Paracetamol

 Generic name:
o Paracetamol, Acetaminophen
 Brand name:
o Biogesic, Panadol, Tylenol
 Classification:
o Non-narcotic analgesic, Antipyretic
 Dosage:
o Adults can take two, 500mg tablets, 4 times in 24 hours.
o 250mg/5ml Oral Suspension, 4 times in 24 hours.
 Frequency:
o Adults can take two, 500mg tablets, 4 times in 24 hours
 Route:
o Oral, IV
 Mechanism of Action:
o Paracetamol has a central analgesic effect that is mediated through activation of descending
serotonergic pathways. Debate exists about its primary site of action, which may be inhibition of
prostaglandin (PG) synthesis or through an active metabolite influencing cannabinoid receptors.
 Indication:
o to relieve mild or moderate pain, such as headaches, toothache or sprains, and reduce fevers
caused by illnesses such as colds and flu.
 Contraindication:
o Renal Insufficiency, Anemia
 Adverse Reaction:
o Minimal GI upset, methemoglobinemia, hemolytic anemia, neutropenia, thrombocytopenia,
pancytopenia, leukopenia, urticarial, CNS stimulation, Hypoglycemic coma, jaundice, glissitis,
drowsiness, liver damage
 Nursing Consideration:
o Do not exceed 4gm/24 hr. In adults and 75mg/kg/day in children.
o Do not take for >5 days for pain in children, ten days for pain in adults, or more than 3 days for
fever in adults.
o Extended-release tablets are not to be chewed.
o Monitor CBC, liver, and renal functions.
o Assess for fecal occult blood and nephritis.
o Avoid using OTC drugs with Acetaminophen.
o Take with food or milk to minimize GI upset.
o Report N&V. cyanosis, shortness of breath, and abdominal pain as these are signs of toxicity.
o Report paleness, weakness, and heartbeat skips.
o Report abdominal pain, jaundice, dark urine, itchiness, or clay-colored stools.
o Phenmacetin may cause urine to become dark brown or wine-colored.
o Report pain that persists for more than 3-5 days
o Avoid alcohol
o This drug is not for regular use with any forms of liver disease.
Nalbuphine

 Generic name:
o Nalbuphine
 Brand name:
o Nubain
 Classification:
o Opioid
 Dosage:
o I.m., I.v., Or Subcutaneous Injection
 Adults weighing 70 kg (154 lb). 10 mg every 3 to 6 hr, as needed.
 Frequency:
o 10 to 20 mg every 4 to 6 hours.
 Route:
o I.V.
 Mechanism of Action:
o The exact mechanism of action is unknown, but is believed to interact with an opiate receptor
site in the CNS (probably in or associated with the limbic system). The opiate antagonistic
effect may result from competitive inhibition at the opiate receptor, but may also be a result
of other mechanisms. Nalbuphine is thought primarily to be a kappa agonist. It is also a
partial mu antagonist analgesic, with some binding to the delta receptor and minimal agonist
activity at the sigma receptor.
o Binds with and stimulates kappa and mu opiate receptors in the spinal cord and higher levels
in the CNS. In this way, nalbuphine alters the perception of and emotional response to pain.
 Indication:
o For the relief of moderate to severe pain.
o To relieve pain severe enough to require an opioid analgesic and for which alternative
treatment options such as nonopioid analgesics or opioid combination products are inadequate
or not tolerated
 Contraindication:
o Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative
equipment; gastrointestinal obstruction, including paralytic ileus; hypersensitivity to
nalbuphine or any of its components; significant respiratory depression
 Adverse Reaction:
o Sedation, dizziness, vertigo, miosis, headache; depression, restlessness, nervousness, crying,
drunkenness, euphoria, floating, hostility, confusion, unusual dreams, faintness, feeling of
heaviness, tingling, numbness; nausea, vomiting, dry mouth; bradycardia, tachycardia, HTN,
hypotension, pulmonary oedema; itching, burning, urticaria; resp depression, dyspnoea,
asthma; speech difficulty, urinary urgency, blurred vision, flushing, warmth, sweatiness,
clamminess.
 Nursing Consideration:
o Be aware that excessive use of opioids like nalbuphine may lead to abuse, addiction, misuse,
overdose, and possibly death. Monitor patient’s intake of drug closely and for evidence of
physical dependence.
o Know that chronic maternal use of nalbuphine during pregnancy can result in NOWS, which
may be life-threatening if not recognized and treated appropriately. NOWS occurs when a
newborn has been exposed to opioid drugs like nalbuphine for a prolonged period while in
utero.
o Use nalbuphine cautiously in patients taking other drugs that can cause respiratory
depression.
o Be aware that during prolonged use, a stool softener may be given to minimize constipation.
o Know that if patient is opioid-dependent, drug will usually not be discontinued abruptly.
o Monitor patient for withdrawal symptoms, such as abdominal cramps, anorexia, anxiety,
backache, bone or joint pain, confusion, depression, diaphoresis, dysphoria, erythema, fear,
fever, irritability, labile blood pressure and pulse, lacrimation, muscle spasms, myalgia,
mydriasis, nasal congestion, nausea, opioid craving, piloerection, restlessness, rhinorrhea,
sensation of crawling skin, sleep disturbances, tremor, uneasiness, vomiting, and yawning.
o Monitor patient for adrenal insufficiency. Although rare, it can be life-threatening. Monitor
patient for anorexia, dizziness, fatigue, hypotension, nausea, vomiting, or weakness. Notify
prescriber if adrenal insufficiency is suspected and expect to do diagnostic testing. If
confirmed, expect to administer corticosteroids and wean patient off nalbuphine, if possible.
Tramadol

 Generic name:
o tramadol
 Brand name:
o Ultram, Ultram ER, ConZip.
 Classification:
o Opioid analgesics
 Dosage:
o (17 years or older): 50 to 100 mg orally every 4 to 6 hours as needed for pain
 Frequency:
o 4-6 hrs
 Route:
o Oral
 Mechanism of Action:
o Tramadol is a centrally acting μ-opioid receptor agonist and SNRI (serotonin/norepinephrine
reuptake-inhibitor) that is structurally related to codeine and morphine. Tramadol binds weakly to
κ- and δ-opioid receptors and to the μ-opioid receptor with 6000-fold less affinity than morphine.
 Indication:
o Tramadol is approved for the management of moderate to severe pain in adults.29,30
o Tramadol is also used off-label in the treatment of premature ejaculation
 Contraindication:
o ever had an allergic reaction to tramadol or any other medicine.
o a condition which causes seizures or fits.
o a head injury.
o an addiction to alcohol, strong painkillers or recreational drugs.
o breathing difficulties.
o kidney or liver problems.
o ever had a reaction to other strong painkillers.
 Adverse Reaction:
o noisy breathing, sighing, shallow breathing, breathing that stops during sleep;
o a slow heart rate or weak pulse;
o a light-headed feeling, like you might pass out;
o seizure (convulsions); or
o low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or
weakness.
o
 Nursing Consideration:
o Avoid drinking alcohol beverages when in medication with this drug
o Assess for hypersensitivity
o Assess for level of severity of pain