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PDAT1 > 2 - Internal Analgesics / Fever / Antipyretics > Flashcards

2 - Internal Analgesics / Fever / Antipyretics Flashcards

1
Q

When to call MD for > 3 months

A

Rectal temp > 104 or equivilant

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2
Q

Ibuprofen PEDIATRIC OTC Dose

A

7.5mg /kg / dose

to

MAX 30mg/kg/day

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3
Q

Digital Thermometers

A

GENERALLY THE BEST CHOICE

  • 10-60 seconds for a reaing
  • Can be used for Oral / Rectal / Axillary
  • Use Watersoluble LUBRICATION for rectal
    • not vaseline = too thick
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4
Q

Naproxen Dosing

A

220mg q8-12 hours

first dose can be 220 or 440

MAX DOSE = 660mg/day

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5
Q

Glucosamine + Chondroitin indications

A

Indicated to manage pain in Osteoarthritis

for moderate to severe pain

  • not too much for mild pain*
  • no evidence for effectiveness in RA*
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6
Q

Osteo Bi-flex

A
  • Glucosamine + Chondroitin
  • MSM + Bosweilla serrata extract
  • Vitamins + Herbs + Melatonin
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7
Q

NSAID Patient Counseling

A
  • Avoid other NSAIDS + ASA** **+ Alcohol
  • Take w/ food or milk
    • minimum full glass of water
  • Notify MD if:
    • weight gain / edema / rash
    • signs of bleeding
  • ​Do not take for >10 days for PAIN
    • >3 days for fever w/o talking to your doctor
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8
Q

Choosing Ibuprofen vs APAP

A

Ibuprofen has longer duration of action

–> can use overnight / less dosing

BUT - Ibu has side effects including GI distress

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9
Q

Can you use Chondroitin / Glucosamine if pregnant?

A

NO

Also avoid in Kids

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10
Q

Oral Fever Temperature

A

> 99.5

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11
Q

Temporal Fever Temperature

for 0-2 months

A

>100.7

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12
Q

Do not take NSAIDS for ___ days

A

>10 days for PAIN

>3 days for FEVER w/o talking to MD

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13
Q

Advantage of NAPROXEN > other NSAIDS (ibuprofen)

A

Longer duration of Action

Up to 12 hours

Can take less frequently

but no anti-pyretic effect

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14
Q

Acetaminophen Max Daily Dosage

A

FDA < 4 Grams a day

Tylenol botles say < 3 grams per day for extra strength

Regular < 3250mg/day

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15
Q

How long can an adult use APAP?

A

<10 days for PAIN

<3 days for FEVER

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16
Q

Symptoms that EXCLUDE self-treatment

“see doctor”

A
  • Spots / Rash
  • CANT DRINK FLUIDS
    • ​refuses fluids / vomiting
  • Fever >3 days w or w/o treatment
  • Diarrhea
  • Stiff neck
  • History of Siezures
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17
Q

NSAID Increased risk of adverse effects

A
  • >60 yrs old
  • Taking oral steroids / warfarin / diuretics
  • ASA sensitivity
  • >3 alcoholic drinks every day while using product
  • History of:
    • bleeding problems
    • stomach problems like heartburn or ulcers
    • CHF / High BP / Heart Disease / Kidney Disease
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18
Q

Heart & Stroke Warning for NSAIDS

A

EXCEPT FOR ASPIRIN (salicylate)

NSAIDS increase risk of heart attack / failure / stroke

patients with risk for CV disease should AVOID NSAIDS

use lowest dose & shortest durations

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19
Q

When to use oral antipyretics for ADULTS / Older Children?

A

Oral temp > 101

and/or fever is ACCOMPANIED by DISCOMFORT

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20
Q

Glucosamine

500mg TID

A

VERY SLOW ONSET OF ACTION

compared to NSAIDS, takes up to 4-6 months for FULL effects

Appears to be safe short-term

Beware of SHELLFISH ALLERGIES

diabetic patients should monitor glucose-amino sugar

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21
Q

Axillary Temperature Measurement

A
  • Inaccurate due to environmental temperatures and physiologic factors​
  • ​Armpit
    • >99.3
  • Fever may shunt blood AWAY from skin, so can be NORMAL when fever is present
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22
Q

What to recommend if patient has history of GI upset with ASA or IBU?

A

Acetaminophen

Enteric Coated Salicylate (if anti-inflammatory needed)

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23
Q

Asperin indications

A

Analgesic (equivilant to APAP)

Antipyretic (equivilant to APAP)

Anti-inflammatory

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24
Q

Ibuprofen Pediatric Safety

A

5-10mg/kg/dose

Boston Uni Fever Study

Looked at GI bleeding / renal failure / anyphylaxis / REYE’s

No Difference in risk for SERIOUS adverse effects

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25
Q

Buffered ASA

Alka-Seltzer

A
  • No REAL evidence that they are better or faster
  • May DECREASE GI UPSET and local Gastric damage
    • pH may be INCREASED by antacids
    • increase dissolution + absorption
  • Only rec if patient can NOT swallow tablets
    • ​avoid in patients w/ High BP & CHF
    • Sodium restricted = HIGH SODIUM LOAD
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26
Q

​Temporal Fever Temperature

>4 y/o

A

>100.1

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27
Q

Glass Thermometers

A
  • Mercury w/ scale
    • AVOID GLASS, can break in rectum
  • Oral = 4 min
  • Rectal = 3 minutes
    • ​negative is HOW LONG it takes to get reading
  • ​
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28
Q

Ibuprofen Infant Dose

A

for 6 mo-23mo

2x more concentrated than Childrens

50mg/1.25ml vs 100mg/5ml

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29
Q

How long can Children use APAP?

A

<5 Days for pain

<3 days for FEVER w/o MD advice

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30
Q

Tympanic Fever Temperature

A

>100

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31
Q

​Temporal Fever Temperature

for 3-47 months

A

>100.3

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32
Q

ASA (salicylate) Contraindications

DO NOT TAKE ASA IF:

A
  • Do not take ASA if:​
    • PUD / GI bleeding / Hemophilia
    • Gout
      • <2 grams per day can increase URIC ACID levels
    • ASTHMA
    • ASA hypersensitivty
    • PREGNANCY / BREASTFEEDING
    • KIDS / TEENS W/ VIRAL INFECTIONS
      • -> Reye’s syndrome
33
Q

ASA Suppositories

A

for patients who are Vomitting or Can’t Swallow

34
Q

APAP Drug Interactions

A

Generally no significant interactions

Can still increase risk of Anticoag Effects (monitor INR carefully)

Still Preferred analgesic for patients on blood thinners

35
Q

Rectal temperature measuring

A
  • MOST ACCURATE MEASURE OF CORE TEMP
  • <1 inch from rectum
  • Preferred for <3 mo
  • Core temperature is HIGHER vs oral
    • >100.4 vs >99.5
36
Q

Reye’s Syndrome

A
  • Acute Nerological Disorder
    • Vomiting / CNS Dmg / hepatic injury / hypoglycemia
  • Virus + ASA ingestion in Children
    • or even a history of RECENT viral illness
37
Q

Enteric Coated ASA

Bayer / Ecotrin

A
  • May prevent Gastric distress
    • dissolution is in GI instead of stomach
  • Delayed Onset of Action
    • takes longer to work, indicated for Long term treatment
  • DO NOT TAKE W/
    • Antiacids / PPI / H2 agonist
      • -> increase pH, NEGATES enteric coating
38
Q

Tympanic Thermometers

A
  • NOT Recommended for Children <6 months
    • ​ear canals are NOT developed
  • Ear wax / infections can affect reading
39
Q

Caffeine Patient Counseling

A
  • Dose = About as much as a CUP OF COFFEE
  • D/C if:
    • fast pulse
    • dizziness
    • Pounding heartbeat
  • Avoid if taking medications that contain caffeine:
    • cns stimulants
    • MAO inhibitors
  • ​HTN / PUD can be aggrevated
40
Q

APAP Side Effects

A

Steven Johnson Syndrome

watch for SKIN REACTIONS

blisters / rash / reddening

see doctor right away

41
Q

Motrin (NSAID) Pediatric Dosing

A

There is dosing for >6mo children

12-17lbs / 6-11 mos = 1.25mL

18-23lbs / 12-23 mos = 1.875mL

42
Q

ASA (salicylate) Risk Factors

A
  • GI risk factors
    • >60 years old
    • h/o of PUD = ulcer disease
    • Gastric ulceration
    • taking blood thinner or Steroid
    • alcoholic liver disease
43
Q

What duration should you exclude SELF CARE for pain?

A

Adults > 10 days

Children > 5 days

go see a doctor

44
Q

Rectal Fever Temperature

A

>100.4

45
Q

OTC NSAIDS:

Ibuprofen / Naproxen

A

Analgesic

Anti inflammatory

Anti-pyretic

Naproxen is not used for anti-pyretic

46
Q

Can APAP be used during pregnancy / breastfeeding?

A

YES

used SPARINGLY during either

47
Q

Anacin

A

Aspirin 400mg

Caffeine 32mg

48
Q

What age of children are rectal assessment MOST accurate?

A

< 3 months old!

Children / Adults -> oral or tympanic can be appropriate if proper

49
Q

Axillary Fever Temperature

A

>99.3

50
Q

ASA (salicylate) Side Effects

A
  • Hematologic
    • Bleeding
  • Local GI Damage
    • ​systemic effect from prostaglandin inhibition
      • -> can effect other parts of body not just GI
    • Ulceration
51
Q

Tympanic Temperature measurement

A
  • Infrared technolagy to measure blood supply inside
    • Ear Canal
  • 5 Second measurement
    • ​>100
  • ​Can be affected by ambient temperature
    • ​wait 15 minutes before measuring if child was Outside
52
Q

APAP and ALCOHOL Counseling

A

Issue is more with Chronic Alcoholics:

<4g per day for <2 days is still okay

53
Q

Magnesium Salicylate

Doans / Percogesic

A

650-100mg Q4-6 hours

Approved OTC for MINOR ACHES & PAINS

associated w/ backache + Muscular aches

  • Lower incidense of GI upset*
  • can cause magnesium toxicity in pts w/ renal insufficiency*
54
Q

Two Types of ASA Allergy/Intolerance

A
  • CUTANEOUS
    • ​uticarial / angioedema
      • -> RASH / Skin issues
  • RESPIRATORY
    • bronchospasm / laryngospasm / rhinorrea
    • 10% of asthma patients have ASA sensitivity
    • Shortness of breath
  • ​Usually occurs within 3 hours of ASA ingestion
55
Q

When to call MD for Children < 3mo

A

>100.4 RECTAL

56
Q

How long to wait for fevers for children < 2 years?

A

>24 hours call doctor for <2yearsold

57
Q

Oral Temperature Measurement

A
  • >99.5
    • ~ 1 degree less than rectal
  • Wait 20-30 minutes after drinking or eating
  • Best temp below tongue as far back as possible
58
Q

Midol (teen)

A

APAP 500mg

Pamabrom (diuretic) 25mg

no caffeine

59
Q

NSAIDS & Pregnancy

A

DO NOT USE IN 3rd TRIMESTER

Compatible w/ Breast Feeding

First line is APAP

60
Q

Pacifier Thermometer

A
  • Useful for infants who Cannot hold probe under tongue
  • 3-8 minute reading
    • wait 20-30 min after drinking or eating
61
Q

OTC NSAID (naproxen) SIDE EFFECTS

A
  • GI intolerance
  • Hemtalogic
    • -> inhibit platelet function
  • CNS
    • dizziness / headache / drowsy / nervousness
  • Renal
    • renal function decrease
    • NA/water retention
    • Dehydration
62
Q

Acetaminophen Infant dose

A

IS NOW THE SAME AS CHILDRENS

160/5ml

but drops might still be at HOME so ASK!

63
Q

Ibuprofen Dose / Max per day

A

Max 1.2 grams per day

FOR OTC

200-400 mg q46

64
Q

ASA (salicylate) Patient Counseling

A
  • Take w/ food or milk
  • Take w/ full glass of water
  • Avoid LYING DOWN 15-30 min after taking
  • Do not use ASA if it has a strong vinegar odor
  • do not use ASA if drinking >3 alcoholic drinks / day
  • notify provider if Tinnitus or Signs of bleeding
  • if difficulty in swallowing > use film coated tabs
65
Q

Ibuprofen vs APA

in antipyretic / analgesic efficacy in CHILDREN

A

APAP 15mg/kg/dose

comparible in efficacy to

Ibuprofen 10mg/kg/dose

66
Q

Percogesic

A

APAP 325mg

Diphenhydramine 12.5mg

67
Q

Do NOT use Naproxen if…?

A

in 3rd Trimester of pregnancy

68
Q

MSM

A

Used for chronic pain of OSTEOARTHRITIS

use for <3months

  • No data support MSM in creams or lotions (poorly absorbed)*
  • little date support Oral MSM*
69
Q

ASA DOSING

A

Adults: 2-3 (325mg) tablets q-4-6 hours

  • RARELY USED IN CHILDREN*
  • NEVER IN OTC SETTING*
  • typically dosed by age/weight*
70
Q

Infrared Thermometer

A
  • Infrared -> heat from ARTERIAL blood supply
    • Tympanic Artery / Temporal Artery
    • tympanic = in ear
    • temporal = temples
  • <5 seconds
  • dirty lens / bad placement –> innacurate reading
71
Q

Excedrin Migraine

A

ASA 250mg

APAP 250mg

Caffeine 65mg

72
Q

Pediatric APAP Dose

A

10-15 mg/kg/dose

<5 doses per day

no doses for children <2 y/o on label

73
Q

Temporal Thermometer

A
  • Forehead Scan
  • Conflicting results -> RECTAL themometer still gold standard
  • Let thermometer adjust to room temp for >30 minutes
  • Remain in contact with skin at ALL times
74
Q

Chondroitin

A

Some commercial products made from cow trachea

Similar to Heparin

be cautious w/ pts on ASA or warfarin, check INR

•400mg TID​
with food if nausea / GI upset

75
Q

Midol Complete

A

APAP 500mg

Caffeine 60mg

Pyrilamine (antihistamine) 15mg

76
Q

PAIN SCORE

What is an EX-ST

A

Mild = 1-3

Moderate = 4-6

Severe = 7-10

EXST if > 6

77
Q

Questions to ask for PAIN

A

WHERE is the pain?

Does it RADIATE?

Is it Constant or Sporadic?

What is your PAIN SCORE?
(>6 =exst)

What other meds have you tried?
how much / how often

How LONG?
>10days for adults / >5 days children = EXST

Current medications / conditions
gout / ulcers / allergies / bleeding issues / GI UPSET
ALCOHOL / pregnant/BF

78
Q

Questions to ask for FEVER

A

HOW did yo take the temprature?

What symptoms are present & how long?

What medications have you tried / what dose?

Allergies?

Is the patient drinking fluids?

Other disease states = SEIZURES / HIV / CANCER

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