Pain & Sedation Flashcards
(148 cards)
1
Q
No P450 enzyme has developed in kids less than ___ months of age.
A
6 months of age
—impacts metabolism
2
Q
What type of medication are these:
Morphine, oxycodone, hydromorphone, methadone, and fentanyl.
A
opioids
3
Q
What type of medication are these:
Tylenol
A
analgesic
4
Q
What type of medication are these:
Motrin, aspirin, toradol.
A
NSAIDS
5
Q
What type of medication are these:
topomax and gabapentini
A
antiepileptics
6
Q
Antiepileptics such as topomax and gabapentin can be used for ______ pain
A
neuropathic pain
7
Q
What type of medication are these:
ketamine, propofol, dexmedetomidine
A
anesthetics
8
Q
What type of medication are these:
EMLA, LMX
A
topical anesthetics
9
Q
What type of medication are these:
injection blocks, caudals, epidurals, inhaled anesthetic agents
A
local anesthetics
10
Q
Opioids increase the risk for r____d_____, ab____, mi____, and ad_____
A
respiratory depression
abuse
misuse
addiction
11
Q
Morphine
__-___ minute onset
A
5-10
12
Q
morphine side effects include v______ and h_____ release leading to i_____
A
vasodilation
histamine
-itching
13
Q
fentanyl onset is ______
A
immediate
14
Q
If given too quickly, fentanyl can cause c____ w____ r_____
A
chest wall rigidity
15
Q
What opioids can be used in children who have P450 3A4 inhibitors?
____ and
________
A
fentanyl and methadone
16
Q
Methadone has a
____ onset and ____ duration
A
slow onset
long duration
17
Q
What opioid is good to use in patients with opioid dependence?
A
methadone
18
Q
Methadone increases the patients risk for q__ _______, to_____, ar_____ and h_______
A
QT prolongation
Torsades
Arrhythmias
Hypotension
19
Q
Prior to sedating with methadone obtain a baseline _____
A
EKG
20
Q
Methadone use needs to be w_____. If stopped abruptly, it can cause w____ and s____ in patients
A
weaned
withdrawal and seizures
21
Q
Hydromorphone onset is about ____ minutes
A
5
22
Q
Hydromorphone may cause __/_____
A
hypo/hypertension
23
Q
Opioid habituation and addiction is diagnosed with a?
A
urine drug screen
24
Q
What drug is indicated for children with opioid dependence?
Me______
A
methadone
24
Children admitted for opioid addiction should have a _____ withdrawal of the addicted drug.
slow withdrawal
25
What drug is indicated for children with mild to moderate opioid withdrawal?
bupren_____
buprenorphine
26
What drug is indicated for children to prevent opioid use relapse?
naltr______
naltrexone
27
What is the term for adaptation to an opioid?
dependence
28
Dependence s/s include w_____ syndrome with ce______
withdrawal syndrome with cessation
29
What is the term for opioid-compulsive and continued use despite impaired control and harm?
addiction
30
Addiction is associated with opioid c____
cravings
31
Sedation weaning tools include the w___ and N____
WAT (withdrawal assessment tool)
-used for infants and children
NAS (neonate scale)
32
For patients with a WAT score less than 3, the median duration of opioid or benzodiazepine weaning is ____ days
6 days
33
For patients with a WAT score > 3, the median duration of opioid or benzodiazepine weaning is ____ days
10 days
34
What NAS score indicates the need for an infant to receive opioid and/or sedation withdrawal pharmacologic therapy?
8 or greater
35
Abrupt d/c of sedation can lead to di____, di____, ta____, ir____, and hy_____
diaphoresis, diarrhea, tachycardia, irritability, hypertension
36
Kids with > ___ days of sedation are at increased risk for withdrawal
5 days
-in these cases, wean slowly
37
During sedation weaning, ____ doses should be available. Have intermittent doses of mo____ or me_____
rescue
morphine, methadone
38
Analgesics block ______
prostaglandins
39
The most common analgesic is ______.
Tylenol
40
What is the max Tylenol dose? ___ mg/kg/day
75 mg/kg/day
41
Tylenol is rapidly absorbed in the ___ tract and metabolized in the _____
GI
liver
42
Tylenol overdose treatment includes?
N-acetylcysteine
43
What scale assesses for Tylenol toxicity?
Ru____-Ma___ nomogram
Rumack-Mathew nomogram
44
NSAIDs decrease le_____ synthesis and inhibit pr______
leukotreine
prostaglandins
45
The Max Motrin dose is
___ mg /kg/dose or
____ mg/day
40 mg/kg/dose
2400 mg/day
46
Use NSAIDs cautiously in patients with h___ f____ or h____ disorders.
hepatic failure or heme disorders
47
NSAIDs inhibit p____ a____ and can cause g__ b____
platelet aggregation
GI bleeds
48
A___-e____ and A___-d___ are used when pain is unresponsive to narcotics and NSAIDs
anti-epileptics and antidepressants
49
What antiepileptic is indicated for neuro pain or nerve damage?
Gabapentin
50
Gabapentin is indicated for pain that is described as b____, n____, or t_____
burning
numb
tingling
51
What medications are used as adjunctive therapy for use in neuro pain?
Tricyclic antidepressants
52
What TCAs are used as neuro pain adjunct therapy?
nort_____ and desipr_____
nortriptyline
desipramine
53
Atypical antidepressants are indicated for n___ pain and f_____
nerve pain and fibromyalgia
54
What atypical antidepressants can be used in children to treat nerve pain and fibromyalgia?
dul____ and venlaf_____
duloxetin
venlafaxine
55
What medication can treat myofascial pain?
Bac_____
baclofen
56
Haloperidol is used to treat agi____ and irr______
agitation and irritability
57
Haloperidol sedation is _____
long
58
What is a side effect of haloperidol?
Dys______
dystonia
59
Propofol is used for pr____ se_____ and se____ we______
procedural sedation
sedation weaning
60
Propofol has a f____ onset and is s____ acting
fast onset
short-acting
61
The risk for propofol infusion syndrome increased when propofol is used for > ___-___ hours
24-48 hours
62
With long-term therapy, propofol increases the risk for m___ a____
metabolic acidosis
63
Propofol side effects include
h____, b____, and b____ at IV site
hypotension
bradycardia
burning
64
Ketamine is used for p____ s____ requiring a f____ onset
procedural sedation
fast
65
In intubated patients, ketamine can be used c_____
continuously
66
Ketamine can lead to h_______, ensure to have s____ available when in use
hypersalivation
suction
67
Ketamine induced hypersalivation can lead to o____ or l______
obstruction or
laryngospasm
68
Ketamine s/s include a high ___ and ___
BP and HR
69
Ketamine emergence phenomena is described as increased ag______ s/p ketamine sedation
agitation
70
Ketamine sedation emergence can be treated with m____/v_____: dosage is ___ mg/kg
midazolam/versed
1mg/kg
71
Topical anesthetic agents are indicated for m_____ procedure or as an ad_____.
When using topical anesthetics, ensure to p___ a____, and prepare skin about ___ hour before procedure
minor procedures or as an adjunct
plan ahead
1 hour before
72
Intradermal anesthetics include l____ i_____ and are indicated for a q____ o_____
local injections
quick onset
--For example: lidocaine
73
Regional/Epidural blocks are indicated for children s/p s___ f____, this pain management is used for ____-___ hours
spinal fusion
24-48 hours
74
S/p spinal fusion surgery, regional/epidural blocks decrease the need for n___ and increase the patients goal to w_____
narcotics
walk
75
Inhaled sedation is indicated for m____ sedation and for d____ procedures
moderate
dental
76
Inhaled sedation examples include
intranasal mi____ or dexmato______
-monitor these children very closely
midazolam or dexmatomadine
77
Dexmedetomidine dosing is ___ mcg/kg/hr. Bolus dosing is ___ mc/kg
1 mcg/kg/hr
0.5 mcg/kg
78
Dexmedetomidine is not an opioid but an a___-2 a____, that is metabolized in the _____
alpha-2-agonist
liver
79
Dexmedetomidine s/s include a decrease in ___ and _____.
Patients on Dexmedetomidine are at increased risk for ______
HR and BP
acidosis
80
Dexmedetomidine does not decrease _____, this is why is can be used before, during, and after _____
RR
extubation
81
Clonidine is a non-narcotic that can be used s/p d_______ use via a c____ p_____
Dexmedetomidine
clonidine patch
-prevents Dexmedetomidine habituation
82
Clonidine can lead to a__ b____, h____ and c___ p____
AV block, hypotension, chest pain
83
When used with stimulants, clonidine can cause c______ events
cardiovascular
84
When used with opioids, benzodiazepines can cause p____ s______
profound sedation
85
The benzodiazepam Midazolam is ___ acting and can lead to C____ d_____
short
CNS depression
86
Midazolam is good for s____ procedural sedation. Midazolam can be used during v_____
short
ventilation
87
Lorazepam is used for acute s____ management
seizure
88
Lorazepam toxicity increased when mixed with _____
miralax
89
Diazepam is indicated for use in children with m___ t____ and s_____
muscle tremors and
spasms
90
If given too quickly, Diazepam may cause h____ and r___ d_____
hypotension and respiratory depression
91
According to the State Behavioral Score, the best sedation score to tolerate ventilation is?
0
92
According to the State Behavioral Score, a score of 2 indicates?
Agitation
93
According to the State Behavioral Score, a score of 3 indicates?
unresponsiveness
94
The goal of sedation during mechanical ventilation is for the patient to have a re___ Dr____, some co___, and st_____ re_____
respiratory drive
coughing
stimulation response
95
According to the Richmond Agitation Scoring system, the best sedation score to tolerate ventilation is?
0
96
According to the Richmond Agitation Scoring system, a score of 4 indicates?
co______
combativeness
97
According to the Richmond Agitation Scoring system, a score of 5 indicates?
unarousable
98
Pre-sedation assessment Ample mnemonic includes assessment of the patient's?
Allergies
Medications
PMH
Last oral intake
Events leading to illness
99
NPO Guidelines
__ hours for clear liquids
___ hours for breast milk
___ hour for formula
___ hours for solids
2
4
6
8
100
For procedural sedation, the patient requires a separate ____
consent
101
Minimal sedation provides a_____.
An example of minimal sedation includes i___ m____
anxiolysis
inhaled midazolam
102
Moderate sedation provides a d____ c_____, pt should be a____.
An example of a medication that provides moderate sedation includes?
depressed consciousness
arousable
ketamine
103
Deep sedation provides either a partial/complete loss of r____. The patient will not be e___ a____.
An example of a medication that provides deep sedation includes?
reflexes
easily arousable
propofol
104
What is the only ASA class that NPs are allowed to intubate?
ASA class 1 & 2
105
For an ASAa class 3-5 an i____ should intubate
intensivist
106
Infants less than 4 weeks of age who require intubation are considered ___ risk and require an i___ to intubate
high risk
intensivist to intubate
107
An ASA class of 1 describes a n___ h___ child
normal healthy child
108
An ASA class of 2 describes a child with m___ s____ d_____
mild systemic disease
109
Malampati scores describe the v___ p____ a_____
visual pharynx appearance
110
What malampati scores are considered safe for NPs?
1 and 2
111
In what malampati score can you see the uvula, soft palate, and tonsils?
1
112
In what malampati score can you see the soft palate and uvula?
2
113
In what malampati score can you only see the uvula?
3
114
Neuromuscular blockade is reserved for c___ i___ children for the purpose of controlling v_____
*end in
critically ill
ventilation
coronium
115
Neuromuscular blockade is indicated for children who are f___ the v_____.
fighting the ventilator
116
Neuromuscular blockade allows the ventilator to?
take over breathing
117
Neuromuscular blockade is indicated to help provide n_____-_____
normothermia
118
Neuromuscular blockade can be given to allow for s____ and a_____ drug h____
sedatives and analgesics
drug holidays
119
Use the ______ neuromuscular blockade dosages. Neuromuscular blockade administration should be taken o___ i_____ to determine if the blockade is still needed.
lowest
off intermittently
120
Neuromuscular blockade long term sequela include the development of myo____ and loss of re_____
myopathies
reflexes
121
While on neuromuscular blockades, the NP should assess that the patient still has?
reflexes
122
What is the reversal agent for benzodiazepines?
fl_____
Flumazenil
123
When using flumazenil as a reversal agent, keep in mind that you may need to r___ doses
repeat
124
Monitor your patient for the development of _____ when administering flumazenil to reverse benzodiazepines
seizures
125
What is the reversal agent for opioids?
Naloxone
126
Naloxone is ___ acting, patient may need r___ or an i____
fast acting
re-dosing
infusion
127
Small doses of naloxone may be indicated to prevent r___ d____ and provide a_____
respiratory depression
analgesia
128
When administering Naloxone, monitor your patient for the development of?
withdrawal s/s
129
What is the reversal agent for a neuromuscular blockade?
neost______
neostigmine
130
When giving neostigmine, ensure to concurrently administer glycopy______ to prevent h_____s____
glycopyrrolate to prevent hypersalivation
131
When giving neostigmine, monitor your patient for the development of se_____, lar_____, bro_____, and agi_____
seizures
laryngospasms
bronchospasm
agitation
132
Pediatric delirium is described as a disturbance of co____, aw____, inability to f____/t___, and development of be___ i_____
consciousness
awareness
focus/think
behavioral issues
133
S/P hospitalization, the risk for pediatric delirium is increased in children less than ___ YOA and m____
5 and males
134
What medication increases the risk for pediatric delirium?
B_______
benzodiazepines
135
Hyperactive delirium is described as the development of psy___, ag____, and res_____
psychosis, agitation, restlessness
136
Hypoactive delirium is described as the development of a wi____, fl____, apa_____ affect
withdrawn
flat
apathetic
137
The pediatric confusion assessment is for children less than __ YOA. It assesses for d____
5 YOA
delirium
138
Delirium treatment includes the administration of m____, which resets the c____ r_____
melatonin
circadian rhythm
139
Treat pediatric delirium psychosis with a____ a____ and h____
atypical antipsychotics
---less side effects
Haldol
140
Atypical antipsychotics used for pediatric delirium psychosis include?
ris____
ola_____
ziprasi____
risperidone
olanzapine
ziprasidine
141
OSA affects children g____
growth
142
OSA is diagnosed with a?
sleep study
143
When screening for OSA, assess for en____, an___, and ni___ te____
enuresis, anxiety, night terrors
144
Succycholinate May lead to m____ h_____, treat with d_____
Malignant hyperthermia
Dantrolene
145
Succycholine is contraindicated in children with a ____ deficiency
—will lead to profound and prolonged ____
cholinesterase
Apnea
146
Succsycholine can lead to muscle injury,
Leading to h_____ and a_____
Hyperkalemia
Arrhythmias
147
Propofol infusion syndrome
r______
k_____ f_____
h______
Rhabdomyolysis
Kidney failure
Hyperkalemia
