Module Test 3 Set 3

Front 1

Thermoregulation response to cold (7)

Back 1

1)incr heat production
2)decr heat loss
3)incr muscle tone
4)skin vasoconstriction
5)incr voluntary exercise
6)behavior adap (warm clothes)
7)nonshivering thermogenesis (E and thyroid hormone)

Front 2

Thermoregulation response to heat (7)

Back 2

1)decr heat production
2)incr heat loss
3)decr muscle tone
4)skin vasodilation
5)decr voluntary exercise
6)sweating
7)behavior adap (cool clothes)

Front 3

Alterations in thermoregulation for...
a)fever
b)hyperthermia (2)

Back 3

a)incr set pt
b1)incr heat production
b2)decr heat dissipation

Front 4

Etiology of fever (4) and which is main cause

Back 4

1)infexn***
2)inflammation
3)drugs
4)neoplasm (especially ones of hypothalamus)

Front 5

Clinical course/symptoms of fever (besides high temp) (5) (and which 2 are first 2 symptoms in kids)

Back 5

1)chills/flushing b/c normal body temp is too low for new set pt
2)pallor (loss of color)
3)irritability***
4)anorexia***
5)malaise (not feeling well)

Front 6

Oral thermometer (2)

Back 6

a)best in adults/kids over 3
b)must be placed in SL pocket

Front 7

Rectal thermometer (2)

Back 7

a)BEST FOR NEONATES (3 months or younger)
b)average temp is 1F higher than oral method

Front 8

Tympanic thermometer (2)

Back 8

1)best for children 4months to 3yo
2)variable readings

Front 9

What to consider before taking a temperature (2)

Back 9

1)oral intake prior to measurement
2)local inflammation @ site of measurement

Front 10

What to get before assessing fever (6)

Back 10

1)medication history
2)medical history (mainly liver/renal disease)
3)social history
4)drug allergies
5)physical exam
6)labs/cultures

Front 11

Physiologic variables to fever (4)

Back 11

1)age (older = decr body temp)
2)gender (F higher temp than M)
3)sleep-wake cycle
4)local climate

Front 12

APAP and fever
a)dosing for kids/adults

Back 12

Kids- 10mg/kg q6h, max 65mg/kg/d

Adults- 325-500mg q4-6h max of 4000mg/day (lower doses for renal/hepatic insufficiency)

Front 13

NSAID and fever
a)kid dosing
b)adult dosing (2)

Back 13

a)5-10mg/kg q6-8h, max 40mg/kg/d
b)200-400mg q4-6h; max 3200mg daily; lower dose in renal/hepatic insufficiency

Front 14

ASA precautions (3)

Back 14

1)avoid in kids UNDER 16 (reye's/encephalopathy)
2)asthma or bleeding disorders
3)pregnancy

Front 15

Hydration to control fever
a)necessary to...
b)OTC products for kids/adults

Back 15

a)maintain blood flow and intravascular volume
b)adults (gatorade, carbonate beverage)
kids (pedialyte)

Front 16

Physical methods to control a fever (4) and thing about them

Back 16

NOT RECOMMENDED
1)sponging
2)ice packs
3)cooling blankets
4)circulating fans

Front 17

Fever complication

Back 17

FEBRILE SEIZURES (tonic seizure)

Front 18

Febrile seizure stuff (6)

Back 18

a)occurs within first 24hrs
b)in 2-4% of children
c)in kids 6months to 5yo
d)in fevers 102F plus
e)associated w/ degree and rate of rise of fever
f)having 1 will incr risk of having another

Front 19

Febrile seizure treatment and thing about them (3)

Back 19

TREAT BUT WON'T PREVENT
a)antipyretics
b)diazepam
c)anticonvulsants

Front 20

Fever conditions requiring immediate evaluate (8)

Back 20

1)2months or younger
2)6months to 24months w/ rectal temp greater than 102
3)immunocompromised
4)temp over 106 in adults
5)asplenia
6)pregnancy
7)cardiac disease
8)epilepsy

Front 21

Hyperthermia def (3)

Back 21

1)normal set pt temp
2)imbalance b/w heat gain/loss
3)pt can't get rid of heat and is producing too much

Front 22

Hyperthermia management (2)

Back 22

1)medical emergency
2)seek immediate medical attn

Front 23

Barriers to pain control (3)

Back 23

1)inadequate knowledge of HC professionals
2)cultural/social barriers
3)gov't regulations

Front 24

Inadequate knowledge of HC professionals consists of...(5)

Back 24

1)MD reluctance to prescribe opioids
2)lack of knowledge on equianalgesic dosing
3)poor pain assessment
4)misunderstanding of ADR's and addiction
5)"ceiling effect"

Front 25

First line and second line treatment for nociceptive pain

Back 25

1st- opioids
2nd- adjuvant/coanalgesics often req'd

Front 26

Neuropathic pain
a)underlying cause
b)desc
c)can be caused by...(4)

Back 26

a)results from damage to central or peripheral nervous system
b)burning, stabbing, shooting pain
c)compression, infiltration, ischemia, metabolic injury

Front 27

First and second line treatment for neuropathic pain

Back 27

1st- adjuvants/coanalgesic often reqd
2nd- opioids

Front 28

Acute pain
a)desc (2)
b)ex cause (2)
c)DPh role...

Back 28

a1)well defined pattern
a2)objective physical signs (sweat, BP, pulse)
b)dental pain, traumatic injury
c)conforting

Front 29

Chronic pain
a)def
b)desc.
c)DPh role

Back 29

a)persistent pain greater than 3 months w/o a well defined onset
b)lacks objective signs due to adaptations, no test for it
c)frustrating and improve fxnality

Front 30

Pain history mechanism

Back 30

PQRST
P- provocation/pallation (what makes worse/better)
Q- quality of pain
R- region and radiation
S- severity on 0-10 scale
T- timing (sudden/gradual/length)

Front 31

One dimensional pain measurement tools (2)

Back 31

1)visual analogue scale (line w/ no pain and worst pain at ends)
2)numerical rating scale

Front 32

WHO three step analgesic ladder (3)

Back 32

1)mild pain (non-opioid + adjuvant) (NSAIDS)
2)moderate pain (opioid + nonopioid + adjuvant) (opioid w/ APAP and tramadol)
3)severe pain (opioid + nonopioid + adjuvant) (opioid not in combo w/ APAP so no limits on dosing)

Front 33

Adjuvant?

Back 33

gabapentin

Front 34

Pain adjuvant referral (4)

Back 34

1)psychiatric
2)rehab/PT
3)pain clinic
4)neurology

Front 35

General principles of non-opioid analgesia (4)

Back 35

1)dose agents ATC
2)use max dose of each
3)switch to agents of a different class if one doesn't work
4)all agents have ceiling effect

Front 36

Ceiling effect

Back 36

if above max dose all you do is increase SE's

Front 37

Tylenol
a)pain dosing
b)SE's (3)

Back 37

a)325-650mg q4-6h (oral or rectal)
b)rash, hepatotoxic, incr risk of liver disease

Front 38

2 NSAIDS w/ no anti-platelet effects

Back 38

1)salsalate
2)choline magnesium salicylate

Front 39

NSAIDS
a)....b/w analgesics
b)really good for...
c)only injectable one

Back 39

a)equal analgesia b/w all agents, @ max doses, of this class
b)BONE PAIN
c)toradol

Front 40

COX2 vs. nonselective NSAID (2)

Back 40

a)decr GI effects
b)decr renal effects

Front 41

ASA max dose

Back 41

4000mg/day

Front 42

Naproxen max dose

Back 42

1500mg/day

Front 43

All OTC NSAIDS are of ____ category

Back 43

Proprionic Acids

Front 44

GI toxicity of NSAIDs and how to prevent

Back 44

cause duodenal AND gastric ulcers use PPI not H2 to protect against them (or use misoprostel (cytotec))

Front 45

COX2
a)affect on anti-plaletes
b)good for...
c)may cause...

Back 45

a)no effect on platelets
b)pts w/ risk factors for GI ulcers/bleeding
c)CV events

Front 46

ASA effect on platelets

Back 46

permanently acetylates COX1&2

Front 47

NSAIDs interact w/...(2)

Back 47

1)warfarin
2)antihypertensives

Front 48

a)Renal sparing NSAID
b)GI/platelet sparing NSAID
c)NSAID w/ worst GI effects

Back 48

a)Sulindac
b)COX2's
c)Prioxicam

Front 49

Worst tolerated NSAIDS (one other thing about this drug) and best tolerated

Back 49

Indomethacin is worst (incr CNS toxicity in old)

ASA/Ibu best tolerated

Front 50

General principles of opioid use (9)

Back 50

1)choose the appropriate route
2)start w/ lowest dose possible
3)titrate quickly
4)schedule agents ATC
5)use PRN doses for breakthru
6)use equianalgesic doses
7)anticipate and manage ADR's
8)use as much drug as necessary
9)understand tolerance and dependence vs. addiction

Front 51

Morphine
a)dosing
b)drug of choice for...
c)dosage form
d)metabolism
e)ratio?

Back 51

a)use LA ATC and SA for breakthru
b)chronic severe pain
c)all of em
d)significant first pass
e)Oral to IV; 3:1

Front 52

Fentanyl
a)onset
b)duration
c)dosing
d)ORAL MORPHINE conversion

Back 52

a)24hrs b4 onset of analgesia
b)48-72hrs
c)Max 25mcg/hr starting dose
d)oral morphine dose for 24hrs divided by 2 (in mcg/hr)

Front 53

Pts acceptable to get fentanyl (3)

Back 53

1)pts w/ intractable n/v
2)pts w/ chronic, stable baseline pain!!!!
3)NOT FOR ACUTE, UNSTABLE PAIN

Front 54

No tolerance develops to what opioid SE? and how to treat?

Back 54

CONSTIPATION

senokot 2 hs and docusate 100mg bid

Front 55

How to calc a PRN dose?

Back 55

15% of daily dose every 3-4h

Front 56

Antidepressant as adjuvants
a)which ones for what
b)how to dose
c)ADR's (5)

Back 56

a)TCA's good for neuropathic pain
b)start low and gradually incr
c)orthostasis, sedation, constipation, anti-SLUD, confusion

Front 57

Anticonvulsants as adjuvants
a)which ones for what? (5)
b)ADR's (4)

Back 57

a)gabapentin, pregabalin, tegretol, phenytoin, valproic acid for neuropathic pain
b)sedation, confusion, GI, bone marrow suppression

Front 58

Neuropathic pain
a)Poor response to...
b)Gabapentin dosing
c)Amitriptylline dosing

Back 58

a)NSAIDs/opioids
b)100mg TID
c)10-25mg q hs

Front 59

For bone pain use...

Back 59

NSAIDs