Drug #1

Gabapentin is an anti-epileptic medication, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Gabapentin is used alone or in combination with other medications to treat seizures caused by epilepsy in adults and children who are at least 12 years old. Gabapentin is also used with other medications to treat partial seizures in children who are 3 to 12 years old. Gabapentin is also used in adults to treat nerve pain caused by herpes virus or shingles (herpes zoster), and to treat restless legs syndrome (RLS).

Important information about gabapentin

You should not use this medication if you are allergic to gabapentin. Before taking gabapentin, tell your doctor if you have kidney, liver, or heart disease. You may have thoughts about suicide while taking gabapentin. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, depression, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself. Do not stop taking gabapentin for seizures without first talking to your doctor, even if you feel fine. You may have increased seizures if you stop using gabapentin suddenly. You may need to use less and less before you stop the medication completely.

Before taking gabapentin

You should not use this medication if you are allergic to gabapentin. To make sure you can safely take gabapentin, tell your doctor if you have any of these other conditions:
kidney disease; liver disease; heart disease; or (for patients with RLS) if you are a day sleeper or work a night shift.

You may have thoughts about suicide while taking gabapentin. Tell your doctor if you have new or worsening depression or suicidal thoughts during the first several months of treatment, or whenever your dose is changed. Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments. FDA pregnancy category C. It is not known whether gabapentin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Gabapentin can pass into breast milk and may harm a nursing baby. Do not use gabapentin without telling your doctor if you are breast-feeding a baby.

What should I avoid while taking gabapentin?

This medication may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. Avoid taking an antacid within 2 hours before or after you take gabapentin. Antacids can make it harder for your body to absorb gabapentin. The Horizant brand of gabapentin should not be taken during the day. For best results, take Horizant with food at about 5:00 in the evening.

The Neurontin brand of gabapentin can be taken with or without food. If you break a tablet and take one half of it, take the other half at your next dose. Any tablet that has been broken should be used as soon as possible or within a few days. Avoid taking an antacid within 2 hours before or after you take gabapentin. Antacids can make it harder for your body to absorb gabapentin.

Brand names: Neurontin, Gabarone Generic Name: gabapentin

MIMS Class ATC Classification Mechanism of Action Anticonvulsants N03AX12 - Gabapentin ; Belongs to the class of other antiepileptics. Gabapentin is structurally related to the neurotransmitter GABA but is neither a GABA agonist nor antagonist. Gabapentin-binding sites have been identified throughout the brain tissues e.g. neocortex and hippocampus. However, the exact mechanism of action is still unknown. Absorption: 50-60% absorbed (oral); peak plasma concentrations after 2 hr. Distribution: Widely distributed; enters breast milk. Protein-binding: Minimal. Metabolism: Poor. Excretion: Urine and faeces; 5-7 hr (elimination half-life). Hypersensitivity. Lactation.

Contraindications

drug # 2 Brand Name: ULTRAM Generic Name: TRAMADOL CLASSIFICATIONS Therapeutic: Analgesics (centrally acting)

ACTIONS Physiologic Mechanism Decreased pain. Pharmacologic Mechanism Binds to mu-opioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS. MOA: binds to opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; Also inhibits the reuptake of norepinephrine and serotonin which also modifies the ascend pain pathway. INDICATION Moderate to moderately severe pain Management of pain in the operation site SE: DIZZINESS, NAUSEA,DROWSINESS, DRY MOUTH, CONSTIPATION, H/A, SWEATING, VOMITING, ITCHING, RASH, VISUAL DISTURBANCES, VERTIGO Contraindications: hypersentivity to tramadol, opioids or any companion of the formulation; opioid-dependent pts; acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic.

NURSING CONSIDERATIONS 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 constipating effects. Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms. Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. Most patients who receivetramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain. Tramadol is considered to provide more analgesia than codeine 60 mg but less than combined aspirin 650mg/codeine 60 mg for acute postoperative pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.
TELL the pt that driving or operating machinery should be avoided until the effect of drug wears off. Instruct pt to report cravings to physician immediately Inform client that medication may cause cns depression and/or respiratory depression particularly when combined with or other cns depressants.