Pharm - Pca & Oa/ra Tx

Front 1

What is PCA?

Back 1

Pt controlled analgesia: pt can self administer small doses at frequent intervals for optimal pain relief via IV or epidural (SC)

Front 2

PROs vs CONs of PCA pump?

Back 2

PROs: Inc effects, dec side effects, with less of drug. The analgesia is maintained within the "therapeutic window:
CONs: Cognitive issues (not pushing button), operating error, clogged up

Front 3

Explain the therapeutic window of PCA

Back 3

Area of the doseage-time graph where optimal analgesia occurs. Above this level results in side effects (sedation) and below this level results in pain (not enough opiods)

Front 4

Define loading dose, demand dose, and lockout interval

Back 4

Loading dose: Initial large does of opioid to bring drug concentration up to the therapeutic window
Demand dose: Dose to maintain conc in ther window (each time pt hits button)
Lockout interval: Minimal amt of time allowed between demand doses

Front 5

What are 1 and 4 hour limits for PCA?

Back 5

Total amt of drug that will be administered in the certain amount of time.

Front 6

What is background infusion rate and when might you want to use it?

Back 6

Small amount of the drug is pumped through the IV continuously. May use it when pt is sleeping or otherwise unable to hit the button

Front 7

What are "total demands" for PCA?

Back 7

Successful demands plus unsuccessful demands due to lockout period. Recorded so demand dose can be adjusted if need be

Front 8

What drugs are used with a PCA?

Back 8

Opioid or combo opioid non-opioid such as tylenol, NSAID, or local anasethetic

Front 9

Mechanisms of delivery for PCA?

Back 9

IV (most common)
Epidural or intrathecal (More potent but more dangerous)
Transdermal

Front 10

Definition and s/s of RA?

Back 10

Chronic, systemic d/o primarily characterized by synovitis and articular tissue destruction
S/s: pain, stiffness, inflammation of small joints of hands and feet, as wel as larger joints such as the knee

Front 11

Typical course of RA progression

Back 11

Exacerbationa nd remission but overall progressive with advanced stages leading to jiont destruction and bone erosion

Front 12

2 forms of RA

Back 12

Adult and juvenile - juvenile may may not respond to certain drugs

Front 13

Diagnosis criteria for RA (4 of 7)

Back 13

1. Morning stiffness
2. Arthritis of 3 or more joint areas
3. arthritis of the hands
4. symmetric arthritis
5. Rheumatoid nodules
6. Serum rheumatoid factor
7. Radiographic changes

Front 14

Etiology of RA

Back 14

Initiiating factor is unknown, but it appears body make ABs that are later recognized as antigens. Immune system launches attack with end result of synovitis and articular destruction

Front 15

Overall goals of drug tx for RA

Back 15

1. Dec joint inflammation
2. Arrest progression of dx

Front 16

3 Drugs used to treat RA

Back 16

NSAIDs
Glucocorticoids
Disease-modifying antirheumatic drugs (DMARDs)

Front 17

What are DMARDs?

Back 17

Disease-modifying antiheumatic drugs that seem to stop or slow the RA dx process
Appear to modify the immune response but not sure how
These include anticancer, immune suppressants, anti-inflammatory, etc

Front 18

How long to DMARDs take to have an effect? Safe?

Back 18

6 wks to 6 months to see an effect
Controversial b/c some have serious side effects

Front 19

Cause of OA

Back 19

Intrinsic defect in jt cartilage marked by slow, progressive deterioration of articular cartilage that is accompanied with osteophytes, sclerosis, and dec joint space

Front 20

Typical joints affected by OA?

Back 20

Large WB joints = hips and knees
Also small joints of hands and feet

Front 21

Parmaceutical vs. non-pharmaceutical tx for OA?

Back 21

NON: PT, wt loss, jt replacement in long term
Pharm: used to manage pain and maintain active lifestyle but not manage dx process

Front 22

NSAIDs or acetaminophen for pain relief with OA?

Back 22

Tylenol in early stages b/c no gastric irritation and and early OA is not marked by inflammation
Advil in longer term b/c mild synovitis occurs secondary to jt destruction in OA

Front 23

Viscosupplementation?

Back 23

Hylauron is injected into the joint space to restore the lubricating properties of the synovial fluid
Been shown to dec pain and inc fxt in OA
Benefits for 6 mo to 1 year can delay need for jt replacement
However, local pain and inflammation can occur

Front 24

What are glucosamine and chondroitin sulfate?

Back 24

Key precursors to the production of components of AC and synovial fluid: PGs and haluronic acid

Front 25

PROs of glucosamine and chrondioting? CONs?

Back 25

Some evidence that states they may dec pain/inflammation and reduce jt space narrowing
CONs: GI problems and may or may not be efficacious