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Pharm 558 > MidTerm #1 > Flashcards

MidTerm #1 Flashcards

Fever, pain, headache, reproductive, respiratory

1
Q

Primary Headaches: Episodic

A
  • Tension Headache
  • Migraine Headache
  • Sinus Headache
  • Rebound Headache (chronic daily headache)
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2
Q

Secondary Headaches

A
  • Head Trauma
  • Vascular deficit (aneurysm, bleed, etc.)
  • Substance Abuse
  • Infection (meningitis)
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3
Q

Don’t treat a headache that…

A
  • Severe, “worst of my life”
  • Going on for longer than 10 days
  • Pregnancy, especially 3rd trimester
    • could be sign of preeclampsia
  • Kids
  • Infection, fever, secondary HA’s
  • ETOH abuse, caution with acetaminophen
    • can use, just dose appropriately
  • Non-diagnosed migraine
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4
Q

Tension Headache

A
  • Symptoms
    • myofascial pain (muscle pain)
    • bilateral
    • diffuse
    • radiating
    • tight
    • pressing
    • **cap’s too small **
    • Duration: minutes to days
    • Onset: **gradual **
  • Secondary to:
    • Stress
    • Anxiety
    • Depression
    • Emotional Conflicts
    • Fatigue
  • More in women than in men
  • Treat with APAP, NSAIDs, salicylates
    • Right when starts
  • Physical therapy and relaxation exercise
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5
Q

Migraine

A
  • Complex interaction of neuronal/vascular systems
  • Symptoms:
    • With or without **aura **
      • wavy/flashing lights
    • Unilateral/bilateral
    • Throbbing
    • Hours-Days
  • Lots of triggers
  • Rx:
    • Abortive: triptans, aspirin/caffeine, ergots
      • for now and again headache
    • Prophylactic: TCA’s (tricyclic antidepressant), ß-blocker, CCB (calcium channel blocker), etc.
      • more frequent
    • Symptomatic: Aspirin, APAP, NSAIDs, opiates, sedatives, anti-emetics
      • ​Need medical diagnosis before treating
      • Avoid giving shot of morphine
      • Go to bed and lie down
      • Treat at early onset
  • ​​Non-Pharmacologic
    • Sleep, nutrition, cope with stress
    • Avoid Mg supplements, nitrates, tyramin, phenylalanine, MSG, caffiene
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6
Q

Sinus Headaches

A
  • Nasal passageway and sinus opening swelling/obstruction due to trauma, allergies, infection
  • Location
    • Face, forehead, periorbital area
  • Due to trauma, allergies, sinus infection
  • Pseudoephedrine works best to relieve this headache
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7
Q

Rebound Headache

A
  • AKA: Chronic Daily Headache
    • Occurs after 3 mo. of analgesic use (any analgesic)
    • Notice in the morning > rest of day
  • Tapered decrease in analgesic use
    • ​Small dose of tricyclic so they sleep well at night and get over it
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8
Q

Lower Back Pain

Goals of Therapy

A
  • Decrease pain and discomfort
  • Prevent ongoing damage
  • Don’t do any harm
  • Get back to normal routines
    • Back pain from out of shape
      • Don’t let them just lie around
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9
Q

Lower Back Pain: Exclusions

A
  • Chronic (>2 weeks)
  • 3rd trimester of pregnancy
  • Kids <7 yo
  • Fever/infection
  • Numbness/Tingly
  • Loss of bowel/bladder function
    • ​need to elimate spinal cord injury
    • Limited time to deocmpress w/o permanent damage
  • Severe pain
  • Pain that continues 10 days after treatment
  • Increased intensity or change in character
  • Pelvic/Abdominal pain
  • Visually deformed joint, abnormal movement, weakness in limb, suspected fracture
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10
Q

Lower Back Pain: Red Flags

A
  • Numbness/Tingling
  • Referred pain from internal organs
  • Cancer: weight loss; over 50 yo/under 16yrs; night pain or at rest; failure to improve; persists>6 weeks
  • Infection Related: Fever, IVDA (intravenous drug abuser), recent infection, immunocopromised
  • Cauda Equina Syndrome:
    • Note: waiting >72 hours to decompress risks permanent neurological deficit
  • Vertebral Fracture: Steroids, mild trauma at >50yo, >70 yo, osteoporosis, significant trauma
  • Acute Abdominal Aortic Aneurism: abdominal pulsating mass, ASCVD (ateriosclerotic cardiovascular disease), pain at rest or noctural pain, >60 yo, smoker
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11
Q

Pain Types

A
  • Acute Pain:
    • Pain that comes on quickly, can be sever, bust lasts a relatively short time
  • Chronic Malignant Pain:
    • Associated with advanced, progressive disease (often fatal) such as cancer, MS, AIDS, and terminal kidney disease
  • Chronic Non-Malignant:
    • Begins as acute pain, but it continues beyond the typical time expected for resolution of the problem or persists, or reocurrs for other reasons
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12
Q

Lower Back Pain: Treatment

A
  • RICE
    • rest, ice, compression, elevation
    • Ice 10 min 3-4x daily
  • NICE
    • NSAIDs, ice compression, elevation
  • Step Approach (adjuncts):
    • NSAIDs, capsaicin, anesthetics, TCA, gabapentin, opiates
  • Topical methyl salicylate 10% (counter irritant)
  • Capsaicin takes 1+ weeks to begin working
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13
Q

Osteoarthritis vs. Rhumatoid Arthritis

A
  • Osteoarthritis:
    • Dull pain, stiffness in knees, hips, spine, hands, weight-bearing joints, and typically uni-lateral (can be bilateral)
  • Rheumatoid Arthritis:
    • Swollen, tender, warm , symmetrical pain in hands, wrists, fingers
    • Aggravated by movement
    • Worse in the **morning **
    • Needs prescription
    • Psoriasis has arthritis associated
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14
Q

Joint Pain: Self-Treatment Exclusions

A

Same as those in backpain:

  • Chronic (>2 weeks)
  • 3rd trimester of pregnancy
  • Kids <7 yo
  • Fever/infection
  • Severe pain
  • Pain that continues 10 days after treatment
  • Increased intensity or change in character
  • Pelvic/Abdominal pain
  • Visually deformed joint, abnormal movement, weakness in limb, suspected fracture
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15
Q

Joint Pain: Treatment

A
  • APAP
  • Topical analgesic
    • Casaicin: take over a week to begin working
    • Topical methyl salicylate 10%: possible counter irritant but immediate effect
  • NSAID (only when inflammation is present, prostaglandins needed for healing too)
  • Glucosamine
    • Very safe, placebo effect
    • Kills pancreatic cells, increasing risk of developing diabetes
  • SAM-e
    • very safe, may be helpful
    • less joint space narrowing
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16
Q

Tennis Elbow (Tendonitis)

A
  • Symptoms:
    • warm, swollen, red , tender, pain with extension
  • Nonpharmacologic Treatment
    • Palm-up lifting-No
    • Forearm Band
    • RICE, NICE won’t be effective
  • Pharmacologic Treatment
    • Ibuprofen, but need Rx dose
    • Topical Analgesic
17
Q

NSAIDs and inflammatory disease or acute muscle injury

A
  • NSAIDs may be preferred for self treatment
  • Aspirin must be dosed near the self-care max in order to achieve anti-inflammatory response
  • Recommend naproxen to treat swelling and pain, acetaminophen will only treat pain
18
Q

Fever: Symptoms

A
  • Temporal greater than 100.1
  • Oral greater than 99,7
  • Add one degree to oral temperature to get rectal/tympanic temperature
  • Subtract one degree from oral temperature to get axillary temperature
  • axiallary>oral>rectal/tympanic
  • **Don’t Treat Numbers **
19
Q

Fever: Self-Treatment Exclusions

A
  • ​>6 month and 1040
  • <6 month and 1010
  • Systemic Infection
  • Hyperthermia risk
  • Impaired oxygen utilization (COPD, resp. distress, heart failure)
  • Immpaired Immune function (cancer, HIV)
  • CNS damage (head trauma, stroke)
  • Children with history of febrile seizures/seizures
    • Be more aggresive at treating in order to avoid and have a full work up done
  • Children who are vomitting/cannot keep down fluids and are very sleep/irritable/hard to wake up
20
Q

Fever: Non-Pharmacologic Treatment

A
  • Adequate fluids to prevent dehydration
  • Wear light clothing
  • Remove blankets
  • Maintain room temperature at 680F
  • Increase fluid uptake 50-100 mL/hr
21
Q

APAP dosing/info

A
  • Acetaminophen
    • Tylenol
    • Works in CNS, pain & fever
    • NOT anti-inflammatory
  • Child
    • 10-15 mg/kg q4-6h
    • Not to exceed 5 dose in 24 hours
  • Adult
    • 325-1000 mg q4-6h
    • Max 3000 mg
    • ​With moderate drinking, max 1500 mg
      • Male <2 a day
      • Female <1 a day
  • ​Cautions:
    • Liver damage
    • Analgesic of choice for warfarin patients
    • Best for pregnant women
    • Best for elderly and those with hypertension
22
Q

NSAIDS dosing/information

A
  • Naproxen (Aleve), Ibuprofen (Advil, Motrin)
    • Peripheral COX inhibitors
    • Pain, fever, high doses for swelling
  • Ibuprofen:
    • Child: 5-10 mg/kg q6-8h, not to exceed 4 dose in one day
    • Adult: 200-400 mg q4-6h (1200 mg max)
  • Naproxen:
    • Child not recomended for children less than 12
    • Adult: 220 mg q8-12h (660mg max)
  • Ibuprofen slightly better for fever…not much difference
  • Don’t use if history of ulcer/GI bleed
  • Avoid with Gout
  • Caution: risk for heart failure, hypertension and stroke.
  • Asthma, Nasal polyps, aspirin allergy->AVOID
23
Q

Asprin Dosing

A
  • COX inhibitor
  • GI ulcer, HBP, CHF, kidney disease, gout, avoid
  • Avoid in pregnancy
  • Reye’s Syndrome
    • Children under 15
  • Fever, aches and pains
  • Asthma, nasal polyps
  • Dosing:
    • Children: Not recomended
    • Adult: 650-1000mg q4-6h (4000mg)
24
Q

Douching

A
  • NOT GOOD
  • black, little education, incarcerated adolescents
    • Increased risk of PID, reduced fertility, ectopic pregnancy, vaginal infections, STI, low birthweight infants, cervical cancer
  • irritation
  • disrupt normal flora and pH
  • Tactfully discourage
25
Q

Atrophic Vaginits

A
  • Symptoms:
    • dyspareunia, lack of adequate vaginal lube
    • irritation, dryness, burning, itching, leuokrrhea (milky white discharge)
    • Incontinence in older
  • Cause
    • Low estrogen levels
  • Treatment:
    • Lubicrant products
      • water soluable
    • Sexual activity
    • Dryness: estrogen
      • unopposed estrogen associated with endometrial cancer
      • vaginal estrogen very well absorbed
  • Exclusions:
    • postmenopausal bleeding
      • especially if bleeding and on estrogen
    • Not relieved by lubricants
    • Symptoms that are not localized
    • Severe vaginal dryness or dyspareunia
26
Q

PMS

A
  • Behavioral: fatigue, irritable, depression, etc.
  • Physical: bloating, breast tender, acne, appetite changes, headache
  • Sign: bad before period and goes away with start of menses
    • ​Very dramatic, may be PMDD, need referral
  • Treatment:
    • Charting
      • mark days of symptoms and days of period
    • Education, diet modification, exercise, stress managment
    • Vitamin B6 and Calcium and Vitmain D
      • Mood
      • B=100mg, C and D=1000mg
    • Vitamin E
      • Breast tenderness’
    • NSAIDs
      • Headache
    • Midol and Pamprin is a bunch of crap
      • diuretics don’t work
27
Q

Dysmenorrhea

A
  • Primary: associated with cramp-like abdominal pain without pelic disease
    • within 6-12 months of menarche
    • less likely after 25 yo
    • Severe pain, miss school
  • Secondary: associated with pelvic pathology
    • IUD can cause
    • Secondary needs a cause/source
  • Primary Clinical Presentation:
    • Dull pain and cramping
    • N/V/D
    • irritability and headache
    • at the start of menses
  • Non-Pharmacological Therapy
    • Heat, exercise, massage, sleep
    • Omega-3-FA
  • Pharmacological Therapy
    • ​Not aspirin or acetaminophen due to Reyes and CNS
    • NSAIDs
      • prostaglandins have a short half-life, so can work at onset
    • perhaps oral contraceptive pilll
28
Q

Vulvocaginal Candidiasis (yeast)

A
  • Classic Symptoms:
    • Thick, white “cottage cheese”, no odor discharge
    • Normal pH
    • redness, itching, swelling
    • might be from immunosuppresant or antibiotics
  • Treatment
    • not treat partner
  • Non-pharmacological
    • Decrease refined sugar, eat yogurt
  • Pharmacological
    • Avoid 1 day treatments
    • Should improve within 2-3 days
    • If itch, use cream
    • miconazole, clotrimazole, butoconazole, tioconozole
      • nystatin=yeast only=not good choice
      • fluconazole=last a long time in the body
        • may need to use another course if on antibiotics
  • Drug interactions
    • warfarin and miconazole
    • warfarin and flucanazole
  • Exclusions:
    • Preganancy
    • Girls less than 12 yo
    • fever and lower belly pain
    • uncontrolled/undiagnosed diabetes, HIV infection
    • recurrent (>3 VVC/year or within the past 2 months)
29
Q

Bacterial Vaginosis: BV

A
  • Symptoms:
    • thin, water discharge
    • off-white or discolored
    • fishy smell
    • irritation
    • dysuria
    • itch
  • Risk Factors:
    • new partner, IUD, smoking
  • Treatment:
    • Requires referral
    • No treatment of partner
    • change in normal flora, not necissarily an STD
    • Common
30
Q

Trichomoniasis

A
  • Symptoms
    • Smelly, yellow-green discharge
    • Pruritius
    • Erythema
    • Edema
  • Risk Factor:
    • Multiple Sex partner, new sex partner, unprotected sex, other STI
  • Treatment
    • Require referral, reportable disease
    • Treat partner
    • Tinadazole
31
Q

Toxic Shock Syndrome (TSS)

A
  • Symptoms:
    • Red rash on palms
    • low blood pressure
    • cramps
    • nausea
    • dizziness
      • Day 2-3: fever, vomitting, dizziness
  • Within 2 days of menses, using super absorbant tampons
32
Q

Allergic Rhinitis

A
  • Signs and Symptoms
    • Watery eyes; itchy nose, eyes or throat, sneezing, nasal congestion, runny nose
  • Best is avoidance
  • Nasal saline irrigation, HEPA filter
  • Recommended OTC
    • Antihistamines
      • 1st generation: benadryl (diphenhydramine)
        • sedative,
      • 2nd generation, claratin (loratidine), allegra (fexofenadine), zyrtec (cetirizine)
        • non-sedative
        • weak, good for mild allgery
    • ​Inhaled corticosteroids
      • Flonase (fluticasone) and triamcinaclone
      • when taking this, don’t need antihistamine
  • ​Exclusions:
    • Signs of otitis media, sinusitis, lower respiratory problems
    • history of non-allergic rhinitis
    • narrow-angle glaucoma
    • <12 yo
    • pregnant or lactating
  • Other Info:
    • Only treat most prevalent
    • itch: require sedating antihistamine, can use zyrtec due to minial sedation
33
Q

Cold

A
  • Signs and Symptoms:
    • Sore throat, nasal congestion, runny nose, sneezing, low fever, chills, headache, possble cough
  • Exclusions
    • Fever >101.5
    • Chest pain
    • Sign of bacterial infection
    • COPD
    • Not improve in 7 days
    • AID/Immunosuppresed
    • Infant <2 yo
    • Frail/elderly
  • Nonpharmacologic:
    • fluid, rest, toilet
    • Echinacea at the 1st signs/symptoms
  • Recommended OTC:
    • Jolly ranchers
      • instead of local anesthic like benzocaine
    • Decongestant:
      • pseudophedrine, (systemic) oxymetazoline (LA), ephedrine, pheylephrine (topical)
        • AVOID selling phenylephrine (systemic), degraded in liver and not reach nose (ex: sudafed-PE)
    • Antitussive:
      • dextromethorphan: 6-8 hrs, not constipative, not sedative
      • codeine: 4-6 hour, constipative, sedative, use for sleep
      • (benzonatate (Tessalon perle))
    • Expectorants:
      • Guanisefen: witchcraft
    • Analgesics
      • Not aspirin
  • ​​Other Notes
    • No cold preps for kids under 4
    • Honey works such as well to soothe throats
    • Treat symptoms as they come instead of using combo products
    • Echinacea not for those on immunosuppressants
34
Q

Influenza

A
  • Signs and Symptoms
    • Aches and Pains, myalgia
    • Fever
    • Sore Throat, cough, fatigue
  • Use same method as cold
35
Q

Rhinitis Medicamentosa (Rebound Congestion)

A
  • Signs and Symptoms:
    • Stuffy nose due to overuse of decongestants
  • Treatments
    • Quit cold turkey
    • Leversee method
      • one nostril at a time
    • Long-Term: use steroidal nasal spray for allergies
36
Q

Asthma

A
  • Signs and Symptoms
    • Wheezy, cough, shortness of breath
    • cough could be only symptom
  • Don’t sell primatene mist or tablets
  • Refer for MDI
37
Q

Cough

A
  • Exclusions
    • Fever>101.5
    • history of underlying disease associated with cough
      • COPD, chronic bronchitis, CHF​
    • Suspected drug associated cough
    • cough>7 days
    • uninteded weight loss
    • drenching nighttime sweats
  • OTC
    • codeine 10-20 mg q4h
      • constipative, sedative
    • dextromethorphan 10-20 mg q4h
38
Q

Strep Throat Considerations

A
  • Must have at least two of the three:
    1. ​Sore Throat
    2. Tender Lymph Node
    3. Pus on tonsils
  • If there is a cough, then NOT strep
  • 1 to 2 year olds don’t get strep
  • May be associated with fever

Pharm 558 (11 decks)

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