Lecture 12 - Fever Treatment

Question 1

How do antipyretics work?

Answer 1

They work by reducing the level of PGE2 in the thermoregulatory center of the hypothalamus
PGE production depends on COX acting on a substrate of arachnids ic acid
Antipyretics inhibit COX thus preventing PGE2 from being produced

Question 2

Why doesn’t acetaminophen have an anti inflammatory effect?

Answer 2

Poor COX inhibitor in peripheral tissues

Question 3

Why is acetaminophen an effective COX inhibitor in the brain?

Answer 3

Because it is oxidized by the p450 system and the oxidized form inhibits COX

Question 4

Why is acetaminophen the preferred antipyretic?

Answer 4

Less renal toxicity compared to NSAIDs and no harmful effect on GI mucosa

Question 5

Acetaminophen should be used cautiously and at low douses in pts with what?

Answer 5

Hepatic dysfunction (ex. Cirrhosis)

Question 6

Describe NSAIDs

Answer 6

Inhibit COX peripherally and central making it have anti inflammatory effects
Effective at reducing fever

Question 7

What are the adverse effects of NSAIDs?

Answer 7

Adverse effects on platelets and GI mucosa

Also has significant renal toxicity

Question 8

NSAIDs should be avoided in pts with what?

Answer 8

Cirrhosis, CKD, CHF (fluid retention and exacerbation)

Caution with CAD (increased risk for MI)

Question 9

Describe aspirin

Answer 9

Also works by inhibiting COX
Unique MOA - irreversibly inhibits both COX1 and 2
Effective antipyretic

Question 10

Aspirin use should be avoided in infants due to what?

Answer 10

Risk of Reye’s syndrome

Can cause liver damage and encephalopathy

Question 11

Why should you treat a fever?

Answer 11

Primarily to manage sx related to fever including associated HAs, myalgia and arthralgias
No evidence that tx of fever affects mortality of critically ill patients

Question 12

What is the exception to treating a fever?

Answer 12

Temperature >41C likely due to hyperthermia and needs emergent treatment

Question 13

How should you treat a fever?

Answer 13

Acetaminophen 325-650mg q4h
Best to treat fever around the clock since prn dosing can lead to periodic chills and sweats associated with varying drug levels

Question 14

When should Abx be used to treat a fever?

Answer 14

In fever caused by infection, target likely causative pathogen
Management depends widely on clinical status of pt and likely pathogen

Question 15

What is sepsis?

Answer 15

Life threatening organ dysfunction caused by dysregulated host response to infection

Question 16

What are common findings for sepsis?

Answer 16

Fever, altered mental status, hypotension, tachypnea

Question 17

What are common sources of infection for sepsis?

Answer 17

Respiratory, GI, GU and skin/soft tissue infection

Question 18

What is the MCC of sepsis?

Answer 18

Pneumonia

Question 19

What is the initial management of sepsis?

Answer 19

Obtain basic labs including serum chemistries, blood count, cultures, imaging and lactic acid
Fluid resuscitation early in management with IV crystalloid to increase BP
Start antimicrobial therapy within 3 hours of presentation

Question 20

How should you choose an abx for sepsis?

Answer 20

Based on suspected infection site and likely pathogen

Start broad —> narrow coverage once culture data obtained