Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
19 Cards in this Set
- Front
- Back
|
Three components of sedation |
Anxiolysis Hypnosis (induction of sleep) Amnesia |
|
|
Fentanyl onset and duration of action |
Short-acting opioid IV onset time of <1 min Duration of action of 1/2 to 1 hour |
|
|
What is the "forgiving opioid"? |
Remifentanil - rapid onset and offset, independent of liver or renal function
Onset of 1 min Rapidly achievers steady state Effects dissipate within 3-10 mins of discontinuation |
|
|
Half life of hydromorphone |
2-3 hours |
|
|
Which of the analgesics / sedatives increases ICP? |
Morphine |
|
|
Adverse effects of morphine |
Increases ICP Histamine release Metabolites accumulate in renal failure |
|
|
Patients too sedated to respond, how do you check for signs of pain? |
Increased sympathetic activity - tachycardia, ectopic rhythms, hypertension, lacrimation, sweating, pupillary dilatation. |
|
|
Pharmacological treatment of shivering |
Meperidine Dexmedetomidine Propofol BUspirone NMBAs |
|
|
When to avoid using buspirone? |
Patients with MG, glaucoma, MSOF |
|
|
When to avoid meperidine |
On MAOIs With seizure disorder With renal insufficiency |
|
|
MOA buspirone |
Mild anxiolytics with central antiserotonin effects Synergistic effects on shivering suppression with both meperidine and dexmedetomidine |
|
|
MOA of dexmedetomidine |
Highly selective agonist at alpha 2 adrenoreceptor (throughout body in central, peripheral and autonomic nervous systems)
Stimulation of presynaptic receptors in SNS - inhibits NE release
Activation of central postsynaptic receptors - hyperpolarizes neurons
End result - decreased sympathetic activity
Acts on the alpha 2a receptors in locus cerulean to decrease transmission of noradrenergic output |
|
|
On which receptors does meperidine act? |
Mu Kappa Alpha 2B adrenoreceptors |
|
|
Precautions with meperidine |
Active metabolite - normeperidine, neuroexcitatory effects, cleared by kidney
In patients with renal insufficiency, accumulation of normeperidine may cause seizures
Meperidine may precipitate serotonin syndrome in patients treated with line SOLIS, a weak MAOI |
|
|
Bispectral index monitor values |
Ranges from 1-100 Score <60 associated with inhibition of memory formation under GA |
|
|
High doses of lorazepam - precautions? |
Lorazepam is diluted in propylene glycol - associated with kidney injury and metabolic acidosis |
|
|
PRIS findings |
Progressive lactic acidosis TG elevations Arrhythmias
Death by intractable cardiac failure |
|
|
What are PAMORAs? |
Peripherally acting mu-opioidreceptor antagonists
e.g. Methylnaltrexone Alvimopan |
|
|
Advantages of PAMORAs |
Do not cross BBB Blocks side effects (constipation and i keys) while preserving analgesia |
