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59 Cards in this Set
- Front
- Back
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Prevalence of Headaches
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Over 90% of people experience headaches at some point in their lives
Estimated that 1/3 of non-prescription analgesics use is for headaches Nearly half of patients using OTC pain relievers do not read the labeling on the container |
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Primary Headaches
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Not associated with underlying disease
90% of headaches |
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Secondary Headaches
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Underlying conditions
--Trauma, stroke, substance abuse, withdrawal, bacterial or viral diseases |
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Treatment goals of Headache
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Alleviate acute pain
Restore normal function Prevent relapse Minimize side effects |
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OTC Pharmacologic Therapy
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Acetaminophen
NSAIDs --Ibuprofen --Naproxen Salicylates --Aspirin |
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Acetaminophen Dosing
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Dose by body weight (mg/kg)
10-15mg/kg q 4-6 hours <2 years old Physician referral >95 lb or >12 years old 325mg - 650mg dose Do not exceed 1 g/dose or 4 g/day |
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Acetaminophen
various dosing forms available |
Oral
-Capsules -Tablets -Liquid Rectal -Suppositories |
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Acetaminophen toxicity
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Annually
Greater then 56,000 ER visits 26,000 hospitalizations 458 deaths |
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Ibuprofen dosing
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Ibuprofen
Dose by body weight (mg/kg) 5-10mg/kg q 4-6 hours <6 months old Physician referral >95 lb or >12 years old 200-400mg dose Maximum daily OTC dose 1200mg/day |
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Naproxen dosing
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<12 years old
Not recommended >12 years old --220-440mg as an initial dose followed by 220mg every 8-12 hours --Maximum daily OTC dose 660mg/day |
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Most frequent adverse effects of NSAIDs involve the digestive tract
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Dyspepsia, heartburn, nausea, and epigastric pain
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NSAID's can cause:
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water retention and increase blood pressure
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NSAID's
Increased risk for GI ulceration, perforation, and bleeding |
Older than 60 years old, prior ulcer disease or GI bleed, concurrent use of anticoagulants, higher dose or longer duration, and moderate use of alcohol
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AHA recommendations for NSAID's
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Patients with or high risk for cardiovascular disease should avoid NSAIDs
Patients at low risk should use these agents cautiously Lowest dose and shortest duration |
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FDA has emphasized that patients using NSAIDs for longer than 10 days should do so only with medical supervision
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true
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Aspirin dosing
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Aspirin
Dose by body weight (mg/kg) 10-15mg/kg q 4-6 hours <12 years old Physician referral >12 years old 325-650mg every 4-6 hours Do not exceed 5 doses in 24 hours |
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Aspirin precautions
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Reye’s syndrome
Rare illness that can affect the brain and liver Occurs most commonly in kids recovering from viral infection Link established with Aspirin |
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Prevalence of Fever
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In 2002, patients complaining primarily of fever made approx. 12,250,000 medical office visits
1 out 5 E.R. visits for children is related to fever Children have fevers more often than adults Rate of reported fevers in children <5 years old is 10 in 100 persons 0.5 in 100 in adults |
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The basics of fever
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Average temperature is usually maintained between 97.5°F and 98.9°F
Peak body temperature occurs between 4 and 6pm Lowest body temperature occurs roughly at 6am |
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Non Pharm options for fever
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Adequate fluid intake
Body sponging with tepid water Wearing lightweight clothing Removing blankets Maintaining a room temperature at 78°F |
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How to take a rectal temperature
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Place disposable cover on the tm – the cover should be lubricated (water based)
Infants/young children: Position face down over lap, separate buttocks, gently place thermometer in rectum Insert to about 1 in depth Adults – lie on side with legs at a 45 degree angle, insert tm 0.5-2 in Remove the stem the reverse way, straight out. Never twist or bend it. Wipe away any remaining lubricant Warning: Can produce bowel movement in infants! |
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Which method to use for taking temperature?
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Rectal method is considered the gold standard measurement
Consistently estimates core body temperature |
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what reading constitutes a fever?
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Rectal: >100.4°F
Oral: >99.7°F Axillary: >99.3°F Tympanic: >100°F |
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Conversion from Fahrenheit to Celsius and vice versa
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Celsius = 5/9 (°F – 32)
Fahrenheit = (9/5 x °C) + 32 |
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treatment of fever
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Treatment goal
--Alleviate discomfort of fever Reducing the body temperature to a normal level Self-care measures --Use of antipyretics and nonpharmacological therapy is appropriate unless exclusions exist |
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exclusions from self treatment
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Patients >6 months of age with rectal temperature > 104°F
Children <6months of age with rectal temperature > 101°F Risk for hyperthermia Impaired oxygen utilization (COPD, respiratory distress, heart failure) Impaired immune function CNS damage Children with febrile seizures Fever that persist >3 days with or without treatment Child who develops spots or rash Child who refuses to drink any fluids Child who is very sleepy, irritable, or hard to wake up Child who is vomiting and cannot keep down fluids |
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OTC pharm treatment for fever
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SAME pharmacological treatment options as for headache
Acetaminophen Naproxen Ibuprofen Aspirin |
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Musculoskeletal pain
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Arises from muscles, bones, joints, and connective tissues
Can be idiopathic or related to injury Can be acute or chronic |
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Prevalence of pain
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$2 billion spent on nonprescription analgesics and external counterirritants
Musculoskeletal complaints are estimated to cost the U.S. economy more than $60 billion annually Nearly 80% of adults admit to taking a pain reliever at least once a week |
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Treatment goals of pain
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Decrease subjective intensity and duration of pain
Restoring function of the affected area Preventing re-injury and disability Preventing acute pain from becoming chronic persistent pain |
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Treatment of pain
Nonpharmacological therapy |
RICE
(rest: ice: compression: elevation) |
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Treatment of pain
non prescription analgesics |
NSAIDs or acetaminophen
External analgesics/counterirritants |
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exclusions for self care (pain)
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Moderate-to-severe pain (pain score>6)
Pain that lasts >2 weeks Pain that continues >7 days after treatment Increased intensity or change in character of pain Pelvic or abdominal pain (other than dysmenorrhea) Accompanying nausea, vomiting, fever, or other signs of systemic infection or disorder Visually deformed joint, abnormal movement, weakness in any limb, or suspected fracture Third trimester of pregnancy <2 years of age (FDA minimum age) |
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RICE
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Promotes healing, reduce swelling, and inflammation associated with muscle and joint injuries
Ice should not be applied for more than 15 minutes Use 3-4 times daily for up 72 hours |
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Heat?
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Alternative for patients who develop pain of a non-inflammatory nature
Apply 15-20 minute intervals – 3-4 times daily Heat should NOT: Be applied to recently injured or inflamed areas With other topical agents Over broken skin Should not apply to skin with decreased sensation |
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Systemic analgesics
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NSAIDs and acetaminophen are mainstay of therapy
--SAME DOSAGE Most often chosen as initial treatment options by patients Analgesic therapy should be limited to 7 days for self-care use --Medical care should be sought if condition continues beyond this period |
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topical products
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Analgesic
Reduces pain Anesthetic Causes lack of feeling Antipruritic Relieve or prevent itching Counterirritant |
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counterirritants
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Pain relief results more from nerve stimulation than depression
Produce a less severe pain to counter a more intense one Exert a placebo effect through pleasant odors, warmth, or cooling sensation |
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FDA Labeling
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Counterirritants recognized as safe and effective for use in adults and children (>2 years)
Labels for counterirritants indicate that product is to be used for: “Temporary relief of minor aches and sprains of muscles and joints” “Simple backache, arthritis pain, strains, bruises, and sprains” |
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non prescription counterirritants
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Methyl salicylate
Camphor Menthol Capsaicin |
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Methyl Salicylate
MOA |
Acts as a rubefacient
Causes vasodilation of cutaneous vasculature --> hyperemia |
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Methyl Salicylate
caution if using: |
aspirin
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Methyl Salicylate
what types of rxns occur? |
localized and systemic
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avoid in children?
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yes
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Camphor
MOA |
Produces cooling sensation
--Depressing cutaneous receptors |
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Camphor
strengths/dosages |
0.1%-3%
Analgesic, anesthetic, and antipruritic >3% - stimulates nerve endings in the skin |
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Camphor
can be toxic if ingested: |
Placing directly into the nostrils of an infant may cause respiratory collapse!!!
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Menthol
MOA strength misc |
Mechanism of action
Produces cooling sensation <1% Depresses cutaneous receptor response >1.25% Posses counterirritant properties Used in small quantities as flavoring |
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Capsaicin
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Major ingredient in hot chili pepper
When applied to skin, elicits a transient feeling of warmth through stimulation of TRPV1 receptor |
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Capsaicin
MOA |
Depletion of substance P which is found in the dermis and epidermis
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Capsaicin
other info: |
Patients should be instructed to use a glove or plastic bag for application
Wash hands following use Careful with sensitive areas Pain relief is usually noted within 14 days Can be delayed up to 4-6 weeks Remind patients that the product needs to be used regularly |
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Combination products
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Many products combine active ingredients from one group of counterirritants with one, two, or three other active ingredients
Do not combine with protectants because they would oppose counterirritants effects |
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Counseling points for all counterirritants
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Apply no more often then 3-4 times/day for up to 7 days
Patients should avoid using heating pads or other heating devices in conjunction with any external analgesics Products constantly change their active ingredients Look at active and inactive ingredients on label!! |
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Topical NSAID's
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Not available OTC
RX versions due exist Diclofenac (Flector® and Voltaren®) Patch and gel Has been used in Europe for quite some time Topical therapy has less incidence of GI and other systemic side effects |
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Carol, a frequent patient to your pharmacy calls and explains that while taking her child’s temperature it read 38°C and she is unsure what that translates to in °F.
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100.4
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If Carols child had a rectal temperature of 100 °F, would this constitute as a fever?
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no, > 100.4
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Which of the following would not be considered an appropriate counseling point for topical counterirritants?
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A. Patients should avoid use of heating pad in conjunction with counterirritants
B. Apply every 3-4 hours as needed C. Wash hands after application D. Should only be used if skin is intact B |
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Jimmy is 10 years old and presents with his mom to your pharmacy with a headache. Which of the following would be appropriate for Jimmy assuming he has no underlying exclusions for self-care? Jimmy weighs approximately 78lbs.
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A. Ibuprofen - 600mg three to four times daily
B. Naproxen – 220mg every 8 hours C. Acetaminophen – 500mg every 8 hours D. This patient should be referred to his primary care physician C 78 lb = 35.4 kg 35.4kg x 10-15mg/kg = 531mg |
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LT is a 29 year old male. He is inquiring about some oral pain relief products. After questioning the patient, you determine that he has been in pain for the past 2 weeks after playing some beach volleyball and describes it as 7 on the pain scale. What is an appropriate recommendation for the patient?
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Refer patient to physician
-- acute injury with no improvement in 2 weeks |
