Analgesics/NSAIDS - Acetaminophen (Tylenol/Ofirmev)

Question 1

What is the recommended IV dose of Acetaminophen (Tylenol/Ofirmev) for an adult patient?

A) 500 mg every 4 hours

B) 750 mg every 6 hours

C) 1 g every 6 hours over 15 minutes

D) 1.5 g every 6 hours over 30 minutes

Answer 1

C) 1 g every 6 hours over 15 minutes

TxWes Reference:
1000mg q4-6h
max 3000-4000mg qd

Question 2

For patients weighing less than 50 kg, what is the recommended IV dose of Acetaminophen (Tylenol/Ofirmev)?

A) 500 mg every 4 hours

B) 750 mg every 6 hours

C) 1 g every 6 hours

D) 1 g every 8 hours

Answer 2

B) 750 mg every 6 hours

Corn’s Basics of Pain Managementslides:
15 mg/kg
PO q 4-6 h
Max: 90 mg/kg/d

<50 kg
15 mg/kg IV q6h (750mg q6h)
or 12.5 mg/kg IV q4h prn pain
Max: 75mg/kg/d

Question 2

What is the maximum allowable dose of Acetaminophen (Tylenol/Ofirmev) per day when administered IV?

A) 2 g

B) 3 g

C) 4 g

D) 6 g

Answer 2

C) 4 g

TxWes Reference:
3000-4000mg qd

Question 3

What is the primary mechanism of action of Acetaminophen (Tylenol/Ofirmev)?

A) Inhibition of COX-1 enzyme

B) Inhibition of COX-2 enzyme

C) Competitive blocking of cyclooxygenase (COX) enzymes

D) Enhancement of serotonin reuptake

Answer 3

C) Competitive blocking of cyclooxygenase (COX) enzymes

MOA: Unclear; possibly inhibition of COX-2; Antipyretic and analgesic effects is the inhibition of prostaglandin synthesis by competitive blocking of the enzyme cyclooxygenase (COX)

Question 4

What is the typical onset time for IV administration of Acetaminophen (Tylenol/Ofirmev)?

A) 1 minute

B) 5 minutes

C) 15 minutes

D) 30 minutes

Answer 4

B) 5 minutes

Question 5

The half-life of Acetaminophen (Tylenol/Ofirmev) is approximately:

A) 1-2 hours

B) 2-3 hours

C) 4-5 hours

D) 6-7 hours

Answer 5

B) 2-3 hours

Question 6

How is Acetaminophen (Tylenol/Ofirmev) primarily metabolized in the body?

A) Directly excreted in urine

B) Metabolized by CYP enzymes to glucuronidation and then to glutathione conjugation

C) Metabolized by renal clearance without hepatic involvement

D) Metabolized by bacterial enzymes in the gut

Answer 6

Answer: B) Metabolized by CYP enzymes to glucuronidation and then to glutathione conjugation

Metabolism: CYP to glucuronidation to glutathione conjugation; toxicity in OD leading to hepatic necrosis d/t depletion of antioxidant glutathione, leads to formation of N-acetyl-p-benzoquinone, administer Acetylcysteine as substitute for glutathione within 8 hours of ingestion

Question 6

Acetaminophen (Tylenol/Ofirmev) considered safe for use during pregnancy?

A) No, it is contraindicated during pregnancy

B) Yes, it can be used during pregnancy

C) It is only safe during the first trimester

D) It is only safe during the third trimester

Answer 6

B) Yes, it can be used during pregnancy

Question 7

What is the recommended antidote for Acetaminophen (Tylenol/Ofirmev) overdose and how should it be administered?

A) Activated charcoal, administered orally within 1 hour

B) Acetylcysteine within 8 hours of ingestion

C) Naloxone, administered intravenously within 4 hours

D) Atropine, administered intramuscularly within 6 hours

Answer 7

B) Acetylcysteine within 8 hours of ingestion

Question 8

The formation of which toxic metabolite contributes to liver damage in Acetaminophen (Tylenol/Ofirmev) overdose?

A) N-acetyl-p-benzoquinone

B) Glucuronide conjugate

C) Sulfate conjugate

D) N-acetylcysteine

Answer 8

Answer: A) N-acetyl-p-benzoquinone

Metabolism: CYP to glucuronidation to glutathione conjugation; toxicity in OD leading to hepatic necrosis d/t depletion of antioxidant glutathione, leads to formation of N-acetyl-p-benzoquinone, administer Acetylcysteine as substitute for glutathione within 8 hours of ingestion

Question 9

What is the primary mechanism of action of Acetaminophen (Tylenol/Ofirmev)?

A) Selective COX-2 inhibition

B) Nonselective COX inhibition

C) Serotonin reuptake inhibition

D) Opioid receptor agonism

Answer 9

B) Nonselective COX inhibition

Question 10

For which types of symptoms is Acetaminophen (Tylenol/Ofirmev) primarily used?

A) Severe pain and inflammation

B) Mild to moderate pain and fever

C) Acute infections and seizures

D) Chronic pain and hypertension

Answer 10

B) Mild to moderate pain and fever

Question 10

How is Acetaminophen (Tylenol/Ofirmev) primarily eliminated from the body?

A) Hepatic metabolism

B) Biliary excretion

C) Renal excretion

D) Pulmonary excretion

Answer 10

C) Renal excretion

Question 11

When using Acetaminophen (Tylenol/Ofirmev) in a postoperative setting, what is an important step regarding communication with PACU nurses?

A) Informing them of the dosage and timing

B) Asking them to administer it without informing the surgeon

C) Avoiding any communication to prevent confusion

D) Requesting they monitor for specific side effects only

Answer 11

A) Informing them of the dosage and timing

Question 11

How does Acetaminophen (Tylenol/Ofirmev) impact opioid requirements in patients?

A) Increases opioid requirements by 30-50%

B) Decreases opioid requirements by 30-50%

C) Eliminates the need for opioids entirely

D) Has no effect on opioid requirements

Answer 11

Answer: B) Decreases opioid requirements by 30-50%

Let PACU nurses know; ask surgeon before giving and no CIs

Question 12

How does Acetaminophen (Tylenol/Ofirmev) affect gastrointestinal (GI) function and platelet aggregation?

A) It can cause GI irritation and affect platelet aggregation.

B) It has no significant effects on GI function or platelet aggregation.

C) It enhances platelet aggregation and protects the GI tract.

D) It increases the risk of GI bleeding and decreases platelet aggregation.

Answer 12

B) It has no significant effects on GI function or platelet aggregation.

Question 12

Which of the following conditions is a contraindication for the use of Acetaminophen (Tylenol/Ofirmev)? (Select 2)

A) Mild renal impairment

B) Hypersensitivity to Tylenol

C) Severe hepatic failure

D) Non-severe allergic reactions

Answer 12

B) Hypersensitivity to Tylenol

C) Severe hepatic failure

Question 13

What adjustment is recommended for dosing Acetaminophen (Tylenol/Ofirmev) in patients with severe renal disease?

A) Increase the dose to ensure effectiveness.

B) Maintain the standard dose without changes.

C) Reduce the dose to account for decreased renal clearance.

D) Avoid using Acetaminophen entirely.

Answer 13

C) Reduce the dose to account for decreased renal clearance.

Question 13

Which of the following statements is true regarding the anti-inflammatory effects of Acetaminophen (Tylenol/Ofirmev)?

A) It has significant anti-inflammatory effects similar to NSAIDs.

B) It lacks anti-inflammatory effects and is not classified as a true NSAID.

C) It has anti-inflammatory effects but is less potent than NSAIDs.

D) It primarily acts as an anti-inflammatory agent and only minimally affects pain.

Answer 13

B) It lacks anti-inflammatory effects and is not classified as a true NSAID.

Question 14

How might the use of Acetaminophen (Tylenol/Ofirmev) impact the risk of myocardial infarction (MI) and cerebrovascular accidents (CVA)?

A) It decreases the risk of MI and CVA.

B) It has no effect on the risk of MI or CVA.

C) It may increase the risk of MI and CVA.

D) It has a protective effect against MI and CVA.

Answer 14

C) It may increase the risk of MI and CVA.

Question 14

What is the recommended maximum daily dose of Acetaminophen (Tylenol/Ofirmev) for patients with chronic hepatic disease?

A) 1 g/day

B) 2 g/day

C) 3 g/day

D) 4 g/day

Answer 14

Answer: B) 2 g/day

Reduce dose in severe renal disease and 2g/day for chronic hepatic disease

Question 15

Which of the following is a common side effect of Acetaminophen (Tylenol/Ofirmev)?

A) Nausea and vomiting

B) Hyperglycemia

C) Hypertension

D) Insomnia

Answer 15

A) Nausea and vomiting

Question 16

What is another common side effect associated with Acetaminophen (Tylenol/Ofirmev)?

A) Diarrhea

B) Headache

C) Rash

D) Drowsiness

Answer 16

B) Headache