Drug Study

Drug Study Tramadol Indication

Tramadol is used in the management of moderate to moderately severe pain. Extended release tablets are used for moderate to moderately severechronic pain in adults who require continuous treatment for an extended period.

Dosing

The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25 mg every 3 days to reach 100 mg/day (25 mg 4 times daily). Thereafter, doses can be increased by 50 mg every 3 days to reach 200 mg day (50 mg 4 times daily). Tramadol may be taken with or without food. Recommended dose for extended release tablets is 100 mg daily which may be increased by 100 mg every 5 days but not to exceed 300 mg /day. Extended release tablets should be swallowed whole and not crushed or chewed.

Drug Interactions

Carbamazepine reduces the effect of tramadol by increasing its inactivation in the body. Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50%-60%. Combining tramadol with monoamine oxidase inhibitors (for example, Parnate) or selective serotonin inhibitors [(SSRIs, for example, fluoxetine (Prozac)] may result in severe side effects such as seizures or a condition called serotonin syndrome. Tramadol may increase central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers or sedative hypnotics.

Side Effects

Tramadol is generally well tolerated, and side

effects are usually transient. Commonly reported side effects include nausea, constipation, dizziness,headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received tramadol have reported seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.

Ketorolac Indication

Ketorolac is used for short-term management (up to 5 days) of moderately severe acute pain that otherwise would require narcotics. It most often is used after surgery.

Dosing

Treatment should be started with ketorolac injection. Tablets are used only if treatment is continued after patients begin to eat and drink. The total duration of therapy should not exceed 5 days because of the potential for gastrointestinal bleeding and other side effects. The recommended adult intravenous single dose is 15 to 60 mg. Multiple intravenous doses of 15 or 30 mg every 6 hours, not to exceed 60 or 120 mg a day, also may be used. Following intravenous therapy, the recommended dose is one or two tablets initially followed by 1 tablet every 4-6 hours, not to exceed 40 mg daily. The smaller dose is used for patients with poor kidney function or those older than 65 years

Drug Interactions

Probenecid (Benemid) should not be combined with ketorolac because it reduces the elimination of ketorolac by the kidneys. This may lead to increased levels of ketorolac in the body and increased side effects from ketorolac. Ketorolac may increase the blood levels of lithium (Eskalith) by reducing the elimination of lithium by the kidneys. Increased levels of

lithium may lead to lithium toxicity. Concomitant use of ketorolac and angiotensin converting enzyme (ACE) inhibitors may reduce the function of the kidneys. Individuals taking oral blood thinners or anticoagulants [for example, warfarin(Coumadin) should avoid ketorolac because ketorolac also thins the blood, and excessive blood thinning may lead to bleeding. Side Effects

Common side effects from ketorolac include rash, ringing in the ears,headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation,heartburn, and fluid retention. NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Ketorolac may cause ulcers and bleeding in the stomach and intestines, particularly with use for more than five days. Sometimes, stomach ulceration and intestinal bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of the bleeding. NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients with preexisting impairment of kidney function or congestive heart failure, and use of NSAIDs in these patients should be done cautiously. Liver failure has also been associated with ketorolac. People who are allergic to aspirin and other NSAIDs should not use ketorolac. Individuals withasthma or nasal polyps are more likely to experience allergic reactions to NSAIDs.

Ampicillin + Sulbactam Indication

This medication contains ampicillin, an antibiotic used to treat a wide variety of bacterial infections. Sulbactam makes the ampicillin more effective.

Dosing

The usual oral dose range for most infections is 250 to 500 mg 4 times daily for 7-14 days. When used to treat gonorrhea, a single 3.5 gram dose (seven 500 mg capsules) is administered with probenecid (Benemid). The probenecid slows down the elimination of ampicillin so that ampicillin remains in the body longer. Food in the stomach reduces how much and how quickly ampicillin is absorbed. Therefore, ampicillin should be taken either 1 hour prior to or 2 hours following a meal for maximal absorption; however, for persons who experience nausea or stomach distress after taking ampicillin, it may be taken with meals.

Drug Interactions

Tell your doctor of all the medications you take (prescription and nonprescription) especially of: probenecid, tetracyclines, allopurinol. This drug may interfere with the effectiveness of birth control pills. Discuss using other methods of birth control with your doctor. This medication can affect the results of some diabetic urine testing products (cupric sulfatetype). Consult your doctor or pharmacist for recommendations. Do not start or stop any medicine without doctor or pharmacist approval.

Side Effects

This medication may cause stomach upset, diarrhea, nausea,headache, itching and fatigue during the first few days as your body adjusts to the medication. If these symptoms persist or become severe, inform your doctor. Notify your doctor immediately if an allergic reaction occurs while taking this medication. Symptoms include: skin rash, itching, difficulty breathing, hives, chest pain, facial swelling. If you notice other effects not listed above, contact your doctor or pharmacist.

Ibuprofen Indication

Ibuprofen is used for the treatment of mild to moderate pain, inflammation and fever caused by many and diverse diseases.

Dosing

For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to 6 hours. Arthritis is treated with 300 to 800 mg 3 or 4 times daily. When under the care of a physician, the maximum dose of ibuprofen is 3.2 g daily. Otherwise, the maximum dose is 1.2 g daily. Individuals should not use ibuprofen for more than 10 days for the treatment of pain or more than 3 days for the treatment of a fever unless directed by a physician. Children 6 months to 12 years of age usually are given 5-10 mg/kg of ibuprofen every 6-8 hours for the treatment of fever and pain. The maximum dose is 40 mg/kg daily. Juvenile arthritis is treated with mg/kg/day in 3-4 divided doses.

20

to

40

Ibuprofen should be taken with meals to prevent stomach upset. Drug Interactions

Ibuprofen is associated with several suspected or probable interactions that can affect the action of other drugs. Ibuprofen may increase the blood levels of lithium (Eskalith) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity. Ibuprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure. When ibuprofen is used in combination with aminoglycosides [for example, gentamicin (Garamycin)] the blood levels of the aminoglycoside may increase, presumably because the elimination of aminoglycosides from the body is reduced. This may lead to aminoglycoside-related side effects. Individuals taking oral blood thinners or anticoagulants [for example,warfarin (Coumadin)] should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding.

Side Effects

The most common side effects from ibuprofen are rash, ringing in the ears, headaches,

dizziness, drowsiness, abdominal pain, nausea, diarrhea,constipation and heartburn. NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Ibuprofen may cause ulceration of the stomach or intestine, and the ulcers may bleed. Sometimes, ulceration can occur without abdominal pain, and black, tarry stools, weakness, and dizziness upon standing (orthostatic hypotension) due to bleeding may be the only signs of an ulcer. NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients who already have impaired function of the kidney or congestive heart failure, and use of NSAIDs in these patients should be cautious. People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen. Individuals with asthmaare more likely to experience allergic reactions to ibuprofen and other NSAIDs. Fluid retention (edema), blood clots, heart attacks, hypertension and heart failure have also been associated with the use of NSAIDs.

Ranitidine Indication

Ranitidine blocks the action of histamine on stomach cells, and reduces stomach acid production. Ranitidine is useful in promoting healing of stomach and duodenal ulcers, and in reducing ulcer pain. Ranitidine has been effective in preventing ulcer recurrence when given in low doses for prolonged periods of time. In doses higher than that used in ulcer treatment, ranitidine has been helpful in treating heartburn and in healing ulcer and inflammation of the esophagus resulting from acid reflux (reflux esophagitis).

Dosing

May be taken with or without food. Since ranitidine is excreted by the kidney and metabolized by the liver, dosages of ranitidine need to be lowered in patients with significantly abnormal liver or kidney function.

Drug Interactions

Antacids may decrease the absorption of ranitidine. Safety of ranitidine in children has not been established. Ranitidine is not habit forming. Ranitidine can interfere with the metabolism of alcohol. Patients taking ranitidine who drink alcohol may have elevated blood alcohol levels.

Side Effects

Minor side effects include constipation, diarrhea, fatigue, headache, insomnia, muscle pain, nausea, and vomiting. Major side effects are rare; they include: agitation, anemia, confusion, depression, easy bruising or bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and yellowing of the skin or eyes.