OTC Pain Management lecture for PCI
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| Name 5 neurotransmitters involved in the transmission of pain impulses | 1. Prostaglandins, 2. Bradykinin, 3. Serotonin, 4. Substance P, and 5. Histamine
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| Max daily dose of acetaminophen for adults | 4000mg/day
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| Adult dosage of acetaminophen. | 325-1000 mg q4-6hr PRN pain or fever
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| Children dosage of acetaminophen | 10-15 mg/kg/dose q4-6hr PRN pain or fever
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| Strength of Infant Drops Tylenol | 80mg/0.8mL
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| Strength of Children's Liquid Tylenol | 160mg/5mL
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| Strength of Adult Liquid Tylenol | 500mg/15mL
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| DI for acetaminophen | Chronic alcohol use, liver disease, hepatotoxic meds, pts w/ G6PD deficiency, large doses for pts receiving warfarin
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| Acute overdose of acetaminophen leads to what? | Hepatic necrosis and renal tubular necrosis
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| MOA of NSAIDs | Inhibits prostaglandin synthesis peripherally by inhibiting COX-1 and COX-2
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| Uses for NSAIDs. | Analgesic, antipyretic, and anti-inflammatory
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| Uses for acetaminophen. | Analgesic and antipyretic. NOT anti-inflammatory
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| DI for NSAIDs | Alcohol use, liver disease, anticoagulants, sulfonylureas, lithium, corticosteroids, valproic acid, phenytoin, methotrexate, digoxin, gout/hyperuricemia, hypertension, peptic ulcer disease, and cardiovascular disease
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| AE of NSAIDs | GI upset and ulceration, inhibit platelet aggregation, high doses are potentially additive to anticoagulant effects, hypoglycemia
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| What triad should you beware of for toxicity in NSAIDs? | Asthma, nasal polyps, and aspirin allergy
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| Adult dosage of ibuprofen | 200-400mg q4-6hr
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| Max daily dose of ibuprofen for adults | 1200mg/day
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| Adult dosage of naproxen sodium | 220mg q6-8-12hr
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| Adult dosage of ketoprofen | 12.5-25mg q6-8hr
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| Child dosage of ketoprofen | N/A for under age 16. For > 16, use adult dosage
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| Child dosage of naproxen | N/A for under age 12. For >12, use adult dosage
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| Child dosage of ibuprofen | 7.5mg/kg q4-6hr
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| Max daily dose of ibuprofen for children | 30mg/kg/day
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| Max daily dose of naproxen sodium for adults | 660mg/day
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| Max daily dose of ketoprofen for adults | 75mg/day
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| Max daily dose of aspirin for adults | 4000mg/day
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| Adult dosage of aspirin | 650-1000mg q4-6hr
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| Adult dosage of magnesium salicylate | 650mg q4hr or 1090 q8hr
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| Max daily dose of magnesium salicylate for adults | 4800mg/day
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| Max daily dose of sodium salicylate for adults | 3900mg/day
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| Adult dosage of sodium salicylate | 650mg q4hr
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| What kind of salicylate causes irreversible inhibition of platelet aggregation? | Acetylated salicylate
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| Avoid use of salicylates w/ | GI bleeding; Renal/hepatic disease; children <15 yo; Chronic alcohol use; Asthma, nasal polyps triad; Concomitant drug therapy; Surgery; Gout; Pregnant/breast-feeding; Diabetes; Hypertension; Drug interactions severe or unmanageable; Aspirin allergy
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| MOA of methyl salicylate | Unknown
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| MOA of camphor | Low concentrations - depression of cutaneous receptor response; High concentrations - stimulation of cutaneous receptors
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| MOA of Menthol | Low concentrations - depression of cutaneous receptor response; High concentrations - stimulation of cutaneous receptors
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| MOA of Capsaicin | Depletion of Substance P
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| MOA is Low concentrations - depression of cutaneous receptor response; High concentrations - stimulation of cutaneous receptors | Camphor and Menthol
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| MOA is depletion of Substance P | Capsaicin
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| Name four counterirritants | Methyl salicylate, camphor, menthol, capsaicin
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| Severe pain - refer or treat? | Refer
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| Undiagnosed headache pain > 10 days - refer or treat? | Refer
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| Diagnosed headache pain - refer or treat? | Treat
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| Severe diagnosed headache pain - refer or treat? | Refer
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| Headache and last trimester of pregnancy - refer or treat? | Refer
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| Headache and first trimester of pregnancy - refer or treat? | Treat
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| Headache and breast-feeding - refer or treat? | Refer
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| Headache and 8 yo or older - refer or treat? | Treat
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| Headache and 7 yo or younger - refer or treat? | Refer
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| Headache and hx of liver disease - refer or treat? | Refer
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| Headache and consumption of 3 or more alcoholic drinks per day - refer or treat? | Refer
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| Headache and consumption of 2 alcoholic drinks per day - refer or treat? | Treat
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| Secondary headache - refer or treat? | Refer
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| Migraine-like symptoms w/o formal diagnosis of migraine headaches - refer or treat? | Refer
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| Migraine-like symptoms w/ formal diagnosis of migraine headaches - refer or treat? | Treat
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| High fever or sign of serious infection - refer or treat? | Refer
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| Muscle pain for greater than 2 weeks - refer or treat? | Refer
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| Muscle pain for 8 days - refer or treat? | Treat
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| Muscle pain or joint pain that persists after 10 days of treatment - refer or treat? | Refer
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| Joint pain more severe than diagnosed arthritis pain - refer or treat? | Refer
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| Pain distribution along a nerve - refer or treat? | Refer
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| Rheumatoid arthritis - refer or treat? | Refer
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| Nonpharmacologic treatment for pain. | Rest; Ice; Compression; Elevation; Heat (joint/muscle injuries); Relaxation and stretching (tension headaches)
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| Complementary, nonpharmacological pain treatments. | Herbals, acupuncture, jagnesium (headache prophylaxis)
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| What type of headache has no underlying disease and may be responsive to OTCs? | Primary
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| What type of headache has symptoms of other disease and is seldom/rarely self-treatable and should be referred. | Secondary
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| Tension headache - refer or treat? | Treat
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| Previously diagnosed migraine headache - refer or treat? | Treat
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| Undiagnosed migraine headache - refer or treat? | Refer
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| Sinus headache - refer or treat? | Treat
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| Mixed-type headache - refer or treat? | Treat
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| Fatigue headache - refer or treat? | Treat
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| Eye-strain headache - refer or treat? | Treat
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| Hangover headache - refer or treat? | Treat
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| Rebound headache- refer or treat? | Treat
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| Infection headache - refer or treat? | Refer
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| Ice for the first ________ hours followed by hear after ___________ hours. | 48-72 hours; 48-72 hours
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| Treat joint pain NMT ______ days before referral. | 10 days
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| Number one treatment for osteoarthritis | Acetaminophen
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