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Flashcards in Analgesic Drugs Deck (75):
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ACETAMINOPHEN (functional classification)

Nonopioid analgesic, antipyretic

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ACETAMINOPHEN (Chemical Classification)

Nonsalicylate, paraaminophenol derivative

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ACETAMINOPHEN (Mechanism of Action)

May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis; does not possess antiinflammatory properties; antipyretic action from inhibition of prostaglandins in the CNS (hypothalamic heat-regulating center)

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ACETAMINOPHEN (Uses)

Mild to moderate pain or fever, arthralgia, dental pain, dysmenorrhea, headache, myalgia, osteoarthritis

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ACETAMINOPHEN (Contraindication)

Hypersensitivity (allergy)

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ACETAMINOPHEN (Side Effects)

CNS: stimulation, drowsiness GI: nausea, vomiting, abdominal pain, HEPATOTOXICITY, HEPATIC SEIZURE (OVERDOSE), GI BLEEDING GU: RENAL FAILURE (HIGH, PROLONGED DOSES) HEMA: LEUKOPENIA, NEUTROPENIA, HEMOLYTIC ANEMIA (LONG-TERM USE), THROMBOCYTOPENIA, PANCYTOPENIA INTEG: rash, urticaria Syst: hypersensitivity Toxicity: CYANOSIS, ANEMIA, NEUTROPENIA, JAUNDICE, PANCYTOPENIA, CNS STIMULATION, DELIRIUM FOLLOWED BY VASCULAR COLLAPSE, SEIZURES, COMA, DEATH

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ACETAMINOPHEN (Nursing Considerations)

Assess: -Hepatic Studies (AST, ALT, bilirubin, creatinine before therapy if long-term therapy is anticipated; may cause hepatic toxicity at doses >4g/day with chronic use) -Renal Studies (BUN, creatinine, occult blood, albumin, if patient is on long-term therapy; presence of blood or albumin indicates nephritis) -Blood Studies (CBC, PT if patient is on long-term therapy) -I&O Ratio (decreasing output may indicate renal failure [long-term use]) -For fever and pain (type of pain, location, intensity, duration) -CHRONIC POISONING (RAPID, WEAK PULSE; DYSPNEA; COLD, CLAMMY EXTREMITIES; REPORT IMMEDIATELY TO PRESCRIBER) -HEPATOTOXICITY (DARK URINE; CLAY-COLORED STOOL; YELLOWING OF SKIN, SCLERA; ITCHING; ABDOMINAL PAIN; FEVER; DIARRHEA IF PATIENT IS ON LONG-TERM THERAPY) -ALLERGIC REACTIONS (RASH, URTICARIA; IF THESE OCCUR PRODUCT MAY HAVE TO BE DISCONTINUED)

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ACETAMINOPHEN (Overdose Treatment)

Product level, gastric lavage, activated charcoal; administer oral acetylcysteine to prevent hepatic damage; monitor for bleeding

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CODEINE (functional classification)

Opiate Analgesic, Antitussive

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CODEINE (Chemical Classification)

Opiate, phenathrene derivative

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CODEINE (Mechanism of Action)

Depresses pain impulse transmission at the spinal cord level by interaction with opioid receptors; decreases cough reflex, GI motility

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CODEINE (Uses)

Moderate to severe pain

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CODEINE (Contraindications)

Breastfeeding, hypersensitivity to opiates, respiratory depression, increased intracranial pressure, seizure disorders, severe respiratory disorders

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CODEINE (Side Effects)

CNS: Drowsiness, Sedation, dizziness, agitation, dependency, lethargy, restlessness, euphoria, SEIZURES, hallucinations, headache, confusion CV: bradycardia, palpitations, orthostatic hypotension, tachycardia, CIRCULATORY COLLAPSE GI: Nausea, Vomiting, Anorexia, Constipation, dry mouth GU: urinary retention INTEG: flushing, rash, urticaria, pruritus RESP: RESPIRATORY DEPRESSION, RESPIRATORY PARALYSIS, dyspnea SYST: ANAPHYLAXIS

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CODEINE (Nursing Considerations)

Assess: -PAIN (intensity, type, location, aggravating, alleviating factors; need for pain medication, tolerance; use pain scoring) -I&O ratio (check for decreasing output; may indicate urinary retention, especially among geriatric patients) -GI function (nausea, vomiting, constipation) -COUGH (type, duration, ability to raise secretion for productive cough; do not use to suppress productive cough) -CNS changes, dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reactions (rash, urticaria) -RESPIRATORY DYSFUNCTION (respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min) Perform/Provide: -Assistance with ambulation if needed -Safety measures (top side rails, night-light, call bell)

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CODEINE (Overdose Treatment)

Naloxone 0.4mg ampule diluted in 10ml 0.9% NaCl and given by direct IV push, 0.02mg q2min (adult)

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Fentanyl (Functional Classification)

Opioid Analgesic

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Fentanyl (Chemical Classification)

Synthetic Phenylpiperidine

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Fentanyl (Mechanism of Action)

Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception by binding to opiate receptors

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Fentanyl (Uses)

Controls moderate to severe pain; preoperatively, postoperatively; adjunct to general anesthetic, adjunct to regional anesthesia; FenaNYL: anesthesia as premedication, conscious sedation; Actiq: breakthrough cancer pain

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Fentanyl (Contraindications)

Hypersensitivity to opiates, myasthenia gravis HEADACHE, MIGRAINE

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Fentanyl (Side Effects)

CNS: dizziness, delirium, euphoria, sedation CV: BRADYCARDIA, ARREST, hypo/hypertension EENT: blurred vision , miosis GI: nausea, vomiting, constipation GU: urinary retention INTEG: rash, diaphoresis MS: muscle rigidity RESP: RESPIRATORY DEPRESSION, ARREST, LARYNGOSPASM

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Fentanyl (Nursing Considerations)

ASSESS: -VS after parenteral route; note muscle rigidity, drug history, hepatic/renal function tests -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reactions: rash, urticaria -RESPIRATORY DYSFUNCTION: RESPIRATORY DEPRESSION, character, rate, rhythm; notify prescriber if respirations are /=60mg/day oral morphine, >/=30mg/day oxycodone PO, 8mg/day HYDROmorphone, 25mcg YF fentaNYL/hr

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Meperidine (Demerol) (Functional Classification)

Opioid Analgesic

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Meperidine (Demerol) (Chemical Classification)

Phenylpiperidine derivative

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Meperidine (Demerol) (Mechanism of Action)

Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors

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Meperidine (Demerol) (Uses)

Moderate to severe pain preoperatively, postoperatively

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Meperidine (Demerol) (Contraindications)

Hypersensitivity (allergy)

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Meperidine (Demerol) (Side Effects)

CNS: Drowsiness, Dizziness, Confusion, Headache, Sedation, Euphoria, INCREASED INTRACRANIAL PRESSURE, SEIZURES, serotonin syndrome CV: palpitations, bradycardia, hypotension, change in BP, tachycardia(IV) EENT: tinnitus, blurred vision, miosis, diplopia, depressed corneal reflex GI: nausea, vomiting, anorexia, constipation, cramps, biliary spasm, paralytic ileus GU: urinary retention, dysuria INTEG: rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP: RESPIRATORY DEPRESSION SYST: ANAPHYLAXIS

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MEPERIDINE (Demerol) (Nursing Considerations)

ASSESS: -PAIN: location, type, character, give product before pain becomes extreme; reassess after 60 min (IM, SUBCUT, PO) and 5-10min (IV) -Renal function prior to initiating therapy; poor renal function can lead to accumulation of toxic metabolite and seizures -I&O ratio; check for decreasing output; may indicate urinary retention -For constipation; increase fluids, bulk in diet; give stimulant laxatives if needed -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reactions with chronic or high-dose use -Allergic reactions: rash, urticaria -RESPIRATORY DYSFUNCTION: depression, character, rate, rhythm; notify prescriber if respirations are <12/min -CNS stimulation: with chronic or high doses PERFORM/PROVIDE: -Safety measures: night-light, call bell within easy reach

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Meperidine (Demerol) (Overdose Treatment)

Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors

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Methadone (functional classification)

Opioid Analgesic

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Methadone (Chemical Classification)

Synthetic diphenylheptane derivative

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Methadone (Mechanism of Action)

Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors; produces CNS depression

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Methadone (Uses)

Severe pain, opioid withdrawal

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Methadone (Contraindications)

Hypersensitivity to this product or chlorobutanol (inj); asthma, ileus

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Methadone (Side Effects)

CNS: Drowsiness, Dizziness, Confusion, Headache, Sedation, euphoria, SEIZURES CV: palpitations, bradycardia, change in BP, CARDIAC ARREST, SHOCK, hypotension, TORSADES DE POINTES, QT PROLONGATION EENT: tinnitus, blurred vision, miosis, diplopia GI: Nausea, Vomiting, Anorexia, Constipation, Cramps, biliary tract spasm GU: increased urinary output, dysuria, urinary retention, impotence INTEG: Rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP: RESPIRATORY DEPRESSION, RESPIRATORY ARREST

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METHADONE (Nursing Considerations)

ASSESS: -PAIN: type, location, intensity, grimacing before, 1 1/2-2 hr after administration; use pain scoring -I&O ratio; check for decreasing output; may indicate urinary retention -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reactions: rash, urticaria -RESPIRATORY DYSFUNCTION: respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min -Opioid detoxification: no analgesia occurs, only prevention of withdrawal symptoms (BP, pulse, ECG; QT prolongation, hypotension, palpitations may occur) -Bowel changes, bulk, fluids, laxatives should be used for constipation PERFORM/PROVIDE: -Assistance with ambulation -Safety measures: night-light, call bell within easy reach

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Methadone (Overdose Treatment)

Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors

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MORPHINE (Functional Classification)

Opioid Analgesic

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MORPHINE (Chemical Classification)

Alkaloid

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MORPHINE (Mechanism of Action)

Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors

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MORPHINE (Uses)

Moderate to severe pain

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MORPHINE (Contraindications)

Hypersensitivity, addiction (Opioid), hemorrhage, bronchial asthmam, increased intracranial pressure, paralytic ileus, hypovolemia, shock

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MORPHINE (Side Effects)

CNS: drowsiness, dizziness, confusion, headache, sedation, euphoria, insomnia, SEIZURES CV: palpitations, BRADYCARDIA, change in BP, SHOCK, CARDIAC ARREST, chest pain, hypo/hypertension, edema, TACHYCARDIA EENT: tinnitus, blurred vision, miosis, diplopia GI: nausea, vomiting, anorexia, constipation, cramps, biliary tract pressure GU: urinary retention HEMA: THROMBOCYTOPENIA INTEG: rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP: RESPIRATORY DEPRESSION, RESPIRATORY ARREST, APNEA

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MORPHINE (Nursing Considerations)

ASSESS: -PAIN: location, type, character; give dose before pain becomes severe -Bowel status; constipation common, use stimulant laxative if needed -I&O ratio; check for decreasing output; may indicate urinary retention -BP, pulse, respirations (character, depth, rate) -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction (ABRUPT DISCONTINUATION: gradually taper to prevent withdrawal symptoms; decrease by 50% q1-2days; avoid use of narcotic antagonists -Allergic Reactions: rash, urticaria -RESPIRATORY DYSFUNCTION: depression, character, rate, rhythm; notify prescriber if respirations are <12/min; accidental overdose hase occurred with high-potency oral sols PERFORM/PROVIDE: -Assistance with ambulation -Safety measures: side rails, night-light, call bell within easy reach -Gradual withdrawal after long-term use

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Morphine (Overdose Treatment)

Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors

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Naloxone (Narcan) (Functional Classification)

Opioid Antagonist, Antidote

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Naloxone (Narcan) (Chemical Classification)

Thebaine derivative

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Naloxone (Narcan) (Mechanism of Action)

Competes with opioids at opiate receptor sites

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Naloxone (Narcan) (Uses)

Respiratory depression induced by opioids, pentazocine, propoxyphene

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Naloxone (Narcan) (Contraindications)

Hypersensitivity

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Naloxone (Narcan) (Side Effects)

CNS: drowsiness, nervousness, SEIZURES, tremor CV: rapid pulse, increased systolic BP (high dose), VENTRICULAR TACHYCARDIA, FIBRILLATION, hypo/hypertension, CARDIAC ARREST, SINUS TACHYCARDIA GI: nausea, vomiting, HEPATOTOXICITY RESP: hyperpnea, PULMONARY EDEMA

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Naloxone (Narcan) (Nursing Considerations)

ASSESS: - WITHDRAWAL: cramping, hypertension, anxiety, vomiting, signs of withdrawal in drug-dependent individuals may occur <10/min, administer naloxone; probably due to opioid overdose; monitor LOC -PAIN: duration, intensity, location before and after administration; may be used for respiratory depression

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Naltrexone (Functional Classification)

Opioid Antagonist

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Naltrexone (Chemical Classification)

Thebaine derivative

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Naltrexone (Mechanism of Action)

Competes with opioids at opioid-receptor sites

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Naltrexone (Uses)

Blockage of opioid analgesics; used for treatment of opiate addiction, alcoholism

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Naltrexone (Contraindications)

Hypersensitivity, opioid dependence hepatic failure, hepatitis

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Naltrexone (Side Effects)

CNS: Stimulation, Drowsiness, dizziness, confusion, SEIZURES, headache, flushing, hallucinations, nervousness, irritability, SUICIDAL IDEATION, syncope, anxiety CV: rapid pulse, PULMONARY EDEMA, hypertension, DVT EENT: tinnitus, hearing loss, blurred vision GI: Nausea, Vomiting, Diarrhea, Heartburn, anorexia, HEPATITIS, constipation, abdominal pain GU: delayed ejaculation, decreased potency INTEG: Rash, urticaria, bruising, oily skin, acne, pruritus, inj site reactions MISC: increased thirst, chills, fever MS: joint and muscle pain RESP: wheezing, hyperpnea, nasal congestion, rhinorrhea, sneezing, sore throat, pneumonia

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Naltrexone (Nursing Considerations)

Assess: -Hepatic Status: LFTs, jaundice, hepatitis, hepatic failure -ABGs including PO2, PCO2, LFTs, VS q3-5min -Signs of withdrawal in drug-dependent individuals -Cardiac status: tachycardia, hypertension -RESPIRATORY DYSFUNCTION: RESPIRATORY DEPRESSION, character, rate, rhythm; if respirations <10/min, respiratory stimulant should be administered -Mental status: depression, suicidal

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Oxycodone (Functional Classification)

Opiate Analgesic

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Oxycodone (Chemical Classification)

semisynthetic derivative

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Oxycodone (Mechanism of Action)

Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception

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Oxycodone (Uses)

Moderate to severe pain

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Oxycodone (Contraindications)

Hypersensitivity, addiction (opiate), asthma, ileus

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Oxycodone (Side Effects)

CNS: Drowsiness, Dizziness, Confusion, Headache, Sedation, Euphoria, fatigue, abnormal dreams/thoughts, hallucinations CV: palpitations, bradycardia, change in BP EENT: tinnitus, blurred vision, miosis, diplopia GI: Nausea, Vomiting, Anorexia, Constipation, Cramps, gastritis, dyspepsia, biliary spasms GU: increased urinary output, dysuria, urinary retention INTEG: Rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP: RESPIRATORY DEPRESSION

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Oxycodone (Nursing Considerations)

Assess: -PAIN: intensity, location, type, characteristics; need for pain medication by pain/sedation scoring; physical dependence -I&O ratio; check for decreasing output; may indicate urinary retention -CNS CHANGES: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -ALLERGIC REACTIONS: rash, urticaria -RESPIRATORY DYSFUNCTION: respiratory depression, character, rate, rhythm; notify prescriber if respirations are BP, pulse -BOWEL STATUS: constipation; stimulant laxative may be needed with fluids, fiber PERFORM/PROVIDE: -Assistance with ambulation -Safety measures: night light, call bell within reach

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Oxycodone (Overdose Treatment)

Naloxone (Narcan) 0.2-0.8mg IV, O2, IV fluids, vasopressors

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Tramadol (Functional Classification)

Analgesic - miscellaneous

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Tramadol (Mechanism of Action)

Binds to mu-opioid receptors, inhibits reuptake of norepinephrine, serotonin

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Tramadol (Uses)

Management of moderate to severe pain, chronic pain

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Tramadol (Contraindications)

Hypersensitivity, acute intoxication with any CNS depressant, alcohol, asthma, respiratory depression

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Tramadol (Side Effects)

CNS: dizziness, CNS stimulation, somnolence, headache, anxiety, confusion, euphoria, SEIZURES, hallucinations, sedation, NEUROLEPTIC-MALIGNANT-SYNDROME-LIKE-REACTIONS CV: vasodilation, orthostatic hypotension, tachycardia, hypertension, abnormal ECG EENT: visual disturbances GI: nausea, constipation, vomiting, dry mouth, diarrhea, abdominal pain, anorexia, flatulence, GI bleeding GU: urinary retention/frequency, menopausal symptoms, dysuria, menstrual disorder INTEG: pruritus, rash, urticaria, vesicles, flushing SYST: ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, serotonin syndrome

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Tramadol (Nursing Considerations)

Assess: -PAIN: location, type, character, give before pain becomes extreme -I&O ratio: check for decreasing output; may indicate urinary retention -Need for product; dependency -Bowel pattern; for constipation, increase fluids, bulk in diet -CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reactions: rash, urticaria -Increased side effects in renal/hepatic disease -SEROTONIN SYNDROME, NEUROLEPTIC MALIGNANT SYNDROME: increased heart rate, shivering, sweating, dilated pupils, tremors, high BP, hyperthermia, headache, confusion; if these occur, stop product, administer serotonin antagonist if needed PERFORM/PROVIDE: -Assistance with ambulation -Safety measures: side rails, night-light, call bell within easy reach