Acetaminophen

TopazLover, BSN, RN · Sep 2, 2008

Every doc I work with maxes the Tylenol @ 4 Gm/24 hr. If Tylenol is indicated for temp they usually would change pain med to either Percodan (obviously not Percocet), or Ultram. In cases where there is some indication of liver problems they usually max @ 2 Gm.

Tylenol is well known to be toxic to liver so it is good to remind all of us to recalculate all the "hidden" Tylenol. :up:

rjflyn, ASN, RN · Sep 2, 2008

Depends. Some facilities limit tylenol aka acetaminophen to 3GM/d others to 4GM/d. SInce this pt is having such a problem with fever 1) I would see if there is an order for Motrin/ibuprofen or get one. And 2) possibly change the pain med to something i.e. plain oxycodone avoiding the none narcotic component.

curious4life · Sep 2, 2008

I am a nursing student. Thank you for the rationale! I am interested in a formula for the equation :p

I have figured out that the times are a factor in figuring out this problem. I believe i will start the day at 6am and leave out the 2am?? any clues you can give would be awesome:redbeathe

wooh, BSN, RN · Sep 2, 2008

I am a nursing student. Thank you for the rationale! I am interested in a formula for the equation :p
I have figured out that the times are a factor in figuring out this problem. I believe i will start the day at 6am and leave out the 2am?? any clues you can give would be awesome:redbeathe

You need to factor in for the 2am if it's before 2am the next day. It's for the previous 24 hours. So everything between 2am and 2am or between 6am and 6am or between 4pm and 4pm.

curious4life · Sep 2, 2008

ok great use the starting time 0200 until the 1400 and leave off the rest which would be the 1900.. I think I got it. XO

kmoonshine, RN · Sep 2, 2008

The clients order is for Vicodin (hydrocodone 5 mg/acetaminophen 500mg) every 4 hours prn. The client has already received two doses of Tylenol 650 mg po for an elevated temperature on the midnight shift (at 0200 hours and 0600 hours) and has had 3 doses of Vicodin (at 0800, 1300, and 1900 hours). How many Vicodin tablets can the client safely recieve today?
Please give me an example of how to work this out. Thank you soooo much in advance:redbeathe

2 doses of Tylenol @ 650mg ==> 650mg x 2 = 1300 mg.

3 doses of vicodin @ 500mg/pill ---> 500mg x 3 = 1500 mg.

Total tylenol consumed between 0200 and 1900:

1300mg + 1500mg = 2800mg

Max dose of tylenol is 4000mg/day.

4000mg - 2800mg = 1200mg (available to consume before maxing out tylenol in 24 hrs).

Last vicodin dose was at 1900; next dose (every 4 hrs) would be 2300.

The patient can receive no more than 1200 mg of tylenol from the hours of 2300 and 0200. Since vicodin is every 4 hrs, one dose of vicodin at 2300---> 500mg. Next dose of vicodin would be 0300, but the day starts over at 0200 (when the first dose was initially administered) and you go back to 4,000mg/24 hrs (first dose taken was at 0200 the day before).

Answer: the patient can receive a tylenol total of 1200mg until 0200; according to the doctor's orders, one dose of vicodin can be administered every 4 hrs. The patient received a dose of vicodin at 1900, so the next dose would be at 2300 (4 hrs later). One dose of vicodin can be safely administered before 0200 according to dr's orders, but the patient can consume a total of 1200mg of tylenol between the hours of 1900 and 0200.

Is this what you were looking for?

TheCommuter, BSN, RN · Sep 2, 2008

More and more providers are prescribing Norco (hydrocodone 5mg with acetaminophen 325mg) instead of the Vicodin (5/500mg) to avoid issues that might arise from receiving too much acetaminophen in a 24 hour period.

curious4life · Sep 2, 2008

2 doses of Tylenol @ 650mg ==> 650mg x 2 = 1300 mg.
3 doses of vicodin @ 500mg/pill ---> 500mg x 3 = 1500 mg.
Total tylenol consumed between 0200 and 1900:
1300mg + 1500mg = 2800mg
Max dose of tylenol is 4000mg/day.
4000mg - 2800mg = 1200mg (available to consume before maxing out tylenol in 24 hrs).
Last vicodin dose was at 1900; next dose (every 4 hrs) would be 2300.
The patient can receive no more than 1200 mg of tylenol from the hours of 2300 and 0200. Since vicodin is every 4 hrs, one dose of vicodin at 2300---> 500mg. Next dose of vicodin would be 0300, but the day starts over at 0200 (when the first dose was initially administered) and you go back to 4,000mg/24 hrs (first dose taken was at 0200 the day before).
Answer: the patient can receive a tylenol total of 1200mg until 0200; according to the doctor's orders, one dose of vicodin can be administered every 4 hrs. The patient received a dose of vicodin at 1900, so the next dose would be at 2300 (4 hrs later). One dose of vicodin can be safely administered before 0200 according to dr's orders, but the patient can consume a total of 1200mg of tylenol between the hours of 1900 and 0200.
Is this what you were looking for?

That was a lot of work and I appreciate it! :bow:

Xbox Live Addict · Sep 2, 2008

I had a physician one time that had Vicodin 5/750 ordered 2 tabs Q6H PRN - that's a total of 6000mg APAP if the patient took it as often as allowed. Which she did.

It took several days of wrangling, including one fax where the physician actually said "I don't understand" before that got straightened out. He eventually changed her to Norco 5/325 mg 2 tab Q4H, which kept her just under the 4000mg considered the maximum safe daily dose of APAP, and that worked out fairly well.

For a drug so easily available OTC and mixed with so many other medications, it took me far longer in second semester nursing to write up all of the contraindications, adverse effects, and nursing implications for acetaminophen than for any other drug I dealt with.

Xbox Live Addict · Sep 2, 2008

I've also noticed that physicians anymore always order acetaminophen mixes like Percocet or Darvocet rather than aspirin-mixed drugs like Percodan. I guess this is because they are afraid of GI bleeds from aspirin?

rjflyn, ASN, RN · Sep 2, 2008

I've also noticed that physicians anymore always order acetaminophen mixes like Percocet or Darvocet rather than aspirin-mixed drugs like Percodan. I guess this is because they are afraid of GI bleeds from aspirin?

That and because of Aspirin allergies. My facility has pushed for plain narcotic prescribing. In fact Darvon is auto substituted for Darvocet, they ask that oxycodone be ordered over combos such as Percocet to cut down on the amount of ingested acetaminophen. They also define fever as temps >101.5 and not to treat it unless it exceeds or the pt complains of discomfort. The RX committee is also looking at cutting the limit to 3G/24hrs as well.

Rj