Acetaminophen

ACTIVE LEARNING TEMPLATE: Medication STUDENT NAME _____________________________________ Acetaminophen MEDICATION __________________________________________________________________________ REVIEW MODULE CHAPTER ___________ 1, 5, 12, 35~38 NSAID, antipyretics, nonopioid analgesics; Pregnancy category B CATEGORY CLASS ______________________________________________________________________ PURPOSE OF MEDICATION Expected Pharmacological Action Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in CNS. Has no significant anti-inflammatory properties or GI toxicity. Therapeutic Use 1. Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat. 2. Analgesic: Site and mechanism of action unclear. Complications 1. CNS: Headache 2. CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr 3. GI: Hepatic toxicity and failure, jaundice 4. GU: Acute kidney failure, renal tubular necrosis 5. Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia 6. Hypersensitivity: Rash, fever Contraindications/Precautions 1. Hepatic disease/renal disease (lower chronic dosage recommanded) 2. Chronic alcohol use/abuse 3. Malnutrition. 4. Previous hypersensitivity; Products containing alcohol, aspartame, saccharin, sugar, or tartrazine (FDC yellow dye #5) should be avoided in patients who have hypersensitivity or intolerance these compounds. 5. Use cautiously with pregnancy, lactation. Interactions DRUG-DRUG: 1. Chronic high dose acetaminophen(more than 2g/day) may increase risk of bleeding with Wafarin. Hepatotoxicity is additive with other hepatotoxic substances, including alcohol. 2. Concurrent use of sulfinpyrazone, isoniazid, rifampin, rifabutin, phenytoin, barbiturates, and carbamazepine may increase the risk of acetaminophen-induced liver damage; and these agents will also decrease therapeutic effects of acetaminophen. 3. Concurrent use of NSAIDs increase the risk of adverse renal effects. eg) Propranolol decreases metabolism and may increase effects. May decrease effects of lamotrigine and zidovudine. Evaluation of Medication Effectiveness 1. Relief of mild pain. 2. Reduction of fever. ACTIVE LEARNING TEMPLATES Medication Administration A. Over 12 yrs: 1.PO: 325-650mg q 4-6 hr or 1g 3-4 times daily or 1300mg q 8 hr (not to exceed 4g or 2.5g/24hr) 2. Suppository: 325-650mg 4-6 hr prn or 1g 3-4 times/day(not exceed 4g/24hr) B. 1-12 yrs: 1. PO: 10-15mg q 4-6 hr prn (not to exceed 5 doses/24hrs) 2. Suppository: 10-20mg q 4-6 hr prn C. Infant: 1. PO: 10-15mg q 4-6 hr prn (not to exceed 5 doses/24hrs) 2. Suppository: 10-20mg q 4-6 hr prn D. Neonate : 1. PO: 10-15mg q 6-8 hr prn (not to exceed 5 doses/24hrs) 2. Suppository: 10-15mg q 6-8 hr prn Nursing Interventions 1. Do not exceed the recommended dosage. 2. Consult physician if needed for children < 3 yr; if needed for longer than 10 days; if continued fever, severe or recurrent pain occurs (possible serious illness). 3. Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products. 4. Give drug with food if GI upset occurs. 5. Discontinue drug if hypersensitivity reactions occur. 6. Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a specific antidote; basic life support measures may be necessary. Client Education 1. Advise pt not to exceed recommended dose; not to take for longer than 10 days(for adult) or 5 days (for child). 2. Advise to take the drug only for complaints indicated; it is not an anti-inflammatory agent. 3. Advise to avoid the use of other NSAIDs concurrently for more than a few days. 4. Inform pats with diabetes that acetaminophen may alter results of blood glucose monitoring. 5. Advise patients to consult Dr. if discomfort of fever is not relieved by routine doses of this drug or if fever is greater than 39.5 C (103 F) or less longer than 3 days. THERAPEUTIC PROCEDURE A7