
| theophylline and aminophylline |
|
|
Term
| agitation and restlessness |
|
Definition
|
|
Term
| withdrawal, flat effect, apathy,, lethargy and decreased responsiveness |
|
Definition
|
|
Term
| fluctuations between hyperactive and hypoactive states |
|
Definition
|
|
Term
|
Definition
| anticholinergics, corticosteroids, opiates, benzodiazepines |
|
|
Term
| delirium assessment tools |
|
Definition
|
|
Term
| recommended for acute agitation; avoid in patients with underlying arrhythmias (can lead to torsades), avoid in patients with Parkinson's disease |
|
Definition
|
|
Term
| no strong evidence supporting use in delirium; but can decrease EPS and QT prolongation incidence, fewer hypotension/orthostatic effects, unlikely to cause laryngeal dystonia |
|
Definition
|
|
Term
| Midazolam +/- fentanyl vs. dexmedetomidine +/- fentanyl |
|
Definition
|
|
Term
| dexmedetomidine vs lorazepam |
|
Definition
|
|
