Drug Order Tramadol 50 mg IV q6

Brand Name Ultram

Pharmacologic Action ANALGESIC. tramadol binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain from throughout the body. Inhibits reuptake of serotonin and norepinephrine in the CNS.

Indication and Contraindication Indication. Moderate to moderately severe pain Contraindication. Opoid dependent

Adverse Reaction nausea, constipation, dizziness, headache, drowsiness, and vomiting., itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo,

Desired Action to Patient To relieve pain.

NSG. Consideration

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. Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

Drug Order Cefoxitin 1 gm Tiv q8 for 7 days

Brand Name Dintaxin

Pharmacologi c Action ANTIBIOTIC (cephalosporin) . The bactericidal action of cefoxitin results from inhibition of cell wall synthesis.

Indication and Contraindication Indication. Susceptible bacterial septicemia, lower respiratory or urinary tract, skin and skin structure, bone and joint, gynecologic, intraabdominal infections. Surgical prophylaxis. Contraindication. Penicillin or other allergy. Renal impairment GI disease (esp. colitis).

Adverse Reaction Local reactions, rash, pruritus, drug fever, GI upset, anaphylax is, blood dyscrasias , elevated liver enzymes.

Desired Action to Patient To treat lower respiratory tract infection.

NSG. Consideration

Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy . Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response . Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction . Lab Test Considerations: May cause positive results for Coombs' test, especially in patients with azotemia. May cause increased serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine. May cause falsely elevated test results for serum and urine creatinine; do not obtain serum samples within 2 hr of administration. May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and eosinophilia

Drug Order Ipratropi um bromide 18mcg, albuterol (as sulfate) 90mcg Neb q12

Brand Name combivent

Pharmacologic Action Reducing bronchospasm through two distinctly different mechanisms, anticholinergic (parasympathol ytic) and sympathomimeti c.

Indication and Contraindicatio n Indication. Reversible bronchospasm. Contraindication. Hypertrophic cardiomyopathy Tachyarrythmia, Hypersensitivity to soya, lecithin or related food products.

Adverse Reaction Fine tremor, palpitation, headache, dizziness, nervousne ss, dryness of mouth, throat irritation and urinary retention.

Desired Action to Patient Relieve difficulty of breathing.

NSG. Consideration

Check inhaler technique. - Ensure that patients are able to correctly use the delivery device for their medication and consider use of a space if appropriate. - If administering by nebulisers use a mouthpiece rather than face mask. - If administered by nebuliser the dilution of the solution should be adjusted according to equipment and length of administration. - Advise patients not to exceed the prescribed dose. - Rinse mouth after each use of the inhaler. - Frequent drinks and the use of sugar-free gum can help with dry mouth. - Seek medical attention if more than the usual dosage is required. - Keep delivery devices clean and dry.