Headache, Fever and Pain Flashcards by Olivia Hofer

nociceptive pain can be either

somatic or visceral

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nociceptive pain pathway

stimulation
transmission
perception
modulation

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what part of nociceptive pain differs the most in patients

modulation

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neuropathic pain

direct consequence of a lesion or disease
affects central and peripheral somatosensory system
pain regardless of stimuli

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exclusions for self treatment of musculoskeletal injury and disorders

severe pain
pain over 10 days
pain 7 days after treatment of topical analgesic
change in pain/inc sensitivity
back pain and loss of bowel/bladder control
pregnancy
deformed joint
N/V, fever or signs of systemic infection

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you cannot self treat for musculoskeletal injury and disorders for ages under

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RICE therapy

rest
ice
compression
elevation

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you should ice for no more than

four times a day only 15-20 minutes each time

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do not apply ________ to an area with acute traumatic injury

heat

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heat should not be applied to ___________ because it can intensify

inflamed areas

vasodilation and exacerbate vascular leakage

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how does heat alleviate pain?

increases blood flow, reduces muscle spasm and relieves stiffness

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topical analgesics examples

rubefacients, vasodilators and cooling sensing agents
Methyl salicylate and menthol 10% (Icy hot)
methyl salicylate and menthol 8% (bengay arthritis formula)
camphor (joint flex)
menthol (mineral ice)
methyl nicotinate

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exclusions for self treatment for musculoskeletal injuries and disorders (9)

severe pain (over 6)
pain over 10 days
pain after 7 days of trx
pelvic/abdominal pain
N/V, fever, other signs of infection
deformed joint
pregnancy
less than 2 years old
back pain and loss of bladder/bowel control

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irritants without rubefaction

capsaicin 0.025 or 0.075% (zostrix, capzasin)

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how does capsaicin work?

desensitizes neurons with long term use
release and depletion of substance P resulting in pain inhibition

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capsaicin is useful in treating

joint pain, arthritis and certain neuralgias

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should heat be applied when using topical analgesics?

NO!

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what adverse reaction can occur after using a topical analgesic?

pain, swelling or blistering of the skin

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Lidocaine relieves _____________________ by providing a _________________

musculoskeletal and back pain in patients over 12 years

temporary numbing sensation (anesthetic)

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Lidocaine has a primary role in

neuropathic pain

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when to avoid lidocaine

if patients are allergic to amide local anesthetics

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examples of lidocaine products

aspercreme
lidocare
salonpas

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lidocaine is applied

every 6-8 hours as needed
do not exceed 3 applications in 24 hours

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diclofenac gel 1%

topical NSAID
applied up to 4 times a day

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diclofenac gel is approved for

the temporary relief of joint pain from osteoarthritis in people over 18

oral analgesics examples

tylenol aspirin ibuprofen naproxen caffeine in combination with APAP or ASA (anacin, excedrin) magnesium salicylates (Doans)

dosage forms of aspirin

oral (325mg, 500 mg, 650 mg, 81mg) suppository (300mg, 600mg)

when using aspirin for analgesia or antipyresis in adults

325-650mg every 4 hours 650-1000mg every 6 hours MDD = 4000 mg

when using aspirin for analgesia or antipyresis in children

10-15 mg/kg

aspirin can be used for no longer than __________ for pain and __________ for fever

10 days 3 days

when using aspirin for antirheumatic in adults

3600mg-4500mg daily in divided doses take 2 weeks or more for full benefit

when using aspirin for anti-inflammatory in adults

4000-6000mg/day take 2 weeks or more for full benefit

aspirin is not labeled for

nonprescription use in children under 2 years or less than 24 lbs

precautions when using aspirin

hypersensitivity to aspirin (do not take if allergic to other NSAIDS)

side effects of aspirin

GI disturbance bleeding hyperuricemia renal insufficiency reyes syndrome mild toxicity

reyes syndrome

aspirin is administered to children under 15 with influenza or varicella zoster

ibuprofen and naproxen therapeutic uses

mild-moderate pain fever reducer anti-inflammatory

precautions of using NSAIDs

increased risk of MI, HF, HTN or stroke

patients with or at high risk of CV diseases should ___________ NSAIDs

avoid

common side effects of NSAIDs

GI disturbances bleeding renal insufficiency

OTC dosage forms of ibuprofen

200 mg tablet 100mg/5ml suspension pediatric/infant drops 50mg/1.25ml

dosing information on OTC packaging for children for ibuprofen is as young as

6 months of age or weighing more than 12 pounds

dosing for children for ibuprofen

7.5mg/kg

ibuprofen in children can be used no longer than _________ for pain and _________ for fever

5 days 3 days

dosage forms for naproxen

220mg

administration and dosage for ibuprofen in adults

200-400 mg every 4-6 hours as needed for 10 days for pain, 3 days for fever MDD 1200 mg Max for RA - 3200mg/day

naproxen sodium is not recommended for children under

12 years of age

administration and dosage for naproxen in adults

220 mg every 8-12 hours for 10 days for pain, 3 days for fever MDD - 660mg Max for RA - 1100 mg/day

acetaminophen

analgesic and antipyretic

APAP is routinely used in patients who are

sensitive to GI disturbances from NSAIDs prone to bleeding disorders hypersensitive to salicylates

is APAP the drug of choice for osteoarthritis?

not anymore :( now its NSAIDs

APAP dosage forms

chewable tabs (80mg and 160mg) tabs (325mg, 500mg, 650mg) suppository (80mg, 120mg, 325mg, 650mg) solution (160mg/5ml)

adult dose for APAP for analgesia or antipyresis

325-650 mg every 4-6 hours 1 gram every 6 hours MDD - 4g/day

In elderly patients and patients with liver insufficiency, consider recommending a

lower daily dose for APAP

Immediate release OTC labeling for APAP

2 tablets (650mg) every 4 to 6 hours prn MDD 3.25g/day

extra strength OTC labeling for APAP

2 tablets (1g) every 6 hours prn MDD 3g/day

extended release OTC labeling for APAP

2 tablets (1.3g) every 8 hours prn MDD 3.9g/day

APAP is not labeled for

nonprescription use in children who are younger than 2 or weigh less than 24 lbs

APAP dosing for children

10-15 mg/kg

for APAP, acute doses of _____________ are hepatotoxic

10g or more

the MDD of APAP was switched to __________ by the mfr what else did the mfr of tylenol do?

3000 mg/day standardized the solutions of tylenol to 160mg/5ml

exclusions for self care of headache

severe head pain headache with rapid onset of max pain concerning change in HA pattern headache over 10 days age less than 8 high fever/ signs of infection neck stiffness neurologic change high risk comorbid condition new HA during pregnancy HA with underlying patho symptoms consistent with migraine history of liver disease or more than 3 drinks a day

exclusions for self treatment of primary dysmenorrhea

severe dysmenorrhea or menorrhagia dysmenorrhea symptoms inconsistent with primary dysmenorrhea history of PID, infertility, irregular periods, endometriosis, ovarian cysts use of IUC allergy to aspirin, NSAIDs use of warfarin, heparin, lithium active GI disease bleeding disorder

drug of choice for primary dysmenorrhea

NSAIDs

a common premenstrual symptom is

the subjective sensation of fluid accumulation

diuretics to relieve water retention, weight gain, bloating, swelling, feeling of fullness

ammonium chloride caffeine pamabrom

common drugs for PMS-type symptoms

Midol (pamabrom/APAP) Pamprin Max (caffeine/APAP/ASA) Diurex water Pills and Pain relief (caffeine/magnesium salicylate)

preferred method of temperature measurement for patients less than 6 months

rectal

normal range of oral temperature measurement

95.9-99.5 F (35.5-37.5C)

fever criteria for oral temperature measurement

over 99.5 F

which is the most unreliable form of temperature measurement

axillary (under armpit)

fever for rectal temperature measurement

over 100.4 F (38C)

fever for axillary temperature measurement

over 99 F (37.2 C)

fever for tympanic temperature measurement

over 100.4 (38 C)

non-pharmacologic therapy for fever

adequate fluid intake body sponging with tepid water

is bathing with ice water or sponging with hydroalcoholic solutions recommended?

no uncomfortable and dangerous

exclusion for self treatment of fever

patients over 3 months with rectal fever of 104F children under 3 months with rectal fever of 100.4F severe symptoms of infection that are not self limiting risk of hyperthermia impaired oxygen utilization CNS damage children with a history of seizures patients over 2 with fever more than 3 days child with spots/rash child refuses to drink fluids sleeps, irritable child child vomiting or diarrhea child under 2 with fever over a day fever above 104F in any child child with stiff neck