2 - Internal Analgesics / Fever / Antipyretics Flashcards
1
Q
When to call MD for > 3 months
A
Rectal temp > 104 or equivilant
2
Q
Ibuprofen PEDIATRIC OTC Dose
A
7.5mg /kg / dose
to
MAX 30mg/kg/day
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
4
Q
Naproxen Dosing
A
220mg q8-12 hours
first dose can be 220 or 440
MAX DOSE = 660mg/day
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*
6
Q
Osteo Bi-flex
A
- Glucosamine + Chondroitin
- MSM + Bosweilla serrata extract
- Vitamins + Herbs + Melatonin
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
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
9
Q
Can you use Chondroitin / Glucosamine if pregnant?
A
NO
Also avoid in Kids
10
Q
Oral Fever Temperature
A
> 99.5
11
Q
Temporal Fever Temperature
for 0-2 months
A
>100.7
12
Q
Do not take NSAIDS for ___ days
A
>10 days for PAIN
>3 days for FEVER w/o talking to MD
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
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
15
Q
How long can an adult use APAP?
A
<10 days for PAIN
<3 days for FEVER
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
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
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
19
Q
When to use oral antipyretics for ADULTS / Older Children?
A
Oral temp > 101
and/or fever is ACCOMPANIED by DISCOMFORT
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
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
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)
23
Q
Asperin indications
A
Analgesic (equivilant to APAP)
Antipyretic (equivilant to APAP)
Anti-inflammatory
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
25
**Buffered ASA**
**Alka-Seltzer**
* *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
26
**Temporal Fever Temperature**
**\>4 y/o**
**\>100.1**
27
**Glass Thermometers**
* Mercury w/ scale
* *AVOID GLASS, can break in rectum*
* **Oral = 4 min**
* **Rectal = 3 minutes**
* *****negative is HOW LONG it takes to get reading*
* **
28
**Ibuprofen Infant Dose**
for **6 mo-23mo**
**2x more concentrated than Childrens**
50mg/1.25ml vs 100mg/5ml
29
**How long can Children use APAP?**
**\<5 Days for pain**
**\<3 days for FEVER** w/o MD advice
30
**Tympanic Fever Temperature**
**\>100**
31
**Temporal Fever Temperature**
**for 3-47 months**
**\>100.3**
32
**ASA** (salicylate) **Contraindications**
DO NOT TAKE ASA IF:
* 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
**ASA Suppositories**
for patients who are **Vomitting** or **Can't Swallow**
34
**APAP Drug Interactions**
***Generally no significant interactions***
Can still increase risk of **Anticoag Effects** (monitor INR carefully)
**_Still Preferred analgesic for patients on blood thinners_**
35
**Rectal temperature measuring**
* **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
**Reye's Syndrome**
* Acute **Nerological Disorder**
* Vomiting / CNS Dmg / hepatic injury / hypoglycemia
* **Virus + ASA ingestion** in **_Children_**
* *or even a history of RECENT viral illness*
37
**Enteric Coated ASA**
**Bayer / Ecotrin**
* *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
**Tympanic Thermometers**
* ***NOT Recommended for Children \<6 months***
* **ear canals are NOT developed
* Ear wax / infections can affect reading
39
**Caffeine Patient Counseling**
* **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
**APAP Side Effects**
**Steven Johnson Syndrome**
watch for **SKIN REACTIONS**
**blisters / rash / reddening**
see doctor right away
41
**Motrin (NSAID) Pediatric Dosing**
_There is dosing for_ **_\>6mo children_**
12-17lbs / 6-11 mos = **1.25mL**
18-23lbs / 12-23 mos = **1.875mL**
42
**ASA** (salicylate) **Risk Factors**
* **GI** risk factors
* **\>60 years old**
* h/o of **PUD** = ulcer disease
* Gastric ulceration
* taking **blood thinner or Steroid**
* **alcoholic liver disease**
43
What duration should you exclude SELF CARE for pain?
**Adults \> 10 days**
**Children \> 5 days**
go see a doctor
44
**Rectal Fever Temperature**
**\>100.4**
45
**OTC NSAIDS:**
**Ibuprofen / Naproxen**
**Analgesic**
**Anti inflammatory**
**Anti-pyretic**
*Naproxen is not used for anti-pyretic*
46
**Can APAP be used during pregnancy / breastfeeding?**
**YES**
used SPARINGLY during either
47
**Anacin**
**Aspirin 400mg**
**Caffeine 32mg**
48
**What age of children are rectal assessment MOST accurate?**
**\< 3 months old!**
Children / Adults -\> oral or tympanic can be appropriate if proper
49
**Axillary Fever Temperature**
**\>99.3**
50
**ASA (salicylate) Side Effects**
* **Hematologic**
* Bleeding
* **Local GI Damage**
* ****systemic effect from **prostaglandin inhibition**
* -\> can effect other parts of body not just GI
* **Ulceration**
51
**Tympanic Temperature measurement**
* 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
**APAP and ALCOHOL Counseling**
Issue is more with **Chronic Alcoholics:**
**\<4g per day for \<2 days** is still okay
53
**Magnesium Salicylate**
**Doans / Percogesic**
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
Two Types of **ASA Allergy/Intolerance**
* **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
**When to call MD for Children \< 3mo**
**\>100.4 RECTAL**
56
**How long to wait for fevers for children \< 2 years?**
**\>24 hours call doctor for \<2yearsold**
57
**Oral Temperature Measurement**
* **\>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
**Midol (teen)**
**APAP 500mg**
**Pamabrom (diuretic) 25mg**
*no caffeine*
59
**NSAIDS & Pregnancy**
*DO NOT USE IN* ***3rd TRIMESTER***
Compatible w/ **Breast Feeding**
First line is APAP
60
**Pacifier Thermometer**
* **Useful for infants who Cannot hold probe under tongue**
* **3-8 minute reading**
* wait 20-30 min after drinking or eating
61
**OTC NSAID (naproxen) SIDE EFFECTS**
* **GI intolerance**
* Hemtalogic
* -\> ***inhibit platelet function***
* **CNS**
* dizziness / headache / drowsy / nervousness
* **Renal**
* *renal function decrease*
* NA/water retention
* **Dehydration**
62
**Acetaminophen Infant dose**
**IS NOW THE SAME AS CHILDRENS**
**160/5ml**
but drops might still be at HOME so ASK!
63
**Ibuprofen Dose / Max per day**
Max **1.2 grams per day**
_FOR OTC_
**200-400 mg q46**
64
**ASA** (salicylate) **Patient Counseling**
* 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
**Ibuprofen vs APA**
**in antipyretic / analgesic efficacy in CHILDREN**
**APAP 15mg/kg/dose**
comparible in efficacy to
**Ibuprofen 10mg/kg/dose**
66
**Percogesic**
**APAP 325mg**
**Diphenhydramine 12.5mg**
67
**Do NOT use Naproxen if...?**
**in 3rd Trimester of pregnancy**
68
**MSM**
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
**ASA DOSING**
**Adults: 2-3 (325mg) tablets q-4-6 hours**
* RARELY USED IN CHILDREN*
* NEVER IN OTC SETTING*
* typically dosed by age/weight*
70
**Infrared Thermometer**
* Infrared -\> heat from ARTERIAL blood supply
* **Tympanic Artery / Temporal Artery**
* tympanic = in ear
* temporal = temples
* **\<5 seconds**
* dirty lens / bad placement --\> innacurate reading
71
**Excedrin Migraine**
**ASA 250mg**
**APAP 250mg**
**Caffeine 65mg**
72
**Pediatric APAP Dose**
**10-15 mg/kg/dose**
\<5 doses per day
*no doses for children \<2 y/o on label*
73
**Temporal Thermometer**
* **Forehead Scan**
* Conflicting results -\> RECTAL themometer still gold standard
* Let thermometer adjust to room temp for **\>30 minute**s
* **Remain in contact with skin at ALL times**
74
**Chondroitin**
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
**Midol Complete**
**APAP 500mg**
**Caffeine 60mg**
**Pyrilamine (antihistamine) 15mg**
76
**PAIN SCORE**
**What is an EX-ST**
**Mild = 1-3**
**Moderate = 4-6**
**_Severe = 7-10_**
**EXST if \> 6**
77
**Questions to ask for PAIN**
**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
**Questions to ask for FEVER**
**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**
