GENERIC/ BRAND NAME & CLASSIFICATION Generic: tramadol hydrochloride Brand: Ultram Classification: central nervous system (cns)

agent; analgesic; narcotic (opiate) agonist

DOSE, STRENGTH & FORMULATION Ordered: 50 mg IVTT Timing: every 6 hours Duration: Other forms: tablets: 50 mg

INDICATION/ MECHANISMS OF DRUG ACTION Indications: Management of moderate to moderately severe pain. Mechanism of action: A centrally acting analgesic not related chemically to opiates. Precise mechanism is not known. Two complimentary mechanisms may be applicable: It may bind to muOpioid receptors and inhibit reuptake or norepinephrine and serotonin. The analgesic effect is only partially antagonized by the antagonist naloxone. Causes significantly less respiratory depression than morphine. In contrast to morphine, tramadol does not cause release of histamine. Produces dependence of mu- opioid type (i.e., like codeine or dextropropoxyphene); however, there is little evidence of abuse.

ADVERSE/ SIDE EFFECTS DRUG INTERACTION CNS: dizziness, vertigo, headache, somnolence, CNS stimulation, anxiety, confusion, incoordination, euphoria, nervousness, sleep disorders, seizures, paresthesia, cognitive dysfunction, hallucinations, tremor, amnesia, concentration difficulty, abnormal gait, migraine, development of drug dependence, speech disorders, depression, increased risk of seizures. GI: Nausea, constipation, vomiting, dyspepsia, dry mouth, diarrhea, abdominal pain, anorexia, flatulence, GI bleeding, hepatitis, stomatitis, dysgeusia, liver failure.

NURSING RESPONSIBILITIES

RATIONALE

CLIENT TEACHING

Check doctors order. Let the patient verbalize her name.

- To prevent medication error. - To correctly identify the patient so as to prevent error. - So that the patient will not be knowledge deficit about the medication she is taking. - Keeping patient well- hydrated reduces risk of nephrotoxicity. - To indicate patients baseline data and monitor drugs effectiveness. - To establish proper precationary measures and management for possible adverse effects of the drug.

Explain the possible side effects of the drug.

1. Do not perform activities that require mental alertness; drug may cause drowsiness and impair mental or physical performance. Alcohol may intensify drug effects. 2. Report lack of response. Review list of side effects (nausea, dizziness, constipation) that one may experience and report if persistent or intolerable. 3. Advise patient to avoid alcohol while taking tramadol. 4. Urge caregivers to watch patient closely for evidence of suicidal tendencies, especially when therapy starts or dosage changes and to report

Monitor any changes in intake and output of the patient.

Assess patients infection before therapy and regularly thereafter. Be alert for signs and drug interactions like fever and rashes, notify physician immendiately.

Tolerance occurs but is relatively mild; the withdrawal syndrome is not as severe as with other opiates. Rapidly absorbed after PO administration. Food does not affect the rate or extent of absorption.

CV: Vasodilation, syncope, orthostatic hypotension, hypertension, tachycardia, abnormal ECG, myocardial ischemia, palpitations, pulmonary edema/ embolism. Dermatologic: pruritus, sweating, rash, urticaria, vesicles, StevensJohnson syndrome, toxic epidermal necrolysis. Body as a whole: asthenia, malaise, allergic reation, accidental injury, weight loss, suicidal tendency. GU: urinary retention/ frequency, menopausal symptoms, dysuria, menstrual disorder. Ophthalmic: miosis, visual disturbances, cataracts. Miscellaneous: anaphylaxis, deafness, tinnitus, hypertonia, dyspnea, serotonin

Assess patients and familys knowledge of drug therapy. Avoid giving tramadol to patients with acute abdominal conditions.

- To know patients and familys knowledge about the drug. - It may mask evidence and disrupt assessment of the abdomen.

concerns at once to prescriber.

syndrome. Drug Interaction: Alcohol/ increase respiratory depression. Anesthetics, general/ increase respiratory depression. Carbamazepine/ decrease tramadol effect R/T increase metabolism. CNS depressants/ Additive CNS depression. Cyclobenzaprine/ increase risk of seizures. Digoxin/ increase risk (rare) of digoxin toxicity. MAO Inhibitors/ increase risk of seizures. Naloxone/ increase risk of seizures if naloxone used for tramadol overdose. Promethazine/ increase risk of seizures. Quinidine/ increase levels of tramadol and decrease levels of M1 R/T inhibition of metabolism. SSRIs/ increase risk

of seizures and increase risk of serotonin syndrome. Tricyclic antidepressants/ increase risk of seizures. Warfarin/ increase PT and INR.