ACCS Pharmacology questions with correct
answers
Fentanyl Citrate (Sublimaze) Answer✔✔ Pain management (Analgesia) (Opioid)
Use: any indication of pain (vitals, pain scale), s/p MVA, SCI, vent asynchrony
Adverse: resp depression
Notes: may also come across Sufentanil and Remifentanil (both opiod based as
well)
Morphine Answer✔✔ Pain management (Analgesia) (Opioid) (Powerful narcotic)!
Use: any indication of pain (vitals, pain scale), dyspnea, hospice, pallative care,
end of life
Adverse: resp depression, cardiac, lowers RR, BP, cardiovascular hemodynamics.
Reverse: Naloxone (Narcan)
Notes: nebulize for SOB, may be instilled via ETT, large doses required for
continuous sedation so not optimal choice for that. Inhaled morphine has less
potential side effects than the IV route
Hydromorphone (Dilaudid) Answer✔✔ Pain management (Analgesia) (Opioid)
(very powerful narcotic)!
Use: any indication of pain (vitals, pain scale)
Adverse: resp depression, cardiac, reduce dosage for renal failure
Reverse: Naloxone (Narcan)
Ketorolac (Toradol) Answer✔✔ Pain management (Analgesia) (NSAID)
Use: for management of moderately severe pain
Adverse: do not use if renal failure + hypotensive d/t volume
,Notes: often used in combination w/ an opioid as it decreases the required opioid
dose dose to adequately manage pain
Ibuprofen (Advil, Motrin) Answer✔✔ Pain management (Analgesia) (NSAID)
Use: management of pain
Notes: just like Ketorolac, Ibuprofen is often used in combo w/ an opioid as it
decreases the required opioid dose dose to adequately manage pain
Naloxone (Narcan) Answer✔✔ Opioid Reversal Agent
Reverses: opioids (Fentanyl, Morphine, Hydromorphone)
Opioids may cause resp depression or cardiac effects. If it is clinically significant,
reverse.
Quick duration, may require several doses (adverse effect will reappear)
Adverse: hypertension, tachycardia
Clues to use Narcan: pt on Morphina PCA, Fentanyl, any opioids, pin point pupils
Lorazepam (Ativan) Answer✔✔ Anti-anxiety (Benzodiazepines)
Use: anxiety (weaning, NPPV), drug/alcohol withdrawal
Adverse: may interact w/ narcotics and suppress resp drive, play role in ICU
delirium
Reverse: Flumazenil
Midazolam (Versed) Answer✔✔ Anti-anxiety (Benzodiazepines)
Use: procedural sedation, anxiety (weaning, NPPV), drug/alcohol withdrawal
Adverse: may interact w/ narcotics and suppress resp drive, play role in ICU
delirium
Reverse: Flumazenil
, Notes: use in either kidney or liver failure will prolong effect of the drug (takes
longer to leave the system)
Admin: IV push or drip
Diazepam (Valium) Answer✔✔ Anti-anxiety (Benzodiazepines)
Use: procedural sedation, anxiety (weaning, NPPV), drug/alcohol withdrawal
Adverse: may interact w/ narcotics and suppress resp drive, play role in ICU
delirium
Reverse: Flumazenil
Note: NOT OFTEN USED in critical care d/t "drug accumulation" issues
Flumazenil (Romazicon) Answer✔✔ Reversal Agent for Benzodiazepines
Reverses: Bendodiazepines potential side effects which are seizures (Lorazepam
(Ativan), Midazolam (Versed), Diazepam (Valium) etc.)
Administer when excessively drowsy while on benzos
Look for drugs that end in PAM or LAM
Adverse: Resp depression, somnolence, hypotension
Propofol (Diprivan) Answer✔✔ Sedative (common)
Use: pain, sedation (procedural, ventilator)
-Intermittent: a bolus of propofol given for a procedure (combative pt, very short
procedure). Note that propofol has such a QUICK HALF LIFE that intermittent
use is difficult
-Continuous: IV infusion that is maintained at the lowest rate to achieve adequate
sedation (usually based on RASS score)
Adverse: resp depression, hypotensive, lowers BP - watch for falling hemo
Reverse: wears off quickly, no need to reverse (just stops)
answers
Fentanyl Citrate (Sublimaze) Answer✔✔ Pain management (Analgesia) (Opioid)
Use: any indication of pain (vitals, pain scale), s/p MVA, SCI, vent asynchrony
Adverse: resp depression
Notes: may also come across Sufentanil and Remifentanil (both opiod based as
well)
Morphine Answer✔✔ Pain management (Analgesia) (Opioid) (Powerful narcotic)!
Use: any indication of pain (vitals, pain scale), dyspnea, hospice, pallative care,
end of life
Adverse: resp depression, cardiac, lowers RR, BP, cardiovascular hemodynamics.
Reverse: Naloxone (Narcan)
Notes: nebulize for SOB, may be instilled via ETT, large doses required for
continuous sedation so not optimal choice for that. Inhaled morphine has less
potential side effects than the IV route
Hydromorphone (Dilaudid) Answer✔✔ Pain management (Analgesia) (Opioid)
(very powerful narcotic)!
Use: any indication of pain (vitals, pain scale)
Adverse: resp depression, cardiac, reduce dosage for renal failure
Reverse: Naloxone (Narcan)
Ketorolac (Toradol) Answer✔✔ Pain management (Analgesia) (NSAID)
Use: for management of moderately severe pain
Adverse: do not use if renal failure + hypotensive d/t volume
,Notes: often used in combination w/ an opioid as it decreases the required opioid
dose dose to adequately manage pain
Ibuprofen (Advil, Motrin) Answer✔✔ Pain management (Analgesia) (NSAID)
Use: management of pain
Notes: just like Ketorolac, Ibuprofen is often used in combo w/ an opioid as it
decreases the required opioid dose dose to adequately manage pain
Naloxone (Narcan) Answer✔✔ Opioid Reversal Agent
Reverses: opioids (Fentanyl, Morphine, Hydromorphone)
Opioids may cause resp depression or cardiac effects. If it is clinically significant,
reverse.
Quick duration, may require several doses (adverse effect will reappear)
Adverse: hypertension, tachycardia
Clues to use Narcan: pt on Morphina PCA, Fentanyl, any opioids, pin point pupils
Lorazepam (Ativan) Answer✔✔ Anti-anxiety (Benzodiazepines)
Use: anxiety (weaning, NPPV), drug/alcohol withdrawal
Adverse: may interact w/ narcotics and suppress resp drive, play role in ICU
delirium
Reverse: Flumazenil
Midazolam (Versed) Answer✔✔ Anti-anxiety (Benzodiazepines)
Use: procedural sedation, anxiety (weaning, NPPV), drug/alcohol withdrawal
Adverse: may interact w/ narcotics and suppress resp drive, play role in ICU
delirium
Reverse: Flumazenil
, Notes: use in either kidney or liver failure will prolong effect of the drug (takes
longer to leave the system)
Admin: IV push or drip
Diazepam (Valium) Answer✔✔ Anti-anxiety (Benzodiazepines)
Use: procedural sedation, anxiety (weaning, NPPV), drug/alcohol withdrawal
Adverse: may interact w/ narcotics and suppress resp drive, play role in ICU
delirium
Reverse: Flumazenil
Note: NOT OFTEN USED in critical care d/t "drug accumulation" issues
Flumazenil (Romazicon) Answer✔✔ Reversal Agent for Benzodiazepines
Reverses: Bendodiazepines potential side effects which are seizures (Lorazepam
(Ativan), Midazolam (Versed), Diazepam (Valium) etc.)
Administer when excessively drowsy while on benzos
Look for drugs that end in PAM or LAM
Adverse: Resp depression, somnolence, hypotension
Propofol (Diprivan) Answer✔✔ Sedative (common)
Use: pain, sedation (procedural, ventilator)
-Intermittent: a bolus of propofol given for a procedure (combative pt, very short
procedure). Note that propofol has such a QUICK HALF LIFE that intermittent
use is difficult
-Continuous: IV infusion that is maintained at the lowest rate to achieve adequate
sedation (usually based on RASS score)
Adverse: resp depression, hypotensive, lowers BP - watch for falling hemo
Reverse: wears off quickly, no need to reverse (just stops)
