Tylenol/Tramadol Flashcards
(36 cards)
A patient has a fever of 102°F and muscle aches. The provider orders acetaminophen.
Why is acetaminophen effective in lowering this patient’s fever and pain?
Hint: Describe MOA
- Tissue damage/illness occurs
- Body releases chemicals (cytokines) to signal fever/pain
- COX enzymes activated and make prostaglandings in CNS
- Prostaglandins act in CNS to raise body temperature and stimulate pain perceptions
- ACETAMINOPHEN TAKEN
- Inhibit COX enzymes in the CNS
- ↓ prostaglandins = ↓pain/fever
-> Pain signal reduced and hypothalamus resets body temp to normal - Hypothalamus signals peripheral blood vessel dilation = heat loss via sweat = decrease body temperature
What are the indications in which to take acetaminophen?
Relief of mild to moderate pain:
- Headache
- Toothache
- Muscle aches
- Back pain
- Menstrual cramps
- Minor arthritis pain
Reduction of fever at level of hypothalamus (antipyretic use)
What is the therapeutic class (2) of acetaminophen?
What is the brand name of acetaminophen?
Therapuetic Class:
- Centrally Acting Non-opioid analgesic
- Antipyretic
Name
- Tylenol (acetaminophen)
A patient is confused about the difference between acetaminophen and ibuprofen.
What is the key difference in their mechanisms of action?
Acetaminophen works in the CNS only and does not reduce inflammation, while ibuprofen reduces inflammation and pain peripherally. Both inhibit COX enzymes, but acetaminophen is weaker
A patient taking acetaminophen is reading the drug label that describes the side effects and adverse effects of the drug.
What are the side effects and adverse effects that the patient may experience while taking acetaminophen?
Side Effects
- Nausea/Vomitting
- Abdominal pain
- Loss of appetite
- Fatigue/Headache
Adverse Effects
- Hepatotoxicity (esp w overdose or chronic high doses)
- Anaphylatic reaction
A nurse is monitoring a patient after 3 days of acetaminophen use for fever. The patient develops dark urine, fatigue, right upper quadrant pain, and appears confused
What does the nurse suspect?
Hepatotoxicity (serious adverse effect of acetaminophen)
The nurse is reviewing four patients’ charts to determine who can safely receive a scheduled dose of acetaminophen 650 mg PO for pain.
Which patient is the most appropriate candidate for this medication? Explain why
A. A 45-year-old with a known allergy to phenacetin, complaining of back pain.
B. 70-year-old with cirrhosis and a history of daily alcohol use complaining of back pain.
C. A 60-year-old with stage 4 chronic kidney disease, on dialysis.
D. A 30-year-old recovering from a dental procedure
D. There are no contraindications to give acetaminophen to this patient
Contraindications for acetaminophen
- Hypersensitivity to acetaminophen or phenacetin
-> may cause allergic reaction - Chronic alcochol consumption
-> ↑ risk liver damage - Liver disease
-> Cirrhosis/Hepatitis can increase risk of liver damange - Renal (kidney) impairement
-> drugs are excreted by kidney
What are the contraindication for acetaminophen (Tylenol) ?
-
Hypersensitivity to acetaminophen or phenacetin
-> may cause allergic reaction -
Chronic alcochol consumption
-> ↑ risk liver damage -
Liver disease
-> Cirrhosis/Hepatitis can increase risk of liver damange -
Renal (kidney) impairement
-> drugs are excreted by kidney
A patient with a headache asks whether they can take acetaminophen (Tylenol) with their cold and cough meds.
What should the nurse educate the patient about?
Warn them about duplicate dosing — many OTC meds contain acetaminophen and can lead to drug toxicity
A patient notifies their HCP that they have been taking acetaminophen (Tylenol) for approx 40 days.
What should the nurse be concerned about?
Prolonged or high dosing of acetaminophen can increase risk of hepatotoxicity
Prior to administration of acetaminophen (Tylenol), what should the nurse assess the patient for?
- Pain/Fever
- Assess vital signs (temp, BP, pulse)
- Assess liver function tests
A patient with hepatitis asks his nurse if he can take acetaminophen (Tylenol). The nurse responds with “no.”
What is the rationale for this?
Acetaminophen is metabolized in the liver
When the liver is already damaged, it can’t process the drug safely
This increases the risk of hepatotoxicity (liver injury)
A patient accidentally took 5,000 mg of acetaminophen (Tylenol) in 24 hours.
What would be the antidote for overdosing on acetaminophen?
Administer N-acetylcysteine (NAC) if there is an overdose of toxicity of acetaminophen
An adult patient was just prescribed acetaminophen (Tylenol) for pain. The patient asks, “What is the maximum daily dose of acetaminophen I can take?”
What should the nurses response be?
Be sure that your daily dose does not exceed 3g per day (in adults), or it may increase your chance of developing hepatotoxicity
T/F: aceminophen (Tylenol) cannot be combined with opiods to enhance pain relief
FALSE, tylenol can be combined with opioids to enhance pain relief (synergistic effect).
Just be sure to lower dose of opioid
Why is acetaminophen (Tylenol) the primary alternative to NSAIDs?
acetaminophen does NOT cause GI issues (bleeding or ulcers), unlike NSAIDs
What two drugs should be avoided when taking acetaminophen?
- Warfarin
- Other hepatotoxic drugs (phenytoin, barbiturates)
What is the pharmacologic and therapeutic class of tramadol (Ultram)?
Pharmacologic Class:
- WEAK Opioid agonist
Therapeutic Class:
- Opioid analgesic
A patient is on tramadol. The patient expressess concern about taking this medication because they state, “I might get highly addicted to this drug because it is a Schedule II drug.”
What part of his statement should be corrected?
Tramadol is a Schedule IV drug.
It can be addicitve, but there is a lower risk of abuse and dependence
A patient states they have abdominal pain and rate it as a 2/10. The patient asks for tramadol.
Should you give this patient tramadol? What or why not?
Hint: Pain scale
DO NOT give this patient tramadol. Tramadol should only be used as an alternate option for moderate - severe pain when a non-opiod analgesic is inadequate.
What is the brand name for tramadol?
Ultram
A patient is taking tramadol for moderate pain. A patient wants to understand how the drugs works on the body.
Describe the MOA for tramadol.
Weak opiod receptor agonist
- Tramadol binds to mu receptors in the CNS (brain and spinal cord)
- By doing this, it reduces perception of pain signals (pain relief)
It also
- Inhibites reputake of serotonin and NE
- increases levels of seratonin and NE in the CNS which can modulate pain perceptions
What are the indications (conditions) to give tramadol?
Moderate - Severe Pain
- Chronic pain
- Post op pain
Pain management (in certain conditions)
- neuropathic pain
Alternative for stronger opiods when non-opiod analgesics are insufficient
A patient is taking tramadol (Ultram) and asks about what side effects they can expect with this medication?
Side Effects
- Nausea
- Dizziness/drowsiness (sedation)
- Constipation
- Low blood sugar
