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116 Cards in this Set

  • Front
  • Back
What is the most common ailment for which patients seek medical care?
Define pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage.
List the three distinct entities under which pain may be considered.
1. Acute

2. Chronic with malignancy

3. Chronic not associated with malignancy
What is the most common pain complaint?
There are many types of headaches. Are they treatable with OTC meds?
Only a few are self-treatable with OTC meds.
What are the two broad categories for headaches?
1. Primary

2. Secondary
What are primary headaches?
Just a HA not caused by something else. HA is the only symptom.
What are secondary headaches?
Not primary, secondary to some other problem, tend to be more chronic (ex. concussion)
What is the most common type of headache?
Tension-Type HA
Describe a tension-type HA?
Caused by pain or tightness in the muscles of the upper back, neck, or scalp in response to stress, anxiety, depression, emotional conflict, fatigue or repeated hostility.
Tension type HAs may be ? or ?.
Either chronic or episodic.
A chronic tension-type HA is held up to what medical standard?
Occurs at least 15days/month.
What are the signs and symptoms of a tension HA?
Bilateral diffuse pain over the top of the head and extending to rear and base of skull. Pain may radiate into shoulders. Patient may complain of tightness or pressure. Typically more of an aching than a throbbing sensation.
How could an episodic tension-type HA be treated?
Typically respond well to OTC analgesics.
How could a chronic tension-type HA be treated?
May require measures other than OTC meds.
What is the prevalence of migraines in children? (boys compared to girls)
The prevalence is equal in boys and girls.
What is the prevalence of migraines in adults? (men compared to women)
Women are 3X more likely than men to suffer from migraines. Women over 50 are the greatest sufferers.
What are vascular HAs?
Fairly common. Recurrent, hemicranial (one-sided) and throbbing. Includes both migraine and cluster HAs. Diagnosed migraines are self-treatable, cluster HAs require medical referral.
Cluster HAs tend to be more what than migraines.
More focused.
What are the signs and symptoms of a vascular HA?
Patient complains of throbbing HA on one side of head, may be associated with aura or not.
What is an 'aura'?
A "premonition" that a HA will occur. Many different manifestations, such as nausea, hallucinations, etc. Observed in 50% of pts.
Patients often refer to any severe HA as a what? Why might this be a problem?
Patients often refer to any severe HA as a migraine. This can be an issue because cluster HAs do not respond well to OTC meds, therefore clinician's diagnosis is reqd before recommending any OTC product.
What supplement may prevent the frequency of HAs?
Magnesium supplements.
A cluster is a type of what?
What are some general recommendations for migraines?
1. Est. regular sleep and eating patterns

2. Avoid triggers
Location of the pain for a Sinus HA?
Intense pain in the forehead or periorbital area of the face. More diffuse than a cluster HA.
Signs and Sx of a sinus HA
Patient usually presents with sx of sinus infection, inflamed and clogged nasal passages. Usually worst upon awakening. Stooping over or blowing nose intensifies pain.
How do you discern between an infection and an allergy?
Infections = colored mucous.

Allergy = clear mucous.
Describe the treatment for Sinus HAs?
Since sinus HA is typically the result of a sinus infection, patient should be referred to a physician for an antibiotic. However, temporary relief may be obtained from OTC products indicated for sinus HA.
What is a hangover HA caused by?
Caused by buildup of acetaldehyde which is a toxic metabolite of ethyl alcohol.
Describe the tx for a sinus HA.
OTC’s may provide some relief.
What is a fever HA?
HA which accompanies high body temperature.
What should a fever HA respond to?
Should respond to OTC’s used to lower fever.
What is a rebound HA?
May result from overuse of OTC meds used to treat HA.

For example a continued use of NSAIDs and/or caffeine predisposes patients to rebound HA. Abrupt cessation may result in a rebound HA.
Continuation relieves HA. You should taper off and stop not just quit 'cold turkey'.

(pt should not be taking a med everyday for a HA...should see a dr.)

This may also be seen with caffeine use.
List some exclusions to tx for HAs.
1. If secondary to injury.

2. High fever associated with infection.

3. If child is less than 7yo

4. If pt is in last trimester of pregnancy

5. If HA is persisting for more than 10 days w/ or w/out tx.
Taking an NSAID or other appropriate analgesic often will often relieve the pain of a ? HA or mild-to-moderate ?.
Taking an NSAID or other appropriate analgesic often will often relieve the pain of a tension HA or mild-to-moderate migraine
Aspirin is aka?
Acetylsalicylic Acid
Where does ASA absorption take place?
Absorption takes place in the stomach and small intestine.
What is ASA absorption slowed by?
Slowed by presence of food or antacids.
What occurs with buffered-ASA products?
They are absorbed more rapidly but this fact has little therapeutic significance.
What occurs with effervescent ASA solutions? also absorbed more quickly, also no significance
Like buffered products they are absorbed more quickly but this also has no therapeutic significance.
Most ASA products are absorbed within what time frame?
Within 12-13 minutes. Products that claim faster absorption are usually just implementing marketing ploys (may be slightly quicker but not significant and only timing not effectiveness differs between forms).
What are the adverse effects of ASA?
GI distress, increased GI bleeding and potential for ulceration.
ASA use should be discontinued at least three days before what test?
Discontinue aspirin use at least three days before fecal occult blood test.
Allergies to ASA are seen in what percentage of the pop?
Allergies are seen in less than 1%.
List 5 sx of true ASA allergies.
1. Urticaria (hives)

2. Edema (swelling)

3. SOB

4. Rhinitis

5. Shock
Is an upset stomach a sx of ASA allergies?
No. Upset stomach is a side effect of ASA.
What are the 4 therapeutic effects of ASA?
1. Analgesic (relives pain)

2. Anti-inflammatory

3. Anti-pyretic (relieves fever)

4. Anti-platelet
List 4 Drug interactions with ASA.
1. Anticoagulants (like Warfarin)

2. Valproic Acid

3. Sulfonylurea agents (Glipizide, Glyburide...anti-diabetics)

4. Alcohol
ASA and Anticoagulants may cause what?
Can cause excessive bleeding.
Together ASA and valproic acid may cause what?
ASA increases the blood levels of valproic acid and increases it's toxic effects.
Drug interaction between Sulfonylurea agents (glipizide and glyburide) and ASA?
ASA will cause a greater decrease in blood sugar so it increases the hypoglycemic index. (?)
Drug intrxn between ASA and alcohol?
Alcohol tends to dissolve mucous lining of the stomach so ASA will cause increased irritation.
List 4 areas of Precautions and Special Considerations for ASA use.
1.Chronic alcohol use

2. Patients with asthma or nasal polyps

3. Pregnancy

4. Children under 15 with possible influenza or chickenpox
Why should children under 15 with possible flu or chickenpox be cautious about ASA use?
They could develop Reye's syndrome. This is fatal in 50% of pts. (Vomiting, Coma, Death)

So Children under 15yo who have had a viral infection should not take ASA.
Choline Salicylate is aka what?
Arthropan Liquid
What dose of Choline Salicylate (Arthropan Liquid) is equivalent to 650mg ASA?
Choline Salicylate (Arthropan Liquid) 5mL dose or 870 mg = 650 mg ASA
What is a brand name for Magnesium Salicylate?
Doan’s Regular Strength Caplets
What dose of Magnesium Salicylate (Doan’s Regular Strength Caplets)
is equivalent to 325mg ASA?
Magnesium Salicylate (Doan’s Regular Strength Caplets)
377mg = 325mg ASA
Magnesium Salicylate (Doan’s Regular Strength Caplets)
is useful for what?
Useful for patients allergic to ASA.
What does Choline Salicylate smell like?
Has a fishy odor.
Choline Salicylate does not ? like ASA does.
Dose not irritate the stomach.
Choline Salicylate is not as good of a ? as ASA is.
Not as good as an antipyretic.
Choline Salicylate is usually used for what?
Joint pain when pts can't take ASA. (but it's also taken for HA)
Alka-seltzer (original formula) contains how much ASA?
325 mg of ASA.
Alka-Seltzer Plus which is available in five different combinations of ingredients contains what?
Plus has 325 mg of APAP. (normal has 325mg of ASA)
Ecotrin has what?
Enteric coating.
Enteric coatings will not dissolve until they hit what? What benefit is this?
Not until they hit the intestine. This helps avoid gastric irritation but it takes longer to work. (this is not a prolonged release)
Approximately how many products contain APAP?
Tylenol and over 100 other products. One of the most common products. This makes it easy to overdose. Pts typically have APAP at home so there is really no reason to buy another product that has it.
APAP is an ? and ?.
APAP is an analgesic and antipyretic.
APAP decrease pain and fever but it is not ?.
It is not anti-inflammatory.
APAP has little or no effect on ? time and ? aggregation. What does this indicate?
APAP has little or no effect on bleeding time and platelet aggregation. This means you can take it with Warfarin.
APAP does not cause ? ? irritation.
APAP does not cause significant GI irritation like ASA does.
Who is APAP safe to use for that ASA is not?
Pregnant women and nursing mothers.
Excessive APAP use may lead to ? toxicity.
Excessive use may lead to liver toxicity.
What may increase the chances of liver toxicity associated with APAP use?
Unintentional double dosing because of so many products.

Drinking alcohol also increases this.
APAP is the most common drug that is reported to who? Why?
Most common drug in acute overdoses reported to poison control centers in the US. This may because of its wide availability, attempted suicides, etc.
How many tabs of APAP is considered over an overdose? How many could kill?
30 tabs of regular strength could cause hepatotoxicity.

50-60 tabs can kill.
List 4 types of HA meds other than ASA and APAP?
1. Non-salicylate NSAIDS

2. Ibuprofen

3. Naproxen

4. Ketoprofen
Do Non-salicylate NSAIDS, Ibuprofen, Naproxen, and Ketoprofen cause liver damage?
No they do not cause liver damage.
Can Non-salicylate NSAIDS, Ibuprofen, Naproxen, and Ketoprofen be taken in pregnancy?
Yes, but only in the 1st 2 trimesters.
Non-salicylate NSAIDs, Ibuprofen, Naproxen, and Ketoprofen are all ?, ?, and ?.
They are all analgesic, antipyretic, and anti-inflammatory.
List some general indications for Non-salicylate nsaids, ibuprofen, naproxen, and ketoprofen?
Aeadache, muscular aches, arthritis, toothache, backache, minor aches and pains associated with the common cold, pain associated with menstrual cramps, and reduction of fever.
What are some brand names for ibuprofen?
Motrin IB, Advil, Nuprin
What is a brand name for naproxen?
What is a brand name for Ketoprofen?
Orudis, Actron
List 2 interactions of drugs with NSAIDS.
1. Anticoagulants (increased effect with ASA, ibuprofen)

2. Alchohol (increases GI irritation and bleeding)
In Dr N.'s opinion what is the best med for HA?
Ibuprofen. It is relatively safe. Works well. Typical dose is in 200mg tabs otc(there are 400, 600, etc as RX but you could just take more OTC product). Q4-6h.
Comparison of OTC products for the tx of moderate to severe HA?
ASA (650mg) was superior to 1000mg APAP.
Comparison of OTC products for the control of pain 2ndary to dental surgery or episiotomy?
APAP 1000mg superior to ASA 650mg.
Comparison of OTC products for postepisiotomy pain?
Ibuprofen 400mg superior to ASA 600mg.
Comparison of OTC products for extraction of impacted teeth?
Ibuprofen 100mg superior to 650mg ASA.
Comparison of OTC products in producting analgesia?
Ibuprofen 10-200mg is equal to 650mg APAP.

Ibuprofen 400mg is superior to 1000mg of APAP.
Comparison of OTC products in the tx of migraine HA?
Ibuprofen 400mg superior to 900mg APAP.
Naproxen ? mg is considered equivalent to ? mg of ibuprofen. What is the difference?
Naproxen 220mg is considered equivalent to 200mg ibuprofen but the duration of naproxen is somewhat longer.
Caffeine in combination with ?, ?, and ? significantly increases the analgesic potency.
Caffeine in combo with ASA, Ibuprofen, and APAP significantly increases the analgesic potency.
Naproxen is not recommended for children under what age?
Ketoprofen is not appropriate for children under what age?
<16yo. "There's too many side effects for anybody anyway."
? are not for people with kidney damage.
NSAIDs are not for people with kidney damage.
Dose by body wt for APAP?
Dose by body wt for ASA?
Dose by body wt for ibuprofen?
Dose by body wt for ketoprofen for people under 16yo?
Not recommended
What is the dose for ketoprofen for people over 16yo?
12.5mg q4-6h (max 75mg/day)
What is the usual adult dosage and (max adult dosage) for ASA?
650-1000mg (4000mg)
What is the usual adult dosage and (max adult dosage) for APAP?
325-1000mg q4-6h (4000mg)
What is the usual adult dosage and (max adult dosage) for ibuprofen?
20-400mg q4-6h (1200mg)
What is the usual adult dosage and (max adult dosage) for ketoprofen?
12.5-25mg q4-6h (75mg)
What is a fever?
An elevation in normal body temp.
What is the normal rectal temp? What is considered a fever?
Rectal 97.9 – 100.4 F Fever > 101.84 F
What is the normal oral temp? What is considered a fever?
Oral 95.9 – 99.5 F Fever > 100.0 F
What is the normal axillary temp? What is considered a fever?
Axillary 94.5 – 99.0 F Fever > 99.0 F
What is the normal tympanic temp? What is a fever?
Tympanic 96.4 – 100.4 Fever > 100.4 F
What is the least dependable method for taking temps?
Axillary (armpit) is least dependent.
When is body temp generally higher?
Temp is higher later in the day (~dinner time).
Oral is typically higher or lower temp than rectal?
Typically lower.