CHAPTER VIII DRUG STUDY

Generic Name: Tramadol Hydrochloride

CLASSIFICATION

DOSAGE AND ADMINISTRATION

PHARMACOLOGIC ACTION

INDICATIONS

SIDE EFFECTS

NURSING CONSIDERATIONS

Analgesic (centrally acting) Opioid analgesic

Dosage: 50 mg Route: IV Frequency: q6h

Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin; causes many effects similar to the opioidsdizziness, somnolence, nausea, constipation, but does not have the respiratory depressant effects.

Relief of moderate to severe pain Relief of moderate to severe chronic pain in adults who need aroundthe-clock treatment for extended periods

Dizziness sedation drowsiness headache confusion dreaming sweating anxiety seizures hypotension tachycardia bradycardia pruritus rash pallor urticaria dry mouth constipation flatulence impaired visual acuity Nausea

Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess BP & RR before and periodically during administration. Assess bowel function routinely. Assess previous analgesic history. Prolonged use may lead to physical and psychological dependence and

vomiting loss of appetite anaphylactoid reaction

tolerance, although these may be milder than with opioids. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants, analgesics, or other drugs that decreses the seizure threshold. Overdose may cause respiratory depression and seizures. Encourage patient to cough and breathe deeply every 2 hr to prevent atelectasis and pneumonia.

Generic Name: Ketorolac tromethamine CLASSIFICATION

Antipyretic Nonopioid analgesic NSAID

DOSAGE AND ADMINISTRATION Dosage: 30 mg Route: IV Frequency: q6h

PHARMACOLOGIC ACTION Anti-inflammatory and analgesic activity; inhibits prostaglandins and leukotriene synthesis

INDICATIONS Short term management for pain (up to 5 days)

SIDE EFFECTS drowsiness abnormal thinking dizziness euphoria headache asthma dyspnea edema pallor vasodilation

NURSING CONSIDERATIONS Patients who have asthma, aspirininduced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions Assess pain prior to and 1-2 hr following administration. Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. Caution patient to

GI Bleeding abnormal taste diarrhea dry mouth dyspepsia GI pain nausea oliguria renal toxicity urinary frequency pruritis purpura sweating urticaria prolonged bleeding

avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndromes occur. Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

time

injection site pain paresthesia allergic reaction

Generic Name: Ranitidine hydrochloride CLASSIFICATION

Histamine-2 antagonist

DOSAGE AND ADMINISTRATION Dosage: 50 mg Route: IV Frequency: q8h

PHARMACOLOGIC ACTION Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibits basal gastric secretion and gastric acid secretion that stimulated by food, insulin,

INDICATION

short term treatment of active duodenal ulcer maintenance therapy for duodenal ulcer at

SIDE EFFECTS Headache Malaise dizziness somnolence insomia vertigo tachycardia bradycardia rash

NURSING CONSIDERATIONS Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.

Nurse should

histamine, cholinergic agonists, gastrin and pentagastrin.

reduced dosage short term treatment and maintenance therapy of active, benign gastric ulcer Short term treatment of GERD Pathologic hypersecreto ry condition treatment of erosive esophagitis treatment for heartburn, acid indigestion, sour stomach

alopecia constipation diarrhea nausea vomitting abdominal pain hepatitis impotence or decrease libido local burning or itching on IV site

know that it may cause false-positive results for urine protein; test with sulfosalicylic acid.

Inform patient that it may cause drowsiness or dizziness Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray

black.