What medication(s) should be ordered for a patient with acute pericarditis?

Treatment of Acute Pericarditis

For a patient with acute pericarditis who reports a recent flu-like illness but is currently afebrile without signs of upper respiratory infection, the AGACNP should order NSAIDs (such as aspirin or ibuprofen) plus colchicine as first-line therapy. 1, 2

First-Line Medication Regimen

• NSAIDs are the mainstay of therapy for acute pericarditis, with aspirin (750-1000 mg every 8 hours) or ibuprofen (600 mg every 8 hours) recommended for 1-2 weeks 1, 2
• Colchicine should be added to NSAIDs as part of first-line therapy at weight-adjusted doses: 0.5 mg once daily if <70 kg or 0.5 mg twice daily if ≥70 kg for 3 months 1, 2
• Gastroprotection should be provided when using NSAIDs to prevent gastrointestinal complications 1, 2

Treatment Duration and Monitoring

• Treatment with NSAIDs should continue until complete symptom resolution and normalization of C-reactive protein (CRP) 1, 2
• NSAIDs should be tapered gradually (e.g., aspirin by 250-500 mg every 1-2 weeks) after symptoms resolve 1, 2
• Colchicine should be continued for 3 months to reduce the risk of recurrence 2, 3
• CRP should be monitored to guide treatment duration and assess response 2, 4

Second-Line Options

• Corticosteroids should only be considered as a second option when:
  • There are contraindications to NSAIDs and colchicine 1, 2
  • First-line therapy fails 2, 3
  • Infectious causes have been excluded 2, 5
• If corticosteroids are necessary, low to moderate doses (prednisone 0.2-0.5 mg/kg/day) should be used rather than high doses 1, 2

Activity Recommendations

• Physical activity restriction is recommended until symptoms resolve and CRP normalizes 1, 2
• For athletes, exercise restriction should last at least 3 months 1, 2
• For non-athletes, restriction until symptom remission may be suitable 1, 2

Common Pitfalls to Avoid

• Using corticosteroids as first-line therapy, which increases the risk of chronicity and recurrence 2, 3
• Inadequate treatment of the first episode, which is a common cause of recurrence 2, 6
• Failure to add colchicine to NSAIDs, which significantly reduces recurrence rates from 37.5% to 16.7% 3, 6
• Premature discontinuation of anti-inflammatory therapy before complete resolution of symptoms and normalization of inflammatory markers 2, 7

Based on the evidence presented and the patient's clinical presentation with acute pericarditis following a flu-like illness, the correct answer is C. Toradol (ketorolac, an NSAID) and colchicine, which aligns with the guideline recommendations for first-line therapy combining an NSAID with colchicine 1, 2.