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PHTH 564 - ICU > Meds > Flashcards

Meds Flashcards

(67 cards)

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1
Q

4 types of meds we need to be aware of ?

A
  1. analgesics
  2. sedatives and paralytics
  3. vasopressors and inotropes
  4. anticoagulants
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2
Q

To optimize analgesia, use what kind of pain scale?

A

patient-specific validated pain scale

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3
Q

Infusion goals should be reassessed every __ hours; reduce by ___% if sedation goals are met

A

6;25

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4
Q

Goal in the ICU is to keep pt’s pain intensity rating NRS < __ or BPS < __

A

4;6

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5
Q

BPS scores range from __ (no pain) to __ (max pain)

A

3;12

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6
Q

What are the 3 categories in the BPS?

A
  1. facial expression
  2. upper limb movements
  3. compliance with mechanical ventilation
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7
Q

The critical-care pain observation tool ranges from -

A

0-8

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8
Q

_____ = pain relief; includes opiates, NSAIDS, other oral meds

A

analgesia

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9
Q

______ = blocking sensation, including pain; includes general anesthetic, nerve blocks, numbing agents

A

anesthetic

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10
Q

____ _____ analgesia uses multiple types of analgesia, and works on different levels of the NS

A

multi-modal

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11
Q

_____ blocks pain signals sent from brain to the body and release large amounts of dopamine

A

opioids

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12
Q

3 non-opioid drugs used in the ICU?

A
  1. acetaminophen
  2. NSAIDS
  3. gabapentin or pregabalin
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13
Q

Issues with acetaminophen?

A

caution with liver failure / alcoholism

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14
Q

Issues with NSAIDS?

A

long term use can increase GI / renal bleeding complications

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15
Q

Take note of what with gabapentin or pregabalin?

A
  • for neuropathic pain
  • can sedate
  • monitor renal dysfunction
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16
Q

3 opioid drugs used in ICU?

A
  1. morphine
  2. hydromorphone
  3. fentanyl
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17
Q

Issues with morphine ?

A

drug accumulates in renal failure, itchy skin

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18
Q

Take note of what with hydromoroph / dilaudid?

A
  • 5 x as strong as morphine

- preferred in elderly and renal dyfunction

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19
Q

Take note of what with fentanyl?

A
  • quick onset
  • good for procedural pain
  • 100x as strong as morphine
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20
Q

Opioid side effects in CNS?

A

decreased LOC, delirium

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21
Q

Opioid side effects in resp?

A

depression (decreased drive to breathe, decreased RR)

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22
Q

Opioid side effects in CVS?

A

decrease BP/MAP/HR

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23
Q

Opioid side effects in gut?

A

decreased motility, nausea

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24
Q

Opioid side effects derm?

A

rashes

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25
3 common anti-emetics?
1. dimenhydrinate (gravol) 2. ondansetron 3. dexamethasone
26
4 PT implications with analgesics?
1. consider timing of analgesia with active treatment for optimal pain control 2. look for trends in analgesia needs with care / movement 3. be alert for resp side effects 4. be aware of how our interventions can increase or prevent pain, and consider what we can offer for pain control
27
Always address ______ sources for sedation
underlying
28
3 types of sedation ?
1. Light IV sedation 2. Daily sedation interruption 3. Deep IV sedation
29
Current best practice is to _____ sedation
minimize (least amount to reach goal)
30
3 common sedatives?
1. benzodiazepines 2. propofol 3. dexmedetomidine (Precedex)
31
Most commonly used benzo?
midazolam
32
Sedative side effects CNS?
decreased LOC; delirium
33
Sedative side effects resp?
depression
34
Sedative side effects CVS?
decreased BP/MAP/HR
35
_____ may occur as a side effect of propofol
arrhythmias
36
PT implications of sedation?
consider why the pt is being sedated, and what level (RASS goal) to determine if active treatment/stimulation is appropriate
37
For pt's with RASS -3/-2 it is appropriate to do AROM and active exercise (T/F)
FASLE ; just PROM and sit
38
When are paralytics use (3 instances)
1. endotracheal tube intubation 2. to allow full mechanical ventilation 3. to manage increased ICP (lower cerebral O2 consumption)
39
Succinylcholine, rocuronium and cisatracurium are all examples of ______
paralytics
40
Paralytics contain no analgesic, anxiolytic or amnesiac properties so pt's must be adequately sedated (T/F)
TRUE
41
There is a prolonged ______ recovery post paralysis
motor
42
Acute quadriplegic myopathy syndrome and myositis ossificans are potential side effects of _____
paralytics
43
Challenge/stimulation (is/is not) appropriate if the medical goal is full sedation / paralysis
IS NOT
44
______ increase the hearts force of contraction, increasing CO
inotropes
45
_______ primarily increase systemic vascular resistance via vasoconstriction, increase MAP
vasopressors
46
Why use vasopressors or inotropes?
to treat hypotension
47
Dopamine is an example of a ______ vasopressor/inotrope
mixed
48
________ is used to increase cardiac output through its inotropic/chhronotropic effects in both septic and cardiogenic shock states
dobutamine
49
______ has strong vasodilatory effects which are of significant benefit in its with decompensated heart failure
dobutamine
50
________ is similar to dobutamine but has a much longer therapeutic effect
milrinone
51
4 common vasopressors ?
1. norepinephrine/ epinephrine 2. phenylephrine 3. vasopressin 4. midodrine
52
3 side effects of inotrope s/ vasopressors ?
1. hypoperfusion 2. cardiac dysrhythmias 3. myocardial ischemia 4. inotropes = hypotension post initial vasodilation
53
PT implications of pt on vasopressor/inotrope = consider whether it is appropriate to impose a _____ challenge on a pt requiring vasotropic/inotropic support
cardiac
54
List any 3 of the 6 active mobility guidelines for pt on vasopressors/inotropes
1. no increased dose of any vasopressor infusion for at least 2 hrs 2. no evidence of myocardial ischemia (24 hrs) 3. no arrhythmia requiring the administration of new antiarrythmic agent (24 hrs) 4. HR < 75% age predicted max HR at rest 5. less than 20% variability in BP 6. pt on low dose inotrope support (usually < 10mcg/kg/min)
55
3 common anticoagulants ?
1. heparin 2. low molecular weight heparin 3. warfarin
56
______ (anticoagulant) is used in hospital only
heparin
57
What is normal INR?
0.9-1.3
58
What is the INR for a pt on anticoagulants?
2-3
59
_____ looks at coagulation and clotting time of blood
INR
60
Higher INR = increased risk of _____, lower INR = increased risk of _____
bleed; clot
61
PT implications of pt on anticoagulants?
Be aware of risk of bleed, any restricted activity orders for clots.
62
________ is a sudden and severe change in brain function that causes a person to appear confused or disoriented, typically with a fluctuating course
delirium
63
3 features of delirium?
1. acute onset , fluctuating mental state 2. inattention 3. disorganized thinking
64
3 subtypes of delirium?
1. hyperactive 2. hypoactive 3. mixed
65
3 goals of therapy for delirium?
1. interdisciplinary approach, try non-drug measures first, use anti-psychotics when needed 2. minimize/eliminate precipitating factors 3. screen using a validated tool
66
Screening tool used in ICU for delirium?
Confusion assessment method for ICU
67
Early mobilization is a non-drug approach for treating delirium (T/F)
TRUE

PHTH 564 - ICU (15 decks)

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