acetaminophen (N-acetyl-p-aminophenol) Drug Study

Drug Name

Generic Name: acetaminophen (N-acetyl-p-aminophenol)


Brand Name:

  • Suppositories: Abenol (CAN), Acephen
  • Oral: Aceta, Apacet, Atasol (CAN), Genapap, Genebs, Liquiprin, Mapap, Panadol, Tapanol, Tempra,Tylenol
Classification: Antipyretic, Analgesic (nonopioid)

Pregnancy Category B



Dosages
ADULTS
  • PO or PR
  • By suppository, 325–650 mg q 4–6 hr or PO, 1,000 mg tid to qid. Do not exceed 4 g/day.
PEDIATRIC PATIENTS
  • PO or PR
  • Doses may be repeated 4–5 times/day; do not exceed five doses in 24 hr; give PO or by suppository.
 Age  Dosage (mg)
 0–3 mo  40
 4–11 mo  80
 12–23 mo  120
 2–3 yr  160
 4–5 yr  240
 6–8 yr  320
 9–10 yr  400
 11 yr  480

Therapeutic actions
  • Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat.
  • Analgesic: Site and mechanism of action unclear.

Indications
  • Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses, upper GI disease, gouty arthritis
  • Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically significant antirheumatic and anti-inflammatory effects)
  • Common cold, flu, other viral and bacterial infections with pain and fever
  • Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain

Adverse effects
  • CNS: Headache
  • 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
  • GI: Hepatic toxicity and failure, jaundice
  • GU: Acute kidney failure, renal tubular necrosis
  • Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia
  • Hypersensitivity: Rash, fever

Contraindications
  • Contraindicated with allergy to acetaminophen.
  • Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation.

Nursing considerations
Assessment
  • History: Allergy to acetaminophen, impaired hepatic function, chronic alcoholism, pregnancy, lactation
  • Physical: Skin color, lesions; T; liver evaluation; CBC, LFTs, renal function tests
Interventions
  • Do not exceed the recommended dosage.
  • 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).
  • Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products.
  • Give drug with food if GI upset occurs.
  • Discontinue drug if hypersensitivity reactions occur.
  • Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a specific antidote; basic life support measures may be necessary.
Teaching points
  • Do not exceed recommended dose; do not take for longer than 10 days.
  • Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
  • Avoid the use of other over-the-counter preparations. They may contain acetaminophen, and serious overdosage can occur. If you need an over-the-counter preparation, consult your health care provider.
  • Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in voiding patterns.

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