Pain 2: Pca And Oa/ra

Front 1

What is the purpose of PCA?

Back 1

pt can self administer small doses of pain meds relatively frequently for optimal pain control

Front 2

What are the pros for PCA?

Back 2

1 pain control is achievable with less drug
2. less side effects

Front 3

What are the cons with PCA?

Back 3

1. dependence
2. user error meaning pt is not clicking the button or nurse operator error
3. mechanical problems such as a clog in the pump

Front 4

Name a benefit of using PCA in terms of rehab and pain control

Back 4

you have a tighter control over the drug concentration in bloodstream so that it may provide analgesia and not sedation or pain

Front 5

What is loading dose?

Back 5

initial large dose that is used to bring the concentration of the drug up min analgesic range

Front 6

Define demand dose

Back 6

amount of drug administered when patient clicks the button

Front 7

Define lockout interval

Back 7

minimum of time allowed between demand doses

Front 8

Define 1 and 4 hour limits

Back 8

it is the max amount of drug given in that time frame

Front 9

Define background infusion rate

Back 9

there is a small amount of drug given continuously similar to background baclofen levels

Front 10

Define successful vs total demands

Back 10

successful means that the patient clicked and received drug, total demands means the times that patient tried to recieve medication

Front 11

What are the drugs most often used in PCA?

Back 11

opioid, opioid + non opioid, local anesthetic + opioid, and anesthetic

Front 12

What are the delivery methods for PCA? what is the most common?

Back 12

IV (most common), epidural or intrathecal, transdermal

Front 13

Definition of RA

Back 13

chronic, systemic d/o primarily characterized by synovitis and articular tissue destruction

Front 14

Signs and symptoms of RA

Back 14

pain, inflammation, stiffness

Front 15

Typical joints affected by RA

Back 15

small joints such as hands, wrists, feet, ankles

Front 16

Typical course of RA

Back 16

progressive disease with some advanced stages leading to joint destruction but some are in remission

Front 17

T or F: There are only adult forms of RA

Back 17

F: there are both juvenile and adult forms

Front 18

What is the etiology of RA?

Back 18

somewhat unknown, but there is an autoimmune response that occurs followed by an end result of synovitis and articular destruction

Front 19

What are the treatment goals of RA

Back 19

decrease inflammation and stop disease progression

Front 20

What 3 drug types are used for treatment of RA?

Back 20

NSAIDS, glucocorticoids, and DMARDS

Front 21

Which drug types are responsible for stopping the disease progression?

Back 21

DMARDS

Front 22

Which drugs are responsible for stopping inflammation?

Back 22

NSAIDS and glucocorticoids

Front 23

What is the advantage to using NSAIDS? Name two types of drugs

Back 23

fewer side effects and analgesia; aspirin and COX-2 inhibitors

Front 24

Why would acetaminophen be used to combat inflammation?

Back 24

provides some analgesic effects but it is not optimal for decreasing inflammation

Front 25

How do glucocorticoids help with inflammation in RA patients?

Back 25

used in an acute flare up stages and can be injected into the joint but there are long term side effects

Front 26

What does DMARD stand for?

Back 26

disease modifying antirheumatic drugs

Front 27

What are DMARDS used for and how?

Back 27

seem to slow or top the RA disease process by modifying the immune response specifically inhibiting the function of monocytes and T and B lymphocytes

Front 28

Describe the characteristics of DMARDS such as how long they take to produce an effect and the types of side effects

Back 28

they are slow acting often taking 6 wks to 6 mos to see an effect, some have serious side effects leading to toxicity in the liver

Front 29

Name the 4 drug types/primary effect of DMARDS

Back 29

anticancer, immune suppressants, anti-inflammatory, anti-inflammatory with TNF inhibition

Front 30

Give the drug name for anticancer DMARDS and how it helps

Back 30

methotrexate (Rheumatrex), often first choice will impair DNA, RNA from rapidly dividing

Front 31

Give drug name or example of immune suppressant DMARD and its affects

Back 31

azathioprine (imuran) used for severe and active RA will produce flu like symptoms and increase potential for infections and fatigue

Front 32

Give drug name or example of anti-inflammatory DMARD and its effects

Back 32

gold compounds (anti malarial) and it has a high likelihood of toxicity

Front 33

Give drug name or example of anti-inflammatory (via TNF inhibition) DMARD and its effects

Back 33

infliximab (remicade), used in combo with methotrexate

Front 34

What is the cause of OA?

Back 34

intrinsic defect in joint cartilage that causes slow progressive deterioration of cartilage leading to bony changes

Front 35

What joints does OA typically affect?

Back 35

large weight-bearing joints such as knees, hips

Front 36

What are the availabe treatment options for OA?

Back 36

non-pharmaceutical: PT, weight loss, joint replacement, pharmaceutical

Front 37

Why use NSAIDS or acetaminophen for pain relief in OA?

Back 37

they both have analgesic effects and while acetaminophen doesn't have the anti-inflammatory relief it is not as much a concern in OA, Tylenol doesn't have gastric irritation

Front 38

What are some disease-modifying OA drugs?

Back 38

viscosupplementation and other precursors to joint tissue constituents (glucosamine and chondroitin sulfate)

Front 39

What are the benefits to having viscosupplementation for OA treatment?

Back 39

inject hyaluronan into the joint and can last up to 6 mos leading to delaying need for surgery and is tolerated well

Front 40

What are some adverse effects of viscosupplementation?

Back 40

local pain and inflammation

Front 41

Name the pros and cons for using glucosamine and chondroitin sulfate

Back 41

pros: may decrease pain/inflammation, well tolerated; cons: may cause GI problems, takes a number of weeks to take effect

Front 42

Name two precursors to joint tissue constituents

Back 42

glucosamine, chondroitin sulfate