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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
Atrophic Vaginits
* **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
PMS
* **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
Dysmenorrhea
* 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
Vulvocaginal Candidiasis (yeast)
* 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
Bacterial Vaginosis: BV
* 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
Trichomoniasis
* 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
Toxic Shock Syndrome (TSS)
* 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
Allergic Rhinitis
* 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
Cold
* **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
Influenza
* Signs and Symptoms * Aches and Pains, myalgia * Fever * Sore Throat, cough, fatigue * Use same method as cold
35
Rhinitis Medicamentosa (Rebound Congestion)
* 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
Asthma
* Signs and Symptoms * Wheezy, cough, shortness of breath * cough could be only symptom * Don't sell primatene mist or tablets * Refer for MDI
37
Cough
* 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
Strep Throat Considerations
* 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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