Acetaminophen

Question 1

APAP reaches peak serum levels at what time after ingestion?

Answer 1

30-60 minutes

Question 2

Is APAP protein-bound?

Answer 2

No

Question 3

Name sites of metabolism of APAP (2)

Answer 3

Liver (glucuronidation, sulfation)

Liver and kidney (P450 2E1 –> NAPQI)

Question 4

You need this to get rid of NAPQI:

Answer 4

Glutathione

Question 5

Conditions which may decrease gluathione availability (4):

Answer 5

Alcohilsim, malnutrition, HIV, chronic disease

Question 6

APAP can interfere with what common lab test?

Answer 6

Blood glucose measurement

Question 7

APAP overdose results in what type of acid-base disturbance?

Answer 7

Anion gap acidosis (accumulation of 5-oxoproline)

Question 8

Potentially toxic dose of APAP in an adult:

Answer 8

7.5g

Question 9

Potentially toxic dose of APAP in a child:

Answer 9

150mg/kg

Question 10

Measure APAP at what time after ingestion?

Answer 10

4hr

Question 11

These 5 markers are prognostic for degree of liver injury in APAP overdose:

Answer 11

PT/INR > 3
Serum bicarb
pH < 7.3 (arterial)
lactate > 3
renal function
phos > 3

Question 12

Loading dose for NAC:

Answer 12

140mg/kg

Question 13

Maintenance dose for NAC:

Answer 13

70mg/kg q4hr for 17 doses

Question 14

Main adverse reaction associated with NAC:

Answer 14

Anaphylactiod (not anaphylaxis)

Question 15

In fulminant hepatic failure, consider:

Answer 15

Plasmapheresis

Transfer to a liver center

Question 16

You may want to consider these three factors in deciding whether to re-check a 4hr APAP level that is below the nomogram:

Answer 16

Co-ingestions
Large ingestions of immediate release (pylorospasm)
XR