PARACETAMOL N-acetyl-p-aminophenol Discovered in 1877. aka acetaminophen (APAP). Mild analgesic. Antipyretic. Not NSAIDs. C8H9NO2

MAIN MEDICATION USED To treat PAIN & FEVER Painkiller - headache, sprains, toothache, backache, arthritis, muscle ache Reducing fever in people of all ages. (antipyretic) - flu (influenza) - cold

Commercial products Over-the-counter drugs Panadol Paracetamol Calpol Types: - Tablets - Capsules - Oral suspension

Precautions Dose recommended > Adult: 1000 mg per dose > Kids: 10-15 mg/kg/dose (1 month to 12 year-old) > Adolescence: 325-650 mg (>=12 year-old) (in every 4 to 6 hrs) > Alcoholic dependent individual: 500mg per dose > Individual with liver and/or kidney problem; deficiency in glucose-6-phosphate dehydrogenase enzyme: - professional advice required

Causes (TOXICITY) Allergy - rash/ swelling (face, lips, tongue, throat) - hypotension (low BP) - difficulty breathing - hives Excessive used/ overdose (Paracetamol toxicity) - > 0.2 mg/ml (4hrs) or 0.05 mg/ml (12hrs) - ACUTE LIVER FAILURE - HEPATOTOXICITY - ANALGESIC NEPHROPATHY

ALF & ANALGESIC NEPHROPATHY Acute Liver Failure (ALF) - hepatocellular dysfunction (80-90%) - complications Hepatotoxicity - chemical-driven liver damage Analgesic Nephropathy - chronic kidney disease - damage/injuries induced by excessive used of analgesic - renal papillary necrosis; chronic interstitial nephritis - acute tubular necrosis

Methods for diagnosing of diseases caused by Paracetamol Drug Nomogram - Prognosis of risk of potential hepatotoxicity Emergency & Overdose Drug Testing - Toxicology assay: quantifying the amount of drugs Hepatic Function Panel = Liver Panel - symptoms: jaundice, fatigue, dark urine/ light stool, nausea, vomit, loss of appetite, etcetera. CT Scan - diagnosis of analgesic nephropathy

Principle of method Hepatic function panel > a group of tests > diagnosis of liver injury/ viral infections > Evaluates: - Alanine aminotransferase (ALT) -> increased - Alkaline phosphatase (ALP) -> increased - Aspartate aminotransferase (AST) -> increased - Total Bilirubin -> increased - Albumin & total protein -> decreased

Sources AACC Lab Tests Online® (2015) Emergency and Overdose Drug Testing. Available at: https://labtestsonline.org/understanding/analytes/emergency/tab/sample/ [Accessed 14 February 2016] AACC Lab Tests Online® (2015) Liver Panel. Available at: https://labtestsonline.org/understanding/analytes/liver-panel/tab/test/ [Accessed 13 February 2016] Boots Pharmaceutical, (2016). Boots-Paracetamol-500mg-Capsules. [image] Available at: http://www.boots.com/en/Boots-Paracetamol-500mg-Capsules-16- Capsules_1254856/ [Accessed 10 February 2016] Boots Pharmaceutical, (2016) Paracetamol-Tablets-500mg. [image] Available at: http://www.boots.com/en/Boots-Paracetamol-Tablets-500mg-16- Tablets_228844/ [Accessed 10 February 2016] Calpol, (2016) Calpol Infant Liquid Suspension Sugar Free 100ml. [image] Available at: http://www.stylepinner.com/calpol-brand/Y2FscG9sLWJyYW5k/ [Accessed 10 February 2016] Drugs.com (2016) Paracetamol. Available at: http://www.drugs.com/paracetamol.html [Accessed 11 February 2016] Durani Y. (2014) Blood Test: Hepatic (Liver) Function Panel. Available at: http://kidshealth.org/parent/general/sick/labtest6.html# [Accessed 13 February 2016] Panadol, (2016) Panadol-optizorb-tablets. [image] Available at: http://www.chemmart.com.au/product/panadol-optizorb-tablets-p397462 [Accessed 10 February 2016] Panadol, (2016) Panadol-Ultra-Tablets-20. [image] Available at: http://www.boots.com/en/Panadol-Ultra-Tablets-20-_11541/ [Accessed 10 Febuary 2016] WIKIPEDIA, The Free Encyclopedia (2016) Analgesic Nephropathy. Available at: https://en.wikipedia.org/wiki/Analgesic_nephropathy [Accessed 12 February 2016] WIKIPEDIA, The Free Encyclopedia (2016) Acute Liver Failure. Available at: https://en.wikipedia.org/wiki/Acute_liver_failure [Accessed 12 February 2016] Willacy H. (2013) Paracetamol poisoning. Available at: http://patient.info/doctor/paracetamol-poisoning [Accessed 12 February 2016]