Tramadol

 Analgesics (centrally acting)

 Opiod
 INDICATION: Moderate to moderately severe pain
 ACTION: Binds to mu-opiod receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS.
 EFFECTS: Sedation, dizziness/vertigo, headache, confusion, dreaming, anxiety, seizures, Hypotension,
tachycardia, bradycardia, Sweating, pruritus, rash, pallor, urticaria, Nausea, vomiting, dry mouth,
constipation, flatulence
 INTERVENTION:
• Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration.

• Assess BP & RR before and periodically during administration. Respiratory depression has not occurred
with recommended doses.

• Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of
fluids and bulk and with laxatives to minimize

METOCLOPRAMIDE

 Classification: gastrointestinal stimulant

 Action: dopamine antagonist that acts by increasing sensitivity to acetylcholine; results increase motility of
the upper GI tract and relaxation of pyloric sphincter and duodenal bulb.
 Indication: For the treatment of gastroesophageal reflux disease (GERD)
 side effects: change in mood (depression), constipation, diarrhea, drowsiness, fatigue, involuntary
movements of the limbs or eyes, restlessness
 Nursing responsibilities:
o Inject IV slowly over 1-2 mins to prevent transient feelings of anxiety
o Note reasons for therapy
o Assess abdomen bowel sounds, distention, N& V
o Instruct to take as directed may dilute syrup in water, juice or carbonated drink
o Advise that drug increases movements or contractions

RANITIDINE

 Classification: Anti-ulcer
 Mechanism of Action: Inhibits the action of histamine at theH2 receptor site located primarily in gastric
parietal cells, resulting in inhibition of gastric acid secretion has some antibacterial action against H. pylori
 Effects: Constipation, Diarrhea, Fatigue, Headache, Insomnia, Muscle pain, Nausea, Vomiting, Agitation,
Anemia, Confusion, Depression, Easy bruising or bleeding
 Nursing Responsibilities:
o Instruct client to report any adverse reaction to the physician or nurse.
o Inform patient that the medication may cause drowsiness, dizziness, or fatigue
o Allow 1 hour between any other antacidand ranitidine
o Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or
gastric aspirate
o Inform patient that increased fluid and fiber intake may minimize constipation
PARACETAMOL

 Classification: ANTYPYRETIC, Analgesics, Muscle Relaxants

 MECAHNISM OF ACTION: Decreases fever by inhibiting the effects of pyrogens on the hypothalamus heat
regulating centers & by a hypothalamic action leading to sweating & vasodilatation. Relieves pain by
inhibiting prostaglandin synthesis at the CNS but does not have anti-inflammatory action because of its
minimal effect on peripheral prostaglandin synthesis.
 INDICATIONS: Relief of mild-to-moderate pain; treatment of fever.
 ADVERSE EFFECTS OF THE DRUG
Stimulation, drowsiness, nausea, vomiting, abdominal pain, hepatotoxicity, hepatic seizure(overdose, Renal
failure(high, prolonged doses), leucopenia, neutropenia, hemolytic anemia (long term use)
thrombocytopenia, pancytopenia, rash, urticaria, hypersensitivity, cyanosis, anemia, jaundice, CNS,
stimulation, delirium followed by vascular collaps, convulsions, coma, death.
 NURSING INTERVENTION and PRECAUTIONS
♥ Assess patient’s fever or pain: typeof pain, location, intensity, duration, temperature, and diaphoresis.

♥Assess allergic reactions: rash, urticaria; if these occur, drug may have to be discontinued.

♥Teach patient to recognize signs of chronic overdose: bleeding, bruising, malaise, fever, sore throat.

♥Tell patient to notify prescriber for pain/ fever lasting for more than 3 days.

LACTULOSE

 Classifcation: Laxative
 Action: Causes an influx of fluid in the intestinal tract by increasing the osmotic pressure within the intestinal
lumen. Bacterial metabolism of the drug to lactate and other acids which are only partially absorbed in the
distal ileum and colon augments the osmotic effect of lactulose. The distention of the colon due to increased
fluid enhances intestinal motility and secretion. These result to the passage of soft stools. Decrease in the
lumenal due to bacterial metabolism further increase motility and secretion. Lactulose also lowers intestinal
absorption o ammonia presumably due to increased utilization o ammonia by intestinal bacteria.
 Indication: Constipation
 Adverse Reactions: abdominal discomfort associated with flatulence and intestinal cramps. Nausea and
vomiting, diarrhea on prolonged used.
 Nursing Considerations:
o Assess patient's condition before therapy and reassess regularly thereafter to monitor drug's
effectiveness
o monitor for possible adverse reaction
o monitor fluid and electrolyte status