GENERIC NAME: celecoxib BRAND NAME: Celebrex

DRUG CLASS AND MECHANISM: Celecoxib is a nonsteroidal antiinflammatory drug (NSAID) that is used to treat arthritis, pain, menstrual cramps, and colonic polyps. Prostaglandins are chemicals that are important contributors to the inflammation of arthritis that causes pain, fever, swelling and tenderness. Celecoxib blocks the enzyme that makes prostaglandins (cyclooxygenase 2), resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling and tenderness are reduced. Celecoxib differs from other NSAIDs in that it causes less inflammation and ulceration of the stomach and intestine (at least with short-term use) and does not interfere with the clotting of blood. NSAIDs have been found to prevent the formation and reduce the size of polyps in patients with the genetic disease, familial adenomatous polyposis (FAP). In FAP, patients develop large numbers of polyps in their colons, and the polyps invariably become malignant. The only cure of FAP is removal of the entire colon. Celecoxib is approved as an adjunctive (secondary) treatment among patients with FAP. The cramping and pain during menstrual periods is due to prostaglandins, and blocking the production of prostaglandins with celecoxib reduces the cramps and pain.

DRUG INTERACTIONS: Concomitant use of celecoxib with aspirin or other NSAIDs (for example, ibuprofen, naproxen, etc.) may increase the occurrence of stomach and intestinal ulcers. It may be used with low dose aspirin. SIDE EFFECTS: The most common adverse effects are headache,abdominal pain, dyspepsia, diarrhea, nausea, flatulence, and insomnia. Other side effects include fainting, kidney failure, heart failure, aggravation of hypertension, chest pain, ringing in the ears, deafness, stomach and intestinal ulcers, bleeding, blurred vision, anxiety, photosensitivity, weight gain, water retention, flu-like symptoms, drowsiness and weakness. Celecoxib, like other NSAIDs may cause serious stomach and intestinal ulcers that may occur at any time during treatment. Celecoxib does not interfere with the function of the blood platelets and, as a result, does not reduce clotting and lead to increased bleeding time like other NSAIDs. Allergic reactions can occur with celecoxib. Individuals who have developed allergic reactions (rash, itching, difficulty breathing) from sulfonamides [for example, sulfamethoxazole and trimethoprim (Bactrim)], aspirin or other NSAIDs may experience an allergic reaction to celecoxib and should not take celecoxib. USES: This medication is a nonsteroidal anti-inflammatory drug (NSAID), specifically a COX-2 inhibitor, which relieves pain and swelling (inflammation). It is used to treat arthritis, acute pain, and menstrual pain and discomfort. The pain and swelling relief provided by this medication helps you perform more of your normal daily activities. Celecoxib is also used to decrease growths found in the intestines (colon polyps) of persons with a family history of this condition.This drug works by blocking the enzyme in your body that makes prostaglandins. Decreasing prostaglandins helps to reduce pain and swelling.

GENERIC NAME: tramadol BRAND NAME: Ultram, Ultram ER

DRUG CLASS AND MECHANISM: Tramadol is a man-made (synthetic) analgesic (pain reliever). Its exact mechanism of action is unknown but similar morphine. Like morphine, tramadol binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain from

throughout the body to. Tramadol, like other narcotics used for the treatment of pain, may be abused. Tramadol is not a nonsteroidal antiinflammatory drug (NSAID) and does not have the increased risk of stomach ulceration and internal bleeding that can occur with NSAIDs. SIDE EFFECTS: Tramadol is generally well tolerated, and side effects are usually transient. Commonly reported side effects include nausea,constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received tramadol have reported seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.

Manufacturer Distributor Contents Indications

Pascual Pharex Celecoxib Treatment of rheumatoid arthritis & osteoarthritis. Adjunctive treatment of adenomatous colorectal polyps. Also used in the management of acute pain & dysmenorrhea. Osteoarthritis 200 mg daily as a single dose or in 2 divided doses. Max: 200 mg bid. RA 100-200 mg bid. Acutepain Initial dose: 400 mg followed by 200 mg bid. Adenomatous colorectal polyps 400 mg bid. May be taken with or without food (OA/RA: w/ or w/o meals. Adenomatous colorectal polyps: must be given w/ meals.).

Dosage

Administration

Contraindications Patients w/ allergy to celecoxib, sulfonamides, aspirin or other NSAIDs, asthma, severe hepatic impairment or heart failure, inflammatory bowel disease & renal impairment (CrCL <30 mL/min). Lactation. Special Precautions Caution use in patients w/ ischemic heart disease & those w/ risk for heart disease; HTN, hyperlipidemia, diabetes, smoking & peripheral arterial disease, fluid retention, familial adenomatous polyposis. Hemoglobin & hematocrit should be checked for sign & symptoms of anemia or blood loss. Elderly. Pregnancy. GI discomfort, nausea & diarrhea. Headache, vertigo, dizziness, nervousness, tinnitus, depression, drowsiness & insomia. Anemia, thrombocytopenia, neutropenia, eosinophilia & agranulocytosis. Fluid retention. Alveolitis, pulmonary eosinophilia, pancreatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis. Induction or exacerbation of colitis. Hypersensitivity reactions. View ADR Monitoring Form Thiazide diuretics, loop diuretics or ACE inhibitors. Lithium, fluconazole, warfarin. View more drug interactions with Pharex Celecoxib

Adverse Drug Reactions

Drug Interactions

Celebrex Classifications: central nervous system agent, analgesic, nsaid, cyclooxygenase-2 inhibitor, antipyretic Pregnancy Category: C first and second trimesters; D third trimester

NURSING IMPLICATIONS
Assessment & Drug Effects

Therapeutic effectiveness is indicated by relief of joint pain. Lab tests: Periodically monitor Hct and Hgb, liver functions, BUN and creatinine, and serum electrolytes. Monitor closely lithium levels when the two drugs are given concurrently. Monitor closely PT/INR when used concurrently with warfarin.

Monitor for fluid retention and edema especially in those with a history of hypertension or CHF. Patient & Family Education Avoid using celecoxib during the third trimester of pregnancy. Promptly report any of the following: unexplained weight gain, edema, skin rash. Stop taking celecoxib and promptly report to physician if any of the following occurs: S&S of liver dysfunction including nausea, fatigue, lethargy, itching, jaundice, abdominal pain, and flulike symptoms; S&S of GI ulceration including black, tarry stools and upper GI distress. Do not breast feed while taking this drug.