Patient controlled Analgesia (PCA)what

describe oral route PCA

bedside device provides a pill when activated by pt

in order to control pain how should pain meds be delivered

drugs should be delivered into the blood stream or target tissues in a constant and predictable manner -with traditional pain meds there are periods of time when concentration of the drugs falls below the therapeutic window and this causes pain to increase -with PCA the drug levels are kept more constant and remain in the therapeutic window

what is loading dose?

initial large dose given to bring the level of analgesia to the therapeutic window

what is lockout interval?

minimal amount of time allowed between each demand dose

what is PCA?

pt can self administer small doses of a pain medication (often opioid) at frequent intervals -typically delivered through an IV or into the spinal canal by a type of pump -allows the pt to have some control over pain-as pain increases the pt can administer more medication

describe regional PCAs

pt self-administers the drug directly into an anatomical site: peripheral joint, peripheral nerve, or into a wound -provides localized pain relief without side effects on other tissues or organs

what is background infusion rate?

small amount of analgesic that can be continuously administered -provides low background level of analgesia -can lead to increased risk of side effects -not routinely used

what are the rehab implications of PCAs?

these pts typically have less sedation and are more alert -PCA decreases the need to schedule therapy around medication administered since plasma concentrations are constant -Pts may be more mobile with PCA than with traditional pain methods: increased pain relief means the pt is out of bed sooner -pts should monitor for signs of problems or malfunction with PCA (also be cautious is the family is controlling the PCA) -if pt show signs of respiratory depression or excessive sedation it could indicate that the pt has been overdosed by the PCA

when are PCAs used?

used s/p surgery, in pts with cancer and other chronic pain

what are adverse effects of PCA?

when opioid are used in PCAs the side effects are the same as with other opioid administration -sedation, GI problems, respiratory depression -decreased or equal risk to these side effects as with other methods of administration

describe Epidural PCA

-Drugs are administered directly into the area outside of the meninges surrounding the spinal cord -can also be administered directly into the subarachnoid space: spinal or intrathecal administration -epidural is the preferred method: it is safer and there is less risk of damaging the meninges -Epidural PCA gives more effective analgesia with less drug as compared to IV PCA ~drug is closer to the spinal cord and gets into systemic circulation quicker

What can pumps be?

-External -Implantable

describe IV PCAs

-Most common way to use PCA is through IV -Small intermittent doses of the drug are administered through a catheter and directly into systemic circulation -effective for a short period of time-first few days after surgery -if it is needed for a longer period of time then a central venous access point is recommended ~port is located directly under the skin

what are the types of analgesia used for PCAs?

-Opioids are the primary PCA medication ~PCAs are a safer way to administer opioids because they keep plasma levels stable without large fluctuations -Non-opioids analgesics can be combined with opioid analgesics to reduce the quantity of opioids needed -PCAs can also deliver local anesthetics EX: epidural used during childbirth

how do PCAs compare to other analgesics?

-pts report increased satisfaction with PCA as compared to other methods of analgesic administration -continous infusions are another method that are rated very highly pts ~they tend to supply more quantity of the drug though which places the pt at risk for increased side effects

What are the routes of PCAs?

IV epidural regional

what is successful versus total demands?

PCA systems record the total times the pt demanded the medication vs how many times they were allowed to have it

what is demand dose?

amount of drug that can be self administered by the pt each time they activate the PCA

why are side effects nearly non-existent with PCAs?

because the concentration does not rise above the therapeutic window