GENERIC NAME

Tramadol
Hydrochloride

BRAND NAME
DRUG

Ultram
Central nervous system (cns) agent;

CLASSIFICATION

Analgesic;

ORDERED DOSE
DATE ORDERED
MODE OF ACTION

Narcotic (opiate) agonist

50mg IVTT q 1 hr PRN
August 20, 2015
Centrally acting opiate receptor agonist that inhibits the
uptake of norepinephrine and serotonin, suggesting both
opioid and nonopioid mechanisms of pain relief. May
produce opioid-like effects, but causes less respiratory

INDICATION
CONTRAINDICATIONS

depression than morphine.

Moderate to moderately severe pain.
Hypersensitivity to tramadol or other opioid analgesics;
patients on MAO inhibitors; patients acutely intoxicated
with alcohol, hypnotics, centrally acting analgesics,
opioids, or psychotropic drugs; substance abuse; alcohol

DRUG INTERACTIONS

intoxication
Carbamazepine significantly decreases tramadol levels
(may need up to twice usual dose). Tramadol may
increase adverse effects of mao inhibitors. Tricyclic
antidepressants, cyclobenzaprine, phenothiazines,
selective serotonin-reuptake inhibitors (ssris), mao
inhibitors may enhance seizure risk with tramadol. May
increase CNS adverse effects when used with other cns

SIDE EFFECTS

depressants.
headache, dizziness, drowsiness, tired feeling;
constipation, diarrhea, nausea, vomiting, stomach pain; or
feeling nervous or anxious, itching, sweating, flushing

NURSING
RESPONSIBILITIES

(warmth, redness, or tingly feeling).

1. Assess for level of pain relief and administer prn
dose as needed but not to exceed the
recommended total daily dose.
2. Monitor vital signs and assess for orthostatic
hypotension or signs of CNS depression.
3. Discontinue drug and notify physician if S&S of
hypersensitivity occur.
4. Assess bowel and bladder function; report urinary
frequency or retention.
5. Monitor ambulation and take appropriate safety
precautions.
6. Control environment (temperature, lighting) if
sweating or CNS effects occur.
7. Encourage patient to cough and breathe deeply
every 2 hr to prevent atelactasis and pneumonia.

GENERIC NAME

Ketorolac

BRAND NAME
DRUG

Toradol
Nonsteroidal anti-inflammatory agents,

CLASSIFICATION
ORDERED DOSE
DATE ORDERED
MODE OF ACTION

nonopioidanalagesics
30mg IVTT q1 x 3
August 20, 2015
inhibits prostaglandin synthesis, producing peripherally
mediated analgesia. Also has an antipyretic and antiinflammatory property. Therapeutic effect: decreased pain.
Short term management of pain (not to exceed 5 days
total for all routes combined)

Hypersensitivity

INDICATION
CONTRAINDICATIONS

Cross-sensitivity with other NSAIDs may exist pre-

or pre-operative use.

DRUG INTERACTIONS

Known alcohol intolerance, use cautiously in:

History of GI bleeding

Renal impairment

Cardiovascular disease
Probenecid (Benemid) should not be combined with
ketorolac because it reduces the elimination of ketorolac
by the kidneys. This may lead to increased levels of
ketorolac in the body and increased side effects from
ketorolac.
Ketorolac may increase the blood levels of lithium
(Eskalith, Lithobid) by reducing the elimination of lithium
by the kidneys. Increased levels of lithium may lead to

lithium toxicity.
Concomitant use of ketorolac and angiotensin converting
enzyme (ACE) inhibitors may reduce the function of the
kidneys.
Individuals taking oral blood thinners or anticoagulants for
example, warfarin (Coumadin), should avoid ketorolac
because ketorolac also thins the blood, and excessive
SIDE EFFECTS

blood thinning may lead to bleeding.

CNS: drowsiness, abnormal thinking, dizziness, euphoria,
headache
RESP: asthma, dyspnea
CV: edema, pallor, vasodilation
GI: GI bleeding, abnormal taste, diarrhea, dry mouth, GI

NURSING

pain
-Patients who have asthma, aspirin-induced allergy, and

RESPONSIBILITIES

nasal polyps are at increased risk for developing

hypersensitivity reactions. Assess for rhinitis, asthma, and
urticaria.
- Assess pain (note type, location, and intensity) prior to
and 1-2 hr following administration.
- Ketorolac therapy should always be given initially by the
IM or IV route. Oral therapy should be used only as a
continuation of parenteral therapy.
- Caution patient to avoid concurrent use of alcohol,
aspirin, NSAIDs, acetaminophen, or other OTC
medications without consulting health care professional.
- Advise patient to consult if rash, itching, visual
disturbances, tinnitus, weight gain, edema, black stools,
persistent headche, or influenza-like syndromes
(chills,fever,muscles aches, pain) occur.

- Effectiveness of therapy can be demonstrated by

decrease in severity of pain. Patients who do not respond
to one NSAIDs may respond to another.

Date ordered:
GENERIC NAME

BRAND NAME
DRUG
CLASSIFICATION
ORDERED DOSE
MODE OF ACTION
INDICATION
CONTRAINDICATIONS
DRUG INTERACTIONS
SIDE EFFECTS

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NURSING
RESPONSIBILITIES