Headache, fever, MSID Flashcards
Tension type headache
Location: bilateral Nature: diffuse ache to tight pressing, constricting pain Onset: gradual Duration: minutes to days Non-headache symptoms: scalp tenderness
Migraine headache
Usually unilateral Throbbing; may preceded by an aura Onset suddenly Hours to 2 days Nausea
Sinus headache
Face, forehead or preorbital area
Pressure behind eyes or face; dull; bilateral pain, worse in the AM
Onset simultaneous with sinus symptoms, including nasal discharge
Duration Days Resolves with sinus symptoms
Nasal congestion
Secondary headaches (medications that cause headaches)
Blood-pressure lowering medication Antibiotics Oral contraceptives Vasodilators Over of medications: ergot derivatives, opioids, nonopiod agents, triptans Caffeine withdrawal
Secondary headache ( medication overuse symptoms and treatment)
Frequent use >3 month and from stopping medication
Continuous HA: waking, increase with frequency
TX: need to taper the medication to eliminate
Exclusions for self treatment HA
Severe head pain
Headache that persists for 10 days with or without treatment
Last trimester of pregnancy
<8 years of age
High fever or signs of serious infection
History of liver disease disease or consumption of 3or more alcoholic drinks per day
Secondary headache ( except minor sinus headache)
Symptoms consistent with migraine without formal diagnosis
General treatment for episodic tension type headaches
Apap
NSAID
Salicylate
General treatment for chronic tension type headaches
Candidates for prescription medications
If using OTC, limit to 3 days per week
Benefit from non pharmacologic treatment
General treatment for migraine headaches
Medical diagnosis is required before self treatment
Treat with NDAID or salicylate
General treatment for sinus headache
Decongestant and/or OTC analgesic
Nonpharmacologic therapy of chronic tension headaches
Relaxation exercise
Physical therapy focused on stretching and strengthening of head and neck muscles
Nonpharmacological treatment for migraines
Regular sleeping and eating schedule
Methods for coping with stress
Ice+pressure to forehead or temple are
Dietary: Avoid Food that triggers; avoid hunger or low blood glucose; magnesium supplements; avoid food with nitrates, tyramine, phenylalanine, monosodium glutamate ( msg), caffeine and theobromine
MOA of APAP
Inhibitors of prostaglandins synthesis centraly
Not an anti inflammatory
Not considered NSAID
Indications for APAP
Analgesic ( mild to moderate pain of non visceral origin)
Antipyretic
Onset of APAP
30 minutes
Duration of APAP
Four hours, 6-8 hours with ER formulation
DI with APAP
Alcohol
Warfarin
APAP Dosing
Adult dosing:
325 mg - 1000 mg 4-6 hours ( MDD 4000mg)
New dosing: extra strength tablets (500mg): 2tab every 6 hours ( MDD 3000 mg)
Regular strength tablets (325mg): MDD 3250 mg
APAP pediatrics dosing
10-15 mg/kg
Acute overdose of APAP
One time dose 10g or more leading acute liver failure
Chronic overdose of APAP
Daily dose more than 4 g for several weeks leading acute liver failure
Prevention of overdose of APAP
Follow dosing instructions and max daily dose exactly as on package labeling
Read labels of all medications to avoid excess APAP
Conservative dosing (2g/day or less) in patients at risk for hepatotoxicity:
-Concurrent use of other potential hepatotoxic drugs
-Poor nutrition intake
-Ingestion of 3 or more alcoholic drinks per day
Symptoms of overdose of APAP
Early symptoms: nausea, vomiting, drowsiness, confusion, abnormal pain. Or no symptoms
Serious clinical manifestation: begin 2-4 days after acute ingestion; increased liver enzymes ( alt/ast); increased plasma bilirubin w/jaundice; prolonged prothrombin time; obtuntation
Majority of cases, hepatic damage is reversible over week-months but fatal hepatic necrosis can occur
Refer to poison control center/ER
NSAID salicylate
ASA
NSAID non acetylated salicylate
Magnesium salicylate
Choline salicylate
Non salicylate nsaid
Ibuprofen
Ketoprofen
Naproxen
NSAID MOA
Anti inflammatory: nsaid decreases prostaglandins synthesis via inhibitions of cox1 and cox2 ( non selective)
- ASA irreversibly binds to receptors
- Ibuprofen, ketoprofen, naproxen reversible binds to receptors
Analgesic and antipyretic Activity: inhibit the production of prostaglandin synthesis resulting in reduced nonciceptor sensitization and increase pain threshold.
- temperature-inhibition of PGE2
- Analgesic-inhibition of PGE and PGF
Platelet Effect: the inhibition of platelet aggregation
Indications for no salicylate nsaid
Fever
Minor pain from headaches, common cold, toothache, muscle aches, backache, arthritis, menstrual cramps
Mild-moderate pain of non visceral origin
Inflammation
Non salicylate nsaid ADR:
GI: dispepsia, heartburn, nausea, anorexia, epigastric pain, peptic ulcer, bleeding
Dizziness, rash, fluid retention, renal failure
Non salicylate nsaid CI
-increased risk for MI,heart failure, hypertension, stroke
-patients at risk for CV should avoid: hyperlipidemia, HTM, DM
All patients, use lowest dose for shortest duration:
-history of GI bleeds
-asthma
-impaired renal/hepatic function
Non salicylate nsaid DDI
NSAID and ASA ( cardio protection): take ASA 30 min before or 8 hr after: allowing ASA time to bind irreversible
PHenytoin:displacement from protein binding sites
Bisphosphonates: increased risk of GI irritation
Digoxin: inhibition of digoxin renal clearance
Anti hypertensive effects inhibited ( BB, ACE-I, Vadodilators, diuretics)
Anticoagulant: increased risk of bleeding
Alcohol:increased risk of bleeding
Methotrexate: decreased clearance
Ibuprofen dosing
> 12 yo 200-400 mg Q 4-6 hr 1200mg/day
Naproxen dosing
12-65 220 mg Q 8-12 hr max 660mg/day
>65 yo 220mg Q 12 hr max 440 mg/day
Aspirin 650-1000mg Q 4-6 hr 4000 mg/ day
Not recommended younger than 12 years old
ASA dosing
650-1000 mg Q 4-6 hr max 4000mg/day
Ibuprofen pediatric dosing
5-10 mg/kg
Salicylate indications
Treatment of symptoms Of osteoarthritis, rheumatoid arthritis
Temporary relief of minor aches And pains from backache and muscle aches
Mild-moderate pain from musculoskeletal conditions/fever
ASA: prevention of thromboembolic events ( MI and Stroke)
Salicylate drugs interactions
Nsaid and ASA
Valporic acid: Displacement from protein binding site And incubation of metabolism
Nsaid and anticoagulants, alcohol: increased GI bleeding
Antihypertensive effect inhibited ( BB, ACE I, vasodilator, diuretic)
Methotrexate: decreased clearance
Sulfonylureas: increased risk of hypoglycemia
Salicylate ADR
GI : dyspepsia, epigastric discomfort
Gastritis ulceration of upper GI tract
- penetrates protective mucous and bicarbonate layers of gastric mucosa, allowing back diffusionof acid leading to cellular and vascular erosion: local irritant effect from medication contacting gastric mucosa and systemic effect from prostaglandins inhibition
GI blood loss is dose dependent
Aspirin intolerance:
-urticaria-angioedema and bronchi spastic ( risk factor: asthma with nasal polyps )
ASA CI
Discontinue 3 days before fecal occult blood testing
Discontinue 2-7 days Before surgery
Do not use to relive pain after any surgery
In patients with hypothrombinemia, vitamin K deficiency, hemophilia, history of bleeding disorder, history of peptic ulcer disease