Generic/Brand Name & Dose Strength & Indication/ Mechanism of Adverse/Side Effects & Nursing Responsibilities Rationale Client
g Responsibilities Rationale Client Teaching
Drug Classification Formulation
Dose Strength:
Generic Name: Usual dose
Tramadol +
Paracetamol Oral Moderate to Severe
Pain Adult: Available
Brand Name: Preparations: Indications
ConZip, Rybix ODT, and Dosage
Ryzolt, Ultram, Ultram
ER Tabs containing 37.5 mg of
tramadol and 325 mg of
Drug Classification: paracetamol
Analgesic Opioids
Tab with 75 mg of tramadol
and 650 mg of paracetamol
Effervescent tab containing
tramadol 37.5 mg and
paracetamol 325 mg
As needed, use 1-2 tabs
every 4-6 hours of tramadol
37.5 mg and paracetamol
325 mg film-coated tablets.
8 tablets maximum daily.
As with a standard tab of
paracetamol 650 mg and
tramadol 75 mg, take one
every six hours as needed.
4 tabs maximum daily.
Take 2 effervescent tabs of
tramadol 37.5 mg and
paracetamol 325 mg as
needed every six hours. 8
tablets maximum daily.
Maximum daily doses are
similar to 300 mg of
tramadol and 2,600 mg of
paracetamol. Use the
Evaluation
Drug Action
Indication:
To relieve moderate to
moderately severe pain
Mechanism of Drug Action:
Binds with mu receptors
and inhibits the reuptake of
norepinephrine and
serotonin, which may
account for tramadol’s
analgesic effect.
Drug Interaction
Adverse/Side Effects:
CNS: Agitation, anxiety,
asthenia, depression,
dizziness, emotional lability,
euphoria, fatigue, fever,
hallucinations, headache,
hypertonia, hypoesthesia,
insomnia, lethargy,
nervousness, paresthesia,
restlessness, rigors,
seizures, serotonin
syndrome, somnolence,
suicidal ideation, tremor,
vertigo, weakness
CV: Chest pain, orthostatic
hypotension, vasodilation
EENT: Blurred vision, dry
mouth, nasal or sinus
congestion, sore throat,
vision changes ENDO: Hot
flashes GI: Abdominal pain,
anorexia, constipation,
diarrhea, indigestion,
nausea, vomiting GU:
Urinary frequency, urine
retention
MS: Arthralgia; back, limb,
or neck pain
RESP: Cough, dyspnea
SKIN: Diaphoresis,
dermatitis, flushing, pruritus,
rash Other: Flulike illness,
physical and psychological
dependence
DRUGS INTERACTIONS
anti-inhibitor coagulant
concentrates, factor IX
complex concentrates,
• Avoid giving tramadol because it may mask  Observe the patient's
to patients with acute evidence and disrupt  Urge patient to follow response to the
abdominal conditions assessment of the prescribed dose limits treatment
abdomen and dosing intervals
to prevent respiratory  Monitor for adverse
• assess patient for depression and effects
evidence of dependence seizures.
or abuse before giving Because tramadol may  Instruct patient
first dose of tramadol. lead to physical and prescribed  Asking the patient
Avoid giving drug to psychological extendedrelease form about the drug, its
patients with a history of dependence to swallow tablet indication, and
dependence on other whole and not to potential side effects
opioids chew, crush, or split will help you
tablet. determine how well
•After patient receives  Instruct patient they comprehend
first tramadol dose, prescribed orally your pharmacological
watch for allergic disintegrating tablets therapy.
reactions, including to place the tablet on
angioedema, his tongue until it is
bronchospasm, pruritus, completely dissolved,
Stevens-Johnson As baseline data for which may take up to
syndrome, toxic controlling the dose a minute, and then
epidermal necrolysis, swallow it. Tablet
and urticaria. Also watch may be taken with or
for signs and symptoms without water but
of anaphylaxis, such as tablet must be
dyspnea and completely dissolved
hypotension before water is taken.
 Caution patient not to
stop tramadol
abruptly.
 Instruct patient to
avoid hazardous
activities until drug’s
CNS effects are
known.
 Advise patient to
avoid alcohol while
shortest treatment period
possible while still using the
lowest effective dose.
Depending on the patient's
sensitivity and level of
discomfort, the dose must
be changed.
hormonal contraceptives:
Increased thrombotic risk
tissue plasminogen
activators: Possibly
decreased effectiveness of
both tranexamic acid and
the tissue plasminogen
activator tretinoin (oral):
Possibly exacerbation of the
procoagulant effect of
tretinoin
Drug Interaction:
Tramadol:
 May increase the risk of
convulsions with SSRIs,
serotonin-norepinephrine
reuptake inhibitors (SNRIs),
TCAs and other seizure
threshold lowering-drugs
(e.g. bupropion,
mirtazapine). Decreased
serum concentrations with
CYP3A4 inducers (e.g.
rifampicin, carbamazepine,
phenytoin). CYP2D6
inhibitors (e.g. quinidine,
fluoxetine) may increase
plasma levels of tramadol
and decrease plasma
concentrations of M1 (active
metabolite). CYP3A4
inhibitors (e.g. erythromycin,
ketoconazole, ritonavir) may
elevate tramadol plasma
levels and result in
increased amount of
metabolism by CYP2D6
isoenzyme and higher M1
levels. Mixed opioid
agonist/antagonists (e.g.
taking tramadol.
 Urge patient to notify
prescriber about
known, suspected, or
intended pregnancy.
 Urge caregivers to
watch patient closely
for evidence of
suicidal tendencies,
especially when
therapy starts or
dosage changes and
to report concerns at
once to prescriber.
 Tell patient to notify
prescriber
immediately if he
develops any sudden
onset, unusual,
persistent, or severe
adverse reactions.
 Instruct patient to
inform all prescribers
of tramadol therapy
because of potential
drug interactions.
 nalbuphine, pentazocine)
may reduce the analgesic
effect or precipitate
withdrawal symptoms of
tramadol. May result in
serotonin syndrome with
serotonergic agents (e.g.
triptans, SSRIs, SNRIs,
TCAs). May lead to
increased INR when used
with warfarin.

Paracetamol:
increased risk of
hepatotoxicity when
administered alongside
other drugs that could be
hepatotoxic. Colestyramine
causes a reduction in
absorption. When used with
various anticonvulsants and
rifampicin, serum
concentrations may be
reduced (e.g. phenytoin,
phenobarbital,
carbamazepine, primidone).
enhances warfarin's ability
to prevent clotting.
Metoclopramide causes an
increase in absorption.
Probenecid may raise the
serum concentration
Generic/Brand Name & Dose Strength & Indication/ Mechanism of Adverse/Side Effects & Nursing Responsibilities Rationale Client Teaching Evaluation
Drug Classification Formulation Drug Action Drug Interaction
Dose Strength: Indication: Adverse/Side Effects: • Be aware that women • Neonatal opioid • Instruct patient to avoid  Observe the patient's
Generic Name: Usual dose Indication: Sedation, clamminess, should not be withdrawal syndrome alcohol and other CNS response to the
Fentanyl • Short-acting analgesics lethargy, palpitation, cardiac administered opioids like (NOWS), which can depressants during fentanyl treatment
Dose Strength: used during anesthesia arrest, arrhythmias, nausea fentanyl when they are manifest as poor feeding, therapy unless prescribed
Brand Name: Pre-med: 50-100 mcg IM and the first several hours and vomiting, slow and pregnant, giving birth, or rapid breathing, trembling,  Monitor for adverse
ConZip, Rybix ODT, 30-60 min. before surgery. after surgery. shallow respirations, nursing a baby. and excessive or high- • Advise patient not to stop effects
• A supplement of constipation, rash, anorexia. pitched crying, can affect
Ryzolt, Ultram, Ultram
ER Adjunct to general
anesthesia: Initial dosage is
Drug Classification: 2-20 mcg/kg.
Analgesic Opioids
With oxygen for
anesthesia: Total high dose
is 20-50 mcg/kg IV.
Drug Formulation:
Lozenges, Transdermal,
Injection, Buccal Tablets
analgesics during general
or local anesthesia.
• As an anesthetic
medication in combination
with oxygen in certain high-
risk individuals.
Mechanism of Drug Action:
causes analgesia,
respiratory depression,
bodily depression, and
euphoria by acting at
certain opioid receptors.
Drug Interaction:
Potentiation of effects when
used in conjunction with
macrolide antibiotics,
ketoconazole, itraconazole,
and protease inhibitors;
effects may also occur
when used with other CNS
depressants or barbiturate
anesthetics; reduce fentanyl
dosage when co-
administered.
•Use with the utmost
caution in people who
have severe COPD or
cor pulmonale, as well as
in people who have a
significantly reduced
respiratory reserve,
hypoxia, hypercapnia, or
underlying respiratory
depression.
a newborn or infant. taking drug unless directed by
prescriber because withdrawal  Asking the patient
• Due to the fact that even symptoms may occur. Warn about the drug, its
therapeutic doses of against increasing dose or indication, and
fentanyl may cause these frequency potential side effects
patients' respiratory drive will help you
to diminish to the point of determine how well
apnea. they comprehend
your pharmacological
therapy.

• Use caution when Because these patients

titrating fentanyl dosage are more sensitive to the
in elderly, cachectic, and drug’s effects
debilitated patients,
especially when using
intravenous route

• spray the allergy inhaler

triamcinolone on the • To reduce skin irritation
patient’s skin, as
prescribed, before
applying a fentanyl
patch.

• Expect the blood

fentanyl level to be • Because drug is
prolonged if patient absorbed slowly from GI
chews or swallows the tract
transmucosal form

• also plan to give a

nonopioid analgesic,
such as acetaminophen, • To achieve optimum
as prescribed. pain control with the
lowest possible fentanyl
 dose
Generic/Brand Name & Dose Strength & Indication/ Mechanism of Adverse/Side Effects & Nursing Responsibilities Rationale Client Teaching Evaluation
Drug Classification Formulation Drug Action Drug Interaction
Generic Name: • 325 mg acetaminophen Indication: Adverse/Side Effects: • both before and after • given that • Inform the patient that tablets  Observe the patient's
Oxycodone and 5mg oxycodone Oxycodone Acetaminophen prolonged therapy acetaminophen can be broken up or taken response to the
+Acetaminophen • 5 mg oxycodone alleviation of moderate to Early Signs of includes monitoring and hepatotoxic effects. Make whole. treatment
hydrochloride and 300 mg severe pain (often in Acetaminophen Toxicity: parenteral treatment sure the • Concentrated infant drops are
Brand Name: acetaminophen 7.5 mg with non-opioid analgesics Anorexia, nausea, outcomes of liver daily acetaminophen no longer produced and are  Monitor for adverse
Oxecta, OxyContin, oxycodone hydrochloride in combination). diaphoresis, fatigue within function tests, including intake from all being phased out, however effects
RoxicodoneRyzolt, and 300 mg first 12–24 hrs. Later Signs AST, sources don't go over the they might still be available.
Ultram, Ultram ER acetaminophen Acetaminophen of Toxicity: Vomiting, right levels of ALT, bilirubin, daily limit • Tell the patient to carefully
• 10 mg oxycodone Relief of mild to moderate upper quadrant tenderness, and creatinine limits. read the manufacturer's label Asking the patient about
Drug Classification: hydrochloride and 300 mg pain, fever elevated hepatic function ordered and follow the dose the drug, its indication,
Opioid agonists-para- acetaminophen tests within 48–72 hrs after instructions. Describe how and potential side effects
aminophenol derivatives • 2.5 mg oxycodone ingestion. Antidote: • Check renal function in acetaminophen liquid for will help you determine
hydrochloride and 325 mg Drug Action: Acetylcysteine (see patients receiving long- children and infants has a how well they comprehend
acetaminophen Oxycodone: Appendix K for dosage). term treatment. different medication your pharmacological
•7.5 mg oxycodone binds to opioid receptors in Oxycodone concentration and is not therapy.
hydrochloride and 325 mg the central nervous system, Effects are dependent on interchangeable. Parents
acetaminophen dosage amount. Ambulatory • Remember that blood or should exercise particular
inhibiting ascent of pain albumin in the urine could
• 10 mg oxycodone pathway. pts, pts not in severe pain attention to ensure the correct
hydrochloride and 325 may experience dizziness, mean nephritis; dose is administered while
acetominophen nausea, vomiting, reduced urine production using the appropriate strength
Acetominophen: could be a sign of renal
appears to prevent the hypotension more until concentrated infant drops
frequently than those in failure; moreover, black are completely phased out. To
Capsules: 5 mg. Oral CNS from producing
supine position or having urine might help ensure precise dosing,
Concentrate: 20 mg/mL. prostaglandins and, to a
severe pain. to demonstrate the advise them to only use the
Oral Solution: 5 mg/5 mL. lesser extent, blocks pain metabolite's presence measurement tool that comes
Tablets: 5 mg, 10 mg, 15 signals through peripheral phenacetin with the bottle.
mg, 20 mg, 30 mg. Tablets, action. produces peripheral Drug Interaction
Abuse Deterrent (Oxaydo): vasodilation (heat loss, DRUG: Alcohol, other CNS • Before and throughout
5 mg, 7.5 mg. depressants may increase • given that
cutaneous erythema, and prolonged therapy
CNS effects, respiratory acetaminophen
diaphoresis) by acting includes monitoring and
depression, hypotension. hepatotoxic effects. Make
Capsules (Extended- centrally on the parenteral treatment
CYP3A4 inhibitors sure the
Release [Xtampza]): 9 mg, hypothalamus heat outcomes of liver
(clarithromycin, daily acetaminophen
13.5 mg, 18 mg, 27 mg, 36 regulating center. function tests, including
ketoconazole) may increase intake from all
mg. Tablets (Controlled- AST,
concentration, toxicity. sources don't go over the
Release 12 Hour Abuse levels of ALT, bilirubin,
CYP3A4 inducers daily limit
Deterrent [OxyCONTIN]): and creatinine
(carbamazepine, rifampin) limits
10 mg, 15 mg, 20 mg, 30 ordered
mg, 40 mg, 60 mg, 80 mg. may decrease
concentration/effects.
MAOIs may produce
serotonim syndrome, a
severe, sometimes fatal
reaction (administer ¼ of
usual oxycodone dose).
FOOD: Grapefruit products
may increase potential for
respiratory depression. LAB
VALUES: May increase
serum amylase, lipase.
• closely observe the
patient's blood pressure,
particularly when starting
oxycodone • since oxycodone can
therapy, as well as result in serious
during dose titration syncope with low blood
pressure in ambulatory
due to its vasodilatory
effects, patients.
In patients, the risk of
hypotension is higher.
who have already had
their security
compromised
decreased blood volume
or simultaneous
the use of a specific CNS
depressant
Medications like general
anesthetics and
phenothiazines.