Paracetaminophen-panadol

 Paracetaminophen (oral, rectal) 

(a-seet-a-min-oh-fen) Abenol,Acephen,Acet,APAP, Artritol, Aspirin Free Anacin, Atasol,Cetafen, Feverall,Fortolin, Infantaire, Little Fevers, Mapap, NortempChildren’s, Ofirmev, Pain-Eze, Pediaphen,Pediatrix, Silapap , Silapap Infant’s,Taminol, Tylenol, Valorin Tempra, Canadian drug name.

 acetaminophen (intravenous) Ofirmev 

Classification Therapeutic: antipyretics, nonopioid analgesics 

Pregnancy Category B (oral, rectal), C (intravenous) 

Indications

 PO, Rect: Treatment of: Mild pain, Fever. 

IV: 

Treatment of: Mild to moderate pain, Moderate to severe pain with opioid analgesics, Fever. 

Action

 Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS. Has no significant anti-inflammatory properties or GI toxicity.

 Therapeutic Effects:

 Analgesia. Antipyresis.

 Pharmacokinetics

 Absorption: Well absorbed following oral administration. Rectal absorption is variable. Intravenous administration results in complete bioavailability.

 Distribution: Widely distributed. Crosses the placenta; enters breast milk in low concentrations.

 Metabolism and Excretion: 85–95%metabolized by the liver (CYP2E1 enzyme system). 

Metabolites may be toxic in overdose situation. Metabolites excreted by the kidneys. 

Half-life: Neonates: 7 hr; Infants and Children: 3–4 hr; Adults: 1–3 hr. 

Contraindications/Precautions 

Contraindicated in: Previous hypersensitivity; Products containing alcohol, aspartame, saccharin, sugar, or tartrazine (FDC yellow dye #5) should be avoided in patients who have hypersensitivity or intolerance to these compounds; Severe hepatic impairment/active liver disease. 

Use Cautiously in: 

Hepatic disease/renal disease (lower chronic doses recommended); Alcoholism, chronic malnutrition, severe hypovolemia or severe renal impairment (CCr 30 mL/min,qdosing interval andpdaily dose may be necessary); Chronic alcohol use/abuse; Malnutrition; OB: Use in pregnancy only.

Adverse Reactions/Side Effects 

CNS: agitation (qin children) (IV), anxiety (IV), headache (IV), fatigue (IV), insomnia (IV).

 Resp: atelectasis (qin children) (IV), dyspnea (IV). CV: hypertension (IV), hypotension (IV).

 GI: HEPATOTOXICITY (DOSES), constipation (qin children) (IV),q liver enzymes, nausea (IV), vomiting (IV). FandE: hypokalemia (IV). 

GU: renal failure (high doses/ chronic use). 

Hemat: neutropenia, pancytopenia. 

MS: muscle spasms (IV), trismus (IV). 

Derm: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, STEVENSJOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash, urticaria. 

Interactions Drug-Drug: 

Chronic high-dose acetaminophen (2 g/day) mayqrisk of bleeding with warfarin (INR should not exceed 4). Hepatotoxicity is additive with other hepatotoxic substances, including alcohol. Concurrent use of isoniazid, rifampin, rifabutin, phenytoin, barbiturates,andcarbamazepine may qtherisk of acetaminophen-induced liver damage (limit self-medication); these agents will alsoptherapeutic effects of acetaminophen. Concurrent use of NSAIDsmayqtherisk of adverse renal effects (avoid chronic concurrent use). Propranololpmetabolism and mayqeffects. Maypeffects of lamotrigine and zidovudine. .

Route/Dosage 

Children 12 yr should not receive 5POorrectal doses/24 hr without notifying physician or other health care professional. No dosage adjustment needed when converting between IV and PO acetaminophen in adults and children 50 kg. 

PO(Adults and Children12yr):325–650mgq 6hror1g3–4timesdailyor1300mgq8hr(notto exceed3gor2g/24hr in patients with hepatic/renal impairment). 

PO(Children 1–12yr):10–15mg/kg/doseq6hr as needed (not to exceed 5 doses/24 hr).

 PO(Infants): 10–15 mg/kg/doseq6hrasneeded (not to exceed 5 doses/24 hr). 

PO(Neonates): 10–15 mg/kg/dose q 6–8 hr as needed.

NURSING IMPLICATIONS 

Assessment ● Assess overall health status and alcohol usage before administering acetaminophen. Patients who are malnourished or chronically abuse alcohol are at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug. ● Assess amount, frequency, and type of drugs taken in patients self-medicating, especially with OTC drugs. Prolonged use of acetaminophen increases the risk of adverse renal effects. For short-term use, combined doses of acetaminophen and salicylates should not exceed the recommended dose of either drug given alone. Do not exceed maximum daily dose of acetaminophen when considering all routes of administration and all combination products containing acetaminophen. ● Pain:Assess type, location, and intensity prior to and 30–60minfollowing administration. ● Fever: Assess fever; note presence of associated signs (diaphoresis, tachycardia, and malaise).

 ● LabTestConsiderations: 

Evaluate hepatic, hematologic, and renal function periodically during prolonged, high-dose therapy. ● Mayalter results of blood glucose monitoring. May cause falselypvalues when measured with glucose oxidase/peroxidase method, but probably not with hexokinase/G6PD method. May also cause falselyq values with certain instruments; see manufacturer’s instruction manual.

Increased serum bilirubin, LDH, AST, ALT, and prothrombin time may indicate hepatotoxicity. 

● ToxicityandOverdose:

If overdose occurs, acetylcysteine (Acetadote) is the antidote. Potential Nursing Diagnoses Acute pain (Indications) Risk for imbalanced body temperature (Indications) 

Implementation

 ● Donot confuse Tylenol with Tylenol PM. ● Toprevent fatal medication errors ensure dose in milligrams (mg) and milliliters (mL) is not confused; dosing is based on weight for patients under 50 kg; programming of infusion pump accurate; and total daily dose of acetaminophen from all sources does not exceed maximum daily limits. ● When combined with opioids do not exceed the maximumrecommended daily dose of acetaminophen. 

● PO:Administer with a full glass of water. ● May be takenwith foodor onanempty stomach.

 IV Administration 

● Intermittent Infusion: For 1000 mg dose, insert vented IV set through septum of 100 mL vial; may be administered without further dilution. For doses 1000 mg, withdraw appropriate dose from vial place in a separate empty, sterile container for IV infusion. Place small volume pediatric doses up to 60 mLin a syringe and administer via syringe pump. Solution is clear and colorless; do not administer solutions that are discolored of contain particulate matter. Administer within 6 hrs of breaking vial seal. Rate: Infuse over 15 min. Monitor end of infusion in order to prevent air embolism, especially if acetaminophen is primary infusion. 

● Y-Site Compatibility: buprenorphine, butorphanol, D5W, dexamethasone, D10W, D5/LR, D5/ 0.9% NaCl, diphenhydramine, dolasetron, droperidol, fentanyl, granisetron, heparin, hydrocortisone, hydromorphone, ketorolac, LR, lidocaine, lorazepam, mannitol, meperidine, methylprednisolone, metoclopraminde, midazolam, morphine, nalbuphine, 0.9% NaCl, ondansetron, potassium chloride, prochlorperazine, sufentanil. 

● Y-Site Incompatibility: 

chlorpromazine, diazepam. 

● Additive Incompatibility: Do not mix with other medications.

 Patient/Family Teaching .

● Advise patient to take medication exactly as directed and not to take more than the recommended amount. Chronic excessive use of 4 g/day (2 g in chronic alcoholics) may lead to hepatotoxicity, renal or cardiac damage. Adults should not take acetCanadian drug name. aminophen longer than 10 days and children not longer than 5 days unless directed by health care professional. Short-term doses of acetaminophen with salicylates or NSAIDs should not exceed the recommended daily dose of either drug alone.

 ● Advise patient to avoid alcohol (3 or more glasses per day increase the risk of liver damage) if taking more than an occasional 1–2 doses and to avoid taking concurrently with salicylates or NSAIDs for more than a few days, unless directed by health care professional. 

● Advise patient to discontinue acetaminophen and notify health care professional if rash occurs.

 ● Inform patients with diabetes that acetaminophen may alter results of blood glucose monitoring. Advise patient to notify health care professional if changes are noted. ● Caution patient to check labels on all OTC products. Advise patients to avoid taking more than one product containing acetaminophen at a time to prevent toxicity. ● Advise patient to consult health care professional if discomfort or fever is not relieved by routine doses of this drug or if fever is greater than 39.5C (103F)or lasts longer than 3 days. ● Pedi: Advise parents or caregivers to check concentrations of liquid preparations. All OTC single ingredient acetaminophen liquid products now come in a single concentration of 160 mg/5 mL. Errors have resulted in serious liver damage. Have parents or caregivers determine the correct formulation and dose for their child (based on the child’s age/ weight), and demonstrate how to measure it using an appropriate measuring device. 

Evaluation/Desired Outcomes

 ● Relief of mild to moderate pain. ● Reduction of fever.