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174 Cards in this Set
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exclusions for self treatment of fever
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patients > 6 months w/rectal temp. >104
patients < 6 months w/rectal temp > 101 signs of systemic infection risk of hyperthermia impaired o2 utilization (COPD, respiratory distress, HF) impaired immune function (cancer/HIV) CNS damage (head trauma/stroke) hx of febrile seizures/seizures fever for more than 3 days w/ or w/o treatment child w/spots/rash child refuse to drink fluids child who is sleepy, irritable, hard to wake up child who is vomiting and cannot keep down fluids |
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fever
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body temperature higher than 100 F
sign of increase in body's thermoregulatory set point symptoms of underlying process does not require tx tx to relieve pain and discomfort |
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hyperthermia
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malfunctioning of the normal thermoregulatory process at the hypothalmic level
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hyperpyrexia
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body temp greater than 106
mental and physical changes |
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symptoms w/fever
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HD
disphoresis malaise chills tachycardia arthralgia myalgia irritability anorexia |
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complications of fever
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infants, elderly(decreased thirst perception/perspiration ability), CNS damage (reduced ability to dissipate heat)
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febrile seizures
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seirzures accompained by fever in the absence of another cuase such as acute metabolic disorder or CNS inflammation
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simple febrile seizures
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most common
nonfocal movements last < 15 minutes occur in 5% of children 6 months-5 years usually not harmful no significant neurologic sequelae prophylaxis not recommended |
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tx fever
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temp ./= 101F
can tx at lower temp. for elderly and if patient is feeling discomfort temp decreases w/age |
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nonpharmacologic therapy
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increase fluid intake (30-60 mL in children and 60-120 mL in adults)
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sponge bath
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recommended for temp > 104
can cause shivering and cause temp. increase do not use alcoholic preparations (alcohol poisoning) |
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pharmacologic therapy
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APAP & ibuprofen
can also use naporxen and ASA max. temp. reduction usually occurs after 2 hours (can take up to 1 day) alternating doses of APAP & ibuprofen is NOT recommended |
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temp > 3 days
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do not use antipyretic agents > 3 days
cannot self treat at this point |
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alcohol
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do not conumse > 3 drinks/day when on antipyretic agent
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APAP
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suppository not recommended due to erratic absorption
hepatotoxic in doses >4g/day use in caution in patients w/glucose-6-phosphate dehydrogenase deficiency |
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Glucose-6-phosphate dehydrogenase deficiency
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Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive hereditary disease characterised by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH), a metabolic enzyme involved in the pentose phosphate pathway, especially important in red blood cell metabolism. Individuals with the disease may exhibit nonimmune hemolytic anemia in response to a number of causes, most commonly infection or exposure to certain medications or chemicals.
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AEs of NSAIDS
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dyspepesia
heart burn anusea anorexia epigastric pain take w/food/milk/antiacids for upset stomach |
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complications of NSAIDs
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gi ulceration
perforation bleeding risk factors: > 60 yrs, prior ulcer disease/GI bleeding, concurrent use of anticoagulants(ASA),high doses,long duration, >3 alcoholic drinks/day |
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AHA recommends CV disease avoid NSAIDs
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associated w/increased risk of MI, HF, HT, & stroke
use naproxen instead of ibuprofen |
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do not use NSAIDs w/impaired renal function, CHF
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NSAIDs decrease renal blood flow and glomerular filtration rate by inhibiting renal prostaglandin synthesis (DI w/ACEIs)
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APAP DIs
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alcohol (increase risk of hepatotoxicity)
warfarin (elevates INR) |
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DIs w/NSAIDs
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ASA (decreased antiplatelet effect)
phenytoin (displacement from plasma protein binding sites) bisphosphonates (increase risk of GI ulceration) anticoagulants (increase risk of GI bleeding) alcohol (increase use of GI bleeding) |
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pregnancy
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can use APAP
NSAIDs contraindicated (prolong labor and increase postpartum bleeding due to inhibition of prostaglandin synthesis) |
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breastfeeding
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APAP and NSAIDs are safe in breast feeding
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pediatrics
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dosing based on weight not by age
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Exclusions for self treatment of HD
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severe head pain
HD for 10 days last trimester of pregnancy <8 yr. of age signs of systemic infection hx of liver disease consume >3 alcoholic drinks/day secondary HD symptoms consistent w/migraine but no dx of migraine |
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primary HDs
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not associated w/underlying illness
90% |
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Tension HDs
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stress HDs
chronic if occurs 15 days/month for 6 month |
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self treat HDs
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tension & sinus HDs
dx of migraine HD before self treating |
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medication overuse HDs
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use analgesics > 3months
occur within hours of d/c agent tx, taper use of agent then d/c may need rx meds to tx withdrawal HDs |
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migraine HDs
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arise from neronal and vascular factors
many stimuli including medications |
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sinus HD
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due to infection/blockage of paranasal sinuses
inflammation and distention of sinus walls |
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sinus HD vs. migraine HD w/o aura
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sinus HD will not be associated w/N/V, or visual distrubances
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tension HDs
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bilateral
on top of head diffuse aching, tight, pressing mild-severe gradual onset lasts minutes-days |
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migraine HDs
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usually unilateral
throbbing pain preceded by aura accompained by N/V, viaul disutrbances, photophobia, phonophobia, sinus symptoms, tiinnitus, light headness, vertigo, irritability sudden onset last hours-2 days |
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aura
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shimmering or flashing area/blind spots in the visual field
difficulty speaking auditory hallucinations one-sided muscle weakness |
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vertigo
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dizziness
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sinus HD
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face/forehead/periobital area
pressure behind the eyes dull bilateral pain worse in the morning w/sinus symptoms -purulent nasal dishcarnge onset: days resolves w/sinus symptoms |
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chronic HDs
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qualify for rx treatment
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nonpharmacologic tx for migraine HDs
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regular sleeping/eating scheduel
stress reduction ice for acute attacks avoid exposure to known triggers |
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APAP
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produces analgesia through central inhibition of porstaglandin synthesis
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NSAIDs and salicylates
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produce analgesia through peripheral inhibition of COX1 and COX2 w/subsequent inhibition of prostaglandin synthesis
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tx tension HD
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APAP or NSAID for 3 days/week to prevent medication overuse HD
take ASAP |
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migraine HD
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DOC: NSAIDs/salicylates
take ASAP less effective once migraine has evolved take 2 days before known trigger |
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caiffene/analgesic combos
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can tx tension/migraine HDs
frequent use can cause caffeine withdrawal HD |
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tx sinus HD
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decongestants to drain sinuses
OTC analgesic |
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tx HD
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do use OTC analgesics > 10 days
do not have >3 alcoholic drinks/day |
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salicylates
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avoid in patients w/hx of gout or hyperuricemia because of dose-related effects on renal uric acid handling
use in caution in renal impaired patients |
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ASA
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50% of people have gi symptoms (decrease by taking ASA w/food)
can prolong bleeding time(contraindicated in hypoprothrombinemia, vit. K deficiency, hemophilia, hx of bleeding disorder, hx of peptic ulcer disease |
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avoid ASA if risk factors for gastritis and ulcertion
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hx of uncomplicated or bleeding peptic ulcer
age > 60 yr.s concomitant use of other NSAIDs, anticoagulants, antiplatelet agents, bisphosponates, SSRIs, systemic corticosteriods higher dose of ASA infection w/ H. pylori RA NSAID-related dyspepsia alcohol |
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ASA intolerance
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uncommon
urticaria, angioedema, difficulty breathing, bronchospasm, profuse rhinorrhea, and shock w/in 3 hours avoid NSAIDs due to cross resistance DOC: APAP (mg/na salicylates may also be used) |
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do not use NA salicylate
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for Na+ restricted diets
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ASA DIs
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valproic acid (displace from plasma protein binding sites and inhibits metabolism)
NSAIDs (increase risk of ulcers) |
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NSAIDs DIs
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ASA (decreased antiplatelet effect of ASA)
phenytoin (displace from plasma protein binding sites) bisphospohonates (increase risk of ulcers) Digoxin (inhibits renal clearance of digoxin) |
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salicylates and NSAIDs DIs
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BBs/ACEis/vasodilators/diretics (inhibits antihypertensive effects by decreasing production of vasdilating prostaglandins/hyperkaliemia w/ K+ sparing diuretics & ACEi)
anticoagulants (increases risk of bleeding) alcohol (increase risk of GI bleeding) methotrexate (decreased methotrexate clearance) |
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salicylates DIs
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sulfonyureas (increase risk of hypoglycemia
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ASA
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avoid throughout pregnancy
cause anemia and postpartum hemorrage can cause growth redtarfation, intoxication, mortality, and decreased albumin binding capacity in the fetus |
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ASA
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avoid in breast feeding
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pediatric HDs
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need MD for children < 8 yr.s
avoid ASA and other salicylates in children < 15 due to Reye's syndrome naproxen can be used in children >12 yr. of age |
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Exclusion for self treatment of musculoskeletal pain
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pain score > 6
pain that last > 2 wks pain that continues 7 days after tx increased intensity or change in character of the pain pelvic/abdominal pain other than dysmenorrhea accompanying N/V, fever visually deformed joint, abnormal movement, weakness in any limb, suspected fracture 3rd trimester of pregos < 2 yr.s of age |
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acute muscoskeletal pain
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tendonitis
sprains strains |
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chronic muscoskeletal pain
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OA
tendonitis |
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muscle injuries
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strains
contrusions delayed onset muscle soreness |
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strains
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stretching/tearing of muscle or tendon
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contrusions
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bruising of muscle by blunt trauma
charley horse |
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delayed onset muscle soreness
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begins > 8 hours after repeated eccentric muscle contraction
peaks at 1-2 days and can last for days |
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muscle spasm
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involuntary muscle contraction
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muscle cramp
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prolonged muscle spasm
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tendontitis
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inflammation of tendon
acute/chronic can be caused by fluroquinolones also cause tendon rupture (greater risk > 60 yr., take steriods) |
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bursitis
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inflammation of bursa(fluid-filled sacs located between the joint spaces)
usually acute |
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sprains
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stretching/tearing of a ligament
usually sprain ankle or knee ligaments |
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OA
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gradual softening and destruction of cartilage between bones
NO INFLAMMATION! caused by genetic, metabolic, and environmental factors |
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chronic muscoskeletal pain
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> 2 weeks
exclusion for self treatment |
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OA
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treat after MD dx
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nonpharmcologic tx measures
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RICE
heat therapy |
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bursitis
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warmth/edema/erythema/possible creptius
acute constant pain that worsens w/movement |
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crepitus
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grating, crackling or popping sounds and sensations experienced under the skin and joints.
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OA
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weight bearing joints
possible joint swelling no inflammation dull pain/stiffness localized to a joint develops over years |
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busitis
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the knee, shoulder, and big toe
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sprain
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swelling and bruising
ligament initial severe pain acute reduction in joint stability and function tenderness |
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strain
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muscle/tendon
swelling/brusing initial severe pain muscle weakness loss of some fucntion acute |
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tendonitis
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warmth/swelling/erythema
mild-moderate pain loss of motion chronic/acute |
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RICE
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rest for 1-2 days
ice for 10-15 min. 3-4 x/day for 1-3 days (ice 2 long 2 much vasoconstriction which reduces clearance of inflammatory mediators) compression elevate for 2-3 hr/day to decrease swelling |
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heat therapy
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for pain of noninflammatory nature (acute lower back pain)
15-20 min 3-4 x/day not for recently injured area (2 days) not for use w/topical meds (increase absorption) |
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OA nonpharmcologic tx
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heat/cold
support physical therapy keep joints active loose weight if heavy use assisitive devices |
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APAP
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DOC for OA of hip and knee
more safe to use chronically than NSAIDs due to nephropathy, GI ulcerations and bleeding, & potential for CV events |
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counterirritants
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tx minor aches and pains including simple backache, arhtiritis, strains, brusises, and sprains)
divert attention away from more intense pain through nerve sitmulation |
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Catergory I counterirritants
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most common
camphor capsicum menthol methly nicotinate methly salicylate |
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counteirritants
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limit use to 3-4 x/day for up to a week
capsicum prepartions can be used for > 7 days w/MD supervision |
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muscoskeletal pain >7 days
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do not use OTC analgesics for >7 days w/o MD
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counterirritants
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do not apply to irritated skin w/heat/bandages
camphor can cause CNS toxicity if ingested |
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caspaicin counterirritants
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burning and stinging which diminishes w/continued use [>0.025%] associated w/cough
[>1%] associated w/nephrotxocity |
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methly niconitate counterirritant
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can cause general vasodilation if absorbed systemically
methly salicylate can cause salicylate toxicity if absorbed systmeically AVOID in children and in people w/allergy to ASA or have severe asthma/nasal polyps |
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Capsaicin
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efficacy is increased w/consistent use
duration of action is 4-6 hr.s must continue using to see benefit (14 days) wash hands following use to avoid getting in mucus membranes |
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naproxen
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use in children > 12 years of age
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counterirriatants in peds
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do not use in children < 12
do not use capsacin in children < 18 do use methly salicylate due to percutaneous absorption avoid camaphor because accidental ingestion can result in respiratory depression |
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sprains
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caused by a rapid change in direction
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grade I
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stretched
can self treat localized pain and tenderness no loss of muscle function |
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grade II
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partial tear
moderate disruption of muscle fibers reduced muscle strength limited mobility |
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grade III
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complete tear
visibly deformed joint severe pain and swelling complete loss of function surgical repair |
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contrusions
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quardriceps - charley horse
discolorations palpadble hematoma |
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tendonitis
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tennis elbow
carpal tunnel syndrome can also occur in achilles tendon |
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PQRST
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P - precipitating factors - what caused the pain?
Q - quality - is pain sharp/dull/achey R - region - where is the pain? S - severity - mild/moderate/severe T - time - when did pain start ask about modifying factors & other symptoms |
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prevent muscoskeletal pain
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warm up and stretch
cool down after a work out increase intensity of exercise gradually ergonomics wear proper shoes maintain healthy weight |
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Group A counterirritants
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redness and irritation
methylsalicylate ammonia water |
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Group B counterirritants
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cooling
camphor menthol |
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group C counterirritants
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vasodilation
histamine methly nicotinate |
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Group D counterirritants
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incite irritation w/o redness
capsaicin in Zostrix |
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do not use salicylated counterirritants
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in children due to percutaneous absorption
and if on warfarin |
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APAP
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analgeis/antipyretic
mild-moderate pain inhibits prostaglandin synthesis in CNS 325-650 mg Q 4 hours /650-100 mg Q 6 hours no more than 4g/day |
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peds dose of APAP
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10mg/kg/dose
do not exceed 5 doses in 24 hours |
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APAP overdosage
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10-15 gm or 4gm/day chronically
metabolized to glucornic acid and sulfuric acid conjugates by CYP450 and is detoxified by glutthione saturation of available glutthione = toxicity |
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APAP toxicity symptoms
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12-24 hr: N/V, anorexis, diaphoreisis, confusion
24-48 hr: AST, bilirubin, and prothrombin elevations 72-96 hr: peak hepatotoxcity leading cause of acute liver failure |
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salicylates
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IRREVERSIBLEY inhibits platelet aggregation for the life of the platelet
dosing: 325-650 mg q 4-6 hours take un-ECT for pain max: 4g/day CV: 81-325 mg/day |
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ASA
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bayer
ecotrin (ECTs) - minmize GI effects Bufferin (buffered |
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choline salicylate
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arthropan liquid
870 mg Q3-4 hours |
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Mg salicylate
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Doan's
650 mg Q 4 hours |
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alka seltzer
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effervescent salicyate
high Na+ content not for HT, HF, or CKD |
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Salicylates hypersensitivity
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<1%
asthma, nasal polyps, urticaria (10-30%) cross reacts w/ibprofen (97%) -DI take 30 min after ASA or 8 hr before ASA) DO NOT GIVE TO ASTHMATICS |
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urticaria
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an itchy skin eruption characterized by weals with pale interiors and well-defined red margins
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Salicylates contraindications
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children < 2 yr.s
Reye's syndrome hx of gi ulcer bleeding disorders allergic to sailcylate asthmatic pregnancy upcoming surger (D/C in 48 hr prior) hx of gout or hyperuricemia |
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Doans
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mg salicylate
can use w/caution in ASA allergic patients |
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nonacetylated salicylates
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do not affect bleeding time/platelet aggregation significantly compared to ASA
less GI erosion/bleeding low-level of cross-resistance of ASA allergies |
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Ibuprofen
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adivil/motrin
dosing: 200-400 mg Q 4-6 hours max. 1200 mg QD peds: 5-10 mg/kg/dose max: 40 mg/kg |
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naproxen
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aleve
dose: 220-440 mg Q8-12 hours max 660 mg QD over 65 max dose is 440 mg QD |
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GI effects
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NSAIDs (10-20%) also associated w/dizziness and fatigue
ASA (30%) |
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GI bleeding
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increase risk 2-3x w/chronic NSAID use
ASA risk is dose-dependent |
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NSAIDs
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do not use in children < 6 months
decrease renal excretion of lithium |
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Celebrex
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increased risk of CVD
selective COX-2 inhibitor |
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98.6 F
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37 C
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pyrogens
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activate body's host defenses by increasing hypothalamic set points via PGE2
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complications of fever > 106
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dehydration
coma delirium seiruzre heart/pulomonary problems due to increased O2 demand |
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febrile seizures
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infants
usually no reoccurance (10-15% chance in 1st year) long term damage is unlikely |
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exclusions for self treatment of HD
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high fever + stiff neck
> 10 days in adults > 5 days in children head injury new migraine (not dx yet) worst HD of one's life 3rd trimester of pregos mental status changes |
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high fever and stiff neck
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usually indicative of menigitis
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caffeine
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use w/migraine HDs not tension HDs to avoid precipitation of withdrawal HDs
excedrin is better than ibprofen for migraines |
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primary dysmenorrhea
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abnormal uterine activity
50% of females |
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secondary dysmenorrhea
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endometriosis
PID ovarian cysts uterine tumore/biroids |
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menstruation exclusion to self care
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dysmenorrhea began after age 25
pain begins > 24 hr after menses uses IUD pelvic pain w/no period abnormal vaginal discharge painful intercourse abnormal/perfuse bleeding irregular menstrual periods hx of infertility or PID PMDD severe PMS symptoms on HRT uncertain pattern of symptoms |
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tx for primary dysmenorrhea
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NSAIDs take ATC for 2-3 days
combo (diruetic/APAP/salicylate/antihistamine pyrilamine) effectiveness of Mg, Ca, vitamin B12, & black cohosh only demonstrated in small preliminary studies |
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premenstrual syndrome
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physical and emotional symptoms during the luteal phase
usually improve/disappear after 1 week |
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tx PMS
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DOC: NSAIDs
combo products (diruetics pamabrom, caffeine) fluoxetine for PMDD OCTs vitamins and supplements Vit. B6 max of 100 mg Q Ca 600 mg BID mG 200-400 MG QD |
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best tx for PMS!
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NSAIDs + 600mg Ca2+ BID!
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secondary HD
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A headache that is caused by another medical condition such as high blood pressure.
Do not self tx |
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Hemophilia
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hemophilia, haemophilia, bleeder's disease (congenital tendency to uncontrolled bleeding; usually affects males and is transmitted from mother to son)
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Hyperpyrexia
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temp >106
harmful don't self tx!!! |
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Fever
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is a symptom of underlying condition
NOT a disease |
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Fever with bacterial infection
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generally higher than fever from viral infection
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Fever =
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rectal temp >100.4
oral temp > 99.7 axillary temp > 99.4 tympanic temp > 100.0 |
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drug induced fever
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not a true fever
usually occurs 7-10 days after taking drug can get fever from vaccine 48 hours later |
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treat fever
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oral temp. > 101
tx elderly at lower temp because temp decreases w/age by 1.4 degrees/decade also can tx if in pain |
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at risk for APAP toxicity if
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have liver disease
take hepatotoxic drugs poor nutrition >3 drinks/day DON'T TAKE MORE THAN 2 GRAMS/DAY |
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AHA recommends if have or at risk for CV disease (HT, hyperlipidemia, DM)
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avoid NSAID use
if must use Naproxen but not in children |
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3rd trimester of pregos
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no NSAID use!
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sprain
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injury to ligament
involves bruising |
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strain
|
involves muscle/tendon
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Sprains of tendon
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tend to occur suddenly
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sprain of muscle
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tend to occur from sudden acceleration/deacceleration
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hematoma
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localized swelling filled with blood that occurs in contrusion
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causes of tendonities
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acute injury
chronic injury due to overuse aging (loss of elasticity) |
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causes of bursitis
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acute injury
chronic injury due to overuse (miner's elbow) infection gout/arthritis |
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crepiticus
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symptom of bursitis
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duration of migraine HD
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4-72 hours
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Sinus HD are worse
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in the AM
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Triptans/ergots may help
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migraine HDs
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Tx dysmenorrhea
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need to rule out secondary dysmenorrhea
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nonpharm tx for dysmenorrhea
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heat therapy
regular exercise smoking cessastion |
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patients use analgesic to tx HD >3days/wk
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taper over a few days
still have HD need MD |
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Avoid salicylates & NSAIDs in
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asthma
nasal polys chronic GI ulcers gout coagulation disorders anticoagulant therapy high BP CHF kidney dx ASA allergy |
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< 12 years of age avoid
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Naproxen
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</= 15 years of age avoid
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salicylates
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self tx HDs for less than
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3x/week or need MD
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Secondary HDs caused by
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head trauma
stroke substance abuse/withdrawal bacterial/viral disease disorder of craniofacial structure |
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medication-overuse HDs are at their worst in
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1st thing in the morning
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