PCA

Question 1

What is Patient-controlled Analgesia?

Answer 1

When the patient can self administer small doses of a pain med at frequent intervals through an IV or into the spinal canal by a pump

Question 2

When is PCA used?

Answer 2

used s/p surgery and/or for patients with cancer or other chronic pain conditions

Question 3

Benefits of PCA

Answer 3

Allows the patient to have control over their pain since they can administer meds when their pain increases and it keeps drug levels more constant and remain in the therapeutic window. There are also basically no side-effects since the concentration does not rise above the therapeutic window

Question 4

What is the Loading Dose?

Answer 4

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

Question 5

What is the demand dose?

Answer 5

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

Question 6

What is the lockout interval?

Answer 6

The minimum amount of time allowed between each demand dose

Question 7

What is background infusion rate?

Answer 7

A small dose of the analgesic that can be continuously administered- but can lead to increase risk of side effects and is not routinely used

Question 8

What successful versus total demands mean?

Answer 8

The total number of times the patient tried to administer the meds vs the number of times it was actually received

Question 9

What are the primary drugs used for PCA?

Answer 9

Opioids- this allows for a safer way to administer them by keeping plasma levels stable without large fluctuations

Question 10

What other types of drugs can be used for PCA?

Answer 10

-Non-opioids can be combined with opioids to reduce the quantity of opioids needed
-local anesthetics: epidural for childbirth

Question 11

What are the different types of PCA pumps?

Answer 11

-external
-implantable

Question 12

What are the different routes of PCA pumps?

Answer 12

-IV
-Epidural
-Regional
-oral (no pump)

Question 13

What is the most common route to use a PCA pump?

Answer 13

IV administration- drug is administered through a catheter directly into the circulatory system

Question 14

What is the preferred route for PCA?

Answer 14

Epidural- it is safer and there is less risk of damaging the meninges, also is more effective with less drug because it is closer to the SC and gets into the systemic circulation quicker

Question 15

What the different locations for epidural PCA?

Answer 15

1. administered directly into the area outside of the meninges surrounding the spinal cord
2. administered directly into the subarachnoid space

Question 16

What is the Regional PCA route?

Answer 16

When the drug is administered directly into an anatomical site: joint, nerve, or into a wound

Question 17

What is the benefit of using the regional PCA route?

Answer 17

Provides localized pain relief without side effects on other tissues or organs

Question 18

What is the oral route PCA?

Answer 18

There is a bedside device that provides a pill when activated by the patient

Question 19

Side effects of PCA

Answer 19

When Opioids are taken:
-sedation
-GI problems
-respiratory depression
**same side effects as normal opioid usage

When other drugs are used:
-decreased or equal risks of side effects

Question 20

Benefits of PCA with therapy

Answer 20

-patients have less sedation and are more alert
-no need to schedule around med administration since plasma concentrations are more constant
-patient may be more mobile due to increased pain relief

Question 21

Is it possible to overdose on PCA?

Answer 21

Yes if there is a malfunction with the PCA system, an incorrect prescription given or the pt is sensitive to opioids- if patients show signs of respiratory depression or excessive sedation than an overdose may have occurred