Self-Care: Headache, Fever, Musculoskeletal Injuries

Tension-Type Location

bilateral, over top of the head

Tension-Type Nature

varies; tight, constricting pain

Tension-Type Onset

Gradual

Tension-Type Duration

minutes to days

Tension-type non-headache symptoms

scalp tenderness, neck or muscle pain

Migraine Location

unilateral

Migraine Nature

Throbbing, aura

Migraine Onset

sudden

Migraine Duration

hours to days

Migraine Non-headache symptoms

nausea

Sinus Location

face, forehead, periorbital

Sinus Nature

Pressure behind eyes or face, bad in the morning

Sinus Onset

Simultaneus with sinus symptoms

Sinus Duration

Days

Sinus

Nasal congestion

Medication-overuse headache

• rebound effect of medications

Exclusions: Most important

• more than 10 days

• occurs 15 days per month for 6 months

• 3rd trimester

• <8 years

• liver disease

Tension non-pharma therapies?

• relaxation

• physical therapy

• diary

Migraine non-pharma therapies?

• stress manage

• ice packs

• avoid light, noise, trigger foods, low blood sugar

How long should I limit general OTC

< 3 days per week

OR

< 14 days per month

When is it best to take meds for migraines?

During aura

Sinus headaches responds well to what else?

decongestants + nonprescription analgesic help to relieve sinus headache pain

What is the average body temperature?

98.6 F (37 C)

What are pyrogens?

fever-producing substances

• exogenous: toxins, microbes

• endogenous: immune cytokines

What are prostaglandins?

produced and released in response to pyrogens and increase body temp

What is the most reliable to measure fever?

rectal

• >100.4 F

What are exclusions for fever?

• >3 months rectal temp more than 104 F

• < 3 months rectal temp more than 100.1 F

• children with seizures

• > 2 years with more than 3 day fever

• < 2 years with more than 24 hr fever

What are non-pharma therapies for fever?

Fluid replacement

• Children: increase by 30-60 ml (1-2 oz) per hour

• Adults: increase by 60-120 mL (2-4) per hour

Light Clothing

Myalgia

Muscle pain, swelling, acute or gradual

Tendonitis

inflammation of tendons and joints, swelling, warm, gradual

Busitis

inflammation, injury to bursa (joints), warm, swelling, acute with injury

Sprain

Tearing a ligament, swelling/bruise, acute with injury

Strain

hyperextension of muscle/tendon, swelling/brusing, acute w injury

Osteoarthritis

slow gradual damage of cartilage, possible joint swelling, years

What are exclusions to musculoskeletal pain?

• severe pain (>6)

• pain lasting more than 10 days

• pain lasting more than 7 days with OTC

• Pregnancy

• < 2 years of age

What are non-pharmacologic therapies for musculoskeletal pain RICE?

RICE

• Rest: 1-2 days, splints, slings

• Ice: apply asap, 15-20 min time frames (3-4 x), 1-3 days

• Compression

• Elevation: 2-3 hours per day

What are non-pharmacologic therapies for musculoskeletal pain HEAT?

• only for non-inflamm

  • no broken skin, topical agents

• osteoarthritis

• 15-20 min, 3-4 times daily

What OTC can you use for musculoskeletal pain?

APAP and NSAIDS

LIMIT 10 DAYS

Brand name for acetaminophen?

Tylenol and MAPAP

Mechanism of action of APAP?

inhibit prostaglandin synthesis

Does APAP have a black box warning what can it lead to?

YES, Hepatotoxicity

What are APAP counseling?

follow MDD recs and check other medications that might have APAP

What APAP tablet is regular?

325 mg

What APAP is Extra Strength

500 mg

What APAP is used in ER?

650 mg → arthritis

APAP Dosing Adults >12 years IR?

325- 1000 mg every 4-6 hours

APAP Dosing Adults >12 years ER?

650-1300 mg every 8 hours

APAP Dosing children <12 years ER?

10-15 mg/kg 4-6 hours prn

APAP Dosing children >12 years ER?

max 480 mg per dose (5), (2400 mg ) OR 75 mg/kg/day

What is max APA for acute use?

4000 mg daily

What is max APAP for chronic?

3000 mg daily

What is max APAP for liver disease, poor nutrition, warfarin, or 3 alcohol bev daily?

2000 mg daily

Brand names for ibuprofen (NSAIDS)?

advil, motrin

Brand name for naproxen (NSAIDS)?

aleve

NSAIDS Mechanism of action?

• Reverse inhibit COX-1 and COX-2

• decrease prostaglandin

• OTC are not selective

COX-1 Risk?

increase risk of bleeding

COX-2 Risk?

increased risk of clotting

COX-1 and 2 risks?

increase risk of GI events

Do NSAIDS have a black box warning what if so what are they?

Yes

• stomach/GI bleeding

• cardiovacular events: myocardial, stroke

NSAIDS adverse effects?

edema, heartburn, GI bleeds, CV

What should IBU not be used with?

DO NOT USE W ASA

• not anti-platelet effects

• competitive inhibition of COX-1

NSAID + Salicylate Contraindications

• chronic GI ulcers

• heart failure, kidney dsiease

• aspirin allergy, asthma

• stroke

• last trimester of pregnancy

• AVOID if you have gout

Dosing for ibuprofen ADULTS >12 years

200-400 mg x 6 hours

Dosing for ibuprofen ADULTS >12 years MAX AMOUNT

1,200 mg daily

Dosing for ibuprofen CHILDREN <12 years and > 6 months

5-10 mg/kg every 6-8 hours prn

Dosing for ibuprofen CHILDREN (<12 years and > 6 months) MAX AMOUNT

1,200 mg daily (300 mg per dose x 4) or 40 mg/kg/day

Dosing for naproxen ADULT >12 years

• 220 mg every 8-12 hours

• Can take 440 (2 tablets) within first hour

Dosing for naproxen ADULTS >12 years MAX

660 mg daily

Dosing for naproxen CHILDREN <12 years

DO NOT USE

Brand name for aspirin (salicylate)?

Bayer and Ecotrin

Brand name for magesium salicylate?

Doans

MoA Salicylates?

inhibit COX 1 and 2

• inhibition of TXA2 (thromboxane)

• IRREVERSIBLE

ASA Dosage Form: Regular?

absorbed in stomach/small intestine

• stomach irritation

ASA Dosage Form: Enteric-coated?

delay absorption until small intestine; avoid stomach irritation

ASA Dosage Form: Buffered?

co-formulated with antacid to reduce stomach upset

ASA Dosing CV benefit?

81 mg

ASA Dosing IR?

325 mg

ASA Dosing ER?

500 mg

ASA Dosing ADULTS >18 years

325-1000 mg every 4-6 hours

ASA Dosing ADULTS >18 years MAX

4000 mg daily

ASA Dosing CHILDREN <18 years

DO NOT USE

Magnesium Salicylate Dosing IR?

325 mg

Magnesium Salicylate Dosing ER?

580 mg

Magnesium Salicylate Dosing ADULTS >18 years

1160 mg every 6 hours

Magnesium Salicylate Dosing ADULTS >18 years MAX

4640 mg daily

Magnesium Salicylate Dosing CHILDREN <18 years

DO NOT USE

Considerations when using salicylates?

REYES SYNDROME

• if someone has chickenpox or flu

• Do not use >18 years

NSAID + APAP consist of?

has IBU +APAP

Caffeine treats what and brand name?

Only for headaches?

Excedrin

Caffeine MoA

vasoconstriction through adenosine receptor antagonists,

What should you use if have kidney disease?

What should you take for inflammatory pain?

NSAID

What should you take for non-inflammatory pain?

APAP

When will acetaminophen work?

30-60 min, 4-6 hours

When will ibuprofen work?

15-30 min, 6-8 hours

When will naproxen work?

30-60 min, up to 12 hours

When will aspirin work?

< 60 min, 4-6 hours

Topical NSAID Diclofenac brand name?

voltaren

Topical NSAID Diclofenac used for?

osteoarthritis

Topical NSAID Diclofenac: contact doctor and usage?

• pain more than 7 days

• do not use longer than 21 days