ANALGESIC Analgesics are medications used to relieve pain without reducing the consciousness of the patient.

They work by reducing the amount of pain felt and this is generally achieved by interfering with the way the pain message is transmitted by the nerves. Analgesics will not treat the cause of the pain but they will provide temporary relief from pain symptoms. There are three main categories of analgesics: opioid, non-opioid, and adjuvant analgesics.

Drug Name Tramadol Hydrochloride Ultram

Pharmacologic Action Binds to muopioid receptors and inhibits the reuptake of norepinephrine and serotonin;cause s many effects similar to the opioids dizziness, somnolence, nausea, constipation but does not have the respiratory depressant effects.

Therapeutic Use Analgesic (centrally acting)

Side Effects CNS: Sedation, dizziness or vertigo, headache, confusi on, dreaming, sweating, anxiety,seizures CV:Hypotension, tachycardia, bradycardia Dermatologic:Sw eat ing, pruritus, rash, pallor, urticaria GI: Nausea, vomiting, dry mouth, constipation, flatulence Other: Potential for abuse, anaphylac toid reactions

Indications Relief of moderate to moderately severe pain Relief for moderate to severe chronic pain for adults who need around-theclock treatment for extended periods

Contraindications

Nursing Responsibilities

Contraindicated Assess history with allergy to to hypersensitivity to tramadol or tramadol; pregnancy; opioids or acute acute intoxication intoxication with withalcohol, opioids, alcohol, opioids, or psychotropic drugs or psychotropic other centrally acting drugs. analgesics; lactation; seizures Use cautiously Control environment with pregnancy, lactation, seizures, (temperature, lighting) if concomitant use of sweating or CNS effects CNS depressants occur. or MAOIs, renal or Teaching points hepatic Limit use in patients with impairment. past or present history of addiction to or dependence on opioids. These side effects may occur: Dizziness, sedation, drowsiness, impaired visualacuity (avoid driving or performing tasks that require alertness); nausea, loss ofappetite (lie quietly, eat frequent small meals). Report severe nausea, dizziness, severe constipation.

Morphine Sulfate Immediaterelease tablets: MSIR Timed-release: Kadian, MEslon (CAN), MS Contin, Oramorph SR Oral solution: MSIR, Rescudose, Roxanol, Roxanol T Rectal suppositories: RMS Injection: Astramorph PF, Duramorp h, Epimorph (CAN) Preservativefree concentrate for microinfusion devices for intraspinal use: Infumorph

Principal opium alkaloid; acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

Opioid agonist analgesic

CNS: Lightheadedness, dizziness, sedation, euphori a, delirium, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex CV:Facial flushing, peripheral circulatory collapse, arrhythmia, palpitations, hypertension, hypotension, orthostatic hypotension, syncope GI: Nausea, vomiting, dry mouth, anorexia, constipation GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency Local: Tissue irritation and induration (SC injection)

Relief of Contraindicated with moderate to hypersensitivity to severe acute and opioids; diarrhea chronic pain caused by poisoning until toxins are Preoperative eliminated; during medication to labor or delivery of a sedate and allay premature infant; apprehension, after biliary tract facilitate surgery or induction of following surgical anesthesia, and anastomosis; reduce pregnancy; labor anesthetic dosage Use cautiously with head injury and Analgesic increased adjunct during intracranial pressure; anesthesia acute asthma, Component of COPD, cor pulmonale, most preexisting preparations respiratory that are referred depression, hypoxia, to as Brompton's hypercapnia; cocktail or lactation (wait 4 mixture, an oral 6 hr after alcoholic administration to solution that is nurse the baby); used for chronic acute abdominal severe pain, conditions, CV especially disease, in terminal supraventricular cancer patients tachycardias, Intraspinal use myxedema, seizure with disorders, acute microinfusion alcoholism, delirium devices for the tremens, cerebral relief of arteriosclerosis, intractable pain ulcerative colitis, Unlabeled use: fever, Dyspnea kyphoscoliosis, associated with Addison's disease, acute left

Assess for hypersensitivity to opioids; diarrhea caused by poisoning; labor or delivery of a premature infant and other contraindications. Caution patient not to chew or crush controlledrelease preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. Tell patient to lie down during IV administration. Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medical reasons do not develop dependence syndromes. Teaching points Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives,tranquilizers, over-the-counter drugs. Swallow controlled-release

Major hazards: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest Other:Sweating, p hysical tolerance and dependence, psychological dependence

ventricular failure and pulmonary edema

prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction.

preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or chew them. Do not take leftover medication for other disorders, and do not let anyone else take your prescription Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.