Drug Study DRUG NAME CLASSIFICATION ACTION INDICATION CONTRA INDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION FOODS

TO DRUG INTERACTION Nursing consideration

GENERIC: Amoxicillin Trihydrate BRAND: Amoxil, Dispermox, Trimox Co-amoxilav

Antibiotic (penicillinampicillin type)

Treatment of tonsillitis Bactericidal: and pharyngitis caused by streptococcus Inhibits synthesis of cell pyogenes (ER tablet) wall of sensitive organism, Infections due to susceptible of causing cell Haemophillus influenza, death Escherichia coli, Proteus mirabilis, Neisseria gonorrhea, Streptococcus pneumonia Helicobater pylori infection in combination with other agents Postexposure prophylaxis against Bacillus anthracis Unlabeled used: Chlamydia trachomatis in pregnancy, mild to moderate otitis media in children

Contraindicated with allergies to penisillins, chephalosphori ns, or other allergens Use cautiously with renal disorders, lactation

CNS: lethargy , seizure, hallucination, GI: Glossitis, stomatitis,gastritis, sore mouth, furry tongue, black hairy tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Other: superinfection oral and rectal moniliasis, vaginitis

y Increased effect with probenecid Decreased effectiveness with tetracyclines, chloramphenicol. Decreased efficacy of hormonal contraceptives Delayed or reduced GI absorption with food.

y y y

y y

y y y

Asses for allergy to penicillin, cephalosphorins or other allergens Culture infected area prior to treatment Given in oral preparation only Instruct the importance to take full course of therapy Drugs taken round the clock Antibiotic is specific for infection not be taken for self medication Client may experience side effects: nausea, vomiting, sore mouth, GI upset Instruct client to have small frequent meal for GI upset Teach client proper mouth care to help sore mouth Report for fever, bleeding, rashes, bruising Observe for hives, difficulty of breathing

Drug Study DRUG NAME CLASSIFICATION ACTION INDICATION CONTRA INDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION FOODS TO DRUG INTERACTION Nursing consideration

GENERIC: CAPTOPRIL BRAND: Capoten

Ace inhibitor antihypertensive

Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decrease BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increase in prostaglandin synthesis also may be involve in the antihypertensive action.

Treatment of hypertension alone or in combination with thiazide type diuretics Treatment with heart failure in patients unresponsive to conventional therapy, used diuretics and cardiac glycoside

Contraindicated with allergy to captopril, history to angioedema, second or third trimester pregnancy.

Use cautiously Treatment of left ventricular with renal dysfunction after MI impairment, heart failure, Treatment of diabetic salt or volume nephropathy depletion, history of renal Unlabeled uses: Management artery stenosis, of hypertensive crises; lactation treatment of rheumatoid arthritis; diagnosis of anatomic renal stenosis, hypertension related to scleroderma crisis, diagnosis of primary aldoteronism, idiophatic edema; Batters syndrome; Raynauds syndrome

CV: Tachycardia, angina pectoris, heart failure, MI. Raynauds syndrome, hypotension in salt-or volume-depleted patien Dermatologic: Alopecia, rash, priritus, scalded mouth sensation, pemphigoidlike reaction, exfoliative dermatitis, and photosensitivity. GI: Gastric irritation, apthous ulcers, peptic ulcers, dyseusia, cholestatic jaundice, hepatocellular injury, anorexia, constipation GU: Protienuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency Hematologic: Neutropenia, agranulocytosis, thrombocytopenia, hemolytic anemia, pancytopnea Other; cough, dry mouth, malaise, lymphanopathy

Increased risk of hypersensitivity reaction with allopurinol Decreased antihypertensive effects with indomethacin Increased captopril effects with probenecid

Decreased absorption of captopril with food

 

  

 

Asses for allergy of drug Assess for possible renal impairment heart failure, pregnancy drugs must not be given Monitor patient for drop in BP secondary to reduction of fluid volume due to excessive perspiration, vomiting and diarrhea Reduce dosage to patient with impaired renal function Instruct to take drug 1 hr before meal, not with food Monitor client drug compliance Be sure the client will not get pregnant during medication of captopril it cause severe fetal damage Explain to avoid OTC drug esp cough, cold for possible drug to drug interaction Report sore throat swelling of tongue Report difficulty of breathing

Drug Study DRUG NAME CLASSIFICATION ACTION INDICATION CONTRAINDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION . decreased therapeutic effect with Iron Salts, sucralfate Decreased absorption with antacid, didanosin Increased serum levels and toxic effects of theophyllines if taken concurrently with ciprofloxacin Increased effect of coumarin or its derivatives Increased risk of seizures with foscarnet FOODS TO DRUG INTERACTION Vomiting maybe triggeredadvised small frequent meals, with increase fluid intake Milk and orange juice also may reduce the absorption of ciprofloxacin. Nursing consideration

GENERIC:
CIPROFLOXACIN

Antibacterial Fluoroquinolone

BRAND: Cipro, Cipro XR, Proquin XR

Bactericidal; interfers with DNA replication in susceptible bacteria preventing cell reproduction

For treatment with infection cause by susceptible gramnegative bacteria, including Escherichia coli, Proteus mirabilis, Klebsiella pneumonia, Enterobacter cloacae, Proteus vulgaris, Proteus rettgeri, Morganella morganii, Psuedomonas aeruginosa, Citrobacter freundii, Staphylococcus aureus, group D streptococci Unlabeled used: Cystic fibrosis in patients who have pulmonary exacerbations, gastroenteritis in children, myobacterial infection

Contraindicated with allergy to ciprofloxacin, norfloxacin or other flouroquinolones, pregnancy and lacatation. Use cautiously with renal impairment, seizures, tendinitis or tendon rupture associated with fluoroquinolone use.

CNS: headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision, hallucination, ataxia, nightmares CV: arrhythmias, hypotension, angina EENT:dry eye, eye pain, keratopathy GI:Nausea, vomiting, dry mouth, diarrhea, abdominal pain GU: Renal failure Hematologic: elevated Bun, AST, ALT, serum creatinine and alkaline phospahate; decreased WBC count, neutropil count, Hct Other: Fever, Rash

Assess for allergy to ciprofloxacin, norfloxacin or other quinolones Assess for renal impairment, seizure; lactation Ensure that the patient take the tablet whole not crush Ensure that patient is well hydrated Give antacid at least 2 hr after dosing Encourage patient to complete full course of therapy Take the tablet with the meal of the day Do not touch the tip of the eye of the ointment or solution as this may contaminate the product Report rash, visual changes, severe GI problems

Drug Study DRUG NAME CLASSIFICATION ACTION INDICATION CONTRAINDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION Increased risk of hypoglycemia with sulfonylureas, cimetidine, furosemide, cationic drugs such as digoxin, amiloride, vancomycin Increased risk with lactic acidosis with ethanol Increased risk for acute renal failure and lactic acidosis with iodinated contrast material used in radiologic studies; stop metformin at or before time of procedure and hold for 48 hr afterward FOODS TO DRUG INTERACTION Increased risk with hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery Nursing consideration

GENERIC: METFORMIN hydrochloride BRAND: Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet

Antidiabetic

Exact mechanism is not understood; possibly increases peripheral utilization of glucose, decreases hepatic glucose production, and alters intestinal absorption of glucose

Adjunct to diet to lower blood glucose with type 2 diabetes mellitus in patients 10 yr and older; ER in patients 17 yr and older As part of combination therapy with a sulfonyurea or insulin when either drug alone cannot control glucose levels in patients with type 2 diabetes mellitus Unlabeled uses: treatment of anovulation in women with polysystic ovary syndrome; treatmet of antipsychotic drug-induced weight gain

Contraindicated with allergy to metformin; heart failure; diabetes complicated by fever, severe infections, severe trauma, major surgery, ketosis, acidosis, coma ( use insulin); type I diabetes, serious hepatic impairment, serious renal impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia associated with renal disease, labor and delivery; lactation Use cautiously with the elderly

Endocrine: Hypoglycemia, lactic acidosis GI: anorexia, nausea, vomiting, epigastric discomfort, heartburn, diarrhea, flatulence Hypersensitivity: allergic skin reaction, eczema, pruritus, erythema, urticaria

Assess for allergy of drug Do not give if the patient is diabetic complicated with fever Do not give for patient with severe trauma, minor surgery, severe infections Assess for orientation, peripheral sensation, reflexes Do not continue meds without consulting health care provider Swallow extended table whole do not crush, nor chew Do not use this drug during pregnancy, if pregnant consult physician Avoid alcohol when taking drug Report fever, sore throat, unusual bleeding or bruising Report hypoglycemic or hyperglycemic reaction

Drug Study DRUG NAME CLASSIFICATION ACTION INDICATION CONTRAINDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION FOODS TO DRUG INTERACTION Decreased effectiveness of doxycyline if taken with food , dairy product Nursing consideration

GENERIC: Doxycycline BRAND: Apodoxy,Vibra mycin,Periostat , Oracea Antibiotic, tetracycline Inhibits protein synthesis by binding to ribosomal 30S subunit. Blocks binding of aminoacyl transfer RNA to the messenger RNA complex. Cell wall synthesis is not inhibited. Doxycycline is used to treat periodontitis; respiratory, skin or soft tissue, and urinary tract infections; a rheumatic fever prophylaxis; typhus; smallpox etc. Doxycycline can also be used as treatment for malaria, atypical mycobacterial infections, prophylaxis or treatment of travelers diarrhea, rheumatoid arthritis, and prevention of Lyme disease. Prophylaxis of malaria in pregnant individuals and in children less than 8 years old. Use during pregnancy (may stunt fetal growth), lactation

Dental;discoloring and inadequate calcification of the proimary teeth of the fetus if use by pregnant women Discoloring of permanent teeth if use in the development of teeth Dermatologic:phototic reaction, rash, exfoliative dermatits GI:fatty liver, liver failure, anorexia, vomiting,diarrhea, dyspahagia Hematologic:hemolyti c anemia, thrombocytopenia, eosinophilia, luekopenia Local: local irritation at injection site Other: superinfection, nephrogenic diabetes insipidus syndrome

Barbiturates, carbamezipine, phenytoin / Doxycycline effect by liver breakdown Methotrexate / Possible GI and hematologic toxicity after high doses of methotrexate.

Do not confuse Doxycycline w/ Dicyclomine ( an anticholinergic/ antispasmodic ) When used for streptococcal infections, continue therapy for 10 days. Note reasons for therapy, onset, & characteristics of S&S. Obtain C&S when indicated. Monitor VS, CBC, renal and LFTs. Check for any allergic reactions May take with food. Take entire prescription; do not stop if symptoms subside May cause dizziness, blurred vision direct exposure to sunlight. Discard any unused doxycycline by the expiration date noted on the label.

Drug Study DRUG NAME GENERIC: Chlorpromazine hydrochloride BRAND: Thorazine Largactil CLASSIFICATION ACTION Antiemetic Antipsychotic Anxiolytic Dopaminergic blocker phenothiazine Mechanism not fully understood; antipsychotic drugs blokck postynptic dopamine receptors in the brain; depress those parts of the brain invole with wakefulness and emesis; anticholinergic, and alphaadrenergic blocking INDICATION Management of manifestations of psychotic disorder, control of manic phase of manidepressive illness Relief of preoperative restlessness and apprehension Adjunct to treatment of tetanus Severe behavior problems in children Therapy for combativeness, hyperactivity CONTRA INDICATION Contraindicated with allergy to chlorpromazine, comatose or severely depressed states, bone marrow depression, circulatory collapse, subcortical damage, Parkinsons disease, liver damage, severe hypotension or hypertension SIDE EFFECTS CNS: headache, drowsiness, insomnia, vertigo, weakness, tremors, slurring, cerebral edema, seizures, exacerbation of psychotic symptoms, neuroleptic malignant syndrome CV: hypotension, orthostatic hypotension, hypertension, tachycardia, cardiac arrest, heart failure, cardiomegaly, refractory arrhythmias, pulmonary edema EENT: nasal congetion; glaucoma; photophobia, blurred vision, deposits in cornea and lens; pigmentary retinopathy Endocrine: lactation; breast engorgement in female; galatorrhea; SIADH; amenorrhea; menstrual irregularities; gynecomastia; changes in libido; hyperglycemia; inhibition of ovulation GI: dry mouth, salivation, nauseas, vomiting, anorexia, constipation, paralytic ileus, incontinence GU: urinary retention, polyuria, incontinence, ejaculation inhibition, male impotence, urine discolored pink to red brown Hematologic: Eosinophilia, leujopenia, leukocytosis, anemia, aplastic anemia, hemolytic anemia, purpura, elevated serum cholesterol Hypersensitivity: jaundice; urticaria, angioneurotic edema, laryngeal edema, photosensitivity, eczema, exfoliative dermatitis, contact dermatits Respiratory: Bronchospasm; laryngospam; dyspnea; suppression of cough reflex and possible aspiration Other: fever, heatstroke, sweating, photosensitivity DRUG TO DRUG INTERACTION Additive anticholinergic effects and possibly decreased antipsychotic effect with anticholinergic drugs Additive CNS depression, hypotension if given preoperatively with barbiturate anesthetics, alcohol, meperidine Increased risk of tachycardia, hypotension with epinephrine, norepinephrine Nursing consideration  Assess for allergy to chlorpromazine, comatose or severely depressed states, bone marrow depression, circulatory collapse Take drug exactly as prescribe Avoid over the counter drug and alcohol unless consulted by a health care provider Learn how to dilute oral drug concentrate or how to use rectal suppository Be careful to get oral drug concentrate to the skin or clothes; contact dermatitis may occur Use caution in hot weather; risk for heat stroke Encourage increased fluid intake to prevent heatstroke Avoid driving or operating dangerous machinery client may experience severe drowsiness Avoid prolonged exposure to sun and wear protective garment or sunscreen for sun sensitivity Change position slowly to prevent faintness and dizziness

 

  

Drug Study DRUG NAME GENERIC: haloperidol BRAND: Haldol, Haldol Decanoate CLASSIFICATION Antipsychotic Dopaminergic blocker ACTION Mechanism not fully understood; antipsychotics block postsynaptic dopamine receptors in the brain, depress the RAS, including those parts of the brain involve with wakefulness and emesis, chemically resembles the phenothiazines INDICATION Management of manifestation of psychotic disorders Control of tics and vocalizations in Tourette syndrome in adults and children Behavioral problems in children with combative, explosive hyperexcitability that can not be attributed by immediate provocation Short term treatment of hyperactive children with excessive motor activity, mood lability CONTRAINDICATION Contraindicated with hypersensitivity totypical antipsychotics, coma or severe CNS depression, bone marrow depression, blood dyscrasia, circulatory collapse, subcortical damage. Parkinsons dse, liver damage, cerebral arteriosclerosis, coronary disease, severe hypotension or hypertension SIDE EFFECTS Autonomic: nasal congestion; dry mouth, salivation, nauseas, vomiting, anorexia, fever; pallor;flushed faces; sweating; constipation, paralytic ileus, incontinence urinary retention, polyuria, incontinence, ejaculation inhibition CNS: headache, drowsiness, insomnia, vertigo, weakness, tremors, slurring, cerebral edema, seizures, exacerbation of psychotic symptoms, pseudo parkinsonism; hyperthermia; autonomic disturbance CV: hypotension, orthostatic hypotension, hypertension, tachycardia, bradycardia; cardiac arrest, heart failure, cardiomegaly, refractory arrhythmias, pulmonary edema Endocrine: lactation; breast engorgement in female; galatorrhea; SIADH; amenorrhea; menstrual irregularities; gynecomastia in male; changes in libido; hypoglycemia or hyperglycemia; glysuria; hyponatremia; infertility; inhibition of ovulation Hematologic: Eosinophilia, leujopenia, leukocytosis, anemia, aplastic anemia, hemolytic anemia, purpura, Hypersensitivity: jaundice; urticaria, angioneurotic edema, laryngeal edema, photosensitivity, eczema, asthma; exfoliative dermatitis, anaphylactoid reactions Respiratory: Bronchospasm; laryngospam; dyspnea; suppression of cough reflex and possible aspiration DRUG TO DRUG INTERACTION Additive anticholinergic effects and possibly decreased antipsychotic effect with anticholinergic drugs Increased risk of toxic side effects with lithium Decreased effectiveness with carbamazepine Nursing consideration Do not administer drug to severely depressed states, bone marrow depression, circulatory collapse; subcortical brain damage Take drug exactly as prescribe Do not use haloperidol decanoate fo IV injection Gradually withdraw drug to when patient has been on maintenance therapy to avoid withdrawal-emergent dyskinesia Encourage increased fluid intake to prevent heatstroke Avoid driving or operating dangerous machinery client may experience severe drowsiness Avoid prolonged exposure to sun and wear protective garment or sunscreen for sun sensitivity Change position slowly to prevent faintness and dizziness Instruct proper mouth care and suck sugarless lozenges for dry mouth Encourage to empty bladder before taking drug to prevent urinary retention

Drug Study DRUG NAME CLASSIFICATION ACTION INDICATION CONTRAINDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION Possible increased effect or prolonged anticholinergic effect with MAOIs Risk or increased sedation with alcohol, CNS depressant FOODS TO DRUG INTERACTION Nursing consideration Take as prescribe avoid excessive dosage Take with food if GI upset occur Avoid alcohol serious sedation would occur Avoid performing task requiring alertness and driving Take drug with meals to those experiencing diarrhea or constipation Advice frequent mouth care for dry mouth and suck sugarless lonzengens Use humidifier for thick secretion and dry nasal mucosa Report difficulty of breathing, hallucination; loss of coordination Assess for abnormal bruising and bleeding

GENERIC: Diphenhydramine hydrochloride BRAND: Benadryl

Antihistamine Anti-motion sickness drug Antiparkinsonian Cough depressant Sedative-hypnotic

Competitively blocks the effect of histamine at H1-receptor sites, has atropine-like, anti-pruritic and sedatives effect

Relief symptoms associated with perenial and seasonal allergic rhinitis; vasomotor rhinitisallergic conjunctivitis; amelioration of allergic reaction to blood plasma; therapy in anaphylactic reactions Parkinsonian Night time aid sleep Suppression of cough due to colds and allergens

Contraindicated with allergy to antihistamines, third trimester pregnancy, lactation

CNS: drowsiness, sedation,dizziness; disturbed coordination, weakness, tremors, blurred vision,confusion, headache CV: hypotension, tachycardia, bradycardia, palpitations,extracystole GI: Epigastric distress; nausea, vomiting, anorexia, constipation, increase appetite, wt. gain GU: urinary retention, urinary frequency,dysuria,early menses; decreased libido;impotence Hematologic: anemia, hypoplastic anemia, hemolytic anemia, thrombocytopenia; luekopenia Respiratory: thickening of bronchial secretions; chest tightness; wheezing, nasal stuffness, dry mouth; dry nose; dry throat; sore throat Other: urticaria; Rash; anaphylactic shock; photosensitivity; Excessive perspiration

Drug Study DRUG NAME CLASSIFICATION ACTION INDICATION CONTRAINDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION Decreased effectiveness with bartiburates Disulfiram-like reaction(flushing tachycardia, nausea, vomiting) with alcohol Psychosis if taken with disulfiram Increased bleeding tendencies with oral anticoagulants FOODS TO DRUG INTERACTION Nursing consideration Take full course of drug therapy Take drug with food if GI upset occur Do not drink with alcohol Explain that urine may be darker color than usual; Refrain from intercourse during treatment for trichomoniasis, unless partner wear condom Apply the topical preparation by cleansing the area and then rubbing a thin film into affected area. Eat frequent small meals is advice for nausea ,vomiting and diarrhea Frequent mouth care and sugarless candies for dry mouth Report sever GI upset

GENERIC: metronidazole BRAND: Flagyl, Flagyl 375, Flagyl ER, Flagyl I.V. RTU, Metro I.V., Protostat, Flagyl I.V., Metryl

Amebicide Antibacterial Antibiotic Antiprotozoal

Bactericidal: Inhibits DNA synthesis in specific (obligate) anerobes, causing cell death; antiprozoaltricomonocidal, amebicidal. Biochemical mechanism is not known

Acute infection with susceptible anerobic bacteria Preoperative,itraoperative, posteoperative prophylaxis for patients undergoing colorectal surgery Topical application; Treatment for inflammatory papules, pustules; and erythema of rosacea

Contraindicated with allergy to metronidazole; pregnancy Use cautiously with CNS diseases, hepatic disease, candidiasis, lactation

CNS: headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizure, peripheral neuropathy; fatigue GI:unpleasant metallic taste, anorexia, diarrhea, vomiting, nausea, GI upset, cramps GU: dysuria , incontinence, darkening of the urine, Local: thrombophlebitis (IV); redness, burning, dryness and skin irritation ( topical) Other: severe, disulfiram-like interaction with alcohol

Drug Study DRUG NAME GENERIC: Multivitamin CLASSIFICATION

Multivitamins and minerals.

ACTION Vitamins are very essential for various functioning of the body. To reduce the increasing level of cholesterol in the body.

INDICATION
Promotes normal biochemical reactions, strengthens the immune system, supports normal growth and development and helps prevent growth retardation in children and young adult.

CONTRAINDICATION
There is no contraindication

SIDE EFFECTS When taken as directed, multivitamins are not expected to cause serious side effects. Less serious side effects may include: upset stomach; headache; or unusual or unpleasant taste in your mouth.

BRAND:
y Prozinc

DRUG TO DRUG INTERACTION Taking two multivitamin at the same time with the same vitamin content may cause over dose.

FOODS TO DRUG INTERACTION Calcium may make it harder for the body to absorb certain ingredients of the multivitamin.

Nursing consideration
Instruct patient to take the vitamin with meals or milk.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Avoid taking more than one multivitamin product at the same time unless advice by physician Avoid the regular use of salt substitutes in diet if the multivitamin contains potassium Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Liquid multivitamins may sometimes be mixed with water, fruit juice, or infant formula (but not milk or other dairy products).

Drug Study DRUG NAME CLASSIFICATION ACTION INDICATION CONTRAINDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION Increased toxicity with longterm excessive ethanol ingestion Increased hypoprothrombic effect of oral anticoagulant Increased possible hepathotoxicity and possible decreased therapeutic effects with barbiturates, carbamazepine, hydantions. FOODS TO DRUG INTERACTION Nursing consideration

GENERIC: acetaminophen

Antipyretic Analgesic (nonopioid)

BRAND: Aceta, Apacet, Atasol (CAN), Genapap, Genebs, Liquiprin, Mapap, Panadol, Tapanol, Tempra,Tylenol

Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat. Analgesic: Site and mechanism of action unclear.

Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses, upper GI disease, gouty arthritis Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically significant antirheumatic and anti-inflammatory effects) Common cold, flu, other viral and bacterial infections with pain and fever Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain

Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism.

CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 58 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Hematologic: Methemoglobinemia cyanosis; hemolytic anemiahematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia Hypersensitivity: Rash, fever

Assess the history: Allergy to acetaminophen, impaired hepatic function, chronic alcoholism, pregnancy, lactation Physical: Skin color, lesions; T; liver evaluation; CBC, LFTs, renal function tests Take the drug only for complaints indicated; it is not an antiinflammatory agent. Avoid the use of other over-the-counter preparations. They may contain acetaminophen, and serious over dosage can occur. If