DRUG Generic Name: Tramadol hydrochloride Brand Name: Ultram Classification: Analgesic Dosage: 50 mg Frequency: Q8hours Route: PO

ACTION Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin; causes many effects similar to the opioids

INDICATION Relief of moderate to moderately severe pain

CONTRAINDICATI ON Contraindicated with allergy to tramadol or opioids or acute intoxication with alcohol, opioids, or psychoactive drugs.

SIDE EFFECTS CNS: Sedation, dizziness or vertigo, headache, confusion, dreaming, sweating, anxiety, seizures CV: Hypotension, tachycardia, bradycardia, vasodilation, syncope, orthostatic hypotension Dermatologic: Sweating, pruritus, rash, pallor, urticaria GI: Nausea, vomiting, dry mouth, constipation, flatulence Other: Potential for abuse, anaphylactoid reactions

NURSING RESPONSIBLITIES History: Hypersensitivity to tramadol; pregnancy; acute intoxication with alcohol, opioids,psychotropic drugs or other centrally acting analgesics; lactation; seizures; concomitant use of CNS depressants or MAOIs; renal or hepatic impairment; past or present history of opioid addiction Physical: Skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; auscultation, BP; bowel sounds, normal output; LFTs, renal function tests Control environment (temperature, lighting) if sweating or CNS effects occur.

DRUG Generic Name: Ceftriaxone Sodium Brand Name: Rocephin Classification: Anti-Infective Dosage: 1 gm Frequency: OD Route: TIV ANST (-)

ACTION Interferes with bacterial cell wall synthesis and division by binding to cell wall, causing cell to die. Active against gram () and gram (+) bacteria, with expanded activity against gram (-) bacteria. Inhibits minimal immunosuppressant activity.

INDICATION Infections of respiratory system

CONTRAINDICATI ON hypersensitivity to cephalosporins or penicillins, allergies Renal impairment History of GI disease.

SIDE EFFECTS CNS: headache, confusion, hemiparesis, syncope seizures CV: Hypotension, palpitations, chest pain, vasodilation, EENT: hearing loss GI: Nausea, vomiting, diarrhea, constipation, abdominal cramps, oral candidiasis, pseudomembranous colitis, hepatpmegaly GU: vaginal candidiasis Hematologic: lymphocytosis, eosinophilia, bleeding tendency, haemolytic anemia Musculoskeletal: arthralgia Respiratory: dyspnea Skin: urticaria Other: anaphylaxis, serum sickness

NURSING RESPONSIBLITIES Assess CBC and kidney and liver function test results. Instruct patient to report persistent diarrhea, bruising or bleeding Caution patient not to use herbs unless prescriber approves.