acetaminophen (Tylenol)

Therapeutic Classification Pharmacologic Classification Antipyretic; analgesic. Centrally acting COX inhibitor Use: The primary therapeutic usefulness is to Tx of fever in kids & for relief of mild-mod pain when aspirin is contraindicated. In the Tx of severe pain, it may be combined w/ opioids allowing the dose of opioid to be reduced, thus the r/o dependence & serious opioid toxicity. Action: reduces fever by direct action @ the lvl of the hypothalamus & dilation of peripheral blood vessels, which enables sweating & dissipation of heat; has no anti-inflammatory properties; therefore, is not effective in Tx of arthritis or pain caused by tissue swelling following injury. *it has no effect on platelet aggregation and does not exhibit cardiotoxicity. Most importantly, it does not cause GI bleeding or ulcers, as do the NSAIDs. Admin Alerts: Use appropriate strength product in kids to avoid toxicity. Never admin to pts who consume alcohol regularly d/t potential for hepatotoxicity. Advise pts that it is found in many OTC products & that extreme care must be taken to not duplicate doses by taking several of these products concurrently. -B. AEs: generally safe & AEs are uncommon at therapeutic doses; it causes less gastric irritation than aspirin & does not affect blood coag; It is not recommended in pts who are malnourished d/t acute toxicity may result l/t renal failure=can be fatal; Other signs of acute toxicity (N/V, chills, abd discomfort, & fatal hepatic necrosis.); A major concern w/ use of high doses is r/f liver damage (important in pts using alcohol); Black Box Warning: has potential to cause severe & even fatal liver injury & may cause serious allergic reactions w/ symptoms of angioedema, dyspnea, itching, or rash. In 2011, the (FDA) asked drug manufacturers to limit the strength in prescription combos to 325mg/dosing unit to lower potential for acetaminophen-induced hepatotoxicity. Nursing Actions: Lab Tests: it may hepatic function test values s/a serum bilirubin, AST, & ALT; It may urinary 5-hydroxyindole acetic acid (5-HIAA) & serum uric acid. Interactions: it inhibits warfarin metabolism, causing the anticoag to accumulate to toxic levels. High-dose/L-T use of acetaminophen may r/i elevated warfarin lvls & bleeding; Ingestion of this drug w/ alcohol or other hepatotoxic drugs, s/a phenytoin or barbiturates, is not recommended d/t possibility of liver failure from hepatic necrosis; pt should avoid taking herbs having a potential for liver toxicity (comfrey, coltsfoot, & chaparral.)