Pt 713 Pca/ra/oa

Front 1

What is PCA?

Back 1

(Pain controlled analgesia)

Pt can self-administer small doses of pain relatively frequently for optimal pain control (usually via IV or into spinal cord)

Front 2

What is the benefit of PCA?

Back 2

Pain control is achievable with less drug with less side effects

Front 3

2 cons for using PCA

Back 3

1) User error (not clicking the pain button)

2) Operator error (typing in wrong criteria or mechanical problems)

Front 4

PCA benefit when it comes to sedation and injections

Back 4

PCA gives tighter control of drug concentration in pt's blood (small doses given often), therefore no sedation like bolus amount given

Front 5

What are 6 terms associated with PCA?

Back 5

1) Loading dose
2) Demand dose
3) Lockout interval
4) 1- and 4hr- limits
5) Background infusion rate
6) Successful vs total demands

Front 6

What is a loading dose?

Back 6

A single large dose to bring concentration drug into analgesic range

Front 7

What is a demand dose?

Back 7

Amount administered when pt clicks button

Front 8

What is a lockout interval?

Back 8

Minimal time between doses

Front 9

What are 1- and 4hr- limits?

Back 9

Max amount of drug in a certain time period

Front 10

What is background infusion rate?

Back 10

Small amount of analgesic given continuously (can't change rate)

Front 11

What is an example of background infusion rate?

Back 11

Baclofen during sleep

Front 12

Successful demands (PCA)

Back 12

Screen that shows the drug was given successfully

Front 13

Total demands (PCA)

Back 13

# of total times pt tried to administer drug

Front 14

What is the benefit of using success vs total demands?

Back 14

Good for letting others know they may need more

Front 15

What 4 drugs can be used in PCA?

Back 15

1) Opioid
2) Opioid + non-opioid
3) Local anesthetic + opioid
4) Anesthetic

Front 16

3 ways PCA can be delivered

Back 16

1) IV--most common
2) Epidural or intrathecal
3) Transdermal (patches)

Front 17

What is the most common type of delivery of an opioid?

Back 17

IV

Front 18

What ways can short-term PCA be given? (2)

Back 18

1) IV
2) PCA, postop

Front 19

What ways can long-term PCA be given? (2)

Back 19

1) Chronic
2) Cancer PCA

Front 20

Definition of RA

Back 20

Chronic, systemic disorder primarily characterized by synovitis and articular tissue distruction

Front 21

What are 4 signs and symptoms of RA?

Back 21

1) Pain
2) Swelling
3) Multiple joints
4) Stiffness

Front 22

What are typical joints RA affects?

Back 22

Small bilateral joints like wrists, hands, feet

Front 23

What is the typical course of RA?

Back 23

Progressive disease, but pt can be in remission

Front 24

What are 2 forms of RA and how are they treated?

Back 24

Juvenile RA and adult RA

Treated pharmacologically the same

Front 25

What are most RA drugs?

Back 25

Immune suppressants

Front 26

What is the etiology of RA?

Back 26

Somewhat unknown

An automimmune response occurs with the end result of synovitis and articular destruction

Front 27

What are 2 treatment strategies for RA?

Back 27

1) Decrease inflammation
2) Stop disease progression

Front 28

What are 2 drugs that decrease RA inflammation?

Back 28

1) NSAIDs
2) Glucocorticoids

Front 29

What drug stops RA progression?

Back 29

DMARDs

Front 30

What does DMARDs stand for?

Back 30

Disease Modifying Antirheumatic Drugs

Front 31

Why are RA pts given NSAIDs?

Back 31

For pt comfort and is the 1st line of anti-inflammation and analgesia

Front 32

Why is acetominophen a Rx for RA?

Back 32

It is a COX inhibitor for pain (does not influence inflammation)

Front 33

What do DMARDs do?

Back 33

Slow or stop RA process mostly modifying the immune response--unknown mechanism

Front 34

How long until you would see the effects of DMARDS on RA?

Back 34

Slow-acting and often takes 6 wks to 6 mo to an effect

Front 35

What are 3 side effects or risks when using DMARDs?

Back 35

1) Increase fatigue
2) Increase risk for infections
3) Toxicity

(DMARDs have lower TI, but can be used in combo)

Front 36

What are 4 DMARD drugs used for RA tx?

Back 36

1) Methotrexate (Rheumatrex)
2) Azathioprine (Imuran)
3) Gold compounds
4) Infliximab (Remicade)

Front 37

What does Methotrexate (Rheumatrex) do?

Back 37

Impairs DNA/RNA synthesis

Front 38

What is an anti-cancer drug used for RA and is often 1st choice to use?

Back 38

Methotrexate (Rheumatrex)

Front 39

When is Azathioprine (Imuran) used?

Back 39

For severe and active RA pts and is not used on those in remission

Front 40

What immune suppressant drug is used for RA?

Back 40

Azathioprine (Imuran)

Front 41

What are 2 side effects of Azathioprine (Imuran)?

Back 41

1) Fatigue
2) Flu-like symptoms

Front 42

What are 2 anti-inflammatory drugs used for RA?

Back 42

1) Gold compounds
2) Infliximab (Remicade) via TNF alpha

Front 43

When are gold compounds used for RA pts?

Back 43

Used if others are ineffective and can be added to combo (high toxicity)

Front 44

What is Infliximab (Remicade) used in combo with?

Back 44

Methotrexate (Rheumatrex)

Front 45

What are 2 ways Infliximab (Remicade) binds with TNF alpha?

Back 45

1) Drug binds to joint tissue receptor
2) Drug binds to TNF alpha so it cann't bind to joint tissue to cause inflammation

Front 46

What is often the cause of OA?

Back 46

An intrinsic defect in the joint cartilage which is slow, progressive with bony changes and osteophytes

Front 47

What are the typical joints affected by OA?

Back 47

Large weight bearing bones such as hips, knees and smaller joints like hands and feet

Front 48

What are 3 non-pharm treatments for OA?

Back 48

1) PT
2) Joint replacement
3) Weight loss

Front 49

What are 2 DMOADs?

Back 49

1) Viscosupplementation
2) Precursors to joint tissue constituents (supplements)

Front 50

What is viscosupplementation?

Back 50

DMOAD--drugs that attempt to directly improve the viscosity and function of the synovial fluid

Front 51

What are precursors to joint tissue constituents?

Back 51

DMOAD--supplements such as glucosamine and chondroitin sulfate

Front 52

What is the administration of viscosupplementation for OA?

Back 52

Injection of hyaluronan into the joint (weekly series over time)

Front 53

How long does viscosupplementation last for (OA)?

Back 53

Transient response but can last up to 6 mo

Front 54

What can viscosupplementation delay?

Back 54

Surgery

Front 55

What are 2 adverse effects of viscosupplementation?

Back 55

1) Local pain
2) Inflammation

Front 56

How long does precursors to joint tissue constituents take effect (glucosamine and chondroitin sulfate)

Back 56

Takes weeks for effects

Front 57

What are the pros of using precursors to joint tissue constituents?

Back 57

May decrease pain and inflammation

Front 58

What is a con for using precursors to joint tissue constituents?

Back 58

May cause GI problems

(May or may not be efficacious)