Fever and inflammation Flashcards
What are some exclusions for self-treatment when it comes to pain
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
What nonpharmacologic treatments are available for pain
If it hurts, stop doing it
Stretching cautiously
Massage
REST
When should you Ice after an injury
Ice as soon as possible following injury
DO this for 3-4x per day up to 72 hours
When should you use heat after an injury
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
What is RICE therapy
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
What pharmacologic treatments are available for pain/inflammation?
Systemic analgesics and topical counterirritants
How long should systemic analgesics be used for?
Use for a max of 10 days! Go to doctor if not resolved after 10 days
How long should topical counterirritants be used for?
Max of 7 days
What is the MDD of acetaminophen
3250mg in 24 hours
Changed in 2012 and decreased from 3900mg
How do NSAIDs differ from Acetaminophen?
NSAIDs are peripheral inhibitors of COX and acetaminophen is a central inhibitor of prostaglandin synthesis
Who should not take NSAIDs
those older that 60
prior ulcer
concurrent anticoag use
higher dose and duration
moderate-high use of alcohol
What OTC NSAID agents are available and what is the dosing?
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
How do topical counterirritants work?
Relieve pain through nerve stimulation
Paradoxical pain relieving effect
Pain relief tied with psychological effect
What are the 4 groups of counterirritants
rubefacients
cooling agents
vasodilation
irritant
How do irritants differ from the rest of the counterirritants
You apply for duration of the pain instead of a max of 7 days
Describe methyl salicylate
A rubefacient,
provides a “hot” feeling, vasodilation of blood vessels, inhibits prostaglandin synthesis in central and peripheral
What are some side effects of methyl salicylate
do not take if you are allergic to aspirin, blistering/erythema
T or F: combination products are ok but avoid dual products
True, combination products are okay with counterirritants but do not use 2 medications from the same class
How does camphor work
It stimulates nerve endings to mask deeper pain, provides cooling sensation
How does menthol work
activates transient receptor potential sensory neurons, provides cooling sensation
What are some side effects of camphor and menthol
Camphor: high doses can lead to nausea and vomiting, convulsions and even death. Lethal in children.
Menthol: can sensitize some people
How does histamine hydrochloride work
vasodilation mediated by prostaglandin biosynthesis, reduces reactive oxygen species, suppresses pro-inflammatory cytokines, increases blood flow, which facilitates healing
How capsaicin work
causes indirect vasodilation via stimulation and cause feeling of warmth
How long can it take capsaicin to provide pain relief
relief within 14 days but can take up to 4-6 weeks
What is a febrile seizure
A seizure with a fever in infants/children /o intracranial infection, metabolic disturbance or a defined cause
What is the pathophysiology of a fever
Temperature regulated in the hypothalamus, thermoregulation ‘thermostat’ shifts upwards during a fever, caused by pyrogens
Why should you treat a fever
elevated core temp increases oxygen demand, can aggravate pre-existing heart or lung disease, can induce mental changes in patients with brain diseases
What are exclusions for self-treatment with a fever
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
What are some nonpharmacologic therapy options?
Increase fluid intake
Avoid ice baths
Lightweight clothing, remove blankets and maintain comfy room temps
What is the preferred method for treating fevers pharmacologically
Acetaminophen
How long should acetaminophen be used to treat a fever
No longer than 3 days
What is the most commonly used NSAID for fever reductions
Ibuprofen
Why is there a high rate of error in liquid non-prescription products
inappropriate dosing, inaccurate measurement, duplication of therapy
