Acetaminophen: A Case Study

"The toxicology studies on blood reveal the presence alprazolam, and amphetamine at levels likely consistent with the therapeutic range, a metabolite of buproprion and a high level of fentanyl. Phenylpropranolamine and amphetamine are present in the urine. When fentanyl and alprazolam are taken together there may be a synergistic central nervous system depressive effect. Based on the history and circumstances, s currently known, the manner of death is accident."

B’s tolerance to opiates not considered, Mr. B.’s clinical situation not considered (i.e., Mr. B’s age and renal function), and knowledge deficit of opiates. Drilling down the data to identify the root cause of Mr. B’s death is the fifth step in conducting a RCA on Mr. B’s sentinel event. Upon analyzing the data, causative factors, and events leading to Mr. B’s sentinel event, the RCA team determined that the root cause of Mr. B’s death is a medication error. Mr. B was given an overdose of hydromorphone. The final step in a root cause analysis is to implement changes that will mitigate the root cause. Changes include educating the nursing staff about hydromorphone, such as side effects and adverse reactions,

Following his friends suggestion, Cappitelli called the paramedics who worked on the Janus family and asked if they too had taken Tylenol. To both the men’s surprise, they discovered all three Janus family members had ingested the popular pain reliever. The police were immediately sent to the Kellerman and Janus homes to retrieve the suspicious bottles. Investigators soon discovered the Tylenol link. Urgent warnings were broadcast, and police drove through Chicago neighborhoods issuing warnings over loudspeakers.

Taking multiple products containing acetaminophen can cause liver failure. The maximum allowable daily dose of Tylenol (acetaminophen) is 4 grams (or 4000 mg) in adults and 90 mg/kg in children. Exceeding the maximum allowable daily dose can cause serious side effects and can have potentially fatal consequences. I would educate John on the use of Acetaminophen and liver failure. I would notify the doctor and get an order to check John’s LFT’s. Also, I would ask John the amount of Tylenol consumed on a daily basis and if he have tried any other sleep aids.

During the 1900's, the McNeil company developed and established Tylenol into a well known and recommended analgesic. It has become recognized world wide as a safe brand of acetaminophen. The name Tylenol has become identified as a trusted, safe drug that people can easily purchase over the counter for their ailments. Tylenol is still recommended by doctors even though there was a cyanide scare in the history of the company. It has been discovered by my independent survey that consumers use Tylenol for their pet's needs also.

“An adverse drug event (ADE) is an injury resulting from medical intervention related to a drug. This includes medication errors, adverse drug reactions, allergic reactions, and overdoses” (Kohn, Corrigan, & Donaldson, 2017). These can occur due to the route, timing, dosage, wrong medication, and/or multiple medications given. Hydromorphone can be given via an IV, intramuscularly, orally, or rectally. When given frequently, in wrong doses, in patients who do not process medications as quickly, or in conjunction with other CNS depressants, respiratory depression or respiratory arrest may occur. “Progression to death during an opioid overdose emergency is usually not immediate as sedation generally precedes life-threatening opioid-induced respiratory depression” (Elzey, Barden, & Edwards, 2016, p. 216). When this

Acetaminophen, commonly known as Tylenol, is perhaps the most frequently used painkiller in the United States and Europe. Obtaining Tylenol is as simple as driving to the local grocery store. However, there is a hidden danger overlooked by citizens who frequently consume painkillers such as Tylenol: liver failure. “The active ingredient in Tylenol, acetaminophen, accounts for more than 100,000 calls to poison centers, roughly 60,000 emergency-room visits and hundreds of deaths each year in the United States. In England, it is the leading cause of liver failure requiring transplants” (Citation 1). The outrageous number of medical complications Tylenol is causing is due to how readily available the drug is and how people are taking more than the recommended dose regularly. Liver damage can be reduced due to acetaminophen by making Tylenol prescription-only or by limiting the number of pills per package, thereby decreasing the availability of the pain-killer.

As a widely used analgesic and antipyretic agent, acetaminophen (APAP) overdose induced hepatotoxicity is one of the most common causes of acute liver failure in the USA and in most Western European countries [1]. Although a number of studies have forced on the influences of N-acetyl-p-benzoquinone imine (NAPQI), a highly reactive metabolite of APAP that depletes hepatic glutathione, and increases in oxidative stress during APAP toxicity [2], other mechanisms such as immune response also raise the susceptibility in the early stages of APAP-induced liver injury [3]. Accumulating evidence demonstrates a critical role of inflammatory cytokine released in early liver damage after APAP intoxication [4, 5]. Kupffer cells (KCs), the liver resident macrophages, are major sources of reactive oxygen species (ROS) and inflammatory

You brought to my attention that your cough syrup has one key ingredient that is known to have sever reaction, when taken with aspirin (SNHU , 2017). It is required by law, that any drugs manufactured, must have a label placed directly on the product, listing all the possible risk and harm from its consumption. Now by doing so, it protects you from being found guilty for failing to warn your consumers of possible risk and dangers and for failing to comply with the Negligence Per Se doctrine. Failing to do so, can result in paying a consumer compensatory and punitive damages (Herron, et al., 2011). I recommend that a you foresee what other dangers that can occur, such as glass shattering and perhaps going with a plastic bottle instead, in conjunction

The problematic issue for Bristol-Myers was to position its new aspirin drug to the potential customers and decide a good price which can not only make it acceptable by the customers, but also give a fair profit to the company. In other words, the company had to formulate an effective marketing and promotional strategy for its new drug, Datril. The company was not merely willing to establish its new brand in the analgesic market; the main issue was to establish this new brand in the presence of a strong competitor, Tylenol.

I would explain to Sarah’s mother that although there is no solid evidence demonstrate that tolerance may develop to the bronchodilator effects of Salbutamol [3], there are many studies supported that regular use of β2 agonists include Salbutamol lead to tolerance to their bronchodilator effects. [1][2][4][5][6]

Case Study #3 Tylenol: In 1982, seven people in Chicago died after taking Tylenol due to an unknown suspect lacing the capsules with cyanide after the products reached the shelves. In the immediate aftermath, Tylenol's commanding 37% market share dropped to just 7% nationwide, despite the problem being contained to the Chicago area. Tylenol was not responsible for the tampering of the product, but to maintain the product's reputation, Johnson & Johnson pulled all of the Tylenol from the shelves, absorbing a loss of more than $100 million dollars. Tylenol was successfully reintroduced with tamper-resistant packaging, discounts, and sales presentations to the medical community. The brand survived due to swift action and effective public relations from

Phenobarbital (PB) is a barbiturate that is used as an anticonvulsant drug that is commonly used to treat epilepsy. It is a cytochrome P450 enzyme inducer. Patients who not only use anticonvulsants, such as PB, but also overdose on paracetamol are more susceptible of developing liver damage. Phenobarbital will increase the hepatotoxic effects of paracetamol since it increases its rate of metabolism (Duggett, 2016). The detoxification pathway involving glutathione reserves are saturated and unable to convert paracetamol to form non-toxic cysteine and mercapturic acid conjugates, thus will form toxic metabolite NAPQI (McLen & Day, 1974).

Tylenol was the leading pain-killer medicine in the United States at the time. It was reported that

Systemic toxicity is typically manifested as central nervous system (CNS) toxicity (tinnitus, disorientation, and ultimately, seizures) or cardiovascular toxicity (hypotension, dysrhythmias, and cardiac arrest). The dose capable of causing CNS symptoms is typically lower than the dose and concentration that result in cardiovascular toxicity. This is because the CNS is more susceptible to local anaesthetic toxicity than the cardiovascular system. However, bupivacaine toxicity may not adhere to this sequence, and cardiac toxicity may precede the neurologic symptoms. Although less common, cardiovascular toxicity is more serious and more difficult to treat than CNS