Fever and inflammation

Question 1

What are some exclusions for self-treatment when it comes to pain

Answer 1

Pain score of more than a 6 on a scale of 0-10
Pain lasting longer than 10 days total OR for 7 days with treatment of topical analgesic
Increased intensity or change in pain
Associated N/V and/or fever or infection
Visual deformity, abnormal movement, weakness, numbness, or possible fracture
OTC intolerances
Achilles tendonitis
Pregnancy
Younger than 2 years of age

Question 2

What nonpharmacologic treatments are available for pain

Answer 2

If it hurts, stop doing it
Stretching cautiously
Massage
REST

Question 3

When should you Ice after an injury

Answer 3

Ice as soon as possible following injury
DO this for 3-4x per day up to 72 hours

Question 4

When should you use heat after an injury

Answer 4

DO NOT use heat for the first 48 hours so you don’t exacerbate inflammation
Apply heat for 15-20 minutes, 3-4x a day

Question 5

What is RICE therapy

Answer 5

Rest: after injury and until pain decreases
Ice: ASAP for 10-15 minutes, 3-4x a day, up to 72 hours
Compression: elastic support or bandage
Elevate: at or above heart 2-3 hours per day

Question 6

What pharmacologic treatments are available for pain/inflammation?

Answer 6

Systemic analgesics and topical counterirritants

Question 7

How long should systemic analgesics be used for?

Answer 7

Use for a max of 10 days! Go to doctor if not resolved after 10 days

Question 8

How long should topical counterirritants be used for?

Answer 8

Max of 7 days

Question 9

What is the MDD of acetaminophen

Answer 9

3250mg in 24 hours
Changed in 2012 and decreased from 3900mg

Question 10

How do NSAIDs differ from Acetaminophen?

Answer 10

NSAIDs are peripheral inhibitors of COX and acetaminophen is a central inhibitor of prostaglandin synthesis

Question 11

Who should not take NSAIDs

Answer 11

those older that 60
prior ulcer
concurrent anticoag use
higher dose and duration
moderate-high use of alcohol

Question 12

What OTC NSAID agents are available and what is the dosing?

Answer 12

Ibuprofen: 200-800mg QID, MDD OTC 1200mg/day
Naproxen: 220mg BID, MDD OTC 660mg/day
Diclofenac topical: Apply up to QID, no more than 2 spots on the body. 2 grams for upper body and 4 grams for lower body

Question 13

How do topical counterirritants work?

Answer 13

Relieve pain through nerve stimulation
Paradoxical pain relieving effect
Pain relief tied with psychological effect

Question 14

What are the 4 groups of counterirritants

Answer 14

rubefacients
cooling agents
vasodilation
irritant

Question 15

How do irritants differ from the rest of the counterirritants

Answer 15

You apply for duration of the pain instead of a max of 7 days

Question 16

Describe methyl salicylate

Answer 16

A rubefacient,
provides a “hot” feeling, vasodilation of blood vessels, inhibits prostaglandin synthesis in central and peripheral

Question 17

What are some side effects of methyl salicylate

Answer 17

do not take if you are allergic to aspirin, blistering/erythema

Question 18

T or F: combination products are ok but avoid dual products

Answer 18

True, combination products are okay with counterirritants but do not use 2 medications from the same class

Question 19

How does camphor work

Answer 19

It stimulates nerve endings to mask deeper pain, provides cooling sensation

Question 20

How does menthol work

Answer 20

activates transient receptor potential sensory neurons, provides cooling sensation

Question 21

What are some side effects of camphor and menthol

Answer 21

Camphor: high doses can lead to nausea and vomiting, convulsions and even death. Lethal in children.
Menthol: can sensitize some people

Question 22

How does histamine hydrochloride work

Answer 22

vasodilation mediated by prostaglandin biosynthesis, reduces reactive oxygen species, suppresses pro-inflammatory cytokines, increases blood flow, which facilitates healing

Question 23

How capsaicin work

Answer 23

causes indirect vasodilation via stimulation and cause feeling of warmth

Question 24

How long can it take capsaicin to provide pain relief

Answer 24

relief within 14 days but can take up to 4-6 weeks

Question 25

What is a febrile seizure

Answer 25

A seizure with a fever in infants/children /o intracranial infection, metabolic disturbance or a defined cause

Question 26

What is the pathophysiology of a fever

Answer 26

Temperature regulated in the hypothalamus, thermoregulation ‘thermostat’ shifts upwards during a fever, caused by pyrogens

Question 27

Why should you treat a fever

Answer 27

elevated core temp increases oxygen demand, can aggravate pre-existing heart or lung disease, can induce mental changes in patients with brain diseases

Question 28

What are exclusions for self-treatment with a fever

Answer 28

patients older than 6 months with a rectal temp of 104 or higher
infants under the age of 6 months with a rectal temp of 101 or higher
severe symptoms of infection
risk of hyperthermia
impaired oxygen utilizaiton
impaired immune function
CNS damage
children with history of febrile seizures
Fevers that persist beyond 3 days with or without treatment
In children: rash, refusing to drink fluids, extreme lethargy, vomiting, can’t keep down fluids

Question 29

What are some nonpharmacologic therapy options?

Answer 29

Increase fluid intake
Avoid ice baths
Lightweight clothing, remove blankets and maintain comfy room temps

Question 30

What is the preferred method for treating fevers pharmacologically

Answer 30

Acetaminophen

Question 31

How long should acetaminophen be used to treat a fever

Answer 31

No longer than 3 days

Question 32

What is the most commonly used NSAID for fever reductions

Answer 32

Ibuprofen

Question 33

Why is there a high rate of error in liquid non-prescription products

Answer 33

inappropriate dosing, inaccurate measurement, duplication of therapy