This document discusses pain and its classification into nociceptive and neuropathic pain. It also discusses acute and chronic pain and different types of pain such as cancer and non-cancer pain. Pain is assessed using a pain scale and choice of drug depends on patient's self-reported pain severity. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for mild pain and can be combined with opioids. Acetaminophen is also discussed along with its dosing, mechanisms of action, and toxicity. Side effects and risks of various NSAIDs like ibuprofen, indomethacin, and naproxen are summarized.
learning objective includes : pathogenesis,clinical features, classification of migraine, pharmacology about specific antimigraine drugs, coverage to newer triptan- Lasmiditan and newer prophylactic drug Erenumab a CGRP receptor antagonist.
learning objective includes : pathogenesis,clinical features, classification of migraine, pharmacology about specific antimigraine drugs, coverage to newer triptan- Lasmiditan and newer prophylactic drug Erenumab a CGRP receptor antagonist.
This talk summarizes the definition, diagnosis and management strategies of migraine. It will be useful for general public as well as healthcare professionals.
This is more of a summary of recent evidence available on migraine management. It is easy to read and understand. Please post your queries and comments.
Fever is common problem for children,
If care will be not taken they may get
Fits due to high fever.
They are called fits, Convulsions or seizures due to fever in children.
We will see
The Cause, treatment, diagnosis etc
Migraine and Tension Headache Diagnosis and Treatment Guideline, 1999–2013 Group Health Cooperative. , https://provider.ghc.org/all-sites/guidelines/headache.pdf
This talk summarizes the definition, diagnosis and management strategies of migraine. It will be useful for general public as well as healthcare professionals.
This is more of a summary of recent evidence available on migraine management. It is easy to read and understand. Please post your queries and comments.
Fever is common problem for children,
If care will be not taken they may get
Fits due to high fever.
They are called fits, Convulsions or seizures due to fever in children.
We will see
The Cause, treatment, diagnosis etc
Migraine and Tension Headache Diagnosis and Treatment Guideline, 1999–2013 Group Health Cooperative. , https://provider.ghc.org/all-sites/guidelines/headache.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. PAIN
Pain is classified into two main categories:
1. Nociceptive pain: occurs when sensory nerves (nociceptors) identify tissue
damage. Injured tissue releases substances (such as prostaglandins (PGs),
substance P, histamine. which stimulate the nociceptors to send impulses to the
brain that result in feeling pain.
2. Neuropathic pain: it does not result from tissue injury or damage, but from
damage or malfunction of the nervous system. Such as fibromyalgia, diabetic
neuropathy
Background and Types of Pain
3.
4. Acute and Chronic Pain
• Acute Pain
• Begins suddenly
• Never prescribe ER/LA opioids for acute pain
• Chronic Pain
• Persists beyond normal healing time
• Cancer pain and non cancer pain
N.B Pain is subjective and assessed by using pain scale where the
choice of drug depends on the patient’s self-reported pain severity.
5. NSAIDS
• NSAIDs are most commonly used or mild pain but can be
added to an opioid-based regimen to reduce the total opioid
dose required and provide better pain relief
• Acetaminophen (Tylenol)
• MOA:
• Reduces pain and fever (is an antipyretic) but does not provide an anti-
inflammatory effect.
• Inhibition of PG synthesis in the central
• BW:
• Severe hepatotoxicity (can require liver transplant or result in death),
associated with doses> 4 grams/day or use of multiple acetaminophen-
containing products.
6. • Acetaminophen (Tylenol)
• Dose:
• 10-15 mg/kg Q4-6H Pediatric dose.
• Conc of infant and children suspension product is 160mg/5ml
• Combination products
• Exist in combination with hydrocodone-oxycodone-caffeine-
diphenhydramine.
• Antidote
• Antidote for Tylenol is NAC that restores hepatic glutathione. It is
administered IV or orally using Rumac*-Matthew nomogram.
7. • The COX-1 and 2 enzymes catalyze the conversion of arachidonic acid to PGs
and thromboxane A2 (TA2). All NSAIDs decrease the formation of PGs which
results in decreased inflammation.
• Non-selective NSAIDs block the synthesis of both COX enzymes. COX-2
selective NSAIDs block the synthesis of COX-2 only, which decreases Gl risk
because COX-1 protects the gastric mucosa
• Aspirin is an irreversible COX- 1 and 2 inhibitor and is an effective antiplatelet
agent that provides cardiovascular benefit.
8. • Non-Aspirin Boxed Warnings
• All prescription, non-aspirin NSAIDs require a MedGuide due to
these risks.
• GI Risk: NSAIDs can increase the risk of serious Gl adverse events
including bleeding and ulceration.
• CV Risk: NSAIDs can increase the risk of MI and stroke. Avoid use
in patients with CV disease or risk factors. This warning includes all
OTC non-selective NSAIDs except aspirin.
• Coronary Artery Bypass Graft ( CABG) Surgery: NSAID use is
contraindicated after CABG surgery. Antiplatelet therapy (commonly
aspirin) is recommended after CABG surgery.
9. • Side Effects of all NSAIDS
• Used cautiously ( or avoided) in renal failure because they can
decrease renal clearance
• Avoid in patients with uncontrolled hypertension. Can increase
blood pressure
• Can cause premature closure of the ductus arteriosus. Do not use
NSAIDs in the third trimester of pregnancy(> 30 weeks).
• Take with food
• Can cause photosensitivity
Non-Aspirin NSAIDs
Non-selective Increased COX-2
selectivity
Ibuprofen (lower risk of GI complications)
Indomethacin Celecoxib
Naproxen Diclofencac
Ketorolac Meloxicam and Etodolac
Others Nabumetone
10. Non-Aspirin NSAIDS
1. IBUPROFEN
• OTC strength is 200 mg
• Pediatric dose is 5-10mg/kg/dose Q6-8 hours
• SE: dyspepsia, abdominal pain, nausea
2. INDOMETHACIN
• Has high risk CNS side effects. Avoid in psych patients.
• Preferred in Gout
3. NAPROXEN
• Dosed BID. Preferred by les compliant patients
• Used in combination medications for migraines with sumatriptan.
4. KETOROLAC
• BW: max combined duration for IV/IM and PO is five days.
• Warning. Not used in renal failure and liver failure
5. PIROXICAM AND SULINDAC
11. Juanito Carlo M. Deita VI, RPh
Doctor of Pharmacy, Centro Escolar University – Makati
Over the Counter Drugs and Self-Care
12. Headache
• Headache – cephalgia; A painful and disabling pain in the head
• Headaches include migraine, tension headache and trigeminal
neuralgia such as cluster headaches.
• According to GBD 2019, headache disorders are fifth cause of
disability-adjusted life years (DALYs) for both adolescent and
adult men and women .
• 46% suffers from general headache in a year, and 64% suffered
in a lifetime.
13. Fever
• Fever – pyrexia; a body temperature that is higher than normal
• NOT classified as a disease but, a symptom.
• Usually caused by an underlying condition (for most cases, it is
caused by an infection)
• COMMON clinical manifestation of COVID-19 infection.
• It can also be caused by medications, external factors such as
heat exhaustion or heat stroke due to too much exposure to the
sun and inability to regulate temperature by sweating.
14. What about self-care?
• Management of headache and fever can be done through the
use of OTC analgesics and antipyretics to relieve mild-to-
moderate pain and also reduces inflammation and fever.
• Analgesics are effective in treating pain of visceral origin.
• According to survey of 325 parents of children, majority of them
purchase OTC medicines if recommended by a physician and
of the medicines were effective previously.
16. What causes headache?
• Tension-type headaches – caused by stress, anxiety,
depression, emotional conflicts and other stimuli
• Migraine headache
• Oversleeping, missing a meal or vasoactive substances
• Menstrual cycle for women
• Dysfunction of trigemin0vascular system and consequent, magnesium deficiency to
produce aura symptoms
• Sinus headache – Infection or blockages of the paranasal sinuses
• MOH Headache – Related to the overuse which causes rebound effects of analgesics.
17. What causes fever?
• Pyrogens (fever-producing substances) activates the host’s
defenses, resulting in an increase hypothalamic heat regulatory
set point.
• Pyrogens can be exogenous or endogenous.
• Prostaglandins, speficically PGE2, are produced in response to
circulating pyrogens which affects the thermoregulatory set
point in hypothalamus resulting to a new set point and fever
occurs.
18. Clinical Manifestation of Headache
Characteristics of Tension-Type, Migraine and Sinus Headaches
(Handbook of Nonprescription Drugs, 16th Edition)
Tension-Type Headache Migraine Headache Sinus Headache
Location Bilateral
Over the top of head, extending to
base of skull
Usually unilateral Face, forehead or
periorbital area
Nature Varies from diffuse ache to tight,
pressing constricting pain
Throbbing
May be preceded by an aura*
Pressure behind eyes or
face
Dull, bilateral pain
Worse in the morning
Onset Gradual Sudden Simultaneous with sinus
symptoms, including
purulent nasal discharge
Duration Minutes to days
(If chronic – occurs at least 15 days
per month for at least 6 months)
Hours to 2 days Days (resolves with sinus
symptoms)
21. Exclusions for Self-Care for Headache
• Chronic headache – headaches that persist for 10 days with or without treatment
• Severe head pain
• Last trimester of pregnancy
• Younger than 8 years of age
• High grade fever or signs of serious infection
• Persistent nasal discharge (for sinus headache)
• History of liver disease or consumption of ≥3 alcoholic drinks per day
• Secondary headache – headache associated with underlying pathology such as cerebrovascular
accidents
• Symptoms consistent with migraine but no formal diagnosis of migraine headache
22. Clinical Manifestation Fever
• The most important sign of fever is an elevated temperature.
Fever is a symptom of a larger underlying process, whether it is
an infection, abnormal metabolism or drug induced.
• Symptoms that accompany fever and cause a great discomfort
include:
Headache
Diaphoresis
Generalized Malaise
Chills
Tachycardia
Arthralgia
Anorexia
Myalgia
Irritability
23. Exclusion for Self-Care for Fever
• Infants > 6 months with rectal temperature of ≥ 40 ºC or equivalent
• Children < 6 months with rectal temperature ≥ 38 ºC
• Severe symptoms of infection that are not self-limiting
• Risk for hyperthermia
• Impaired oxygen utilization (e.g., severe COPD, ARDS, heart failure)
• Impaired immune function (e.g., cancer, HIV)
• History of CNS damage (e.g., head trauma, stroke)
• Children with history of febrile seizures or seizures
• Fever that persists >3 days with or without treatment
• Child who develops spots or rash, refuses to drink any fluids, very sleep, irritable or hard to wake up
or vomiting and cannot keep down fluids
25. Treatment Goals
• For headache: 1. Alleviate acute pain; 2. Restore normal
functioning; 3. Prevent relapse; 4. Minimize side effects; For
chronic pain: reduction of frequency of headaches is an
additional goal
• For fever: the major goal is to alleviate the discomfort of fever
by reducing the body temperature to normal range.
26. Non Pharmacologic Interventions
(Headache)
• Chronic tension-type headache often respond to relaxation
exercise and physical therapy that emphasizes stretching and
strengthening of head and neck muscle
• For migraines, interventions includes regular sleeping and
eating schedule and create methods for coping stress.
Moreover, nutritional strategies such as dietary restrictions of
food containing triggers should be generally avoided.
• Ice bags/ cold packs can applied to forehead or temporal areas
to reduce pain.
27. Non Pharmacologic Interventions
(Fever)
• Increase fluid intake to prevent dehydration unless fluid is
contraindicated.
• Sponging or baths is not routinely recommended for febrile
patients with less than 40 ºC since it induces shivering leading
to increase body temperature
• Sponging with hydroalcoholic solutions is not recommended,
especially to pediatric patients.
• Wearing light apparels, removal of blankets and maintain a
room temperature are proven to be beneficial.
29. Pharmacologic Interventions
Drug Mechanism of Action
Acetaminophen/ Paracetamol Central inhibition of PG synthesis
(including PGE2 to produce analgesia
and decreases feedback between the
thermoregulatory neurons and the
hypothalamus, thereby reducing the
hypothalamic set point during fever.
NSAIDs (Ibuprofen and
Naproxen)
Peripheral inhibition of COX and
subsequent inhibition of PG synthesis.
Salicylates Irreversible inhibition of COX
enzymes and subsequently, inhibits
PG synthesis. (Primarily peripheral
mechanism)
30. Dosing Guidelines
Drug Usual Adult Dose Usual Pediatric Dose
Acetaminophen 325 – 1000 mg Q4-6 hours
(MAX: 4 g)
Neonate: 10 – 15 mg/kg/dose
PO/PR Q6-8 hours
Pediatric; 10 – 15 mg/kg/dose
PO/PR Q4-6 hours
(MAX: 90 mg/kg/24 hours)
Ibuprofen 200 – 400 mg Q4-6 hours
(MAX: 1.2 g)
For infant and child ≥6 months
for analgesia and antipyretic:
5-10 mg/kg/dose Q6-8hr
(MAX: 40mg/kg/24 hours)
Naproxen Sodium 220 mg Q8 – 12 hours
(MAX: 660 mg)
Child of at least >2 years:
5-7 mg/kg/dose Q8-12 hours
PO
(MAX: 1000 mg/ 24 hours)
Child of at least 12 years:
200 mg Q8-12 PRN PO
(MAX: 600 mg/ 24hr)
Aspirin 650 – 1000 mg Q4 – 6 hours
(MAX: 4 g)
CI to children due to Reye’s
Syndrome
Magnesium
Salicylate
650 mg Q4 hours or 1000 mg
Q6 hours
(MAX: 4 g)
31. Combination Products
Combination Products
Caffeine + Analgesic
combinations (APAP,
Paracetamol)
Effective treatment for variety
of conditions, including
tension-type and migraine
headaches but may cause
MOH with frequent use.
NSAID/Paracetamol + Nasal
decongestants
Effective for sinus headache
or other indications for which
both analgesia and
decongestion are needed.
Analgesics + Antihistamine Enhanced analgesia;
Effective for acute pain
compared to acetaminophen
alone but limited use due to
sedating effects
Orphenadrine/Phenyltoloxami
ne + Acetaminophen
33. Special Population Considerations
(Age)
• It is an important consideration in the selection of an
appropriate OTC medication for both fever and headache.
• Parents of children younger than 8 years old should seek the
advice of their pediatrician before doing self-treatment.
• Aspirin is contraindicated for children ages 15 years and below
• Elderly patients are at high risk for many adverse effects of
salicylates and NSAIDS. Moreover, impaired systems such as
comorbidities, impaired renal function and use of other
medications may contribute to the increased risk
34. Special Population Considerations
(Pregnancy)
• Acetaminophen can cross the placenta, but it is considered safe
during pregnancy and also, compatible with breast feeding.
• NSAIDs are CI during the third trimester of pregnancy due to
delay parturition, prolonged labor, increases postpartum
bleeding and can cause fetal cardiovascular effects such as
premature closure of ductus arteriosus. Although, both
Ibuprofen and Naproxen are compatible with breastfeeding
• Avoidance to aspirin is strictly advised.
35. Patient Factors
(Physiologic)
• Effectiveness and safety vary among age groups.
• Constantly changing physiology of pediatric patients including
different pharmacokinetics and pharmacodynamics.
37. Patient Factors
(Psychosocial)
• Living environment can affect self-care.
• Multiple caregivers can increase risk of miscommunication for
drug administration to pediatric patients.
38. Patient Factors
(Compliance)
• Ensure that the product is safe for use to increase adherence.
• Intolerances to drug therapy necessitates withdrawal to the drug
product, especially if the patient experiences hypersensitivity or
rebound effects
• Ensure that there is a need for medicines and whether the drug
related need were met
• Consider preferences for all ages (palatability, dosing frequency
and etc.) and take note on the past medication experience.
40. Aims of Patient Education
• The objectives of self-treatment are to (1) relieve the symptoms
of headache pain and discomfort of fever by returning the body
temperature to normal, (2) prevent the symptoms of headaches
and prevent complications associated with fever, (3) Prevent
medication overuse, misuse or duplication of therapy.
41. Episodic Headaches
• Instruct the patient to take appropriate dose of analgesic in the
early course of headache.
• Patients who experiences frequent episodic headaches should
be advised to keep a log of their headaches to document
triggers; how frequent they experience them, the intensity and
the duration of episodes and their response to treatment.
42. Tension-Type Headaches
• Non-prescription are usually effective for this condition.
However, consult a medical provider before using them for
chronic tension-type headache.
• Keep records (how often they appear and how often they
medications) and share them with their primary care physician.
• Do not use products containing caffeine because of the risk of
caffeine-withdrawal effects
43. Migraine Headaches
• Avoid triggers
• Follow dietary restrictions
• Eat regularly to avoid hunger and low sugar
• Consider taking magnesium supplements
• If onset of migraines are predictable (e.g., headache occurs during
menstruation), take NSAIDs to prevent headache. Start taking the
analgesic 2 days before you expect the headache and continue
regular use during the time the headache might start.
• Try to abort migraine by taking an NSAID at the onset of headache
pain
• If desired, use an ice bag or cold pack applied with pressure to
forehead or temple to reduce the pain.
44. Fever
• Do not rely on feeling the body for fever. Take a temperature
reading with an appropriate thermometer.
• RECTAL measurement is preferred for children up to 6 months
of age. Tympanic thermometer is not recommended in this age
group due to the size and shape of the infant’s ear canal.
• For 6 months to 5 years, the rectal methods is still preferred;
however, the tympanic, temporal or oral method may be used if
proper technique is followed
• Ages 5 years and above, the oral, temporal or tympanic method
is appropriate.
45. Fever
• Do not use isopropyl or ethyl alcohol for body sponging.
• For all levels of fever, wear lightweight clothing, remove
blankets and maintain room temperature.
• Unless unadvised, drink or provide sufficient fluids to replenish
body fluid loss
46. Fever
• Monitor fever and level of discomfort using the same
thermometer two or three times per day.
• Use OTC antipyretics/analgesics for up to 3 days only, unless
you have an exclusion to self-care
• Avoid alternating antipyretics because of the complexity of the
dosing regimens, increased medication errors and adverse
effects.
• Dosing of either ibuprofen or acetaminophen in children should
be based on weight.
• Use appropriate measuring device
50. Evaluation of Outcomes
Fever
• Primary monitoring
parameters include
temperature and experienced
discomfort.
• If symptoms did not improve
during the 3-day self-care
antipyretic treatment,
regardless of a drop of
temperature, medical
consultation either by phone
or appointment is needed for
evaluation
Headache
• Follow-up will depend on the
headache frequency and
severity and patient factors
• For all cases, the patient
should seek medical attention
if headaches persists longer
than 10 days or become
worse despite self-treatment.
51. References
• MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2020 Jun 24]. Heart attack; [updated 2022
Feb 2; reviewed 2016 Dec 15; cited 2022 Mar 17]; Available from: https://medlineplus.gov/fever.html
• Cann, S. A. H. (2021, January 9). Fever: Could a cardinal sign of COVID-19 infection reduce mortality? The American Journal of
the Medical Sciences. Retrieved March 17, 2022, from https://www.sciencedirect.com/science/article/pii/S0002962921000045
• Islam, M. A., Kundu, S., Alam, S. S., Hossan, T., Kamal, M. A., & Hassan, R. (2021). Prevalence and characteristics of fever in
adult and paediatric patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis of 17515
patients. PLOS ONE, 16(4). https://doi.org/10.1371/journal.pone.0249788
• Kristoffersen, E. S., & Christofer, L. (2014). Medication-overuse headache: Epidemiology, diagnosis and treatment. Therapeutic
Advances in Drug Safety, 5(2), 87-99. doi: http://dx.doi.org/10.1177/2042098614522683
• Trajanovska, M., Manias, E., Cranswick, N., & Johnston, L. (2010). Use of over-the-counter medicines for young children in
Australia. Journal of Paediatrics and Child Health, 46(1-2), 5–9. https://doi.org/10.1111/j.1440-1754.2009.01609.x
• Vos, T., Lim T. S., Abbafati C., et al. (2020).Global burden of 369 diseases and injuries in 204 countries and territories, 1990–
2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. https://doi.org/10.1016/S0140-
6736(20)30925-9
• Trajanovska, M., Manias, E., Cranswick, N., & Johnston, L. (2010). Parental management of childhood complaints: over-the-
counter medicine use and advice-seeking behaviours. Journal of clinical nursing, 19 (13-14), 2065–2075.
https://doi.org/10.1111/j.1365-2702.2009.03092.x
• Trajanovska, M., Manias, E., Cranswick, N., & Johnston, L. (2010). Use of over-the-counter medicines for young children in
Australia. Journal of Paediatrics and Child Health, 46(1-2), 5–9. https://doi.org/10.1111/j.1440-1754.2009.01609.x
• Handbook of Nonprescription Drugs: An Interactive Approach, 16th Edition
• The Harriet Lane Handbook: A Manual of Pediatric House Officers, 20th Edition