Talang, Kristine May BSN 2

Narcotics, Narcotic Antagonists, and Antimigraine Agents

Drug Name Classification Mechanism of Action Indication Adverse Reaction Contraindication/ Nursing Consideration
Interaction & Nursing Diagnosis

Generic Name: Functional Action: Tramadol is approved for CNS: Nursing Consideration:
Tramadol Classification: Narcotic, Binds to μ-opioid the management of Dizziness, CNS stimul Tramadol is
Analgesic, receptors and inhibits moderate to severe pain ation, somnolence, contraindicated in Assessment
Brand Name: miscellaneous, reuptake of in adults. headache, anxiety, patients who have had a • Pain: assess location,
ConZip, Ryzolt, Ultram, norepinephrine, confusion, euphoria, hypersensitivity reaction type, character; give
Ultram ER, Zytram serotonin Tramadol is also used seizures, hallucinations, to any opioid. Patients before pain becomes
off-label in the sedation, neuroleptic under the age of twelve extreme
Pregnancy Category: C Tramadol differs from treatment of premature malignant should not use the
other traditional opioid ejaculation. syndrome–like reactions medication. Patients • Assess for increased
medications in that it under the age of side effects in renal/
doesn't just act as a Cardiovascular: eighteen should not be hepatic disease
μ-opioid agonist, but Vasodilatation, orthost given the medication if
also affects atic hypotension,  they have had a history • Respiratory depression:
monoamines by tachycardia, of tonsillectomy or withhold if respirations
modulating the effects hypertension, abnormal adenoidectomy. ,12/min
of neurotransmitters ECG Because tramadol can
involved in the cause respiratory • Monitor I&O ratio:
modulation of pain such EENT: depression, patients check for decreasing
as serotonin and Visual disturbances with a history of severe output; may indicate
norepinephrine which respiratory depression, urinary retention
activate descending Gastrointestinal: or bronchial asthma with
pain inhibitory pathways. Nausea, constipation,v the absence of • Assess need for
omiting, dry mouth,di necessary equipment, product
Pharmacokinetics: arrhea, abdominal pain, should avoid taking
anorexia, flatulence, GI tramadol. • Assess for constipation
Absorption: Rapidly, bleeding and bowel pattern;
almost completely increase fluids, bulk in
absorbed Genitourinary: diet
 Urinary retention/frequ Patients currently on
Distribution: Steady ency, menopausal MOAs or people who Hypersensitivity: usually
state 2 days symptoms, dysuria, have been on MOAs in after beginning
menstrual disorder the past fourteen days treatment
Metabolism: Extensively should not receive
in liver, may cross INTEG: tramadol. Patients on • Monitor CNS changes:
blood-brain barrier Pruritus, rash, urticari tricyclic antidepressants dizziness, drowsiness,
a, vesicles,  flushing should also not take hallucinations, euphoria,
Excretion: Unchanged tramadol. People who LOC, pupil reaction
product 30% in urine, SYST: have Gl obstruction
protein binding 20% Anaphylaxis, should not use tramadol. • Determine allergic
Stevens-Johnson reactions: rash, urticaria
Half-life: Unknown syndrome, toxic
epidermal necrolysis, Interaction: • Serotonin syndrome,
Pharmacodynamics: serotonin syndrome neuroleptic malignant
Unknown Individual drugs Alcohol: syndrome: assess for
increased CNS increased heart rate,
Dosage: depression shivering, sweating,
CarBAMazepine: dilated pupils, tremors,
Mild to moderate pain decreased tramadol high B/P, hyperthermia,
Adult: PO 25 mg qd, level headache, confusion; if
titrate by 25 mg >3 days these occur, stop
to 100 mg/day (25 mg Drug classifications product, administer a
qid), then may increase serotonin antagonist if
by 50 mg >3 days to 200 CYP3A4 inducers needed
mg (50 mg qid), then (barbiturates, bosentan,
50-100 mg q4-6hr, max carBAMazepine, Patient/family
400 mg/day; use caution efavirenz, nevirapine, education
in elderly phenytoin, rifabutin,
rifampin): decreased • Teach patient to report
Geriatric >75 yr: PO ,300 tramadol effect any symptoms of CNS
mg/day in divided dose changes, allergic
CYP3A4 inhibitors reactions
Hepatic dose (aprepitant, antiretroviral
Adult: PO 50 mg q12hr protease inhibitors, • Teach patient that
clarithromycin, danazol, drowsiness, dizziness,
Renal dose delavirdine, diltiazem, and confusion may
Adult (Child-Pugh C): PO erythromycin, occur; to call for
CCr <30 ml/min q12hr, fluconazole, FLUoxetine, assistance
max 200 mg/day; do not fluvoxaMINE, imatinib,
use ext rel tabs ketoconazole, • Instruct patient to
mibefradil, nefazodone, make position changes
Moderate to severe telithromycin, slowly; orthostatic
chronic pain voriconazole): increased hypotension may occur
Adult: PO-ER (Ultram ER) traMADol levels
100 mg daily, titrate • Tell patient to avoid
upward q5day by 100 MAOIs: inhibition of OTC medication and
mg, max 300 mg/day; norepinephrine and alcohol unless approved
(Ryzolt) 100 mg, titrate serotonin reuptake; use by prescriber
upward q2-3day in 100- together with caution
mg increments; max 300 • Instruct patient not to
mg/day; products are Opiates, discontinue abruptly,
not interchangeable sedative/hypnotics: taper.
increased CNS
Available forms: depression
Tabs 50 mg; ext rel Nursing Diagnosis:
 tab  100, 200, 300 SSRIs, SNRIs,
mg; orally disintegrating serotonin-receptor 1. Decreased cardiac
tab 50 mg; ext rel caps agonists: increased output related to CV
100, 200, 300 mg serotonin syndrome effects

Drug/herb 2. Acute pain related to

withdrawal and CV
Chamomile, hops, kava, effects
skullcap, valerian:
increased CNS 3. Risk for injury related
depression to CNS effects

St. John’s wort: avoid

use

Drug/lab test Increased:

 creatinine, liver enzymes
Decreased: Hgb

SOURCES:

Mosby’s Drug Guide for Nursing Students Fourteenth Edition. pages 1057-1058

Tramadol. Drugbank Online. Retrieved from https://go.drugbank.com/drugs/DB00193

Dhesi, Manraj et.al. (2022 June 6). Tramadol. National Library of Medicine. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK537060/#:~:text=Tramadol%20is%20contraindicated%20in%20patients,history%20of%20tonsillectomy%20or%20adenoidectomy.

Tabangcora, Dawn Iris (2022, May 3). Narcotics, Narcotic Antagonists and Antimigraine Agents. Nurseslabs. Retrieved from
https://nurseslabs.com/narcotics-narcotic-antagonists-antimigraine-agents/
II. Neuromuscular Junction Blocking Agents
Drug Name Classification Mechanism of Action
Generic Name: Functional classification: Action:
Pancuronium Neuromuscular blocker Inhibits transmission
(nondepolarizing) Of nerve
Brand Name: impulses by binding
Pavulon Chemical classification: with cholinergic  mechanical ventilation,
Synthetic curariform receptor sites,
Pregnancy Category: C antagonizing action of
acetylcholine
Pharmacokinetics:
Absorption: Complete
bioavailability
Distribution: Extracellular
space; crosses placenta
Metabolism: Plasma
Excretion: Kidney
Half-life: 2 hr
Pharmacodynamics:
Onset: 3-5 min, dose
dependent
Peak: 3-5 min
Indication Adverse Reaction Contraindication/ Nursing Consideration/
Interaction Nursing Diagnosis
Facilitation of  Cardiovascular: Contraindication:
endotracheal intubation, Bradycardia, tachycardia, Nursing Consideration:
skeletal muscle increased, decreased - Hypersensitivity to
relaxation during B/P, ventricular bromide ion Assessment
extrasystoles, edema,
surgery, or general hypotension Interaction: • Monitor vital signs (B/P,
anesthesia pulse, respirations,
EENT: Individual products airway) until fully
Increased secretions recovered; note rate,
Clindamycin, enflurane, depth, pattern of
INTEG: isoflurane, lincomycin, respirations, strength of
Rash, flushing,pruritus,u lithium, quiNIDine: hand grip; patient should
rticaria,  sweating, increased be intubated before use
salivation neuromuscular
blockade • Monitor for electrolyte
Musculoskeletal: imbalances (potassium,
Weakness to prolonged Theophylline: magnesium) before
skeletal muscle  dysrhythmias product is used;
relaxation electrolyte imbalances
Drug classifications may lead to increased
RESPIRATORY: action of this product
Prolonged apnea, Aminoglycosides,
bronchospasm, cyanosis, anesthetics (local), • Monitor for recovery:
respiratory depression, analgesics (opioid), decreased paralysis of
dyspnea polymyxin face, diaphragm, leg,
antiinfectives, thiazides: arm, rest of body;
SYSTEMIC: Anaphylaxis increased residual weakness and
neuromuscular respiratory problems
blockade may occur during
 recovery period
Duration: 35-40 min Drug/lab test
Decreased: Assess for
Dosage: cholinesterase hypersensitive reactions,
anaphylaxis: rash, fever,
Adult/child/infant > 1 respiratory distress,
mo: pruritus; product should
IV 0.04-0.1 mg/ kg be discontinued
initially or 0.05 mg/kg
after initial dose of Patient/family
succinylcholine; education
maintenance 0.01 mg/kg
60-100 min after initial • Provide reassurance if
dose, then 0.01 mg/kg communication is
q25-60min as needed; in difficult during recovery
obese patients, use ideal from neuromuscular
body weight blockade

Neonate ,1 mo: • Provide explanation to

IV test dose 0.02 mg/ kg, patients regarding all
then 0.03 mg/kg/dose procedures or
initially, repeat 2x as treatments; patient will
needed at 5-10 min remain conscious if
intervals; maintenance anesthesia is not given
0.03- 0.09 mg/kg/dose also
q30min-4hr as needed

Nursing Diagnosis:

1. Impaired gas
exchange related to
depressed respirations

2. Impaired skin integrity

related to immobility
caused by action of
 drugs

3. Impaired verbal
communication related
to effects on muscle
activity

4. Risk for injury related

to loss of muscle control

SOURCES:

Mosby’s Drug Guide for Nursing Students Fourteenth Edition. pages 804- 804

Memon, Nazneen (2022 March 25). Pancuronium. RxList. Retrieved from https://www.rxlist.com/pavulon_pancuronium/drugs-condition.htm

Tabangcora, Iris Dawn (2022 May 3). Neuromuscular Junction Blocking Agents. Nurseslabs. Retrived from
https://nurseslabs.com/neuromuscular-junction-blocking-agents/#:~:text=NMJ%2Dblocking%20agents%20block%20nerve,that%20occur%20at%20the%20junction.