Questions and Answers
Compared with sedatives used in the ISU such as dexmedetomidine or propofol, continuously administered benzodiazepines are associated with what?
Increased length of ICU stay and increased time on the ventilator
When is the pharmacologic strategy of analgeosedation potentially inappropriate as a first-line approach?
Drug-induced agitation, substance-use withdrawal (other than opioids), agitation with a clear reversible cause not associated with pain
Which scales have been recommended by the PAD guideline subcommittee to assess pain in the ICU patient?
Critical care pain observation tool (CPOT), behavioral pain scale (BPS), numerical rating scale (NRS)
Which opioid may offer an additional pain management strategy by increasing analgesia sensitivity by NMDA receptor antagonism?
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What can interfere with delirium assessment in ICU patients?
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Which enteral medication exhibits pharmacologic activity similar to dexmedetomidine and may help wean a patient from it?
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Which sedative agent has the potential to cause propylene glycol toxicity when given as a continuous infusion?
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What recommendations should ICU caregivers strive for within their institution?
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Pharmacologic management of delirium should consist of which evidence-based pharmacologic therapy?
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When selecting an opioid agonist for rapid-onset pain control, which agent should be considered first?
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Study Notes
Sedatives in ICU
- Benzodiazepines administered continuously are linked to longer ICU stays and increased ventilation time compared to sedatives like dexmedetomidine or propofol.
Analgeosedation Guidelines
- Analgeosedation is preferred for ICU patients with agitation but is inappropriate as a first-line treatment in cases of drug-induced agitation, substance-use withdrawal (not opioids), or agitation with a reversible cause not related to pain.
Pain Recognition in ICU
- Pain and discomfort are often underrecognized in ICU, with over 40% of patients feeling their pain was inadequately managed.
- Recommended scales for pain assessment include the Critical Care Pain Observation Tool (CPOT), Behavioral Pain Scale (BPS), and Numerical Rating Scale (NRS).
Opioid Mechanism
- All opioids work mainly by activating the mu-opioid receptor.
- Methadone uniquely enhances pain management by acting as an NMDA receptor antagonist.
Delirium in ICU
- Delirium is a common consequence of ICU care, leading to increased length of stay, mortality, and costs.
- Sedation can hinder the accurate assessment of delirium.
Enteral Medication for Weaning
- Clonidine, a central acting alpha-2 agonist, possesses pharmacologic effects similar to dexmedetomidine and can assist in weaning patients from it if they have a functional GI tract.
Sedative Toxicity
- Lorazepam, when continuously infused, poses a risk for propylene glycol toxicity.
ICU Care Recommendations
- ICU caregivers should prioritize regular assessments of sedation, pain, and agitation to enhance patient care.
Delirium Pharmacologic Management
- Current evidence suggests avoiding haloperidol, quetiapine, and donepezil in the pharmacologic management of delirium.
Opioid Selection for Pain Control
- Fentanyl is recommended as the first choice for opioid agonist selection aimed at achieving rapid pain control.
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Description
This quiz covers essential topics related to sedation and pain management in the Intensive Care Unit (ICU). It discusses the use of sedatives like benzodiazepines, dexmedetomidine, and propofol, as well as guidelines for analgeosedation and pain recognition. Key concepts such as opioid mechanisms and delirium in ICU patients are also explored.
