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Discussion

Tylenol an NSAID?

I had a patient today who was a postop and his temp kept rising. His O2 sat was 89-90% on 3L of O2. This was his second surgery, first was an lap-open appy which resulted in pneumonia, this one was a small bowel resection and lysis of adhesions r/t complications from first surgery. Anyway, his temp reached 104.1 within 2 hours despite all efforts with triflow. His BP was 150/100. I paged the doc twice regarding this, he said "Well Tylenol is an NSAID and I dont want to admin that due to risk for bleeding." I asked the nightshift charge nurse if Tylenol is an NSAID and her response was "yes it is, thats why liver patients cant take it." Now, that just doesnt make any sense to me and I found that comment obsurd. What am I missing here?

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  • Experts

I learned that Tylenol is an antipyretic and a non-opioid analgesic with no significant anti-inflammatory properties. Just to be sure, I looked it up in my Davis's Drug Guide, where that information was confirmed.

Not an NSAID.

true, not an nsaid, but night charge was correct in as much liver patients shouldnt take

  • Author

Thats what I thought. Thanks for your confirmation. :) I am still worrying about my pt with that temp.

Well, it depends on how much you feel like arguing...err...discussing the physiology of Tylenol tm. The exact mechanisms of action are not fully understood and are the subjects of debate in some cases.

Tylenol tm does reduce the production of prostaglandins like all of the other NSAIDS. However, only very limited anti inflammatory activity is noted. Most people suspect it works via multiple pathways and debate theories to explain how exactly it works.

My understanding is that Tylenol is more centrally acting (hence the antipyretic properties) vs an NSAID which works in the peripheral "chemical soup" responsible for pain sensation.

This pt needs aggressive incentive spirometer use. This will increase his o2 levels, decrease the atalectasis, and decrease the fever. Tylenol in the case would simply have been a comfort measure.

  • Guides
This pt needs aggressive incentive spirometer use. This will increase his o2 levels, decrease the atalectasis, and decrease the fever. Tylenol in the case would simply have been a comfort measure.

That was my first thought too . . .. the op may have done it as it is normal post-op procedure but just didn't mention it.

steph

  • Author

I did mention Incentive Spirometer, we just call it triflow. I was agressive with it, VERY aggressive, but it was doing nothing. He was miserable.

  • Author

oh, they also call it "pulmonary toilet".

  • Guides

Oh, I see it now . . . funny how we have different names for things.

steph

If his temp was 104.1, wouldn't blood cultures and a broad spectrum antibiotic be indicated in addition to tylenol (which has no known anticoagulatory properties, despite sharing some similar properties with aspirin) and other potential measures such as icepaks?

Oh, and whether or not it's an NSAID has nothing to do with its potential for hepatotoxicity. That has to do with its metabolism taking place there and potential toxic metabolites produced.

You are correct and the doc is wrong--Tylenol is NOT an NSAID. I just finished my pharmacology class. Happy to know that I learned something.

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