NAME OF DRUG Tramadol

DOSE AND FREQUENCY 50mg q 4hr po

MECHANISM OF ACTION Centrally acting analgesics not chemically related to opioids but binds to mu-opioids receptors and inhibits reuptake of norepinephrine and serotonin

INDICATION Moderate to severe pain

CONTRAINDICATION Hypersensitivity, acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotrophic agents

SIDE EFFECTS Decrease hemoglobin, coordination disturbances, confusion, nervousness, vomiting, dyspepsia, hypertonia, constipation, pruritus sweating and rash

NURSING RESPONSIBILITY Advise patient to avoid alcohol and OTC medication without medical advise Instruct patient to change positions slowly to prevent orthostatic hypotension Instruct patient to take drug only as prescribed

NAME OF DRUG Nifedipine

DOSE AND FREQUENCY 10mg q 8hr

MECHANISM OF ACTION Inhibits Ca ion uniflux across cell membrane during cardiac depolarization, produces relaxation of coronary vascular smooth muscles and peripheral vascular smooth muscles, dilates coronary vascular arteries, increases myocardial oxygen deliver, dilates coronary vascular arteries, increases myocardial oxygen delivery in patients with vasospastic angina.

INDICATION Treatment of vasospastic angina, chronic stable angina

CONTRAINDICATION Hypersensitivity, cardiovascular sac, combination with rifampicin, severe aortic stenosis, severe hypotension.

SIDE EFFECTS Dizziness, flushing, headache, hypotension, peripheral edema, tachycardia and palpitations

NURSING RESPONSIBILITY Advice patient not to take any drugs during therapy Advice patient not to crush or chew,sustained release forms, swallow whole Tell patient to take drug with non-fatty food Tell patient to avoid caffeine, alcohol and grape fruit juice Tell patient to change position slowly, it may cause orthostatic hypotension

NAME OF DRUG Ketorolac

DOSE AND FREQUENCY 30mg q 8hr x 3 doses

MECHANISM OF ACTION Analgesic, antiinflammatory and antipyretic. Inhibits prostaglandin synthesis by inhibition of cyclooxygenase enzyme. It also inhibits leukotriene synthesis, helps stabilize lysosomal membranes and exert anti bradykinin activity

INDICATION

CONTRAINDICATI ON Active peptic ulcer disease. Recent GI bleeding or perforation, moderate to severe renal impairment, hypovolemia or dehydration, during labor or delivery, lactation, hypersensitivity to aspirin or NSAIDs

SIDE EFFECTS

NURSING RESPONSIBILITY Assess patient for GI bleeding: blood in sputum, stools and emesis Assess for blood dyscrasias and signs of bleeding Teach patient that drug is intended only for short-term used but must be continued for prescribed time to be efeective

Short- term manangement of moderate to severe acute post- operative pain.

GI ulceration, bleeding and perforation, post operative bleeding, acute renal failure, anaphylactic and anaphylactoid reaction, liver failure

NAME OF DRUG amlodipine

DOSE AND FREQUENCY 10 mg OD

MECHANISM OF ACTION block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Since calcium is important in muscle contraction, blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. Relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure, which reduces the burden on the heart as it pumps blood to the body.

INDICATION Chest pain or heart pain (angina)

CONTRAINDICATI ON Sick sinus syndrome, second or third degree atrioventricular block except with a functioning pacemaker.

SIDE EFFECTS headache and ede ma(swelling) of the lower extremities, dizziness, flushing, fatigue, na usea, and palpitations.

NURSING RESPONSIBILITY Assess cardiovascular status : Anginal pain, BP, pulse, respiration, , ECG Assess hydration and fluid volume status : input and output ratio, presence of edema, distended neck veins, lung crackles, adequate pulses and skin turgor. Advise patient to avoid hazardous activities until stabilized on drug and dizziness is no longer a problem.