Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
35 Cards in this Set
- Front
- Back
|
What is fever? |
-an elevated core body temp generally caused by an infection |
|
|
At what temp does neurologic damage occur? |
>41.7 C |
|
|
Thermoregulatory center |
-located in anterior hypothalamus -controls temp within a narrow range -fever = elevated set point caused by PGE2 |
|
|
What is a pyrogen? |
Any substance that causes fever --> causes hypothalamus to release PGE2 which elevates the set point -can be endo/exogenous |
|
|
What is the difference between endogenous/exogenous pyrogens? |
Endogenous -produced by monocytes, macrophages, other cells i.e. IL-1 and TNF Exognous -microorganism, toxin, other products -can cause formation/release of endogenous pyrogens |
|
|
What happens after an elevated set point? |
-vasoconstriction of peripheral vessels -shivering = heat production -heat seeking behavioral changes |
|
|
What are the best choices for measuring temp based on age? |
Age < 2 1st - rectum, 2nd - armpit Age 2-5 1st - rectum, 2nd - ear, 3rd armpit Age >5 1st - mouth, 2nd - ear, 3rd - armpit |
|
|
Measuring Temp - Oral |
- not suitable if heavy mouth breathing (stuffed up nose) -avoid hot/cold drinks use: electronic (safer), mercury (hazard mercury) How? clean therm. , place under tongue/side of mouth, hold lips closed or use fingers, read and clean |
|
|
Measuring Temp - Rectal |
- temps are 0.5C higher than oral temp -preferred for newborns How? Clean therm, lubricate therm and rectal opening, insert depth of 1 in., hold buttocks closed, remove, read and clean |
|
|
Measuring Temp - Axillary
|
- 0.5 C cooler than oral temp -noninvasive How? Place therm. in center of armpit, hold on place with arm tucked firmly against body confirm fever by rectal route |
|
|
Measuring Temp - Ear |
-measures infrared emissions from ear -reflects core body temp How? clean probe tip, gently tug on ear pulling back, gently insert therm, wait 2 sec, remove and read |
|
|
Measuring Temp - Transcutaneous |
- measures from skin, not a good indicator of core temp or fever
How? place plastic strip (encapsulated thermophototropic esters of cholesterol) on forehead 1 min, changes color |
|
|
Measuring Temp - Temporal Artery |
-infrared tech -no contact with mucus membranes How? Slide probe across the forehead keeping contact with skin, probe gives reading |
|
|
Treatment of fever - Should we? |
-fever is a symptom, not a disease (find underlying cause) -enhances ability to defend against infection -tool for monitoring infection -most are harmless --> cause discomfort, malaise = fever phobia |
|
|
Who do we treat with fevers then? |
-pregnant women -febrile seizures -temp >41C -impaired cardiac, pulmonary, or cerebral function |
|
|
Fevers in Children |
neonates and < 3 mo - immature thermoregulatory system -fever --> referral All children - febrile seizures are a concern, as long with dehydration |
|
|
What are febrile seizures? |
Any seizure that occurs in febrile children (children with a fever) -can occur at any temp, most common 3 mo - 5 yo |
|
|
Effects of febrile seizures |
-no learning problems -no incr risk of epilepsy -no death -no long term effects -no safe therapy options (or prevention) |
|
|
Fever in the elderly and pregnant women |
Elderly -can incr. metabolic rate = aggravate other diseases Pregnant women -incr. risk of neural tube defects during 1st trim. -acetaminophen safe, do not use NSAIDs |
|
|
What are the goals of therapy for the management of fever? |
-provide patient comfort -relieve parent anxiety -reduce metabolic demand (Pulm/CV disease) -prevent/alleviate fever mental dysfunction NOT TO RETURN BODY TEMP TO NORMAL |
|
|
What are non-pharmacological methods for management of fever? |
1. Tepid Water Sponging -give antipyretics before to reduce set point -sit child in 2 in of lukewarm water, sponging the skin 2. Remove excess clothing and bedding 3. Incr. fluid uptake 4. Avoid physical exertion |
|
|
Do antipyretics lower the body temperature? |
No, they lower the hypothalamic set point to normal (which sets in motion mechanisms for lowering body temp) |
|
|
Acetaminophen for fever management |
MOA - central inhibition of PG synthesis, no anti-infl./platelet activity minimal AE -hepatotoxicity in overdose CI - hypersensitivity, chronic alcohol consumption, malnutrition |
|
|
What are the doses for acetaminophen ? |
Adults -325-650 mg q4 to 6 hr prn (max 4g/day) Pediatrics -10 to 15 mg/kg q4 to 6 hr prn (max 65 mg/kg/day) |
|
|
ASA for fever management |
MOA - inhibits PG synthesis by inhibition of cyclooxygenase -used in mild to moderate fever -avoid in: children < 18yo , pregnancy and lactation, platelet or bleeding disorders |
|
|
AE/ toxicity of ASA? |
common - dyspepsia, abdominal pain, heartburn, bleeding Drug interactions: warfarin/ anti-coagulants, sulfonylureas, probenecid, corticosteroids, alcohol, methotrexate |
|
|
What is the dose of ASA? |
Adults - 325 mg to 650 mg q4 - 6 hr prn (max 4 g/day) |
|
|
Ibuprofen in fever management |
MOA - same as ASA AE/toxicity - upset stomach, long term - ulcer , avoid in pregnancy, bleeding disorders CI - warfaring/anti-coagulants, methotrexate, alchol |
|
|
What are the doses of Ibuprofen ? |
Adult -200 to 400 mg q4 - 6 hr prn (max 1200 mg/day) Pediatrics - 5 to 10 mg/kg q6 - 8 hr prn (max 40 mg/kg/day) |
|
|
Naproxen Sodium in fever management |
Avoid in children < 12 AE/toxicity - similar to ibuprofen, dizziness, rash, allergies, decreased renal function CI - allergies to NSAIDS, history of asthma, uritcaria, coagulation disorders |
|
|
What is the dosing of Naproxen? |
Adults: 220 mg q8-12 hr (Max 440 mg/day) |
|
|
When to refer a fever to a physician? |
-temp > 40.5 C - < 2months of age - confused/delirious -serious underlying disease -recent chemo -persistent wheezing/coughing -recent travel -recent fever |
|
|
How to determine who should get anti-pyretics? |
1st - fever is a symptom of illness, not a disease (identify) |
|
|
Should we alternate anti-pyretics? |
No evidence of greater efficacy, may also lead to confusion --> overdose |
|
|
What is the role of the pharmacist in fever management ? |
-educate the patient on drug therapy -assist in calculating the appropriate dose in mg/kg for child (and how to take/use) -avoid over dose |
