1Nociceptive pain is our _____ pain that's r/t some kind of _______ or _____ pain
- Acute
- Somatic (skin, bone, connective tissue)
- Visceral ( internal organs)
2Functional pain is d/t an abnormal presence of or inappropriate activation of the ______ w/in the _______
- Pain pathways
- Nervous system
3Opiates are the mainstay of _____ & _____ acute pain. It works on our _______ receptors to inhibit ________
- Moderate and severe
- Central opioid
- Pain pathways
4Morphine IV dose is _________ & continuous infusion dose is _______. Duration is ____
- IV dose: 0.1 – 0.2 mg/kg IV q 3-4 hours
- 0.1 mg/kg/hr
- 3-5 hrs
5Meperidine (Demerol®) is an opiate that has an active metabolite, _________, which is a ________. It's a poor choice for pt w/ ______ or hx of _______. Assoc. w/ ______ & _______
- Normeperidine
- CNS stimulant
- Renal dysfunction
- Seizures
- Dependance & Euphoria
6In most places, meperidine (Demerol®) for children is limited only to _________
Post operative trimmers
7Fentanyl can accumulate in the blood and cause a _______ effect or it can cause _______, meaning patients become _______ to it no matter how much you inc. the dose
- Compounding
- Tachyphylaxis
- Refractory
8PCA is used to control moderate-to-severe _______ pain, _____ pain, and _______ pain
- Post-operative
- Sickle cell
- Cancer
9Ketorolac (toradol): Limit IV use to ____ days due to ADR’s
5
10Etomidate (Amidate®) is an ultra short acting, non ______, _______ like compound that causes sedation. Not assoc. w/ _____ or ______
- Barbiturate
- Steroid
- Hypotension or inc. ICP
11Lorazepam (Ativan®) IV dose: ______ mg/kg/dose Q____ hours
- 0.05-0.1
- 6
12Lorazepam (Ativan®) has fewer _______ than other benzos, but it contains ______ that can be toxic to _____
- Drug interactions
- Preservatives
- Neonates
13Benzodiazepines potentiate ______ (neuro inhibitory transmitter) & have sedative, ________, ________ and anticonvulsant properties
- GABA
- Hypnotic
- Amnestic
14Prior to procedure you need to obtain patients “AMPLE” history...This stands for
- Allergies
- Medications
- Past medical history
- Last meal
- Events leading up to scenario
15Pre-Sedation Evaluation includes ______, ______, & ______
Length of procedure; painful v. non-painful; location
16Minimum Fasting Time Period for clear liquids is ____ hrs; Breast milk is ____ hrs; Formula/milk is ____ hrs; & Solid foods is _____ hrs
- 2
- 4
- 6
- 8
17Depolarizing or agonist NMBA produces muscle paralysis through binding with ________, allowing for ________ and then paralysis
- Acetylcholine receptor
- Muscle contraction
18Non-depolarizing or antagonist NMBA produces muscle paralysis through ________ at the ________ receptor site and does not allow for _______
- Competitive binding
- Acetylcholine
- Depolarization
19Most common nerves used for TOF are the _____ & _____ nerves
Facial and ulnar
20Desired number of elicited twitches w/ TOF is at least _____
- ¼
21Pediatric patients receiving sedation and/or analgesic agents greater than or equal to ___ days are at risk for withdrawal
5
22Withdrawal is seen in 100% of pediatric patients receiving opioids or benzodiazepines for >___ days and will require a slow sedation taper
9
23Assessment tools for withdrawal include neonatal assessment scale for infants <____ old and the Withdrawal Assessment Tool (WAT) for ______
- 1 month
- Infants and children
24Patients who have received opioids or other sedative agents for _____ days, benefit from switching from IV agents to ______
- 5 days
- ATC long-acting oral agents
25If s/s of withdrawal are observed during the weaning process, an IV dose of “rescue” morphine _______ mg/kg or lorazepam ______ mg/kg should be given
- 0.05-0.1 mg/kg
- 0.05-0.1
26The most common adjunctive therapy to smooth sedation titration and minimize withdrawal is the use of _______
Clonidine
27Iatrogenic risk factors of delirium: sleep deprivation, _______, _______, ______, and psychoactive meds
Restraints, tubes/catheters, pain
28Long term outcomes of delirium: Inc. risk for psychological conditions (PTSD), _______, & _____
- Disorientation
- Language problems
29The neonatal infant pain scale tool evaluates _____, _____, & ______. It is used in patients < _______ & ranges from 0-7
- Respiratory pattern, facial expression, and level of alertness
- 1 y.o
30Opioid analgesics work on ______ opioid receptors including ____, ____, & ____ receptors. The predominant receptor is _____
- Central
- Mu, delta, and kappa
- Mu
31NSAIDs work by inhibiting _______, thereby blocking the production of ______ & _______
- COX (cyclooxygenase enzymes)
- Inflammatory cytokines and prostaglandins
32Signs of opioid overdose include respiratory depression, lethargy, ______, _____, _______ skin, and decreased level of consciousness
- Euphoria
- Pinpoint pupils (Miosis)
- Cool and clammy
33Etomidate IV dose= _______, onset = _____, duration= _____
- 0.1-0.3 mg/kg
- <1 min
- 3-5 minutes
34Ketamine: produces _______ as well as sedation/analgesia. IV dose= _______, IM= _____
- dissociative amnesia
- 1-1.5 mg/kg
- 4-5 mg/kg
35Propofol is a _______ agent that may be used for _____ sedation, use In ______ or ______, must have anesthesia provider or credentialed physician
- general anesthetic
- status asthmaticus or status epilepticus
36Benzodiazepines: sedative, hypnotic, amnestic, and anticonvulsant properties, no _____
Intrinsic analgesic properties
37Rocuronium new reversal agent= ______. Has less ____ than old
- Sugamadex
- Bradycardia
38Vecuronium reversal agent
neostigmine
39Weaning: Moderate risk (5-7 days): decrease dose
20% every day
40Weaning: High risk (8-30 days): decrease dose
10-20% every other day
41Morphine significant side effects:
respiratory depression, severe hypotension, syncope, *peripheral vasodilation*, orthostatic
hypotension, noncardiogenic pulmonary edema, CNS depression, increased intracranial pressure, *histamine release*
42Fentanyl side effects:
*Chest wall rigidity & nasal pruritis*, orthostatic hypotension, *arrhythmia, syncope, bradycardia and CNS depression
43Methadone side effects:
life threatening respiratory depression, *prolonged QT interval or torsade de pointes*, death, cardiac arrhythmias, increased intracranial pressure and histamine release
44Dexmedetomidine (Precedex) is a __________ with potent sedative and mild analgesic properties. Dosing =
- Selective alpha-agonist
- 0.5-2 mcg/kg/hr
45Dexmedetomidine (Precedex) side effects:
respiratory acidosis, pulmonary edema, bradycardia, sinus arrest, hypotension, and
hypertension
46Clonidine is used for ______.... Significant side effects:
- child pain management
- when combined with stimulants, patients may suffer serious cardiovascular events or sudden
death
47Ketamine preserves ______ & _____, can raise _____ or _____. Assoc. w/
- cardiopulmonary stability and airway
- ICP or BP
- horizontal nystagmus, hallucinatory emergence rxns, hypersalivation, * laryngospasm, inc. cerebral blood flow
48Propofol significant side effects:
- propofol infusion syndrome (severe
metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatosplenomegaly, cardiac failure and kidney failure)
- Hypotension, bradycardia, hypothermia, respiratory depression
49Flumazenil is used for _____
- benzo reversal
50Flumazenil black box warning
- may result in seizures in patients dependent on medication
- Patients may experience resumption of sedation after flumazenil has worn off
51Neostigmine is used for ______
- nondepolarizing neuromuscular blocking (Vec) reversal agent
52Administer neostigmine w/ ____ or _____ to ____
- atropine or glycopyrrolate
- limit salivation, bronchoconstriction, laryngospasm, dyspnea, respiratory arrest, bradycardia, asystole, AV block, agitation, seizures, and salivation
53Lorazepam (Ativan®) significant side effects:
- respiratory depression, apnea, bradycardia, **circulatory collapse
- **High dose or long term use of parental formulation may result in toxicity (lactic acidosis, osmotic gap, renal failure)
54Diazepam (valium) significant side effects:
- sudden hypotension, cardiac arrest
- **laryngospasm and apnea or respiratory depression may result from rapid IV push
55Use Diazepam (valium) w/ caution in neonates- parental and rectal gel formulations contain...
benzoic acid, benzyl alcohol, and
sodium benzoate (increased risk of jaundice -> kernicterus)
56Etomidate (Amidate®) is assoc. w/ _______. other significant side effects:
- Resp. depression, myoclonus and *adrenal crisis (Adrenal suppression may result after a single dose)
- apnea, laryngospasm, bradycardia, tachycardia, hypertension
57Pentobarbital is used for ______. Significant side effects:
- procedural sedation, hypnotic
- respiratory depression, apnea, laryngospasm, arrhythmias, bradycardia, hypotension, syncope, angioedema
58Hydromorphone
Significant side effects: respiratory depression (esp if preexisting respiratory condition), hypotension (may be
exaggerated in patients with hypovolemia), orthostatic hypotension, peripheral vasodilation, CNS depression, increased intracranial pressure, histamine release
59Methadone similar to morphine- start dose at _____ , then wean to ____
- 0.1 mg/kg q6 hrs
- q12
60Fentanyl IV dose= _____
1-4 mcg/kg Q 1hr