BCCCP EXAM 2024/25 | 420 QUESTIONS |
WITH COMPLETE SOLUTIONS!!
What types of things does the Behavioral Pain Scale (BPS) assess and what
score indicates significant pain? Answer - 1. Facial expression (relaxed vs.
grimacing)
2. Upper limbs (no movement vs. permanently retracted)
3. Compliance with ventilation (tolerating movement vs. unable to control
ventilation/fighting vent)
>5
What types of things does the Critical-Care Pain Observation Tool (CPOT) assess
and what score indicates significant pain? Answer - 1. Body movements
(absence of movement vs. restlessness)
2. Muscle tension - flexion/extension of upper extremities (relaxed vs. very
tense or rigid)
3. Compliance with ventilator (tolerating vs. fighting) OR vocalization
>=3
Fentanyl metabolic/drug interaction considerations Answer - Major substrate
of 3A4
Drug accumulation factors to consider with fentanyl Answer - Hepatic failure,
high Vd
,Morphine metabolic/drug interaction considerations Answer - Glucuronidation
Morphine major adverse effects Answer - Hypotension, bradycardia (from
histamine release)
Morphine drug accumulation factors Answer - Hepatic failure, active
metabolite accumulates in renal failure
Hydromorphone metabolic/drug interaction considerations Answer -
Glucuronidation
Hydromorphone drug accumulation factors Answer - Hepatic failure
Methadone metabolic/drug interaction considerations Answer - 3A4 and 2B6
major substrates
Methadone significant adverse effects Answer - QTc prolongation, serotonin
syndrome
Methadone drug accumulation factors Answer - Long half-life, hepatic and
renal failure will delay clearance
Remifentanyl clearance Answer - blood and tissue esterase (not dependent on
organ function)
Which IV opioids will not cause bradycardia Answer - Hydromorphone,
methadone
Which IV opioid will not cause hypotension Answer - methadone
,Which IV opioids carry a risk of serotonin syndrome with other serotinergic
agents Answer - fentanyl, morphine, methadone
Which IV opioids can accumulate with liver failure Answer - fentanyl,
morphine, hydromorphone, methadone
Which IV opioids can accumulate with renal failure Answer - morphine,
methadone
How is propofol cleared Answer - Hepatic (caution in patients with hepatic
impairment or cirrhosis)
How many calories and grams of fat does propofol have Answer - 1.1 kcal/mL
or 0.1 g/mL
What are some clinical characteristics of PRIS Answer - metabolic acidosis,
acute renal failure, cardiovascular collapse, cardiac arrhythmias, rhabdo,
myoglobinuria, hyperkalemia, hyperTG, elevated CK
Which sedative may have weak opiate-sparing antinociceptive effects Answer -
Precedex
Recommended duration of Precedex Answer - Package insert recommends
therapy for 24 hours or less, RCTs have used it up to 5-7 days, and safety
beyond 7 days is not well established
Lorazepam vs. midazolam clearance and volume of distribution Answer -
Lorazepam: hepatic clearance by conjugation to inactive compounds, moderate
to high Vd
, Midazolam: hepatic clearance by glucuronidation to an active metabolite which
is renally cleared, large Vd
What to do with sedation and analgesia during an SAT Answer - Hold
continuous sedative and analgesic infusions and bolus opioids for breakthrough
pain (continuous opioid infusions allowed to continue while stopping sedatives
if presence of active pain)
What to do with sedation and analgesia if SAT fails Answer - Bolus opioids
before restarting infusion. Re initiate sedative infusion, if necessary, at half the
previous dose and titrate to goal
If a patient is delirious, which classes of medications should be scrutinized for
need and appropriate dosage? Answer - 1. Anticholinergics
2. BZDs
3. Opiates
4. Antipsychotics
5. Antispasmodics
6. Anticonvulsants
7. Corticosteroids
What are precipitants of delirium to keep in mind and try to treat Answer - 1.
Infection
2. Dehydration or malnutrition
3. Sleep deprivation
4. Centrally acting medications (benzodiazepines, opiates, anticholinergics)
5. Lack of exposure to sunlight
6. Lack of personal interaction
7. Physical restraints or insertion of catheters or tubes
WITH COMPLETE SOLUTIONS!!
What types of things does the Behavioral Pain Scale (BPS) assess and what
score indicates significant pain? Answer - 1. Facial expression (relaxed vs.
grimacing)
2. Upper limbs (no movement vs. permanently retracted)
3. Compliance with ventilation (tolerating movement vs. unable to control
ventilation/fighting vent)
>5
What types of things does the Critical-Care Pain Observation Tool (CPOT) assess
and what score indicates significant pain? Answer - 1. Body movements
(absence of movement vs. restlessness)
2. Muscle tension - flexion/extension of upper extremities (relaxed vs. very
tense or rigid)
3. Compliance with ventilator (tolerating vs. fighting) OR vocalization
>=3
Fentanyl metabolic/drug interaction considerations Answer - Major substrate
of 3A4
Drug accumulation factors to consider with fentanyl Answer - Hepatic failure,
high Vd
,Morphine metabolic/drug interaction considerations Answer - Glucuronidation
Morphine major adverse effects Answer - Hypotension, bradycardia (from
histamine release)
Morphine drug accumulation factors Answer - Hepatic failure, active
metabolite accumulates in renal failure
Hydromorphone metabolic/drug interaction considerations Answer -
Glucuronidation
Hydromorphone drug accumulation factors Answer - Hepatic failure
Methadone metabolic/drug interaction considerations Answer - 3A4 and 2B6
major substrates
Methadone significant adverse effects Answer - QTc prolongation, serotonin
syndrome
Methadone drug accumulation factors Answer - Long half-life, hepatic and
renal failure will delay clearance
Remifentanyl clearance Answer - blood and tissue esterase (not dependent on
organ function)
Which IV opioids will not cause bradycardia Answer - Hydromorphone,
methadone
Which IV opioid will not cause hypotension Answer - methadone
,Which IV opioids carry a risk of serotonin syndrome with other serotinergic
agents Answer - fentanyl, morphine, methadone
Which IV opioids can accumulate with liver failure Answer - fentanyl,
morphine, hydromorphone, methadone
Which IV opioids can accumulate with renal failure Answer - morphine,
methadone
How is propofol cleared Answer - Hepatic (caution in patients with hepatic
impairment or cirrhosis)
How many calories and grams of fat does propofol have Answer - 1.1 kcal/mL
or 0.1 g/mL
What are some clinical characteristics of PRIS Answer - metabolic acidosis,
acute renal failure, cardiovascular collapse, cardiac arrhythmias, rhabdo,
myoglobinuria, hyperkalemia, hyperTG, elevated CK
Which sedative may have weak opiate-sparing antinociceptive effects Answer -
Precedex
Recommended duration of Precedex Answer - Package insert recommends
therapy for 24 hours or less, RCTs have used it up to 5-7 days, and safety
beyond 7 days is not well established
Lorazepam vs. midazolam clearance and volume of distribution Answer -
Lorazepam: hepatic clearance by conjugation to inactive compounds, moderate
to high Vd
, Midazolam: hepatic clearance by glucuronidation to an active metabolite which
is renally cleared, large Vd
What to do with sedation and analgesia during an SAT Answer - Hold
continuous sedative and analgesic infusions and bolus opioids for breakthrough
pain (continuous opioid infusions allowed to continue while stopping sedatives
if presence of active pain)
What to do with sedation and analgesia if SAT fails Answer - Bolus opioids
before restarting infusion. Re initiate sedative infusion, if necessary, at half the
previous dose and titrate to goal
If a patient is delirious, which classes of medications should be scrutinized for
need and appropriate dosage? Answer - 1. Anticholinergics
2. BZDs
3. Opiates
4. Antipsychotics
5. Antispasmodics
6. Anticonvulsants
7. Corticosteroids
What are precipitants of delirium to keep in mind and try to treat Answer - 1.
Infection
2. Dehydration or malnutrition
3. Sleep deprivation
4. Centrally acting medications (benzodiazepines, opiates, anticholinergics)
5. Lack of exposure to sunlight
6. Lack of personal interaction
7. Physical restraints or insertion of catheters or tubes
