Name of the drug Tramadol HCl

Classific ation Analgesic s (Opioid)

action Tramadol inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It alters perception and response to pain by binding to muopiate receptors in the CNS.

indicatio n Moderate to severe pa in & post-op pain.

Adverse effect Nausea, vomiting, diarrhea, constipation. Tiredness, drowsiness, dizziness, headache, confusion, hallucinations. Skin rashes, tachycardia, orthostatic hypotension, bradycardia, flushing, allergic reactions.

Nursing intervention 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. Culture infected area before treatment; reculture are

ampicillin Penicillin s

Ampicillin exerts bactericidal action on both

Biliary tract infection

GI upset, nausea, vomiting,

gentamici n

Aminogly cosides

gm+ve and gm-ve organisms. Its spectrum includes gm+ve organisms eg, S pneumoniae and otherStreptococci ,L monocytogenes and gm-ve bacteria eg, M catarrhalis, N gonorrhoea, N meningitidis, E coli, P mirabilis, Salmon ella, Shigella, and H influenzae. Ampicillin exerts its action by inhibiting the synthesis of bacterial cell wall. Gentamicin is an aminoglycoside that binds to 30s and 50s ribosomal subunits of susceptible bacteria disrupting protein synthesis,

s Endocard itis Otitis media Peritoniti s Bronchiti s

diarrhoea; blood dyscrasias; urticaria, exfoliative dermatitis, rash; fever, seizures; interstitial nephritis.

a if response is not as expected. Check IV site carefully for signs of thrombosis or drug reaction. Do not give IM injections in the same site; atrophy can occur. Monitor injection sites. Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals with a full glass of water; do not give with fruit juice or soft drinks.

Suscepti ble infection s Biliary tract infection s Brucellos is

Dizziness or vertigo; acute renal failure, interstitial nephritis, acute tubular necrosis; electrolyte imbalances; transient

Culture infected area before therapy. Use 2 mg/mL intrathecal pre paration without preservatives, for intrathecal use. Avoid long-term therapies because of increased risk of

thus rendering the bacterial cell membrane defective.

Cystic fibrosis

elevation of serum bilirubin and aminotransferas es; purpura; nausea, vomiting; convulsions, mental depression, hallucinations. Atrophy or rat necrosis at inj sites.

toxicities. Reduction in dose may be clinically indicated. Patients with edema or ascites may have lower peak concentrations due to expanded extracellular fluid volume. Cleanse area before application of dermatologic preparations. Ensure adequate hydration of patient before and during therapy. WARNING: Monitor renal function tests, CBCs, serum drug levels during long-term therapy. Consult with prescriber to adjust dosage. Monitor bowel sounds Monitor VS prior to drug administration. Tell the patient to avoid driving activities and heavy lifting. Tell the patient to avoid

metoclopr Antieme omide tics

Metoclopramide enhances the motility of the upper GI tract and increases gastric emptying without affecting gastric, biliary or

Diabetic gastric stasis Nausea and vomiting associate d w/

Extrapyramidal symptoms, restlessness, drowsiness, anxiety, diarrhoea, hypotension, hypertension,

cefuroxim Cephalos e porins

pancreatic secretions. It increases duodenal peristalsis which decreases intestinal transit time, and increases lower oesophageal sphincter tone. It is also a potent central dopaminereceptor antagonist and may also have serotoninreceptor (5-HT3) antagonist properties. Cefuroxime binds to one or more of the penicillinbinding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting

cancer chemoth erapy or radiother apy Gastrooesophag eal reflux dis ease Delayed emesis following chemoth erapy

headache, depression, blood disorders (e.g. aganulocytosis, methaemoglobin aemia), hypersensitivity reactions (e.g. bronchospasm, rash), galactorrhoea or related disorders, transient increase in plasma aldosterone levels. Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhoea, GI disturbances; erythema multiforme, StevensJohnson

activities that requires alertness for 2 hrs after doses. Urge patient to report persistent or serious adverse reaction promptly. Advise patient not to drink alcohol during therapy.

Uncompli cated UTI Uncompli cated gon orrhoea Meningiti s Suscepti ble infection s Resp

Question for history of allergies, particularly cephalosporins and penicillins. Give without regards to meals. If GI upset occurs give with food or milk. Avoid crushing tablets due to bitter taste. Suspension must be

biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

tract infection s

syndrome, epidermal necrolysis.

given with food. Intramuscular injections must be administered deep IM to minimize discomfort. Assess mouth for white patches on mucous membranes and tongue. Monitor bowel activity and stool consistency carefully. Mild GI effects may be tolerable but increasing severity may indicate onset of antibioticassociated colitis. Monitor input and output and renal function reports for nephrotoxicity. Be alert for superinfection: severe genital or anal pruritus, abdominal pain, severe mouth soreness, moderate to severe diarrhea. Caution ambulatory

nalbuphi

Analgesic Nalbuphine is a

Adjunct

Sedation,

ne

s (Opioid)

Ranitidin e

Antacids

phenanthrene derivative opioid analgesic with mixed opioid agonist and antagonist activity. It inhibits the ascending pain pathways, altering the perception of and response to pain by binding to opiate receptors in the CNS. It also produces generalised CNS depression. Ranitidine blocks histamine H2receptors in the stomach and prevents histaminemediated gastric acid secretion. It does not affect pepsin secretion, pentagastrinstimulated factor secretion or serum gastrin.

in balanced anesthesi a

Benign gastric and duodenal ulceratio n Eradicati on of H. pylori infection Pathologi cal hyper secretory condition

dizziness, vertigo, miosis, headache; nausea, vomiting, dry mouth; itching, burning, urticaria. Respiratory depression, dyspnoea, asthma; speech difficulty, urinary urgency, blurred vision, flushing, warmth; clamminess. Headache, dizziness. Rarely hepatitis, thrombocytopae nia, leucopaenia, hypersensitivity, confusion, gynaecomastia, impotence, somnolence, vertigo, hallucinations.

patient about getting out of bed or walking. Warn outpatient to avoid driving and other hazardous activities that require mental alertness until drugs CNS effects are known. Teach patient how to manage troublesome adverse effects such as constipation.

Obtain baseline hepatic and renal function tests. Monitor serum AST, ALT levels. Assess mental status in elderly. Antacids may decrease absorption. May decrease absorption of ketoconazole. Give without regards to meals, best given after

Mefenami c acid

Nonstero idal AntiInflamm atory Drugs (NSAIDs)

Mefenamic acid inhibits the enzymes cyclooxygenase (COX)-1 and COX-2 and reduces the formation of prostaglandins and leukotrienes. It also acts as an antagonist at prostaglandin receptor sites. It has analgesic and antipyretic properties with minor antiinflammatory activity.

s Shortterm symptom atic dyspepsi a Prophyla xis during NSAID treatmen t Pain and inflamma tion.

meals or at bedtime. Do not administer within 1 hour of magnesium- or aluminum- containing antacids.

Abdominal pain, dyspepsia, constipation, diarrhoea, nausea, GI ulcers; oedema; bronchospasm; headache, drowsiness, insomnia, visual disturbances; CHF, hypertension, tachycardia, syncope; urticaria, rash; thrombocytopen ia, aplastic anaemia, agranulocytosis;

Discontinue drug promptly if diarrhea, dark stools, hematemesis, ecchymoses, epistaxis, or rash occur and do not use again. Contact physician. Notify physician if persistent GI discomfort, sore throat, fever, or malaise occur. Do not drive or engage in potentially hazardous activities until response to drug is known. It may cause dizziness and drowsiness. Monitor blood glucose

tinnitus; elevated liver enzymes; abnormal renal function.

for loss of glycemic control if diabetic. Do not breast feed while taking this drug without consulting physician.