GENERIC/ BRAND NAME & CLASSIFICATION Generic: tramadol hydrochloride Brand: Ultram Classification: central nervous system (cns) agent;

analgesic; narcotic (opiate) agonist

DOSE, STRENGTH & FORMULATION Ordered: 50 mg IVTT Timing: every 6 hours Duration: Other forms: tablets: 50 mg

INDICATION/ MECHANISMS OF DRUG ACTION Indications: Management of moderate to moderately severe pain. Mechanism of action: A centrally acting analgesic not related chemically to opiates. Precise mechanism is not known. Two complimentary mechanisms may be applicable: It may bind to muOpioid receptors and inhibit reuptake or norepinephrine and serotonin. The analgesic effect is only partially antagonized by the antagonist naloxone. Causes significantly less respiratory depression than morphine. In contrast to morphine, tramadol does not cause release of histamine. Produces dependence of mu- opioid type (i.e., like codeine or dextropropoxyphene); however, there is little evidence of abuse.

ADVERSE/ SIDE EFFECTS DRUG INTERACTION CNS: dizziness, vertigo, headache, somnolence, CNS stimulation, anxiety, confusion, incoordination, euphoria, nervousness, sleep disorders, seizures, paresthesia, cognitive dysfunction, hallucinations, tremor, amnesia, concentration difficulty, abnormal gait, migraine, development of drug dependence, speech disorders, depression, increased risk of seizures. GI: Nausea, constipation, vomiting, dyspepsia, dry mouth, diarrhea, abdominal pain, anorexia, flatulence, GI bleeding, hepatitis, stomatitis, dysgeusia, liver failure.




• Check doctor’s order. • Let the patient verbalize her name.

- To prevent medication error. - To correctly identify the patient so as to prevent error. - So that the patient will not be knowledge deficit about the medication she is taking. - Keeping patient well- hydrated reduces risk of nephrotoxicity. - To indicate patient’s baseline data and monitor drug’s effectiveness. - To establish proper precationary measures and management for possible adverse effects of the drug.

• Explain the possible side effects of the drug.

1. Do not perform activities that require mental alertness; drug may cause drowsiness and impair mental or physical performance. Alcohol may intensify drug effects. 2. Report lack of response. Review list of side effects (nausea, dizziness, constipation) that one may experience and report if persistent or intolerable. 3. Advise patient to avoid alcohol while taking tramadol. 4. Urge caregivers to watch patient closely for evidence of suicidal tendencies, especially when therapy starts or dosage changes and to report

• Monitor any changes in intake and output of the patient.

• Assess patient’s infection before therapy and regularly thereafter. • Be alert for signs and drug interactions like fever and rashes, notify physician immendiately.

orthostatic hypotension. syncope.To know patient’s and family’s knowledge about the drug. dyspnea. accidental injury. dysuria. Miscellaneous: anaphylaxis. deafness. tachycardia. sweating. palpitations. menstrual disorder. . weight loss. CV: Vasodilation. . the withdrawal syndrome is not as severe as with other opiates. vesicles. abnormal ECG. cataracts. myocardial ischemia. . allergic reation. • Avoid giving tramadol to patients with acute abdominal conditions. GU: urinary retention/ frequency. urticaria. StevensJohnson syndrome. malaise. Body as a whole: asthenia. toxic epidermal necrolysis. rash. Ophthalmic: miosis. pulmonary edema/ embolism.Tolerance occurs but is relatively mild. serotonin • Assess patient’s and family’s knowledge of drug therapy.It may mask evidence and disrupt assessment of the abdomen. hypertonia. Food does not affect the rate or extent of absorption. suicidal tendency. menopausal symptoms. hypertension. concerns at once to prescriber. Rapidly absorbed after PO administration. Dermatologic: pruritus. tinnitus. visual disturbances.

Naloxone/ increase risk of seizures if naloxone used for tramadol overdose. Digoxin/ increase risk (rare) of digoxin toxicity. CNS depressants/ Additive CNS depression. Anesthetics. Carbamazepine/ decrease tramadol effect R/T increase metabolism. Quinidine/ increase levels of tramadol and decrease levels of M1 R/T inhibition of metabolism. SSRIs/ increase risk .syndrome. MAO Inhibitors/ increase risk of seizures. Drug Interaction: Alcohol/ increase respiratory depression. Cyclobenzaprine/ increase risk of seizures. Promethazine/ increase risk of seizures. general/ increase respiratory depression.

of seizures and increase risk of serotonin syndrome. Warfarin/ increase PT and INR. Tricyclic antidepressants/ increase risk of seizures. .

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