DRUG STUDY

GENERIC NAME: acetaminophen TRADE NAME: Tylenol
CLASSIFICATION: antipyretics, nonopioid analgesics ACTION: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS. Has no anti-inflammatory properties or GI toxicity. Therapeutic Effects: analgesia and antipresis. PHARMACOKENETICS Absorption:Well absorbed. Distribution Widely distrbuted. Enters breast milk. Metabolis and Excretion: 85-95% metabolized by the liver. Metabolites may be toxic in overdose situations. Excreted by the kidneys. Contraindications/Precautions Contrindicated in: Hypersenistivity. Products containing alcohol, aspartame, sacharin, sugar or tartarzine shoud be avoided in patients who have a intolerance to these compounds. Use Cautiously in: Hepatic disease/renal disease. Chronic alcohol abuse. Malnutrition. ADVERSE REATIONS/SIDE EFFECTS GI:Hepatic Failure, hepatotoxicity (overdose) GU:renal failure (high doses) HEMAT: neutropenia, pancytopenis, leukopenia. DERM: rash, urticaria. INTERACTIONS Drug to drug: Chronic high-dose acetaminopehen ( 2g/day) may increase the risk of bleeding with warfarin. Heptotoxicity is additive with other hepatotoxic substances, including alcohol. Concurrent use of sulfinpyrazone, isoniazid ,rifampin, phenytoin, barbiturates and carbamazepine may increase the risk of acetaminophen-induced liver damage. Concurrent NSAIDs increase the risk of adverse renal effects. Proprnolol decrease metabolism and may increase effects. NURSING IMPLICATIONS OF DRUG ADMINISTRATION Assessment

•Obtain complete health history, incuding allergies, alcohol use and drug history for possible drug interactions. Patients who are malnourished or chronically abuse alcohol are at higher rish of developing hepatotoxicity. •assess prolonged use of acetaminophen increases the risk of adverse renal effects. Combined doses of acetaminophen and salicylates should not exceed the recommended dose of eithe drug given alone.

•Pain: assess type, location and intensity prior to and 30-60 min following
administration.

•Fever: assess fever, note presence of associated signs (diaphoresis,
tachucardia and malaise).

•Lab Test Considerations: Evaluate hepatic,and renal function
periodically during prolonged theraphy. •May alter results of blood glucose monitoring. May cause decreased values.

•Toxicity and Overdose: If overdose occurs, acetylcysteine (Acetadote)
is the antidote. Potential Nursing Diagnoses •Acute pain •Risk for imbalanced bodly temperatures Implementation •When combinedk with opiods do not exceed the maximum recommended daily dose of acetaminophen. •PO: administer with a full glass of water. •May be taken with food or on an empty stomach. Patient Teaching •Advise patient to take exactlly as directed. Chronic use of 4g/day (2g in alcoholics) may lead to hepatotoxcity, renal or cardias camage. Adults should not take longer then 10 days and children no longer than 5 days. Short -term doses with sallicylates or NSAIDs should not exceed recommended daily dose of either drug alone. •Advise patient to avoid alcohol. •Caution patients to check lablels on all OTC products. Advise patients to avoid taking more than one product containing acetaminophen to avoid toxicity.

•Advise patient to report if discomfort or fever is not relieved by routine doses or if fever is greater than 39.5 or last longer than 3 days. •Inform patients with diabetes that acetaminophen may alter blood sugar results. Evaluation •Relief of mild pain •Reduction in fever