Acetaminophen (Tylenol) Nursing Considerations

Hey guys, let’s talk about acetaminophen, better known as Tylenol, also called paracetamol in Europe. This is an oral medication, as you can see here in the picture, but it actually can also be given in the IV form. So, remember that the therapeutic class is what the drug does in the body. And the pharmacologic class is the actual chemical effect. So, acetaminophen is a non-opioid analgesic or pain reliever, and an antipyretic is a fever reducer. It’s pharmacologic class; it’s technically a prostaglandin inhibitor, although we don’t usually refer to it this way. A big thing to note here is that it is not an anti-inflammatory, which is a very common misconception.

So, the exact mechanism of acetaminophen isn’t fully understood, but it is thought to be involved in inhibiting the prostaglandin synthesis in the brain. Prostaglandins actually play a role, not only in the transmission of pain signals in the brain, but also in the fever response. So, what do we give it for? Well, pain and fever.

So typically, acetaminophen doesn’t cause any side effects, but if someone has a bad reaction, they could be really, really itchy or have a rash. Just like any oral medication, it can cause nausea. And the big thing to note is that acetaminophen has a significant impact on the liver. So, we always want to be on the lookout for any signs of liver toxicity like jaundice or yellowing of the skin.

Here are some major nursing considerations for acetaminophen. Because of the risk of the liver, we will set a 24- hour max dose of four grams for anyone taking acetaminophen. A big thing to remember here, both in the hospital and for educating your patients, is that you may also give some combination drugs that have acetaminophen in them like cold medications or things like Percocet or Lortab. So always make sure you’re looking at those drugs too when you’re calculating that max dose.

We know that overdose causes hepatotoxicity or significant damage to the liver. So, make sure you look out for that and know that the antidote is a drug called N-acetyl cysteine or NAC. So, I know of a patient who took a whole bottle of Tylenol PM once. She came into the ER, bright yellow with severe nausea and vomiting. She ended up on a NAC drip for three days before she even really started to recover. So, guys, it is a big, big deal.

As far as interactions, be aware that acetaminophen can cause increased bleeding risk especially if a patient is also taking warfarin and be aware that it can possibly alter blood glucose measurements.