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: IVFrequency: q6h

Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin; causes many effects similar to the opioids-dizziness, 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 around-the-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 DOSAGE AND ADMINISTRATION

PHARMACOLOGIC ACTION

INDICATIONS SIDE EFFECTS

NURSING CONSIDERATIONS

Antipyretic Nonopioid

analgesic NSAID

Dosage: 30 mgRoute: IVFrequency: q6h

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

Short term management for pain (up to 5 days)

drowsiness

abnormal thinking

dizziness

euphoria

headache

asthma

dyspnea

edema

pallor

vasodilation

Patients who have asthma, aspirin-induced 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.

GI Bleeding

abnormal taste

diarrhea

dry mouth

dyspepsia

GI pain

nausea

oliguria

renal toxicity

urinary frequency

pruritis

purpura

sweating

urticaria

prolonged bleeding

Caution patient to 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 DOSAGE AND ADMINISTRATION

PHARMACOLOGIC ACTION

INDICATION SIDE EFFECTS

NURSING CONSIDERATIONS

Histamine-2 antagonist

Dosage: 50 mgRoute: IVFrequency: q8h

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,

short term treatment of active duodenal ulcer

maintenance therapy for duodenal ulcer at

Headache Malaise dizziness somnolence insomia vertigo tachycardia bradycardia rash

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 hypersecretory 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.