NUR 2115 Exam 1 Pharmacology

NUR 2115 Exam 1 Pharmacology

• Medications used during mechanical ventilation fall into four categories

Answer

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sedatives, neuroleptics, analgesics, and paralytics

• Sedatives include

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benzodiazepines, barbituates, and propofol. These drugs decrease anxiety and produce amnesia, but they don't relieve pain. Most of these drugs also have anticonvulsant effects without causing cardiac depression. The exceptions to this are midazolam (Versed) and propofol (Diprivan), which can cause cardiac depression.

• The primary concerns related to use of sedatives during mechanical venti- lation are that

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many have long half lives, and that drug levels can accumulate and cause prolonged effects in the critically ill and elderly. This is particularily true of the barbituates, and may negatively impact weaning attempts.

• has the shortest half life of the benzodiazepines (1 hour), thus it is the most commonly used.

Answer

Midazolam (Versed)

• The other benefit to benzodiazepines is that their effects can be reversed with 1 / 3

Answer

flumazenil (Romazicon)

• One precaution should be mentioned regarding midazolam (Versed).

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It tends to accumulate in the tissues if administered for longer than 48 hours, and can cause excessive sedation. This is especially true of obese patients because of the lipophilic properties of the drug and the high degree of lipid solubility. In obese patients, the ideal body weight should be used to calculate dosing, rather than the actual weight

• Propofol (Diprivan) is the sedative of choice for

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rapid induction of anesthesia in the ICU for minor invasive procedures. It has a rapid onset and a half-life of less than 30 minutes. However, it often causes hypotension and is very expensive

• Lorezapam (Ativan)

Answer Onset 5-15 minutes Half Life

6-15 hours

Loading Dose

0.05mg/kg Infusion rate

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0.5-5mg/hr

• In addition to sedation, neuroleptics may be given to patients who

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are experiencing delirium or "ICU psychosis." This is common in critically ill patients who lose sense of time and events because of altered sleep patterns and a different daily schedule while they're hospitalized. Symptoms include disorganized thinking, audio and visual hallucinations, and disorientation. Sedatives and narcotics often worsen the delirium because they further alter sensory perception. The neuroleptic drug of choice is haloperidol (Haldol). It's usually given intravenously in 2-10 mg doses every 2 to 4 hours. Effects should be observed within 30-60 minutes. Haloperidol can prolong the QT interval on the EKG, and should be used cautiously in patients who are at risk for QT prolongation from other causes.

• Morphine is preferred unless

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the patient has cardiovascular instability. In this case, the patient may not tolerate the transient hypotension produced by morphine-related histamine release, so fentanyl (Sublimaze) or hydromorphone (Dilaudid) can be used instead.

• If a patient receives large or continuous doses of narcotics, they must be monitored for

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the development of ileus. Tolerance of tube feedings and bowel movements should be assessed frequently.

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