Fever

Question 1

What are some normal temperature readings?

Answer 1

Rectum: 37.5C
Mouth: 37C
Armpit: 36.5C
Ear: 37.5C

Question 2

What are some symptoms of a fever?

Answer 2

Temperature rises above its normal range usually accompanied by sweating, chills, headache, and body aches

Question 3

What is the optimal location to measure in kids depending on age?

Answer 3

Age <2
1st choice: rectum
2nd choice: armpit
Ear – not recommended
Not as accurate
Age 2 to 5
1st choice: rectum
2nd choice: ear, armpit
Age >5
1st choice: mouth
2nd choice: ear, armpit

Rectal is best for kids under 5, but not mandatory

Question 4

Are digital ear thermometers recommended for newborns?

Answer 4

No, parents are not able to get accurate readings because their technique isn’t the best

Question 5

Do pharmacists check temperatures?

Answer 5

No, but we should know how to administer them in the case someone asks us how to use

Question 6

How to educate parents on checking their kid’s rectal temperature?

Answer 6

Show them a medsask video, much easier to show than to tell.

Question 7

How to take ear temperatures for newborns and toddlers?

Answer 7

Newborns: pull earlobe down

Toddlers: pull earlobe up

Question 8

How should a fever be treated by a pharmacist?

Answer 8

younger than 3 months: refer to physician
3mo-2y: No need to treat if fever is below 39, but treat if fever is above 39.
older than 2 years: No need to treat if fever is below 39, but treat if fever is above 39

A good rule of thumb for referrals is the following:

if fever lasts…
1 day for 1 year-old
2 days for 2 year-old
3 days for 3-year-old
Then refer to a doctor

Question 9

When should we treat a fever in kids?

Answer 9

Pediatricians recomend that we only give medications to kids that appear sick enough.

Question 10

What can I do if my child has a fever?

Answer 10

Non drug option: remove layers and reduce heat

drug option: ibuprofen or tylenol

Question 11

What is children’s dosing for acetaminophen?

Answer 11

10-15 mg/kg every 4 to 6 hours to a max of 75 mg/kg/day. That comes to 5 doses per day and that is far from overdose

Question 12

Does age matter more than weight when it comes to children’s acetaminophen dosing?

Answer 12

No, weight trumps age.

Question 13

Does acetaminophen have any side effects?

Answer 13

Nausea and heartburn are potential side effect in a small percentage of people. Hepatotoxicity is a result of overdoses, but not at intended dosages

Question 14

Does acetaminophen do something for colds?

Answer 14

No, does nothing for the main symptoms of colds

Question 15

Tell me about Ibuprofen

Answer 15

Ibuprofen has fast onset and delivers up to 8 hours of relief. Ibuprofen is an NSAID and it reduces pain and fever. It is no better or worse for fevers than acetaminophen

Question 16

What is children’s dosing for Ibuprofen?

Answer 16

For children over 6 months, 5-10 mg/kg every 6 to 8 hours up to max dose of 40 mg/kg/day

For children under 6 months, drop down to 5 mg/kg every 8 hours

For children under 3 months, refer to a doctor

Question 17

What are nuissance symptoms?

Answer 17

These are symptoms that manifest themselves at higher doses and duration of use that isn’t found when treating fevers

Question 18

Does ibuprofen have less side effects than acetaminophen at OTC doses?

Answer 18

No, they are have similar reported adverse effects. Ibuprofen has an advantage in fewer number of doses vs acetaminophen

Question 19

Is Naproxen used for fevers in Canada?

Answer 19

No

Question 20

Are acetaminophen and ibuprofen essentially interchangeable?

Answer 20

Yes, go ahead and decide on price, kid prefers one flavour over another

Question 21

What is fever phobia?

Answer 21

Unrealistic and exaggerated misconceptions of parents whose children have a fever. Concerns about fever-induced seizures are unfounded

Question 22

Can you alternate/simulataneously use ibuprofen and acetaminophen?

Answer 22

It isn’t wrong to use both, but scheduling can become tricky to synch. Usually not done as it is overkill

Question 23

What is the maximum daily adult dose for acetaminophen?

Answer 23

4g (4000mg)

Question 24

If monotherapy with ibuprofen or acetaminophen fails, what is a pharmacists greatest concern.

Answer 24

We should worry more about what is causing the fever rather than drug safety. Great time to refer to a physician.

Question 25

Does acetaminophen or ibuprofen affect the immune system’s ability to respond to vaccines?

Answer 25

Only treat a fever (at least 6 to 8 hours after immunization), if your child is uncomfortable, refusing fluids and not sleeping.

Question 26

What are febrile seizures?

Answer 26

They are convulsions that can happen when a young child has a fever above 38*C. The seizures usually last for a few minutes and stop on their own.

Question 27

Are febrile seizures something serious?

Answer 27

While febrile seizures may be very scary, they are harmless to the child. Febrile seizures do not cause brain damage, nervous system problems, paralysis, intellectual disability, or death

Question 28

Do antipyretics like acetaminophen and ibuprofen prevent subsequent febrile seizures?

Answer 28

taking antipyretics after a febrile seizure does not reduce the risk of subsequent febrile convulsions in at risk children

Question 29

Do elderly present flu symptoms differently versus adults?

Answer 29

The elderly have a reduced fever temperature and can have a more serious bacterial or viral infection at a lower temperature