Generic Name: Tramadol Brand Name: Ultram

50 mg Q8 PO

Therapeutic: Analgesics (cent rally acting)

Physiologic Mechanism Decreased pain. Pharmacologic Mechanism Binds to muopioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS.

Moderate to moderately severe pain

Side effects: CNS: Dizziness Drowsiness Headache Skin: Rash Repi: DOB Intestinal: Diarrhea constipation Adverse reaction: Hallucination DOB Rash Difficulty swallowing

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. Monitor patient for seizures. 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.

Generic Name: Celecoxib Brand Name: Celebrex

200 mg TID PO

-NSAID -Analgesic (nonopioid) -Specific COX2 enzyme blocker -Pregnancy Category C (first and second trimester) -Pregnancy Category D (third trimester)

-Inhibit antiinflammatory, analgesic and antipyretic action due to inhibition of enzyme COX2 - DRUG INTERACTION S: Concomitant use of celecoxib with aspirin or other NSAIDs (for example, ibuprof en, naproxen, etc.) may increase the occurrence of stomach and intestinal ulcers. It may be used with low dose aspirin.

Indication: is indicated for the management of Acute pain in adults Contraindication: -Hypersensitivity including those in whom attacks of angioedema, rhinitis and urticaria have been precipitated by aspirin, NSAIDs or sulfonamides. Severe hepatic impairment; severe heart failure; inflammatory bowel disease; peptic ulcer

Side effects: -Severe headache -unexplained weight gain-swelling of the hands or feet -pain/swelling/warmth in the groin/calf -change in amount of urine -difficult/painful swallowing -unusual tiredness -serious liver disease -rash -itching/swelling (especially of the face/tongue/throat) -dizziness -trouble breathing. Adverse effect: -Abdominal pain -diarrhea -nausea -edema -dizziness -headache -insomnia -upper respiratory tract infections

food or after meals if GI upset occurs. -Establish safety measures if CNS, visual disturbances occur. - Arrange for periodic ophthalmologic examination during long-term therapy. WARNING: If overdose occurs, institute emergency procedures gastric lavage, induction of emesis, supportive therapy. Provide further comfort measures to reduce pain (eg, positioning, environmental control), and to reduce inflammation (eg, warmth, positioning, rest).