Acetaminophen monitoring patient with

Medication use must be monitored carefully for potential hepatotoxicity. Hepatically metabolized medications have the potential to accumulate in patients with liver disease. Little guidance is available on drug dosing in hepatic impairment because these patients are often excluded from drug trials. Daily acetaminophen use should not exceed 2 g. Dietary supplements have not been well studied in hepatic impairment and cannot be recommended. 

Acetaminophen may worsen kidney function and increase blood pressure.1516 Nevertheless, acetaminophen remains the preferred analgesic for mild to moderate pain in patients with hypertension or kidney disease owing to the greater risks associated with NSAID use.17 Monitoring specifically for these toxicities generally is unnecessary. 

Recommended dosage and monitoring requirements In patients with AML in first untreated relapse, two 2-hour intravenous doses of 9 mg/m separated by a 14-day interval, are recommended. Patients should receive diphenhydramine and acetaminophen one hour before Mylotarg administration. 

The severity and frequency of abdominal pain should be assessed periodically in order to determine the efficacy of the patient s pain control regimen. Most patients with abdominal pain can be adequately controlled with acetaminophen, NSAIDs, or selective COX-2 inhibitors. A trial of pancreatic enzymes and either an H2-receptor antagonist or proton pump inhibitor may relieve pain in patients with mild to moderate disease. Patients with severe pain will require narcotics. In these patients, pain should be monitored daily and medications adjusted accordingly. Some patients will require endoscopic therapy or pancreatic surgery. 

Acetaminophen (paracetamol) is a commonly used analgesic which is hepatotoxic at high doses in humans and in laboratory animals. Toxicity is believed to be mediated by the reactive metabolite N-acetyl-p-benzoquinone imine which binds to protein thiols as 3-(cystein-S-yl)acetaminophen adducts. Ultrasensitive immimoassays for 3-(with parallel elevations in serum adducts and serum levels of the liver-specific transaminase ALT. This suggested that the serum adducts were of hepatic origin and could be monitored as a biomarker of acetaminophen toxicity. Analysis of serum samples from acetaminophen overdose patients demonstrated a positive correlation between immunochemically detectable serum adducts and hepatotoxicity. 

Drug interactions with acetaminophen can occur for example, iso-niazid can increase the risk of hepatotoxicity. Chronic ingestion of maximal doses of acetaminophen may intensify the anticoagulant effect in patients taking warfarin, so that such individuals may require closer monitoring. Food decreases the maximum serum concentration of acetaminophen by approximately one-half. 

The FDA required a safety study of 90 days duration in at least 300 patients where tapentadol was compared to another immediate-release opioid [7]. For the 849 adult subjects enrolled in this study, the average baseline pain intensity score was 7.1. About half the patients were opioid-experienced. Supplemental analgesics (acetaminophen 2 g per day or ibuprofen 400 mg per day) were allowed in this study. The treatment groups were tapentadol IR 50 mg or 100 mg every 4 to 6 hours PRN versus oxycodone IR 10 mg or 15 mg every 4 to 6 hours PRN. Adverse events were monitored as part of the tolerability evaluation. Tapentadol was well tolerated, and had a lower incidence of GI adverse events than in patients treated with the comparator (refer to Table 31.2). Other tolerability evaluations included findings from the Clinical Opioid Withdrawal Scale (COWS) which indicated that 83% of patients abruptly discontinued from therapy did not experience withdrawal symptoms within 2 to 4 days of treatment cessation. 

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