Acetaminophen

INTRODUCTION

Indications

Mild pain. 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.

Adverse Reactions/Side Effects

GI: HEPATIC FAILURE, HEPATOTOXICITY(OVERDOSE). GU: renal failure (high doses/chronic use). Hemat: neutropenia, pancytopenia, leukopenia. Derm: rash, urticaria.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hepatotoxicity and liver failure, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician immediately of these signs.

• Assess pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage the patient's pain and decreasing impairments.

• Monitor signs of leukopenia and neutropenia (fever, sore throat, signs of infection) or unusual weakness, fatigue, and excessive bleeding that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

• Monitor signs of renal failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for acetaminophen and other analgesics.

• Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

Patient/Client-Related Instruction

• Advise patient that analgesics are usually more effective if given before pain becomes severe; emphasize that adequate pain control will allow better participation in physical therapy.

• Instruct patient and family/caregivers about the signs of liver toxicity and renal failure (see above in Examination and Evaluation). Encourage early recognition and notification of the physician about these signs.

• Advise patient to reduce alcohol intake because alcohol increases the risk of liver toxicity.

• Caution patient about the use of over-the-counter products that contain aspirin, other NSAIDs, or acetaminophen while taking high doses of acetaminophen. Use of multiple analgesics increases the risk of toxicity and overdose.

• Instruct patient and family/caregivers to report severe or prolonged skin reactions such as rash, itching, and hives.

Pharmacokinetics

Absorption: Well absorbed following oral administration. Rectal ...