CLASSIFICATIONS
Therapeutic:
Analgesics (centrally acting)
ACTIONS
Physiologic Mechanism
• Decreased pain.
Pharmacologic Mechanism
INDICATION
• Moderate to moderately severe pain
NURSING CONSIDERATIONS
• Assess type, location, and intensity of pain before and 2-3 hr (peak) after
administration.
• Assess previous analgesic history. Tramadol is not recommended for patients dependent
on opioids or who have previously received opioids for more than 1 wk; may cause
opioid withdrawal symptoms.
• Prolonged use may lead to physical and psychological dependence and tolerance,
although these may be milder than with opioids. This should not prevent patient from
receiving adequate analgesia. Most patients who receivetramadol for pain d not develop
psychological dependence. If tolerance develops, changing to an opioid agonist may be
required to relieve pain.
• Tramadol is considered to provide more analgesia than codeine 60 mg but less than
combined aspirin 650mg/codeine 60 mg for acute postoperative pain.
• Monitor patient for seizures. May occur within recommended dose range. Risk
increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or
Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold.
• Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may
reverse some, but not all, of the symptoms of overdose. Treatment should be
symptomatic and supportive. Maintain adequate respiratory exchange.
• Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and
pneumonia.
CLASSIFICATION
Therapeutic:
Anti-ulcer agents
Pharmacologic:
Histamine H2 antagonists
DOSAGE
20 mg
IV q8h
MECHANISM OF ACTION
• Inhibits the action of histamine at the H2 receptor site located primarily in gastric
parietal cells, resulting in inhibition of gastric acid secretion.
• In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori.
INDICATION
•Treatment and prevention of heartburn, acid indigestion, and sour stomach.
CONTRA INDICATIONS
Contraindicated in:
•Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and
should be avoided in patients with known intolerance.
• CV:
Arrhythmias
• GI:
Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis,
nausea
• GU:
Decreased sperm count, impotence
• ENDO:
Gynecomastia
• HEMAT:
Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia
• LOCAL:
Pain at IM site
• MISC:
Hypersensitivity reactions, vasculitis
NURSING IMPLICATIONS/RESPONSIBILITIES
• Assess patient for epigastric or abdominal pain and frank or occult blood in the stool,
emesis, or gastric aspirate.
• Nurse should 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 car professional promptly.
• Inform patient that medication may temporarily cause stools and tongue to appear gray
black.