Pharmacology Chapter 17 Patient-Controlled Analgesia

What types of drugs can provide "opioid sparing" effects in PCA?

Ketorolac (an NSAID), droperidol (an antipsychotic), ketamine (an anesthetic), low dose naloxone , local anesthetics, bupivacaine or ropivacaine can be added to opioid administration to decrease the amount of opioid needed for adequate analgesia

Advantages of PCEA (Patient controlled epidural analgesia)?

Less drug, less side effects, superior analgesia due to site of administration. Right to CNS

How can Total demands be used to determine efficacy of PCA in controlling pain?

Look at the daily record of when patient is pushing the PCA and if they are using all that's in demand, they could increase the on demand. (maybe patient is using amount for the day and not getting enough at the end of day)

define background infusion rate:

continuous infusion for a small amount of analgesia combined with PCA for patients who are sleeping or unable to manually activate the pump

Where can IV PCA be placed?

indwelling or externally

define lockout interval:

minimum required time interval where PCA pump will not deliver an additional dose

PCRA (Patient controlled regional analgesia):

more of anesthetic instead of opioid infused (analgesia)

Advantages of PCA to PT?

patient always in therapeutic window, so sessions are more flexible. Patient can ambulate for PT. Patient can ambulate sooner for PT.

What is PCA and what are its benefits compared to traditional delivery of pain medication?

provides equivalent or increased analgesic effects with a lower incidence of side effects while using less of the drug

Define loading dose:

single large dose given initially to achieve analgesia in the therapeutic window

Who controls pushing the button?

the patient!

Name a condition that would merit use of PCA?

Cancer, post surgery

how does opioid sparing work?

Competes for same site of which the opioid wants to bind to, thus allows the opioid to float around for a bit longer

Name potential routes of administration for PCA

IV (most common), epidural, transdermal (a patch), regional (patient self-administers into specific anatomic site)

Define demand dose:

amount of drug delivered each time patient activates PCA