Tom, a 26-year-old runner, came into the office today complaining of constant pain in the right ankle. While running his usual route, he accidentally stepped on a branch lying in his path, twisting his ankle inward. He denies hearing a \”pop.\” He was able to walk, or limp,

The patient has a grade I lateral ankle sprain characterized by mild tenderness, swelling, and slight functional loss. Pain control is vital for quality patient care. I would prescribe Acetaminophen (Tylenol) for pain relief. Tylenol would be the best choice since it is an analgesic and has sedating properties, which are helpful for patients who have sustained trauma or injuries and will promote patient comfort (Halabchi & Hassabi, 2020).

It is used as a single agent for mild to moderate pain, as in the patient scenario. Analgesics are recommended if a patient has significant ecchymosis to prevent further hemorrhage into the injury site (Halabchi & Hassabi, 2020). Prescribing the patient an NSAID can result in increased swelling if the ecchymosis is due to platelet inhibition.
I would prescribe Acetaminophen at 1gm orally every 8 hours.

The patient will be cautioned against taking more than 3 gm of Acetaminophen per day due to the risk of hepatic impairment (Bacle et al., 2019). The patient will be informed of potential side effects of Acetaminophen, such as dizziness, disorientation, skin rash, angioedema, and urticaria (Bacle et al., 2019). Besides, I would advise the patient to discontinue the drug immediately and report if he develops allergic symptoms or hypersensitivity reactions.

The patient’s age determined the dose of Acetaminophen. The patient is likely to have a good clearance based on his age and medical history. If he were an elderly patient, 80 years and older, a lower dose would have been prescribed. According to Bacle et al. (2019), increasing age and frailty have been associated with reduced clearance of Tylenol, leading to higher Tylenol plasma concentrations. The high plasma concentration in older patients can result in hepatotoxicity.

References

• Bacle, A., Pronier, C., Gilardi, H., Polard, E., Potin, S., & Scailteux, L. M. (2019). Hepatotoxicity risk factors and acetaminophen dose adjustment, do prescribers give this issue adequate consideration? A French university hospital study. European journal of clinical pharmacology, 75(8), 1143-1151. http //dx.doi.org/10.1136/dtb.2018.6.0636
• Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes Clinical aspects and algorithmic approach. World journal of orthopedics, 11(12), 534–558. https //doi.org/10.5312/wjo.v11.i12.534