Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical 1 (Part A) > Fever & Intro to Pain > Flashcards

Fever & Intro to Pain Flashcards

1
Q

T or F: a fever is a condition

A

false - a symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define: fever

A

1) a normal response to various circumstances - usually due to viral or bacterial infection
2) controlled response where the core temp of body is increased to a new set point and a new balance of heat loss and production is established

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What oral temp classifies as a fever?

A

over 37.5 degrees C

over 38 degrees C (rectal temp)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how long do fevers usually last?

A

3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What rectal temp classifies as a fever?

A

over 38 degrees C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What axillary (armpit) temp classifies as a fever?

A

over 37.3 degrees C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What tympanic (ear) temp classifies as a fever?

A

over 38 degrees C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the recommended way to measure temp: for children aged 0 to 2 yrs

A

1) rectal
2) axillary

  • tympanic not recommended
  • can damage something
  • ear canal is not fully developed so you won’t get the best reading
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the recommended way to measure temp: for kids aged 2 to 5 yrs

A

1) rectal

2) axillary, tympanic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the recommended way to measure temp: older than 5 yrs

A

1) oral

2) axillary, tympanic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain the pathophysiology of a fever

A
  • fever produced by pyrogens or either endogenous or exogenous origins
  • endogenous pyrogens are proteins that induce fever (including interleukin-1, tumor necrosis factor alpha, interleukin-6, ciliary neurotropic factor and interferon gamma)
  • exogenous pyrogens are chemicals produced by bacteria or by components of the organism (these then stimulate the release of endogenous pyrogens)
  • prostaglandins of the E2 series (PGE2) are produced in response to circulating pyrogens and elevate the thermoregulatory set point in the hypothalamus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When the hypothalamus reaches it’s new set point - how does the body temp increase to reach the new set point?

A
  • vasoconstriction of peripheral blood vessels
  • shivering to increase heat production
  • behavioural changes (putting on more clothes/blankets)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

hyperthermia

A

increase in body temperature not due to the hypothalamus (ex. physical exertion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List a few risk factors for fever

A
  • bacterial infection
  • viral infection
  • cancer
  • multisystem diseases (ex. rheumatic diseases, connective tissue disorders, anything that affects more than one system)
  • medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What age group do you want to refer if they have a fever?

A

babies less than 6 months old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

You want to refer a fever lasting > ___ hours (with or without treatment)

A

72 (3 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

You want to refer a fever lasting > ___ hours w/o obvious cause

A

24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

You want to refer a fever > ___ degrees C

A

40.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When else do you want to refer a fever?

A
  • child appears ill, irritable, cries inconsolably
  • child other symptoms that bother parents
  • pt has persistent wheezing/cough
  • pt has rash
  • recently had chemo
  • pt has other serious disease
  • pt has recently travelled
  • recently had surgery
  • eaten raw/poorly cooked meat/fish
  • recently started a new drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Signs/symptoms associated with fever

A
  • sweating
  • headache
  • fatigue
  • pain
  • discomfort
  • dehydration
  • chills
  • febrile seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

goals of therapy for fever?

A
  • patient comfort
  • reduce parental anxiety
  • reduce metabolic demand caused by fever in its with CV (cardiovascular) or pulmonary disease
  • prevent/alleviate fever-associated mental dysfunction in the elderly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why is reducing temp not a goal of therapy?

A
  • because the fever is fighting off infection

- it is providing an increased temp environment so bacteria or virus cannot survive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

List some non-pharms for treating a fever

A
  • remove excess clothing, blankets, bedding (keep cool and comfortable)
  • increase fluid intake
  • avoid physical exertion
  • maintain normal room temp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

antipyretic

A

used to prevent or reduce fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how do antipyretic agents work to reduce body temp?

A

decreases prostaglandin synthesis by inhibiting the cyclooxyegenase (COX) enzyme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the only 2 therapeutic choices for managing fever in children

A

acetaminophen

ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do acetaminophen and ibuprofen help manage a fever?

A

reduce the hypothalamus set point

*they do not lower normal body temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why is regular/short term use of agents recommended?

A

to remain consistent in treating the fever

-intermittent use may cause swings in temp (which will put an increased metabolic demand on the body)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

MOA for acetaminophen

A

inhibits the formulation and release of prostaglandins in the CNS and by inhibiting endogenous pyrogens and the hypothalamic thermoregulatory centre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What temp decrease can you expect from acetaminophen?

A

1-2 degrees C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Oral onset for acetaminophen

A

30 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Rectal onset for acetaminophen

A

slow onset and incompletely absorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

acetaminophen: time to peak

A

3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

acetaminophen: duration

A

4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

acetaminophen: where is it metabolized

A

liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

acetaminophen: GI Tract?

A

rapidly and completely absorbed from the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

acetaminophen: adult dosing

A

325 - 650 mg Q4 to 6H PRN

*max 4000 mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

acetaminophen: pediatric dosing

A

PO 10-15 mg/kg/dose Q4 to 6H PRN

Max:
65-75 mg/kg/day
OR
5 doses/day

*can never exceed adult dose - even if the weight calculates that you should

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

acetaminophen: safe in children?

A

yes - short term use tho

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

acetaminophen: safe in pregnancy and lactation

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

acetaminophen: dosing adjustment may be needed for Pts with ???

A

renal dysfunction

*i.e. bad CrCl

42
Q

acetaminophen & alcohol: ?

A

increased risk of hepatotoxicity

43
Q

acetaminophen & enzyme inducers: ?

A

decreased acetaminophen levels

44
Q

acetaminophen & warfarin: ?

A

chronic use can occasionally enhance warfarin’s anticoagulant effect (this is rare tho)

45
Q

NSAIDS: include ?

A

ASA (acetylsalicylic acid)
ibuprofen
naproxen

46
Q

NSAIDS: pharmacological properties ?

A

analgesic
anti platelet
antipyretic
anti-inflammatory

47
Q

NSAIDS: how do they work?

A

act on COX enzyme which inhibits prostaglandin synthesis

48
Q

Ibuprofen: MOA

A

-inhibits COX enzyme in periphery and CNS and thereby inhibits prostaglandin synthesis

49
Q

Ibuprofen: temp decrease?

A

1-2 degrees celsius

50
Q

Ibuprofen: onset as an antipyretic

A

less than 1 hour

51
Q

Ibuprofen: onset as an analgesic

A

within 60 mins

52
Q

Ibuprofen: onset as an anti-inflammatory

A

less than or equal to 7 days

-peak effect is at 1-2 weeks

53
Q

Ibuprofen: time to peak

A

2-3 hours

54
Q

Ibuprofen: duration

A

6-8 hours

55
Q

Ibuprofen: metabolism?

A

liver

56
Q

Ibuprofen: adult dosing for fever

A

200-400 mg/dose Q4 to 6H PRN

-max 1.2g/day (OTC dosing)

57
Q

Ibuprofen: child dosing for fever

A

PO 5-10 mg/kg Q6 to 8H

max: 40 mg/kg/day or 4 doses/24 hr

**again cannot exceed adult dosing even if calculations based on weight say you should

58
Q

Ibuprofen: things to consider?

A
  • risk of kidney damage if pt becomes dehydrated so pt must stay hydrated on this med
  • take with food - it can disrupt stomach lining and cause discomfort
59
Q

Ibuprofen & ASA

A

decrease ASA’s anti platelet effect

60
Q

Ibuprofen & (alcohol and corticosteroids)

A

increased risk of GI pain/ulceration

61
Q

Ibuprofen & antihypertensive agents (beta-blocker, ACEI, diuretics, vasodilators)

A
  • antihypertensive effect is inhibited

- possible hyperkalemia with ACEI and K+ sparing diuretics

62
Q

Ibuprofen & anticoagulant

A

increased risk of of bleeding

63
Q

Ibuprofen & cyclosporine

A

increased levels/ risk of nephrotoxicity

64
Q

Ibuprofen & lithium, methotrexate

A

increased levels

65
Q

Ibuprofen: children at greatest risk of ibuprofen related renal toxicity include ?

A
  • dehydrated children (avoid in children with diarrhea/ vomiting)
  • CVD
  • preexisting renal disease
  • concomitant use of other nephrotoxic agents
  • those younger than 6 months
66
Q

Ibuprofen: always take with ?

A

food man

67
Q

Ibuprofen: compatible in pregnancy?

A

risk in 1st and 3rd trimester

*if pt is pregnant - acetaminophen is a better choice

68
Q

Ibuprofen: compatible in breastfeeding?

A

yes

69
Q

ASA: MOA ?

A

inhibits the COX enzyme in the periphery and CNS

70
Q

ASA: onset

A

within 1 hour

71
Q

ASA: time to peak

A

3 hours

72
Q

ASA: duration

A

4-6 hours

73
Q

ASA: ok for children?

A

no!

never recommend for children due to Reye’s syndrome

74
Q

Reye’s syndrome

A
  • rapidly progressive encephalopathy (disorder of the brain) with cerebral edema, hepatic dysfunction and metabolic derangements which begins several days after apparent recovery from a viral illness
  • characterized by vomiting and confusion evolving to seizures and coma
  • salicylate use identified as a major precipitating factor
75
Q

ASA: adult dosing

A

325 - 650 mg q4 to 6h PRN

max 4000 mg/day

76
Q

ASA: children dosing

A

not recommended

77
Q

ASA & alcohol and corticosteroids

A

increased risk of GI pain/ulceration

78
Q

ASA & NSAIDs, including COX-2 inhibitiors

A

increased risk of gastroduodenal ulcers and bleeding

79
Q

ASA & anti-hypertensive agents (beta-blockers, ACEI, diuretics, vasodilators)

A
  • antihypertensive effect inhibited

- possibl ehyperkalemia with ACEI and potassium sparing diuretics

80
Q

ASA & anticoagulants

A

increased risk of bleeding

both blood thinners?

81
Q

ASA & methotrexate

A

increased levels

82
Q

ASA & probenecid, sulfinpyrazone

A

decreased therapeutic effect of these agents

83
Q

ASA - always take with ____

A

food

84
Q

ASA compatible in pregnancy?

A

Risk in 1st and 3rd trimester (at a full dose)

Compatible at low dose

85
Q

ASA compatible in breastfeeding?

A

limited data

potential toxicity

86
Q

What is ASA-induced asthma?

A

onset of asthma 30mins-3 hours post ingestion of ASA

87
Q

What is the proposed mechanism for this rxn (ASA-induced asthma) ?

A

decreased PG (prostaglandins) results in increased leukotrienes (important mediator in asthma and allergies)

88
Q

Who does ASA-induced asthma affect?

A

5-20% of asthmatics with concomitant allergic rhinitis (AR) or nasal polyps

89
Q

branded version of naproxen

A

aleve

90
Q

standard dose of naproxen?

A

220mg

91
Q

Is aleve for adults only?

A

yes

92
Q

What is the dosing for naproxen?

A

ages:12-65
220 mg every 8-12 hrs
age: >65 (renal insufficiencies)
220mg every 12 hrs

*max 2 tabs per 24 hours

93
Q

Onset of action for aleve?

A

unknown for fever

20 mins for analgesic affect

94
Q

Take naproxen with food?

A

yes

and water obvs

95
Q

Naproxen in pregnancy?

A

compatible

96
Q

Naproxen in breastfeeding?

A

not recommended

97
Q

Don’t take naproxen if …?

A

allergic to ASA or other NSAIDs

98
Q

What patients are at risk of renal failure when using NSAIDs?

A
  • volume depletion states
  • severe congestive heart failure (CHF)
  • hepatic cirrhosis
  • creatinine clearance < 30 mL/min
  • intrinsic renal disease secondary to diabetes, nephrotic syndrome or hypertension (HTN)
99
Q

What is used as first line therapy ?

A

Acetaminophen

100
Q

Consider acetaminophen as first line treatment in patients that are:
??

A
  • ASA-sensitive asthma
  • gastritis of PUD
  • inceased risk of bleeding
  • pts with renal dysfunction
  • CV or hypertensive patients
  • multiple concurrent drug therapy
  • prego or breastfeeding women (especially 3rd trimester)

Clinical 1 (Part A) (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions