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OTC > Pain > Flashcards

Pain Flashcards

1
Q

Types of pain:

A
  • nociceptive

- neuropathic

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2
Q

Nociceptive pain:

A
  • somatic

- visceral

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3
Q

What does somatic pain feel like?

A
  • well-defined

- aching

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4
Q

What does visceral pain feel like?

A
  • diffuse
  • deep
  • squeezing
  • usually whole hand approach
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5
Q

Neuropathic pain is indicative of…

A

damage/disease affecting the nervous system

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6
Q

What does neuropathic pain feel like?

A
  • burning
  • tingling
  • electrical
  • stabbing
  • pins and needles
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7
Q

For acute pain, you can…

A

anticipate pain resolution

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8
Q

For chronic pain, you can’t…

A

anticipate pain resolution

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9
Q

Chronic pain can impact…

A
  • use of medications
  • monitoring
  • counseling
  • long term side effects
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10
Q

Indications for OTC analgesics:

A
  • aches and pains
  • fever reducer
  • sore throat
  • headaches
  • toothaches
  • muscular aches
  • minor pain of arthritis
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11
Q

Adult OTC maximum dose for acetaminophen:

A

3 g

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12
Q

Adult monitored maximum dose for acetaminophen:

A

4 g

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13
Q

Acetaminophen is the leading cause of…

A

acute liver failure in the US

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14
Q

Risk factors for liver failure include…

A
  • combination acetaminophen in products
  • alcohol ingestion
  • repeat dosing in excess of acetaminophen
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15
Q

OTC medications account for _____ ED visits among children under 12

A

1/3

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16
Q

T/F: FDA issues a safety alert for acetaminophen

A

T

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17
Q

What was the safety alert for acetaminophen about?

A

potentially fatal skin reaction such as:

  • Stevens-Johnson syndrome
  • toxic epidermal necrolysis
  • acute generalized exanthematous pustulosis (AGEP)
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18
Q

For acetaminophen, there are potential fatal skin reactions w/…

A

any dose at any time

  • rash
  • blistering
  • detachment of upper skin
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19
Q

Counseling points for acetaminophen for adults:

A
  • avoid concurrent use of alcohol
  • liver damage w/ overuse and/or alcohol abuse
  • caution w/ combination products
  • don’t need food
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20
Q

Onset of action for acetaminophen:

A

< 1 hr

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21
Q

Duration of action of acetaminophen:

A

4-6 hr or 8 hr

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22
Q

Counseling points for acetaminophen for pediatrics:

A
  • avoid combination products

- can start right away

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23
Q

Salicylates are also known as…

A

aspirin

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24
Q

Max daily dose of salicylates:

A

4 g (10 tab/day)

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25
Q

T/F: you should give children salicylates

A

F

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26
Q

Salicylates can cause…

A

Reyes syndrome

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27
Q

Reyes syndrome is associated w/…

A

previous viral illness, influenza, cold, or chicken pox

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28
Q

T/F: Reyes syndrome is contagious

A

F

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29
Q

Reyes syndrome:

A
  • fat accumulation in the liver and encephalitis

- death within few hours to days

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30
Q

Signs of Reyes syndrome:

A
  • vomiting
  • signs of brain dysfunction
  • personality changes
  • disorientation
  • coma
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31
Q

Side effects of salicylates:

A
  • GI upset
  • bleeding (dose related)
  • ringing in ears
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32
Q

Salicylates have drug interactions w/…

A
  • warfarin
  • antiplatelet (Plavix)
  • NSAIDs/steroids
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33
Q

Contraindications for salicylates:

A
  • salicylates sensitivity/allergies
  • GI ulcers
  • alcohol ( >3 drinks/day)
  • pregnancy
  • elderly ( > 325 mg/day)
  • pediatrics
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34
Q

Higher the dose of salicylates, the higher risk of…

A

side effects

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35
Q

Salicylates can help prevent strokes by…

A

inhibiting prostaglandin synthesis and platelet aggregation

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36
Q

Dosage for salicylates and stroke prevention:

A

81 mg - 325 mg PO QD

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37
Q

Drug interactions for salicylates and stroke prevention:

A

NSAID and Asipirin

- take NSAID 30-120 min after / 8 hrs before aspirin

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38
Q

NSAIDs include…

A
  • ibuprofen
  • ketorolac
  • meloxicam
  • indomethacin
  • etodolac
  • nambutone
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39
Q

Adult dose for ibuprofen:

A

200-400 mg Q4-6 H prn

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40
Q

Max adult dose for ibuprofen:

A

1.2 g/day or < 2.4 g per physician

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41
Q

Child dose for ibuprofen:

A
  • weight (preferred) and age based dosing

- can be repeated 6-8 hr prn w/ max of 4 doses per day

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42
Q

When do you refer children to physician after use of ibuprofen?

A
  • fever/pain lasts > 3 days

- no improvement in 24 hrs

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43
Q

Side effects for ibuprofen:

A
  • GI upset
  • fluid retention/edema
  • dizziness
  • bleeding
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44
Q

Interactions w/ ibuprofen:

A
  • warfarin
  • lithium
  • methotrexate
  • alcohol
  • NSAIDs/steroids
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45
Q

Precautions of ibuprofen:

A
  • NSAID allergy
  • cardiovascular disease
  • pregnancy
  • GI ulcers/bleeding
  • geriatric
  • undiagnosed migraines
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46
Q

One should discontinue ibuprofen if…

A
  • fever lasts > 3 days
  • pain > 10 days
  • alcohol use is >3 drinks/day
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47
Q

200 mg of Naproxen base is the same as…

A

220 mg naproxen sodium

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48
Q

Adult dosage for naproxen:

A

200 mg Q8-12 H

  • can take as much as 400 mg for initial dose
  • take with food
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49
Q

Max dosage of naproxen per day:

A

600 mg

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50
Q

Max dosage of naproxen per dose:

A

400 mg

51
Q

Pediatric ( > 12) dosage for naproxen:

A

same as adult

  • 200 mg Q8-12 H
  • can take as much as 400 mg for initial dose
  • take with food
52
Q

Onset of action for naproxen:

A

1 hr

53
Q

Duration of action for naproxen:

A

7-12 hr

54
Q

Side effects of naproxen:

A
  • GI upset
  • Fluid retention/edema
  • dizziness
  • bleeding
55
Q

Precautions of naproxen:

A
  • NSAID allergy
  • cardiovascular disease
  • pregnancy
  • GI ulcers/bleeding
  • geriatric
  • undiagnosed migraines
56
Q

One should stop taking naproxen if…

A
  • fever > 3 days
  • pain > 10 days
  • alcohol use is > 3 drinks a day
57
Q

NSAID label warning:

A
  • stomach bleeding risk factors
58
Q

People at a higher risk for stomach bleeding risk factors:

A
  • > 60 YO
  • history of stomach ulcers
  • take blood thinners, steroids, other NSAIDs
  • > 3 alcoholic drinks/day
  • taking it longer than directed
59
Q

Cardiovascular concerns w/ NSAIDs:

A
  • increased risk of myocardial infarct, heart failure, hypertension, stroke
  • hypothesized mechanisms (usually dose dependent)
60
Q

Examples of high risk patients that should avoid NSAIDs:

A
  • previous myocardial infarct
  • hyperlipidemia
  • hypertension
  • diabetes
  • other macrovascular disease
61
Q

Types of headaches:

A
  • primary
  • secondary
  • episodic: occasional
  • chronic: very often
  • tension
  • migraine
  • sinus
62
Q

When do you refer a patient with headaches based on descriptions?

A
  • severe head pain
  • fever/signs of infection
  • symptoms of migraine without diagnosis of migraine
  • headache for 10 days
63
Q

When do you refer a patient with headaches based on health status?

A
  • last trimester of pregnancy
  • < 8 YO
  • history of liver disease
  • > 3 alcoholic drinks/day
  • secondary headache
64
Q

Nonpharmacologic ways to treat headaches:

A
  • relaxation
  • hot/cold application
  • exercise
  • hydration
  • regular sleep cycles
  • avoiding food triggers
65
Q

Pharmacologic ways to treat headaches:

A
  • acetaminophen
  • ibuprofen
  • naproxen
66
Q

OTC analgesic use for headaches:

A
  • 3 days per week

- want to prevent medication overuse headaches

67
Q

What medication should a 79 YO use for a headache that lasts 5 days?

A

Tylenol/acetaminophen

68
Q

What medication should a 79 YO use for a headache that lasts 13 days?

A

None, he has to see a MD first

69
Q

What medication should a 64 YO w/ severe cardiovascular disease use for a headache?

A

Tylenol/acetaminophen

70
Q

Where can you measure for a fever?

A
  • rectal
  • oral
  • axillary
  • temporal
  • tympanic
71
Q

What counts as a fever when measured rectally?

A

> 100.4 F

72
Q

What counts as a fever when measured orally?

A

> 99.5 F

73
Q

What counts as a fever when measured axillary?

A

> 99.35 F

74
Q

What counts as a fever when measured temporally?

A
  • 0-2 months: > 100.7 F
  • 3-47 months: > 100.3 F
  • > 4 years: > 100.1 F
75
Q

What counts as a fever when measured tympanically?

A

> 100.7

76
Q

A fever is usually indicative of…

A

an underlying illness

77
Q

Goal of fever treatment is…

A

alleviate discomfort vs. goal temperature

78
Q

How to treat fever?

A
  • APAP

- NSAIDs

79
Q

APAP and NSAIDs reach peak temperature lowering at…

A

2 hours

80
Q

Nonpharmacologic ways to reduce fever:

A
  • bathing not recommended for fevers < 104 F
  • lightweight clothing
  • remove blankets
  • drink enough fluids
81
Q

For children, fluid intake to reduce fever should be increased by…

A

30-60 mL/hour

82
Q

For adults, fluid intake to reduce fever should be…

A

60-120 mL/hour

83
Q

If patient with fever also has diarrhea, they should avoid…

A

excessive fruit juice or sports drinks

84
Q

Refer the patient w/ fever to the MD when temperature is…

A
  • > 3 month w/ rectal temp of > 104 F

- < 3 month w/ rectal temp of > 100.1 F

85
Q

Refer the patient w/ fever to the MD when there are impairments such as…

A
  • breathing concerns
  • immune function
  • CNS damage/injury
86
Q

Refer the patient w/ fever to the MD when they’ve had a fever for more than…

A
  • < 2 YO: > 24 hours

- > 2 YO: > 3 days

87
Q

Refer the child patient w/ fever to the MD when…

A
  • rash/spots occur
  • excessively sleepy, irritable
  • dehydrated
  • history of febrile seizures
88
Q

5 YO has temporal temp of 102 F w/ stuffy nose. What do you advise mom to do?

A
  • keep him hydrated
  • see Dr after 3 days
  • can give ibuprofen/APAP
89
Q

If 5 YO has temporal temp of 102 F w/ stuffy nose can’t eat b/c of upset stomach, what med can he take?

A

motrin/tylenol

90
Q

Menstrual cycle typically starts in what ages?

A

11 to 14.5 YO

91
Q

Dysmenorrhea:

A

6-12 months following menarche

- impacts teens until early 20s

92
Q

Menstrual pain is continuous w/…

A

spasmodic cramping in lower mid abdominal region

- radiates to back and aches extends down thighs

93
Q

Self care of menstrual pain is appropriate for…

A
  • healthy young women
  • presentation consistent w/ dysmenorrhea
  • not sexually active
94
Q

When to refer patients w/ dysmenorrhea:

A
  • prolonged/severe bleeding
  • history of PID, infertility, endometriosis
  • IUD
  • GI disease
95
Q

Treatment of dysmenorrhea:

A
  • NSAIDs
  • APAP
  • BC
96
Q

When to take NSAIDS and APAP for dysmenorrhea?

A

at start of menses

  • if adequate pain control then start 1-2 days prior
  • take on schedule for 2-3 days
97
Q

Nonpharmacologic ways to treat dysmenorrhea:

A
  • heating pads
  • Omega fatty acids
  • vitamin D3 (600 IU/day)
  • regular exercise
  • avoid cigarette smoke
98
Q

Why do patients prefer topical analgesics vs PO analgesics?

A

can put on spot that hurts

99
Q

Indication for capsaicin:

A

temporary relief of minor pain associated w/ muscles and joints

100
Q

MOA of capsaicin:

A

desensitization of sensory axons resulting in pain signal inhibition
- occurs by depletion of substance P and prevention of additional accumulation

101
Q

Capsaicin adult dose:

A
  • apply to affected areas TID or QID
  • need to use at least TID
  • benefits occur in 2-4 weeks
102
Q

Capsaicin patch dose:

A

apply patch to affected area for up to 8 hours per application
- max 5 days use

103
Q

Side effects of capsaicin:

A
  • erythema (redness)

- pain

104
Q

Capsaicin precautions/warnings:

A
  • may cause burns (1st-3rd degree)

- seek medical attention if blister, swelling, or pain at site

105
Q

Interactions w/ capsaicin:

A
  • minor
106
Q

Counseling for capsaicin:

A
  • avoid eyes/mucouse membranes
  • apply to intact skin
  • transient burning may occur and disappears after several days
  • stop use and contact HCP if redness or irritation occurs
107
Q

Administration for capsaicin in dosage forms of gel, cream, liquid, lotion:

A
  • wear gloves

- wash hands w/ soap and water after application

108
Q

Administration for capsaicin topical patch:

A
  • apply to clean and dry affected area
  • remove backing film
  • do not use 1 H before or after bathing
  • avoid heating pads
  • remove after 8 hours
109
Q

Indication of methyl salicylate and menthol:

A

temporary relief of minor aches and pains of muscle joints

110
Q

MOA of methyl salicylate and menthol:

A
  • counter irritant (methyl) and local salicylate analgesic effect (methyl salicylate)
111
Q

When you hear methyl salicylate, think about…

A

NSAIDs and aspirin

112
Q

Adult dosage of methyl salicylate and menthol:

A
  • balm, cream, foam, spray, stick

- apply to affected area TID or QID per day

113
Q

Adult dosage of methyl salicylate and menthol patches:

A
  • dose dependent
  • MS 10% and menthol 1.5%: 1 patch no more than QID and remove after 8 hours
  • MS 10% and menthol 3%: 1 patch no more than 12 H with max of 1 patch per application (max 2 patches/24 hours for 3 days)
114
Q

Side effects of methyl salicylate and menthol:

A

topical irritation

- not as bad as capsaicin

115
Q

Counseling for methyl salicylate and menthol:

A
  • topical, external use only on intact skin
  • wash applied area prior to bandaging, covering, etc
  • avoid heating pads
116
Q

Max dosaging for methyl salicylate and menthol:

A
  • max 3 days for patch

- max 7 days for gels, ointments, etc

117
Q

Warnings/precautions of methyl salicylate and menthol:

A
  • avoid if allergic to NSAIDs, salicylates, menthol
  • can cause burns
  • seek medical attention if blister, swelling or pain at site
118
Q

Warnings/precautions of methyl salicylate and menthol patch:

A
  • same as topical ones plus the ones below
  • GI issues (ulcers, reflux, stomach pain)
  • cardiac conditions
  • anticoagulants
  • geriatric
  • remove prior to MRI b/c has aluminum
119
Q

Indication for trolamine:

A

relief of pain or muscular aches, rheumatism, neuralgia, sprains, arthritis on intact skin

120
Q

MOA for trolamine:

A

local salicylate action in muscle/affected area

- systemic absorption considerations

121
Q

Adult dose for trolamine:

A
  • apply to affected area prn TID or QID

- no odor

122
Q

Side effects of trolamine:

A
  • confusion
  • drowsiness
  • nausea
  • vomiting
  • diarrhea
  • local skin irritation
123
Q

Precatuion/warning of trolamine:

A

avoid irritated skin/eyes

124
Q

Counseling for trolamine:

A
  • wash hands after application
  • contact HCP if pain persists or worsens w/in 7 days
  • may wrap area loosely
  • watch for signs and symptoms of bleeding

OTC (23 decks)

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