Generic name: Tramadol
Classifications: central nervous system (cns) agent; analgesic; narcotic (opiate) agonist
Action: Centrally acting opiate receptor agonist that inhibits the uptake of norepinephrine and
serotonin, suggesting both opioid and non-opioid mechanisms of pain relief. May produce
opioid-like effects, but causes less respiratory depression than morphine
Dose, frequency, and route of administration (doctor's order):
Indication/s for administering the medication to the patient: Treatment of moderate to
severe pain and of Post-operative pain
Contraindications: Hypersensitivity to tramadol or other opioid analgesics; patients on MAO
inhibitors; patients acutely intoxicated with alcohol, hypnotics, centrally acting analgesics,
opioids, or psychotropic drugs; substance abuse; patients on obstetric preoperative medication;
abrupt discontinuation; alcohol intoxication; pregnancy (category C); lactation; children <16 y.
Side Effects: Frequent (25%–15%): Dizziness, vertigo, nausea, constipation, headache,
drowsiness. Occasional (10%–5%): Vomiting, pruritus, CNS stimulation (e.g., nervousness,
anxiety, agitation, tremor, euphoria, mood swings, hallucinations), asthenia, diaphoresis,
dyspepsia, dry mouth, diarrhea. Rare (less than 5%): Malaise, vasodilation, anorexia,
flatulence, rash, blurred vision, urinary retention/frequency, menopausal symptoms.
Adverse Effects: CNS: Drowsiness, dizziness, vertigo, fatigue, headache,
somnolence, restlessness, euphoria, confusion, anxiety, coordination disturbance, sleep
disturbances, seizures.
CV: Palpitations, vasodilation.
GI: Nausea, constipation, vomiting, xerostomia, dyspepsia, diarrhea, abdominal pain, anorexia,
flatulence.
Body as a Whole: Sweating, anaphylactic reaction (even with first dose), withdrawal syndrome
(anxiety, sweating, nausea, tremors, diarrhea, piloerection, panic attacks, paresthesia,
hallucinations) with abrupt discontinuation.
Skin: Rash. Special Senses: Visual disturbances. Urogenital: Urinary retention/frequency,
menopausal symptoms.
Nursing Responsibilities:
Assess for level of pain relief and administer prn dose as needed but not to exceed the
recommended total daily dose.
Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression.
Discontinue drug and notify physician if S&S of hypersensitivity occur.
Assess bowel and bladder function; report urinary frequency or retention.
Use seizure precautions for patients who have a history of seizures or who are
concurrently using drugs that lower the seizure threshold.
Monitor ambulation and take appropriate safety precautions.
Patient health teaching:
Exercise caution with potentially hazardous activities until response to drug is known.
Understand potential adverse effects and report problems with bowel and bladder
function, CNS impairment, and any other bothersome adverse effects to physician.
Do not breast feed while taking this drug.
2. Generic name: acetaminophen, paracetamol
Classifications: central nervous system agent; nonnarcotic analgesic, antipyretic
Action: Produces analgesia by unknown mechanism, perhaps by action on peripheral nervous
system. Reduces fever by direct action on hypothalamus heat-regulating center with
consequent peripheral vasodilation, sweating, and dissipation of heat. Unlike aspirin,
acetaminophen has little effect on platelet aggregation, does not affect bleeding time, and
generally produces no gastric bleeding.
Dose, frequency, and route of administration (doctor's order):
Indication/s for administering the medication to the patient:
PO, rectal: Temporary relief of mild to moderate pain, headache, fever.
IV: (Additional) Management of moderate to severe pain when combined with opioid analgesia.
Contraindications: Hypersensitivity to acetaminophen or phenacetin; use with alcohol; and
severe hepatic impairment or severe active liver disease
Side Effects: Nausea, Vomiting, Mild stomach pain, Diarrhea, Headache, Heartburn
Adverse Effects: Body as a Whole: Negligible with recommended dosage; rash.
Acute poisoning: Anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, epigastric
or abdominal pain, diarrhea; onset of hepatotoxicity—elevation of serum transaminases (ALT,
AST) and bilirubin; hypoglycemia, hepatic coma, acute renal failure (rare).
Chronic ingestion: Neutropenia, pancytopenia, leukopenia, thrombocytopenic
purpura, hepatotoxicity in alcoholics, renal damage.
Nursing Responsibilities:
Monitor for S&S of: hepatotoxicity, even with moderate acetaminophen doses, especially in
individuals with poor nutrition or who have ingested alcohol over prolonged periods; poisoning,
usually from accidental ingestion or suicide attempts; potential abuse from psychological
dependence (withdrawal has been associated with restless and excited responses).
Monitor serum paracetamol levels in patients with hepatic disease during prolonged use.
Assess relief of pain or fever.
Patient health teaching:
Do not take other medications (e.g., cold preparations) containing acetaminophen without
medical advice; overdosing and chronic use can cause liver damage and other toxic effects.
Do not self-medicate adults for pain more than 10 d (5 d in children) without consulting a
physician.
Do not use this medication without medical direction for: fever persisting longer than 3 d, fever
over 39.5° C (103° F), or recurrent fever.
Do not give children more than 5 doses in 24 h unless prescribed by physician.
Do not breast feed while taking this drug without consulting physician.
3. Generic name: ketorolac tromethamine
Classifications: central nervous system agent; nsaid, analgesic; antipyretic
Action: It inhibits synthesis of prostaglandins and is a peripherally acting analgesic. Ketorolac
does not have any known effects on opiate receptors.
Dose, frequency, and route of administration (doctor's order):
Indication/s for administering the medication to the patient: Short-term management of
pain; ocular itching due to seasonal allergic conjunctivitis, reduction of post-operative pain and
photophobia after refractive surgery
Contraindications: Hypersensitivity to ketorolac; individuals with complete or partial syndrome
of nasal polyps, angioedema, and bronchospastic reaction to aspirin or other NSAIDs; during
labor and delivery; patients with severe renal impairment or at risk for renal failure due to
volume depletion; patients with risk of bleeding; active peptic ulcer disease; pre- or
intraoperatively; intrathecal or epidural administration; in combination with other NSAIDs;
lactation.
Side Effects: Frequent (17%–12%): Headache, nausea, abdominal cramps/pain, dyspepsia.
Occasional (9%–3%): Diarrhea. Nasal: Nasal discomfort, rhinalgia, increased lacrimation, throat
irritation, rhinitis. Ophthalmic: Transient stinging, burning. Rare (3%–1%): Constipation,
vomiting, flatulence, stomatitis. Ophthalmic: Ocular irritation, allergic reactions (manifested by
pruritus, stinging), superficial ocular infection, keratitis.
Adverse Effects: CNS: Drowsiness, dizziness, headache. GI: Nausea, dyspepsia, GI
pain, hemorrhage. Other: Edema, sweating, pain at injection site.
Nursing Responsibilities:
Correct hypovolemia prior to administration of ketorolac.
Lab tests: Periodic serum electrolytes and liver functions; urinalysis (for hematuria and
proteinuria) with long-term use.
Monitor urine output in older adults and patients with a history of cardiac
decompensation, renal impairment, heart failure, or liver dysfunction as well as those
taking diuretics. Discontinuation of drug will return urine output to pretreatment level.
Monitor for S&S of GI distress or bleeding including nausea, GI pain, diarrhea, melena,
or hematemesis. GI ulceration with perforation can occur anytime during treatment. Drug
decreases platelet aggregation and thus may prolong bleeding time.
Monitor for fluid retention and edema in patients with a history of CHF.
Patient health teaching:
Watch for S&S of GI ulceration and bleeding (e.g., bloody emesis, black tarry stools)
during long-term therapy.
Note: Possible CNS adverse effects (e.g., light-headedness, dizziness, drowsiness).
Do not drive or engage in potentially hazardous activities until response to drug is
known.
Do not use other NSAIDs while taking this drug.
Do not breast feed while taking this drug.
