DRUG ORDER Omeprazol e 20mg tab OD

PHARMACOL OGIC ACTION OF DRUG Gastric acidpump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

INDICATIONS AND CONTRAINDICATIONS INDICATIONS: Short-term treatment of active duodenal ulcer; First-line therapy in treatment of heartburn or symptoms of gastroesophageal reflux disease (GERD); Short-term treatment of active benign gastric ulcer; GERD, severe erosive esophagitis, poorly responsive symptomatic GERD; Longterm therapy: Treatment of pathologic hypersecretory conditions (ZollingerEllison syndrome, multiple adenomas, systemic mastocytosis); Eradication of H. pylori with amoxicillin or metronidazole and clarithromycin; Prilosec OTC: Treatment of frequent heartburn (2 or more days per wk); Unlabeled use: Posterior laryngitis; enhance efficacy of pancreatin for the treatment of steatorrhea in cystic fibrosis CONTRAINDICATIONS: Contraindicated with hypersensitivity to omeprazole or its components; Use cautiously with pregnancy, lactation.

ADVERSE EFFECTS OF THE DRUG CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis Other: Cancer in preclinical studies, back pain, fever

DESIRED ACTION ON THE CLIENT Treatment of active benign gastric ulcer

NURSING RESPONSIBILITIES/ PRECAUTIONS Assessment History: Hypersensitivity to omeprazole or any of its components; pregnancy, lactation Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal exam; respiratory auscultation Interventions Administer before meals. Caution patient to swallow capsules whole not to open, chew, or crush them. Arrange for further evaluation of patient after 8 wk of therapy for gastroreflux disorders; not intended for maintenance therapy. Symptomatic improvement does not rule out gastric cancer, which did occur in preclinical studies. Administer antacids with omeprazole, if needed. Teaching points Take the drug before meals. Swallow the capsules whole; do not chew, open, or crush them. This drug will need to be taken for up to 8 wk (short-term therapy) or for a prolonged period (> 5 yr in some cases). Have regular medical follow-up visits. These side effects may occur: Dizziness (avoid driving or performing hazardous tasks);

headache (request medications); nausea, vomiting, diarrhea (maintain proper nutrition); symptoms of upper respiratory tract infection, cough (do not selfmedicate; consult with your health care provider if uncomfortable). Report severe headache, worsening of symptoms, fever, chills. 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 Exam: Skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP; bowel sounds, normal output; liver and kidney function tests Control environment (temperature, lighting) if sweating or CNS effects occur. Teaching points Limit use in patients with past or present history of addiction to or dependence on opioids. These side effects may occur: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals). Report severe nausea, dizziness,

Tramadol 50mg tab 1 tab q6h RTC

Has an analgesic effect in all the usual test models for centrally acting analgesics. On parenteral administration, the intensity of the effect is equivalent to that of other opioid analgesics eg, Pentazocine and pethidine. The onset of activity is rapid and the duration of the effect is similar to that of morphine. Tramadol HCL is a pure agonist. The morphine antagonist, naloxone, neutralizes the analgesic effect.

Indication: Moderate to severe pain. Contraindicated in: Hypersensitivity Cross-sensitivity with opioids may occur Patients who are acutely intoxicated with alcohol, sedative/hypnotics, centrally acting analgesics, opioid analgesics, or psychotropic agents Patients who are physically dependent on opioids (may precipitate withdrawal) Not recommended for use during pregnancy or lactation. Use Cautiously in:

Geriatric patients (not to exceed

300 mg/day in patients >75 yr) Patients with a history of epilepsy or risk factors for seizures Renal impairment (increased dosing interval recommended if CCr >30 ml/min) Hepatic impairment (increased interval recommended in patients with cirrhosis) Patients receiving MAO inhibitors or CNS depressants Increased intracranial pressure or head trauma Acute abdomen (may preclude accurate clinical assessment)

CNS: SEIZURES, dizziness, headache, somnolence, anxiety, CNS stimulation, confusion, coordination disturbance, euphoria, malaise, nervousness, sleep disorder, weakness. EENT: visual disturbances. CV: vasodilation. GI: constipation, nausea, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, vomiting. GU: menopausal symptoms, urinary retention/frequency. Derm: pruritus, sweating. Neuro: hypertonia. Misc: physical dependence, psychological dependence, tolerance.

Relief from pain

 Patients with a history of opioid

dependence or who have recently received large doses of opioids Children <16 yr (safety not established).

severe constipation