Acetaminophen

[curious4life]

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

[FroggyMama]

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.

Yeah, a lot of facilities are switching to this for this very reason. Pharmacy does an automatic substitution (previously accepted by the medical staff) for any 5/500 or 7.5/500 orders to be changed to 5/325 or 7.5/325.

[wooh, BSN, RN]

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

I can see lowering the acetaminophen use, but cutting it out entirely? It's been shown that when it comes to narcotic/tylenol combos, 1+1=3 of pain relief. Seems this would just up the amount of narcs we're giving.

[wooh, BSN, RN]

Yeah, a lot of facilities are switching to this for this very reason. Pharmacy does an automatic substitution (previously accepted by the medical staff) for any 5/500 or 7.5/500 orders to be changed to 5/325 or 7.5/325.

I think this is a great idea. The extra 175 per dose doesn't seem to make a great difference each time as far as pain relief when combined with the narcs, but over the course of the day, it adds up.

[classicdame, MSN, EdD]

the safe dose for Tylenol every 24 hours is 2 grams. So whatever adds up to 2 grams is tops. I would ask the MD to change the order for one or the other. If you have evey given charcoal to someone with a Tylenol overdose you will look out for this in the future. Don't ask me how I know. :)

[Xbox Live Addict]

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

I'm from a LTC background, and most physicians in LTC seem to prefer hydrocodone as the default pain management, in the form of Lortab, Vicodin, or Norco - which is always a combo with APAP. I've never seen hydrocodone-only medications, though they may exist somewhere. I only saw one resident on Darvon; usually, if propoxyphene was used it was as Darvocet. Codeine always came as Tylenol # 3, never as straight codeine.

Oxycodone, however, was more commonly ordered as Oxy IR, which is straight oxycodone with no APAP, Oxydose, which is liquid and also contains no APAP, or as OxyContin. I generally only saw Percocet when the resident was coming back from surgery or the dentist, and I never saw Percodan used.

Acetaminophen is a good adjunct to codeine-based narcotics, but the problem is that not only is it mixed with so many other medications, such as narcotics, cough syrups, or cold/flu medications, but it's also used very frequently by itself or in suppositories. You can go over the maximum accepted safe dose fairly quickly... and if your patients already have compromised hepatic function or are on a bunch of other medications, who knows how much stress we're really putting on their poor livers?

[PsychRNOhio]

Also be aware that Vicodin can come in 10/325.

Our facility uses the 4 gram protocol, also

[chaschata]

What the heck is Ultram? I was in the hospital for a week with a bad COPD thing going on and of course was on steroids, the steriods gave me a bad headache so I asked for a Moltrin because I prefer not to take Acetaminophen. I asked what it was and the doctor said it would be preferable to the Moltrin because I didn't want to take any acid reducing medication. I should have asked for further explanation I know, but didn't. Anyway, did not have any effect one way or the other, what is it or what is its equivelent to. Thank you

[rn/writer, RN]

the safe dose for Tylenol every 24 hours is 2 grams. So whatever adds up to 2 grams is tops. I would ask the MD to change the order for one or the other. If you have evey given charcoal to someone with a Tylenol overdose you will look out for this in the future. Don't ask me how I know. :)

The safe dose for Tylenol is 4 grams for most people. This is lowered to 3 grams (some say 2.5 g) for elderly patients and those who have chronic alcohol or other liver problems.