acetaminophen Abenol , Acephen, Anadin Paracetamol ,Apo-Acetaminophen, Aspirin Free Anacin,Atasol, Calpol , Cetaphen, Childrens Tylenol Soft Chews,

Disprol , Feverall, Galpamol , Genapap, Genebs, Little Fevers, Mandanol ,Mapap, Nortemp, Nortemp Children's, Novo-Gesic, Pain Eze, Panadol , Pediatrix, Silapap, Tempra, Tycolene, Tylenol 8 Hour, Tylenol, Tylenol Arthritis,Valorin Pharmacologic class: Synthetic nonopioid p-aminophenol derivative Therapeutic class: Analgesic, antipyretic Pregnancy risk category B 14 acetaminophen Canada UK Hazardous drug High alert drugAction Unclear. Pain relief may result from inhibition of prostaglandin synthesis in CNS, with subsequent blockage of pain impulses. Fever reduction may result from vasodilation and increased peripheral blood flow in hypothalamus, which dissipates heat and lowers body temperature. Availability Caplets, capsules: 160 mg, 500 mg, 650 mg (extended-release) Drops: 100 mg/ml Elixir: 80 mg/2.5 ml, 80 mg/5 ml, 120 mg/5 ml, 160 mg/5 ml Gelcaps: 500 mg Liquid: 160 mg/5 ml, 500 mg/15 ml Solution: 80 mg/1.66 ml, 100 mg/1 ml, 120 mg/2.5 ml, 160 mg/5 ml, 167 mg/5 ml Suppositories: 80 mg, 120 mg, 125 mg, 300 mg, 325 mg, 650 mg Suspension: 32 mg/ml, 160 mg/5 ml Syrup: 160 mg/5 ml Tablets (chewable): 80 mg, 160 mg Tablets (extended-release): 160 mg, 325 mg, 500 mg, 650 mg Tablets (film-coated): 160 mg, 325 mg, 500 mg 1Indications and dosages Mild to moderate pain caused by

headache,muscle ache, backache,minor arthritis, common cold, toothache, or menstrual cramps or fever Adults: 325 to 650 mg P.O. q 4 to 6 hours, or 1,000 mg three or four times daily. Or two extended-release caplets or tablets P.O. q 8 hours, to a maximum dosage of 4,000 mg/day. Or 650 mg P.R. q 4 to 6 hours, to a maximum dosage of 4,000 mg/day. Children: 10 to 15 mg/kg, or as indicated below: Oral use Age Usual Maximum dosage dosage 11-12 years 480 mg q 4 hr 5 doses in 24 hr 9-10 years 400 mg q 4 hr 5 doses in 24 hr Oral use (continued) Age Usual Maximum dosage dosage 6-8 years 320 mg q 4 hr 5 doses in 24 hr 4-5 years 240 mg q 4 hr 5 doses in 24 hr 2-3 years 160 mg q 4 hr 5 doses in 24 hr 1 year 120 mg q 4 hr 5 doses in 24 hr 4-11 months 80 mg q 4 hr 5 doses in 24 hr 0-3 months 40 mg q 4 hr 5 doses in 24 hr Rectal use Age Usual Maximum dosage dosage 12 years 325-650 mg 4,000 mg/day and older q 4 hr 11-12 years 320-480 mg 2,880 mg/day q 4 hr 6-11 years 325 mg q 4 hr 2,600 mg/day 3-6 years 120-125 mg 720 mg/day q 6 hr 1-3 years 80 mg q 4 hr 3-11 months 80 mg q 6 hr Dosage adjustment Renal or hepatic impairment Contraindications Hypersensitivity to drug Precautions Use cautiously in: anemia, hepatic or renal disease elderly patients pregnant or breastfeeding patients children younger than age 2.

Administration Be aware that although most patients tolerate drug well, toxicity can occur with a single dose. Know that acetylcysteine may be ordered to treat acetaminophen toxicity, depending on patients blood drug level. Activated charcoal is used to treat acute, recent acetaminophen overdose (within 1 hour of ingestion). acetaminophen 15 a Reactions in bold are life-threatening. 2Clinical alert (continued) Determine overdose severity by measuring acetaminophen blood level no sooner than 4 hours after overdose ingestion (to ensure that peak concentration has been reached). Route Onset Peak Duration P.O. 0.5-1 hr 10-60 min 3-8 hr (dose dependent) P.R. 0.5-1 hr 10-60 min 3-4 hr Adverse reactions Hematologic: thrombocytopenia, hemolytic anemia, neutropenia, leukopenia, pancytopenia Hepatic: jaundice, hepatotoxicity Metabolic: hypoglycemic coma Skin: rash, urticaria Other: hypersensitivity reactions (such as fever) Interactions Drug-drug. Activated charcoal, cholestyramine, colestipol: decreased acetaminophen absorption Barbiturates, carbamazepine, diflunisal, hydantoins, isoniazid, rifabutin, rifampin, sulfinpyrazone: increased risk of hepatotoxicity Hormonal contraceptives: decreased acetaminophen efficacy Oral anticoagulants: increased anticoagulant effect Phenothiazines (such as chlorpromazine, fluphenazine, thioridazine): severe hypothermia

Zidovudine: increased risk of granulocytopenia Drug-diagnostic tests.Home glucose measurement systems: altered results Urine 5-hydroxyindole acetic acid: falsepositive result Drug-behaviors. Alcohol use: increased risk of hepatotoxicity Patient monitoring 2Observe for acute toxicity and overdose. Signs and symptoms of acute toxicity are as followsPhase 1: Nausea, vomiting, anorexia,malaise, diaphoresis. Phase 2: Right upper quadrant pain or tenderness, liver enlargement, elevated bilirubin and hepatic enzyme levels, prolonged prothrombin time, oliguria (occasional). Phase 3: Recurrent anorexia, nausea, vomiting, and malaise; jaundice; hypoglycemia; coagulopathy; encephalopathy; possible renal failure and cardiomyopathy. Phase 4: Either recovery or progression to fatal complete hepatic failure. Patient teaching Caution parents or other caregivers not to give acetaminophen to children younger than age 2 without consulting prescriber first. Tell patient, parents, or other caregivers not to use drug concurrently with other acetaminophen-containing products. Advise patient, parents, or other caregivers to contact prescriber if fever or other symptoms persist despite taking recommended amount of drug. Inform patients with chronic alcoholism that drug may increase risk of severe liver damage. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

albuterol (salbutamol) Proventil albuterol sulfate (salbutamol sulfate) AccuNeb, Gen-Salbutamol , Nu-Salbutamol, Proventil HFA, Ventolin HFA, Vospire-ER Pharmacologic class: Sympathomimetic (beta2-adrenergic agonist) Therapeutic class: Bronchodilator, antiasthmatic Pregnancy risk category C Action Relaxes smooth muscles by stimulating beta2-receptors, thereby causing bronchodilation and vasodilation Availability Aerosol: 90 mcg/actuation Oral solution: 2 mg/5 ml Solution for inhalation: 0.083% (3 ml), 0.5% (0.5 and 20 ml), 0.63 mg/3 ml, 1.25 mg/3 ml Syrup: 2 mg/5 ml Tabl e t s : 2 mg, 4 mg Tablets (extended-release): 4 mg, 8 mg 1Indications and dosages To prevent and relieve bronchospasm in patients with reversible obstructive airway disease Adults and children ages 12 and older: Tablets2 to 4 mg P.O. three or four times daily, not to exceed 32 mg daily. Extended-release tablets4 to 8 mg P.O. q 12 hours, not to exceed 32 mg daily in divided doses. Syrup2 to 4 mg (1 to 2 tsp or 5 to 10 ml) three or four times daily, not to exceed 8 mg q.i.d. Aerosolone to two inhalations q 4 to 6 hours to relieve bronchospasm; two inhalations q.i.d. to prevent bronchospasm. Solution for albuterol 35 a Reactions in bold are life-threatening. 2Clinical alertinhalation2.5 mg three to four times daily by nebulization, delivered over 5 to 15 minutes.

Children ages 6 to 12: Tablets2 mg P.O. three or four times daily; maximum daily dosage is 24 mg, given in divided doses. Extended-release tablets4 mg q 12 hours; maximum daily dosage is 24 mg/kg given in divided doses. Syrup2 mg (1 tsp or 5 ml) three or four times daily, not to exceed 24 mg. Children ages 2 to 12 weighing more than 15 kg (33 lb): Solution for inhalation2.5 mg three to four times/day by nebulization Children ages 2 to 6: SyrupInitially, 0.1 mg/kg P.O. t.i.d., not to exceed 2 mg (1 tsp) t.i.d.Maximum dosage is 4 mg (2 tsp) t.i.d. To prevent exercise-induced bronchospasm Adults and children older than age 4 (older than age 12 with Proventil): Two inhalations 15 minutes before exercise Dosage adjustment Sensitivity to beta-adrenergic stimulants Elderly patients Off-label uses Chronic obstructive pulmonary disease Hyperkalemia with renal failure Preterm labor management Contraindications Hypersensitivity to drug Precautions Use cautiously in: cardiac disease, hypertension, diabetes mellitus, glaucoma, seizure disorder, hyperthyroidism, exercise-induced bronchospasm, prostatic hypertrophy elderly patients pregnant or breastfeeding patients children. Administration Give extended-release tablets whole; dont crush or mix with food. Administer solution for inhalation by nebulization over 5 to 15 minutes, after

diluting 0.5 ml of 0.5% solution with 2.5 ml of sterile normal saline solution. Know that children weighing less than 15 kg (33 lb) who require less than 2.5 mg/dose should receive 0.5% inhalation solution. Route Onset Peak Duration P.O. 15-30 min 2-3 hr 6-12 hr P.O. 30 min 2-3 hr 12 hr (extended) Adverse reactions CNS: dizziness, excitement, headache, hyperactivity, insomnia CV: hypertension, palpitations, tachycardia, chest pain EENT: conjunctivitis, dry and irritated throat, pharyngitis GI: nausea, vomiting, anorexia, heartburn, GI distress, dry mouth Metabolic: hypokalemia Musculoskeletal: muscle cramps Respiratory: cough, dyspnea, wheezing, paradoxical bronchospasm Skin: pallor, urticaria, rash, angioedema, flushing, sweating Other: tooth discoloration, increased appetite, hypersensitivity reaction Interactions Drug-drug. Beta-adrenergic blockers: inhibited albuterol action, possibly causing severe bronchospasm in asthmatic patients Digoxin: decreased digoxin blood level MAO inhibitors: increased cardiovascular adverse effects Oxytoxics: severe hypotension Potassium-wasting diuretics: ECG changes, hypokalemia Theophylline: increased risk of theophylline toxicity 36 albuterol Canada UK Hazardous drug High alert drugDrug-food.Caffeine-containing foods and beverages (such as coffee, tea, chocolate): increased stimulant effect Drug-herbs. Cola nut, ephedra (ma huang), guarana, yerba mat: increased stimulant effect

Patient monitoring 2Stay alert for hypersensitivity reactions and paradoxical bronchospasm. Stop drug immediately if these occur. Monitor serum electrolyte levels. Patient teaching Tell patient to swallow extendedrelease tablets whole and not to mix them with food. 2Teach patient signs and symptoms of hypersensitivity reaction and paradoxical bronchospasm. Tell him to stop taking drug immediately and contact prescriber if these occur. 2Instruct patient to notify prescriber immediately if prescribed dosage fails to provide usual relief, because this may indicate seriously worsening asthma. Advise patient to limit intake of caffeine-containing foods and beverages and to avoid herbs unless prescriber approves. Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. Advise patient to establish effective bedtime routine and to take drug well before bedtime to minimize insomnia. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above.