Republic of the Philippines

Cebu Normal University

Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254 4837
Email: [email protected]
Website: www.cnu.edu.ph

DRUG STUDY

Patient’s Initials: C.H. Date of Admission: September 12, 2022 Diagnosis: S/P Laparoscopic Cholecystectomy under General Anesthesia
Age: 56 y.o. Height: 158 cm Weight.: 55 kg Clinical Intervention: Medication Administration of Tramadol
Sex: Male Ward: Surgical Ward Bed No.: 4 Name of Physician: Dr. Jaypee Cruz

Drug Information Classification Mechanism of Action Indication Contraindications Side Effects Nursing Responsibilities
Generic Name: Pharmacologic Pharmacodynamics or General Tramadol hydrochloride The most commonly Before Drug Administration
Tramadol Classification: Mechanism of Action: Indication/s: 50 mg/ml solution for reported adverse drug 1. Assess the patient if they have a history of
hydrochloride Opiate (narcotic) Tramadol is a centrally Tramadol is a injection or infusion is reactions are nausea and hypersensitivity to tramadol, its contents, or
analgesics acting analgesic that medication for contraindicated: dizziness, both occurring other opioids.
Trade Name: possesses opioid agonist pain relief and has in more than 10% of 2. Assess the patient if they have a history of
Ultram, ConZip properties. Tramadol specific - in patients who have patients. severe respiratory depression or bronchial
consists of two indications for previously shown asthma.
enantiomers, the (+)- moderate to hypersensitivity to the CARDIOVASCULAR 3. Get the patient's baseline liver function tests
Minimum Dose: isomer is predominantly severe pain. active substance ● palpitation (AST and ALT) because the hepatic
50 mg Therapeutic active as an opioid with tramadol or to any of the ● tachycardia metabolism of the drug can lead to
Classification: preferential activity for the excipients listed in ● bradycardia hepatotoxicity.
Analgesic μ-receptor. The (-)-isomer section 6.1. ● hypertension 4. Perform psychiatric evaluation for suicidal
potentiates the analgesic ● postural ideations, abuse, or misuse of tramadol.
Maximum Dose: effect of the (+)-isomer - in patients suffering hypotension or 5. Assess if the patient is receiving monoamine
400 mg per day and is active as an from acute intoxication cardiovascular oxidase (MAO) inhibitors or has taken them
inhibitor of noradrenaline
Patient’s with alcohol, hypnotics, collapse within the last 14 days
and serotonin uptake Indication: analgesics, opioids, or ● 6. Obtain baseline vital signs of the patient.
thereby modifying theIt is used in the psychotropic medicinal RESPIRATORY 7. Assess the onset, type, location, and duration
Patient’s Dose: transmission of pain patient to help products. ● respiratory of the pain prior to administration.
50 mg iIVTT q6h for impulses. relieve depression
4 doses. 1st dose at postoperative - in patients who are ● dyspnoea
6pm Tramadol also has an pain. receiving monoamine ● hiccups During Drug Administration

Certification Date: 1 February 2021 SDF-CON-304-071-00

Recertification due date: 24 January

2024
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Registration No.

52Q18778
 Republic of the Philippines
Cebu Normal University
Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254 4837
Email: [email protected]
Website: www.cnu.edu.ph

antitussive action. At the oxidase (MAO) inhibitors ● Worsening of 1. Make sure to observe the 6 rights of drug
Route: recommended dosages, or who have taken them asthma administration.
Intravenous the effects of tramadol within the last 14 days NERVOUS 2. Explain to the patient why they are taking this
given orally on the (see section 4.5) ● dizziness drug and the importance of taking it.
respiratory and ● headache 3. Monitor the patient for adverse reactions,
Frequency: cardiovascular systems - in patients with ● somnolence especially respiratory depression.
q6h for 4 doses appear to be clinically epilepsy not adequately ● serotonin 4. Educate the patient and SO on the possible
insignificant. The potency controlled by treatment. syndrome side effects of the drug and tell them to
of tramadol is reported to ● speech immediately call for a healthcare professional
Availability/Form: be 1/10th to 1/6th that of - for use in narcotic disorders once they start experiencing these.
Clear, colourless morphine. withdrawal treatment. ● Convulsions 5. Inform the patient that they should not use
sterile solution for ● epileptiform alcohol, benzodiazepines, or other CNS
injection or infusion Tramadol is an opioid convulsions depressants at the same time while taking
and, like other opioids, Special warnings and ● changes in this medication.
selectively bind to precautions for use appetite
different opiate receptors Tramadol hydrochloride ● paraesthesia After Drug Administration
Contents: in the central nervous 50 mg/ml solution for ● syncope 1. Continue monitoring the patient’s vital signs,
● Tramadol system. The liver injection or infusion may ● hallucinations liver function, blood pressure, respiratory
hydrochlori enzyme, CYP2D6, only be used with ● confusion system, and mental status.
de - 50 converts tramadol to its particular caution in ● sleep 2. Observe the patient for any adverse effects
mg/ml of active metabolite M1, opioid-dependent disturbance or allergic reactions.
injection which has a stronger patients, patients with ● delirium 3. Remind the patient again why the drug is
solution (50 affinity for the mu head injury, shock, a ● anxiety being taken and how often.
ml per 1 ml receptor compared to the reduced level of ● nightmares 4. Remind the patient and SO again about the
ampoule, inactive form. Tramadol consciousness of ● changes in possible side effects of the drugs and report
100 mg per does not bind to the mu uncertain origin, mood (usually to any healthcare professional immediately if
2 ml receptor as much as disorders of the elation, experiencing these .
ampoule) morphine. Unlike other respiratory centre or occasionally
● Sodium - opioids, tramadol does function, increased dysphoria)

Certification Date: 1 February 2021 SDF-CON-304-071-00

Recertification due date: 24 January

2024
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For verification of the certificate please
\* ARABIC
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Registration No.

52Q18778
 Republic of the Philippines
Cebu Normal University
Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254 4837
Email: [email protected]
Website: www.cnu.edu.ph

less than 1 not reverse its course intracranial pressure. ● changes in

mmol (23 completely after the activity (usually
mg) per ml administration of In patients sensitive to suppression,
● Sodium naloxone. Along with the opiates the product occasionally
acetate partial agonist activity on should only be used with increase)
trihydrate the opioid receptors, it caution. ● changes in
● Water for also inhibits the reuptake cognitive and
injections of serotonin and Care should be taken sensorial
norepinephrine when treating patients capacity (e.g.
with respiratory decision
depression, or if behaviour,
concomitant CNS perception
Pharmacokinetics: depressant drugs are disorders)
The mean absolute being administered (see ● Dependence
bioavailability after section 4.5), or if the ● agitation
intramuscular recommended dosage is ● nervousness
administration was found significantly exceeded ● insomnia
to be 100%. (see section 4.9) as the ● hyperkinesia
possibility of respiratory ● panic attacks
The distribution of depression cannot be ● tinnitus
tramadol following excluded in these ● unusual CNS
intravenous situations. symptoms (i.e.
administration is rapid confusion,
and in two phases with Convulsions have been delusions,
different half-lives of 0.31 reported in patients depersonalisatio
± 0.17 hours (initial rapid receiving tramadol at the n, derealisation,
phase) and 1.7± 0.4 recommended dose paranoia)
hours (slower phase) levels. The risk may be GI
respectively. increased when doses ● nausea

Certification Date: 1 February 2021 SDF-CON-304-071-00

Recertification due date: 24 January

2024
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Registration No.

52Q18778
 Republic of the Philippines
Cebu Normal University
Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254 4837
Email: [email protected]
Website: www.cnu.edu.ph

of tramadol exceed the ●vomiting

After intravenous recommended upper ●constipation
administration of 100 mg daily dose limit (400 ●dry mouth
tramadol, the serum mg). In addition, ●retching
concentration was 613 ± tramadol may increase ●gastrointestinal
221 ng/ml at 15 minutes the seizure risk in irritation (a
post dosing and 409 ± 79 patients taking other feeling of
ng/ml at 2 hours post medicinal products that pressure in the
dosing. Tramadol has a lowers the seizure stomach,
high tissue affinity with an threshold (see section bloating)
apparent volume of 4.5). Patients with ● diarrhea
distribution of 203 L after epilepsy or those ● constipation
intravenous dosing in susceptible to seizures INTEGUMENTARY
healthy volunteers. should only be treated ● sweating
with tramadol if there ● dermal reactions
Tramadol undergoes are compelling (e.g. pruritus,
hepatic metabolism with circumstances. rash, urticaria)
approximately 85% of an ●
intravenous dose being MUSCULOSKELETAL
metabolised in young ● tremor
healthy volunteers. In ● involuntary
humans tramadol is muscle
mainly metabolised by contractions
means of N- and O- ● abnormal
demethylation and coordination
conjugation of the O- ● motorial
demethylation products weakness
with glucuronic acid. Only URINARY
O desmethyltramadol is ● micturition

Certification Date: 1 February 2021 SDF-CON-304-071-00

Recertification due date: 24 January

2024
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For verification of the certificate please
\* ARABIC
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Registration No.

52Q18778
 Republic of the Philippines
Cebu Normal University
Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254 4837
Email: [email protected]
Website: www.cnu.edu.ph

pharmacologically active. disorders

There are considerable (difficulty in
interindividual passing urine,
quantitative differences dysuria and
between the other urinary
metabolites. So far, retention)
eleven metabolites have IMMUNE SYSTEM
been found in the urine. ● allergic reactions
Animal experiments have (e.g. dyspnoea,
shown that O- bronchospasm,
desmthyltramadol is more wheezing,
potent than the parent angioneurotic
substance by the factor oedema)
2-4. Its half life t½β (6 ● anaphylaxis
healthy volunteers) is 7.9 EENT
h (range 5.4-9.6 h) and is ● miosis
approximately that of ● mydriasis
tramadol. ● blurred vision
OTHERS
The inhibition of one or ● changes in
both cytochrome P450 appetite
isoenzymes, CYP3A4 ● hypoglycemia
and CYP2D6 involved in ● fatigue
the metabolism of
tramadol, may affect the
plasma concentration of
tramadol or its active
metabolite.

Certification Date: 1 February 2021 SDF-CON-304-071-00

Recertification due date: 24 January

2024
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\* ARABIC
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Registration No.

52Q18778
 Republic of the Philippines
Cebu Normal University
Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254 4837
Email: [email protected]
Website: www.cnu.edu.ph

Tramadol is essentially
excreted via the kidneys.
The mean elimination
half-life of tramadol
following intravenous
administration is 5-6
hours. Total clearance of
tramadol was 28.0 L/h
following intravenous
administration.

References (at least 2):

Electronic Medicines Compendium (emc). (2022, February 24). Tramadol hydrochloride 50 mg/ml solution for injection or infusion - Patient Information Leaflet (PIL) - (emc). Home - Electronic Medicines
Compendium (Emc). https://www.medicines.org.uk/emc/product/3420/pil

Dhesi M, Maldonado KA, Maani CV. Tramadol. [Updated 2022 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK537060/

Medscape. (2022, July 28). Ultram, ConZip (tramadol) dosing, indications, interactions, adverse effects, and more. Medscape Drugs & Diseases - Comprehensive Peer-Reviewed Medical Condition, Surgery,
and Clinical Procedure Articles with Symptoms, Diagnosis, Staging, Treatment, Drugs and Medications, Prognosis, Follow-up, and Pictures; http://reference.medscape.com.
https://reference.medscape.com/drug/ultram-conzip-tramadol-343324#11

PRODUCT ASSESSMENT RUBRICS FOR DRUG STUDY

Student Name: __ _______________ Year/Section: _ ____________ Date: __ ________ Score: ___/30

Directions: Please select the appropriate rating using the following descriptions.

Certification Date: 1 February 2021 SDF-CON-304-071-00

Recertification due date: 24 January

2024
Page PAGE
For verification of the certificate please
\* ARABIC
access www.gcl-intl.com (Certification
Registration No.

52Q18778
 Republic of the Philippines
Cebu Normal University
Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254 4837
Email: [email protected]
Website: www.cnu.edu.ph

Element Very Satisfactory Satisfactory Needs Improvement Comments

Drug ☐ Accurately presented all of the patient and drug information ☐ Accurately presented most of the patient and drug ☐ Accurately presented some of the patient and drug information
Information (name [brand & generic], dosage [patient’s dose; min. & max], information related to the case. 1 missing information or error related to the case. 2 or more missing information or errors noted.
(10%) frequency, route, availability, contents) related to the case. [3] noted. [2] [1]

Classification ☐ Accurately presented the classification (therapeutic and ☐ Accurately presented the classification related to the drug ☐ Inaccurately presented the classification related to the drug.
(10%) pharmacologic) related to the drug. [3] but with 1 irrelevant information or error noted. [2] Classification is not relevant to the drug. [1]

☐ Accurately presented the indication/s (general & patient- ☐ Accurately presented the indication/s related to the drug ☐ Inaccurately presented the indication/s related to the drug.
Indication (10%) specific) related to the drug. [3] but with 1 irrelevant information or error noted. [2] Indication is not relevant to the drug. [1]
Mechanism of ☐ Accurately presented the mechanism of action ☐ Accurately presented the mechanism of action of the drug ☐ Inaccurately presented the mechanism of action of the drug.
Action (10%) (pharmacokinetics, pharmacodynamics) of the drug. [3] but with 1 irrelevant information or error noted. [2] Mechanism of action is not relevant to the drug. [1]
☐ Accurately presented all of the common contraindications ☐ Accurately presented most of the common ☐ Accurately presented some of the common contraindications
Contraindication related to the drug. [3] contraindications related to the drug. 1 missing information related to the drug. 2 or more missing information or errors noted.
(10%) or error noted. [2] [1]
☐ Accurately presented all of the common side effects related ☐ Accurately presented most of the common side effects ☐ Accurately presented some of the common side effects related
Side Effects
to the drug. [3] related to the drug. 1-2 missing information or errors noted. to the drug. 3 or more missing information or errors noted. [1]
(10%) [2]
Nursing ☐ Accurately presented all of the common nursing ☐ Accurately presented most of the common nursing ☐ Accurately presented some of the common nursing
Responsibilities responsibilities (before, during, and after) related to the drug. [9] responsibilities related to the drug. 1-2 missing information responsibilities related to the drug. 3 or more missing information
(30%) or errors noted. [7] or errors noted. [3]
☐ Presented at least 2 sources that are updated (within 5 years), ☐ Presented only one source that is updated (within 5 years), ☐ No source was presented. Sources are not updated (more than 5
References relevant, and credible. [3] relevant, and credible. Other sources are not updated, credible years), relevant, and credible. [1]
(10%) or relevant. [2]
Sub-score = ____ = ____ = ____

Evaluated by:
_______________________________________
Signature over Printed Name of Clinical Instructor

Certification Date: 1 February 2021 SDF-CON-304-071-00

Recertification due date: 24 January

2024
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For verification of the certificate please
\* ARABIC
access www.gcl-intl.com (Certification
Registration No.

52Q18778