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Clinical Pharmacy 1 - Term 1 > 1 - Fever > Flashcards

1 - Fever Flashcards

1
Q

What is a fever?

A
  • A normal response to various circumstances, usually due to viral or bacterial infection
  • Core temperature of the body is increased
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2
Q

What is the definition of a fever in pediatrics?

A
  • Rectal or tympanic temperature above 38 C

- Oral temperature above 37.5 C

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3
Q

What is a good indicator of how serious a fever is in a child?

A

How the child is acting, not the degree of the fever

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4
Q

What is the recommended temperature measuring technique for children from birth to 2 years?

A

First - rectum

Second - armpit

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5
Q

Which temperature measuring technique is NOT recommended for children from birth to 2 years?

A

Tympanic membrane (ear)

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6
Q

What is the recommended temperature measuring technique for children from 2-5 years?

A

First - rectum

Second - ear; armpit

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7
Q

What is the recommended temperature measuring technique for children older than 5 years?

A

First - mouth

Second - ear, armpit

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8
Q

What causes a fever?

A

Pyrogens

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9
Q

What are endogenous pyrogens?

A

Proteins that induce fever

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10
Q

What are exogenous pyrogens?

A

Chemicals produced by bacteria or by components of the organism

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11
Q

What do exogenous pyrogens do?

A

Stimulate the release of endogenous pyrogens

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12
Q

What does the body do when it recognizes pyrogens?

A

Produces prostaglandins of the E2 series (PGE2) and elevates the thermoregulatory set point in the hypothalamus

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13
Q

How is the core body temperature increased?

A
  • Vasoconstriction of peripheral blood vessels
  • Shivering to increase heat production
  • Behavioural changes
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14
Q

Which portion of the brain controls a fever?

A

Hypothalamus

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15
Q

What is hyperthermia?

A

An increase in body temperature not due to the hypothalamus (ex: physical exertion)

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16
Q

What are the risk factors for a fever?

A

1) Bacterial infection
2) Viral infection
3) Cancer
4) Multisystem diseases
5) Medications

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17
Q

When would you refer a fever?

A
  • Babies under 6 months
  • Fever lasting more than 72 hours
  • Fever lasting more than 24 hours with no obvious cause
  • Fever over 40.5 C
  • Patient has persistent wheezing and cough, or a rash
  • Patient has had recent surgery or dental procedures
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18
Q

What are the goals of therapy for a fever?

A
  • Provide patient comfort
  • Reduce parenteral anxiety
  • Reduce metabolic demand caused by fever in patients w/ CV or pulmonary disease
  • Prevent or alleviate fever-associated mental dysfunction in the elderly
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19
Q

Is decreasing the patients temperature a goal of therapy?

A

No

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20
Q

What are some non-pharms you can recommend?

A
  • Remove excess clothing, blankets
  • Increase fluid intake to replace water loss from sweating
  • Avoid physical exertion
  • Maintain normal room temperature
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21
Q

Is it recommended for patients with a fever to take a cold shower or sponge bath?

A

No, because it is not getting rid of pyrogens or prostaglandins, so it will just cause the body to shiver to get back up to the new set core temp

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22
Q

What are the arguments against treating a fever?

A
  • It is a defense mechanism against a bacteria or virus
  • Generally self-limiting
  • A normal physiological response
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23
Q

Why would you want to treat a fever?

A

Patient discomfort

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24
Q

What do antipyretic agents do?

A

Reduce body temperature by decreasing prostaglandin synthesis by inhibiting the cyclooxygenase (COX) enzyme

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25
Q

What are the 2 therapeutic choices for managing a fever in children?

A

Acetaminophen and ibuprofen

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26
Q

How does acetaminophen decrease a fever?

A

By inhibiting the formulation and release of prostaglandins in the CNS and by inhibition of endogenous pyrogens at the hypothalamic thermoregulator center

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27
Q

What is the oral onset of acetaminophen?

A

30 minutes

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28
Q

What is the rectal onset of acetaminophen?

A

Slow, and incompletely absorbed

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29
Q

What is the peak time of acetaminophen?

A

3 hours

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30
Q

What is the duration of acetaminophen?

A

4-6 hours

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31
Q

Which organ metabolizes acetaminophen?

A

Liver

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32
Q

What is the dosing of acetaminophen for adults?

A
  • 325-650 mg every 4-6h

- Max 4g/ 24 hr

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33
Q

What is the dosing of acetaminophen for children?

A
  • 10-15 mg/kg/dose every 4-6 h (not exceeding adult dose)

- Max 65-75 mg/kg/day or max 5 doses/24 hr

34
Q

Is acetaminophen safe for use during pregnancy?

A

Yes

35
Q

Is acetaminophen safe for use during lactation?

A

Yes

36
Q

Does acetaminophen have a lot of adverse effects?

A

No

37
Q

What are the clinically important drug interactions with acetaminophen?

A
  • Alcohol (increased risk of hepatotoxicity)
  • Enzyme inducers (decreased acetaminophen levels)
  • Chronic use can occasionally enhance warfarin’s anticoagulant effect
38
Q

What are 3 common NSAIDs?

A
  • Acetylsalicylic acid
  • Ibuprofen
  • Naproxen
39
Q

What are the pharmacological properties of NSAIDs?

A
  • Analgesic
  • Antiplatelet
  • Antipyretic
  • Anti-inflammatory
40
Q

How does ibuprofen decrease a fever?

A

Inhibits the COX enzyme in the periphery and CNS, thereby inhibiting prostaglandin synthesis

41
Q

What is the onset of ibuprofen as a antipyretic?

A

Less than 1 hour

42
Q

What is the onset of ibuprofen as an analgesic?

A

Less than 1 hour

43
Q

What is the peak time of ibuprofen?

A

2-4 hours

44
Q

What is the duration of ibuprofen?

A

6-8 hours

45
Q

Where is ibuprofen metabolized?

A

Liver

46
Q

What is the adult dosing of ibuprofen for a fever?

A
  • 200-400 mg/dose every 4-6h

- Mac 1.2 g/ day

47
Q

What is the child dosing of ibuprofen for a fever?

A
  • Over 6 months - 5-10 mg/kg every 6-8h
  • Under 6 months - 5 mg/kg every 8h
  • Max 40 mg/kg/day or 4 doses/24 hr
48
Q

What are the most common adverse effects of ibuprofen?

A
  • Abdominal pain w/ cramps
  • Dizziness
  • Heartburn
  • Nausea
  • Skin rash
49
Q

What are some contraindications of ibuprofen?

A
  • Peptic ulcer disease
  • GI perforation
  • Hypersensitivity
50
Q

What are some drug interactions with ibuprofen?

A
  • ASA (decreases ASA’s antiplatelet effect)
  • Alcohol and corticosteroids (increased risk of GI pain/ulceration)
  • Antihypertensive agents
  • Anticoagulants (increase risk of bleeding)
  • Cyclosporine (risk of nephrotoxicity)
  • Lithium, methotrexate
51
Q

Which children are at the greatest risk of ibuprofen related renal toxicity?

A
  • Dehydrated
  • CV disease
  • Preexisting renal disease
  • Younger than 6 months
52
Q

Is ibuprofen safe to use during pregnancy?

A

There is a risk in 1st and 3rd trimesters

53
Q

Is ibuprofen safe to use while breastfeeding?

A

Yes

54
Q

How does ASA decrease a fever?

A

Inhibits the COX enzyme in the periphery and CNS

55
Q

What is the onset of ASA?

A

Within 1 hour

56
Q

What is the peak time of ASA?

A

3 hours

57
Q

What is the duration of ASA?

A

4-6 hours

58
Q

Is ASA recommended in children?

A

NO, has been linked to Reye’s syndrome

59
Q

What is the adult dosing of ASA?

A
  • 325-650 mg every 4-6 h

- Max 4g/ day

60
Q

What are the most frequent adverse effects of ASA?

A
  • Abdominal pain with cramps
  • Heartburn
  • Dyspepsia
  • GI irritation
61
Q

What are some drug interactions with ASA?

A
  • Alcohol and corticosteroids (increase risk of GI pain/ulceration)
  • NSAIDs, including COX-2 inhibitors
  • Antihypertensive agents
  • Anticoagulants (increase risk of bleeding)
  • Methotrexate
62
Q

Is ASA safe to use during pregnancy?

A
  • Yes, in a low dose

- Risk in 1st and 3rd trimesters

63
Q

Is ASA safe to use while breastfeeding?

A

Limited data, potential toxicity

64
Q

What is the proposed mechanism for ASA-induced asthma?

A

Decreased prostaglandins causes increased leukotrienes

65
Q

What is ASA-induced asthma?

A

The onset of asthma 30 mins - 3 hrs post ingestion of ASA

66
Q

What is another name for naproxen sodium 220 mg?

A

Aleve

67
Q

Naproxen has similar indications and method of action as ____

A

Ibuprofen

68
Q

Is naproxen safe for children?

A

No

69
Q

What is the dosing of naproxen for people 12-65?

A

1 tab every 8-12h

70
Q

What is the dosing of naproxen for people over 65 with renal insufficiencies?

A

1 tab every 12 h

71
Q

Is naproxen safe to use while pregnant?

A

No

72
Q

Is naproxen safe to use while breastfeeding?

A

Not recommended

73
Q

Who should not take naproxen?

A

People allergic to ASA or other NSAIDs

74
Q

What happens when the levels of angiotensin 2 and norepinephrine rise?

A

Prostaglandin release is increased

75
Q

What do NSAIDs often interfere with?

A

The effects of antihypertensive agents

76
Q

Is it beneficial to alternate different antipyretics for fever reduction?

A

No, it is not recommended due to risk of overdose

77
Q

When is acetaminophen considered the first line therapy?

A
  • ASA-sensitive asthma
  • Gastritis or PUD
  • Patients w/ renal dysfunction
  • CV or hypertensive patients
  • Pregnant or breastfeeding
78
Q

How long should treatment of a fever be continued?

A

No more than 3 days without referral to determine the underlying cause

79
Q

Should parents wake a sleeping child so they can take their next dose of medication?

A

No, unless they are at risk of seizures during the fever

80
Q

Which antipyretics should be used for children under 18?

A

Acetaminophen or ibuprofen

Clinical Pharmacy 1 - Term 1 (18 decks)

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