Acute Illness

Question 1

Conditions with Fever:

Answer 1

-Influenza (high)
-Acute Rhinosinusitis (high)
-COVID-19

Question 2

Infections with rapid Onset:

Answer 2

-Acute Pharyngitis
-Influenza
-Gastroenteritis (stomach flu)
-Acute Otitis Media
-Urinary Tract Infection
-COVID-19 (differs by variant)

Question 3

What is a possible outcome of untreated Urinary Tract
Infection?

Answer 3

Infection of the kidney and back pain

Question 4

Patient Presentation: Fever

Answer 4

-higher than the normal core temperature of 100˚F (97.5˚F – 98.9˚F) -> variation: 4-6 PM, low between 4-6 AM

-Symptoms: Headache, sweating, generalized malaise (discomfort), chills, tachycardia, arthralgia (joint stiffness), myalgia (muscle pain), irritability, anorexia (loss of appetite)

-Complications: febrile seizures in kids, dehydration

Question 5

Patient Presentation: Urinary Tract Infection

Answer 5

-Predisposing conditions: pregnancy, diabetes, urinary stones,
urinary obstruction, presence of urinary catheters, history of UTIs

-Pain on urination (dysuria)
-Sensation of the urgent need to urinate and frequent urination
-Urinary hesitancy
-Blood in the urine (hematuria)
-Changes in urine color (blood) and odor (bacteria)
-Lower abdominal pain/discomfort (could be due to the kidney)

Question 6

What are the ways to measure a patient’s fever?

Answer 6

Rectal, Oral, Temporal, Tympanic (eardrum), Axillary

Accurate: Skin- Temporal, Tympanic - ear, rectal (gold-standard) -> get the core temperature

less accurate: oral, axillary -> away from core temperature, color-changing strips inaccurate (kids head is warm, leaning on mum, interferences)

Question 7

What are the ways to measure a patient’s fever?

Answer 7

Rectal, Oral, Temporal, Tympanic (eardrum), Axillary

Accurate: Skin- Temporal, Tympanic - ear, rectal (gold-standard) -> get the core temperature
Fever range: 100.4 F

less accurate: oral, axillary -> away from core temperature, color-changing strips inaccurate (kids head is warm, leaning on mum, interferences), pacifier thermometer (oral)
Fever range: oral: 99.5 F, axillary 99 F

Question 8

How do home UTI test work?

Answer 8

-sense nitrate shaded by bacteria -> highly specific but low sensitivity
-Contact a healthcare provider with (+) test, Contact a healthcare provider with a (-) test if symptoms persist

-Example: UTI Home Test: nitrite; AZO Test Strips: nitrite and leukocyte esterase

Question 9

Infections treated with OTC and prescribed drugs:

Answer 9

-OTC: Common Cold, Stomach Flu (gastroenteritis), Vaginal Yeast infections, Fungal infections

-Antibiotics/prescribed/need assessment: Strep Thorat, Flu, Ear infection, sinus infection, COVID, UTI

Question 10

When to treat a fever?

Answer 10

There is no evidence, in general treatment only when there is discomfort

Nonpharmacologic Therapy:
-Rehydration, lightweight clothing, avoiding overexertion, keeping room temperature, sponge bath

Question 11

Difference between children’s MOTRIN (ibuprofen) VS infant’s MOTRIN?

Answer 11

-same dose, but a different device and different concentration, different color
-higher concentration for infants, so a high volume is not needed for infants (up to 2y)

Question 12

How to use the correct dose if the age and weight don’t match?

Answer 12

Use weight for the correct dose

Question 13

Why is the concentration for children and infants Tylenol the same?

Answer 13

-Avoid dosing errors -> hepatic toxicity
-Different devices: Syringe for infants (up to 2y), cups for kids

Question 14

Pharmacologic Options -> Antipyretics

PEDIATRICS dosing

Answer 14

-Aspirin: Only for children ≥ 15 years of age

-Acetaminophen (Tylenol): 10-15mg/kg q 4-6hrs, Max= 5 doses/day

-Ibuprofen: 5-10mg/kg q 6-8hrs; Max = 4 doses/day

Question 15

Pharmacologic Options -> Antipyretics
Adult dosing

Answer 15

-Aspirin: Generally, avoid in favor of safer options

-Acetaminophen (Tylenol): 325-650mg q 4-6 hours; Max= 4000mg/day

-Ibuprofen: 200-400mg q 4-6 hour; Max = 1200mg/day

Question 16

After taking meds:
How long does it take to see a reduction of temperature?

Answer 16

30- 60 min after taking the med

-> Contact PCP (primary care physician) if fevers remain elevated (>103-104˚F) longer than 2hrs after OTC treatment or if it gets higher

Question 17

How long to use OTC regimen without seeing the physician?

Answer 17

No longer than 3 days without improvement in fever

Question 18

How to treat symptoms like:
Headache, Body Aches, Sore throat, and fatigue

Answer 18

Pain meds

Question 19

How to treat symptoms like:
Nasal Discharge & Congestion and Cough

Answer 19

Antihistamines
a lot of cough and cold products have Antihistamines, some might have Decongestants in them (Oxymetazoline, Naphazoline, Phenylephrine)

Question 20

How to treat Urinary Urgency and Discomfort

Answer 20

-It is bacterial -> Antibiotics, it could infect kidneys which is harder to treat
-there are some OTC products to treat the symptoms but they go WITH ANTIBIOTICS

-Example: AZO

Question 21

What is the API of AZO?

Answer 21

• phenazopyridine -> treating the symptoms of UTI alongside the antibiotics
  -Symptoms: urinary burn, pain after urologic procedures
  -only short-term: for 2 days
  -it passes the kidney -> caution in patients with renal insufficiency, safe for geriatrics?

Question 22

Side effects and counseling on administration:

Answer 22

-Side effects: upset stomach, headache, discoloring of the urine (warn patient, don’t wear white underwear (staining)

-Administration: with a glass full of water, it gets washed by the kidney -> stay hydrated

Question 23

OTC product for UTI: Cystex (combo product)

API

Answer 23

API: methenamine (antibiotic but not enough to resolve the infection and sodium salicylate (impact on paint)

Symptoms: symptomatic relief of urinary burning, pain,
frequency/urgency associated with UTIs

Question 24

Cystex: Warnings

Answer 24

-limited to 3 days
bc of salicylate avoid in geriatrics, children, pregnant women, patients with GI problems,

patients on anticoagulant (warfarin) - bleed risk, or on NSAIDS -> Drug interaction !!; Antihypertensive drugs
patients drinking alcohol (3 or more a day) - bc of renal impairment?
patients allergic to Aspirin

Side effects: stomach upset, nausea, vomiting
take it with a glass full of water and after a meal

Question 25

What do patients need to be aware of when taking cranberry?

Answer 25

-some evidence that cranberry y blocks some bacteria (namely
E.coli) from adhering to the bladder, kidney, urethra

-don’t drink cranberry juice bc it bacteria use sugar to grow
-the risk of diarrhea when large doses taken
-interaction with warfarin and risk of kidney stones

Question 26

What are some supplements that help against COVID?

Answer 26

-Vitamin D
-Quercetin & Vitamin C
-Zinc
-Glutathione
-N-acetyl-cysteine NAC
-Melatonin

Question 27

What are Probiotics?

Answer 27

Live microorganisms, given in adequate amounts, confer
benefit to the host (replenish the good gut bacteria after antibiotic treatment)

-Most common species: Lactobacillus, Bifidobacterium,
Saccharomyces

-can also be used for Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), hepatic disorders, skin issues

Example: Philips colon health (with CFU on the label)

Question 28

What is antibiotic-associated diarrhea (AAD)?

Answer 28

Good bacteria in the gut is deplenished
-Clindamycin, Ampicillin, and Amoxicillin/Augment are more prone to cause AAD
-to counteract take probiotics with the antibiotic

Question 29

Example Philips colon health:

Answer 29

Philips colon health (with CFU on the label)
API: Active ingredient: Lactobacillus gasseri, Bifidobacterium bifidum, Bifidobacterium longum

-Avoid in immunocompromised and pregnant patients
-Side effects: flatulence, bloating