Acetaminophen: Why?

[seks]

It seems like 90% of the patients in my internal/acute med unit gets acetaminophen (325, 500, 650, 1000) that is scheduled tid or qid.

I never found out what the rationale behind it is? Is it just a proactive way to manage pain? The ones that usually don't get them are the ones with liver failure

[loriangel14, RN]

Yes, Tylenol is given for pain control.

[SwansonRN]

Mild to moderate pain, maybe fever control. If you don't know why it's ordered ask the provider.

[Emergent, RN]

The rationale is that it doesn't slow clotting.

[blondy2061h, MSN, RN]

Acetaminophen ATC is odd. I can see most patients having it PRN for pain, but I'd be questioning ATC orders for patients without pain, especially with the FDA recommending less acetaminophen.

[CheesePotato, BSN, RN]

Good question.

First, a pre-answer disclosure statement:

~~ Please keep in mind that the answer I am giving only speaks to pain management.

~~ Without knowing your individual patients and their circumstances, it is impossible to give a specific answer.

~~ Also, bear in mind that you, as a nurse, are well within your practice/rights to call into question any order which concerns you in the matters of safety/lack of necessity.

~~ Always keep in mind that some doctors do not appreciate a thinking nurse. What I can say? Ya' win some, ya' lose some.

~~ Answers non-refundable. Not responsible for any cake/pastry left out in the rain. Void where prohibited.

Now I'm not saying that my answer is perfect, but after years of navigating the wonderful world of Ouch, here is what I can tell you:

Acetaminophen in high doses can be toxic.

Acetaminophen crosses the blood brain barrier.

Acetaminophen has been shown to have very little, if any, effect on inflammation.

Does acetaminophen have an antipyretic effect? Yes, of course it does.

Is that why you are giving it? Unless your patient has a fever/known infection, 97.31% of the time the answer is very much no.

The long and short of it: the actual way in which acetaminophen reduces pain is yet to be fully understood (although recent studies involving mice and hotplates within the last decade have shed some light on the topic). The down and dirty quick answer: acetaminophen reduces neuron excitability in the Central Nervous System and Peripheral Nervous System by influencing the binding of other system made chemicals.

Decreased excitability/binding = increased pain threshold = decreased or no opioid use.

This effect has lead to breakthroughs in pre-operative administration of IV acetaminophen to control/manage post-operative pain.

As a side note, whenever a patient is being given an opioid medication and is continuing to complain of pain, scan the orders for our dear friend acetaminophen. The effects may surprise you.

Cheers!

~~CP~~

[Esme12, ASN, BSN, RN]

seks said:

It seems like 90% of the patients in my internal/acute med unit gets acetaminophen (325, 500, 650, 1000) that is scheduled tid or qid.

I never found out what the rationale behind it is???? Is it just a proactive way to manage pain? The ones that usually don't get them are the ones with liver failure

Google is your friend....

Sounds like your MD's have read the 2004 study.....

Quote

A clinical trial of the effectiveness of regularly scheduled versus as-needed administration of acetaminophen in the management of discomfort in older adults with dementia.

Author information

Abstract

OBJECTIVES:

To determine in a sample of nursing home patients with dementia and a painful condition whether the regularly scheduled administration of acetaminophen (650 mg four times a day (qid)) was more or less effective than as-needed (PRN) administration of acetaminophen in reducing discomfort.

DESIGN:

Double-blind, double-dummy, placebo-controlled, crossover study. One arm consisted of 650 mg of acetaminophen administered qid with placebo PRN; the other arm consisted of placebo administered qid with acetaminophen PRN.

SETTING:

Two community and one Veterans Affairs nursing homes in the San Francisco Bay area.

PARTICIPANTS:

Thirty-nine nursing home patients with a mean+/-standard deviation Mini-Mental State Examination score of 4.3+/-5, a mean Global Deterioration Scale score of 5.7+/-0.4, and a mean Discomfort Scale score of 10.7+/-6.8. Approximately 84% had degenerative joint disease.

RESULTS:

Mean Discomfort Scale scores of 7.4+/-3.7 during the PRN arm and 7.2+/-2.1 during the qid arm (t=0.249, nonsignificant) were within the range previously shown to indicate substantial discomfort. No significant differences in discomfort scores were found between the trial arms after controlling for baseline discomfort and PRN use of acetaminophen.

CONCLUSION:

Although this trial was negative in terms of the analgesic effects of acetaminophen, the findings have important implications for clinical practice. PRN administration of acetaminophen is sometimes the standard of care for pain management in nursing homes or is offered as an intervention to assess effectiveness. Findings from this study suggest that a 2,600-mg/d dose of acetaminophen is inadequate for elderly nursing home patients with degenerative joint disease, fractures, or back pain who have significant discomfort.

[MunoRN, RN]

Google is your friend....

Sounds like your MD's have read the 2004 study.....

My impression is that the study showed no significant difference between scheduled and prn acetaminophen administration, and that neither was all that effective in treating discomfort in the dementia population.

[Whispera, MSN, RN]

I remember reading, awhile back, that there's some research that tylenol (acetaminophen) has a cumulative negative effect on the liver. Even if one isn't taking the max or greater dose per day, the drug still causes some damage. I don't know if more has been done to verify that side effect.

Tylenol can easily be toxic to the liver. Be careful that you aren't giving tylenol in amounts greater than 4 g. per day. It's pretty easy to give more if you're giving it around the clock, in the bigger doses. Also, be careful that you aren't also giving medications that have acetaminophen in them (like Vicodin) as well as acetaminophen by itself.

[Esme12, ASN, BSN, RN]

My impression is that the study showed no significant difference between scheduled and prn acetaminophen administration, and that neither was all that effective in treating discomfort in the dementia population.

right...... but maybe they believe differently and have concluded to try this for themselves.

[CrazierThanYou]

I've always said my hospital must be the biggest consumer of Tylenol on the planet. Almost every patient has it scheduled every 4-6 hours. Then, there is the dreaded Ofirmev...

[Aurora77]

I've always said my hospital must be the biggest consumer of Tylenol on the planet. Almost every patient has it scheduled every 4-6 hours. Then there is the dreaded Ofirmev...[/quote']Why dreaded? In my experience it is amazing in assisting with post op pain management.