Generic Name
hydromorphone
Brand Name
Dilaudid
Classification
opioid analgesic
Therapeutic Uses
Headache; muscle and neuropathic
pain; pain related to trauma/fractures
Administration
IV/IM/PO/PR
Mechanism of Action
Activation of opioid receptors in
the brain (mu, kappa, delta)
Normal Dose Range
IV: 0.2-1mg IV q2-3hr PRN
IM: 1-2mg q2-3hr PRN (not
recommended due to variable
absorption and peak)
PO: 2-4mg q4-6hr PRN
PR: 3mg q6-8hr
Common Side Effects
CNS: light-headedness, dizziness,
psychoses, anxiety, fear,
hallucinations, pupil constriction, impaired
mental processes
GI: nausea, vomiting, constipation
GU: ureteral spasm, urinary retention, hesitancy,
loss of libido
Others: physical and psychological dependence
Narcotic-induced respiratory center
depression: respiratory depression with apnea,
cardiac arrest, shock
Nursing Considerations
• Assess for mentioned cautions and contraindications
(e.g. drug allergy, respiratory dysfunction, myocardial
infarction and CAD, hepatorenal dysfunction, etc.) to
prevent untoward complications.
• Conduct pain assessment with patient to establish
baseline and evaluate effectiveness of drug therapy.
• Perform thorough physical (CNS, vital signs, bowel
sounds, urine output) to establish baseline status
before beginning therapy, determine drug
effectiveness and evaluate for any potential adverse
effects.
• Monitor laboratory results (liver function, kidney
function) to determine need for possible dose
adjustment and identify toxic drug effects.
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Patient Education
Non-Pharmacological pain management
methods
Management of side effects
Take exactly as prescribed
Sedation: caution with activities that require
alertness; avoid alcohol
Hypotension: sit or lie down if dizzy; make
position changes slowly
Constipation: increase fluid and fiber intake
Urinary retention: empty bladder every four
hours
Turn, cough, deep breathe regularly
Generic Name
morphine
Brand Name
MS-Contin
Classification
opioid analgesic
Therapeutic Uses
Headache; muscle and neuropathic
pain; pain related to trauma/fractures
Administration
PO/IV/IM/SQ/TD/EPI/intrathecal
Mechanism of Action
Activation of opioid receptors in
the brain (mu, kappa, delta)
Normal Dose Range
IV: 2.5-5mg q3-4hr PRN, infused over
4-5min; dose range 4-10mg
IM/SQ: 5-10mg q4hr PRN; dose range
5-20mg
PO: 15-30mg q4hr PRN
EPI: single dose 5-10mg qd; infusion
2-4mg over 24hr
intrathecal: single dose 0.1-0.3mg;
infusion 0.2-1mg over 24hr
Common Side Effects
Sedation, nausea, vomiting,
constipation, urinary retention,
decreased blood pressure, orthostatic
hypotension
Boxed warning: respiratory
depression, coma, death, neonatal
opioid withdrawal syndrome,
dependence and addiction
Nursing Considerations
Vital signs
Pain assessment
Pain management goal
Medical and medication history
Monitor for side effects
Reassessment for therapeutic effect
Level of consciousness
Hold medication if respiratory rate is less than 12
breaths per minute or for hypotension
• Monitor for side effects; e.g., sedation, respiratory
depression, urinary retention
• Institute fall precautions
• Have naloxone readily available
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Patient Education
Non-Pharmacological pain management
methods
Management of side effects
Take exactly as prescribed
Sedation: caution with activities that require
alertness; avoid alcohol
Hypotension: sit or lie down if dizzy; make
position changes slowly
Constipation: increase fluid and fiber intake
Urinary retention: empty bladder every four
hours
Turn, cough, deep breathe regularly
Generic Name
fentanyl
Brand Name
Duragesic
Classification
opioid analgesic
Therapeutic Uses
Headache; muscle and neuropathic
pain; pain related to trauma/fractures;
anesthesia; surgery premedication
Administration
IV/IM/transdermal patch
Mechanism of Action
Activation of opioid receptors in
the brain (mu, kappa, delta)
Normal Dose Range
Surgery premedication:
Slow IV/IM: 50-100mcg/dose 30-60min prior to
surgery
General Anesthesia:
IV minor surgery: 0.5-2mcg/kg/dose
IV major surgery: 2-20mcg/kg/dose initially;
maintenance infusion 1-2mcg/kg/hr
Analgesia:
IV: 1-2mcg/kg bolus or 25-100mcg/dose PRN or
1-2mcg/kg/hr by infusion
Transdermal Patch: 25-100mcg/hr, reapplied
q72hr until adequate analgesia is acheived
Common Side Effects
Sedation, nausea, vomiting,
constipation, urinary retention,
decreased blood pressure, orthostatic
hypotension
Boxed warning: respiratory
depression, coma, death, neonatal
opioid withdrawal syndrome,
dependence and addiction
Nursing Considerations
Vital signs
Pain assessment
Pain management goal
Medical and medication history
Monitor for side effects
Reassessment for therapeutic effect
Level of consciousness
Hold medication if respiratory rate is less than 12
breaths per minute or for hypotension
• Monitor for side effects; e.g., sedation, respiratory
depression, urinary retention
• Institute fall precautions
• Have naloxone readily available
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Patient Education
Non-Pharmacological pain management
methods
Management of side effects
Take exactly as prescribed
Sedation: caution with activities that require
alertness; avoid alcohol
Hypotension: sit or lie down if dizzy; make
position changes slowly
Constipation: increase fluid and fiber intake
Urinary retention: empty bladder every four
hours
Turn, cough, deep breathe regularly
Generic Name
tramadol
Brand Name
Ultram
Classification
opioid analgesic
Therapeutic Uses
Headache; muscle and neuropathic
pain; pain related to trauma/fractures
Administration
PO
Mechanism of Action
Activation of opioid receptors in
the brain (mu, kappa, delta)
Normal Dose Range
50-100mg q4hr PRN; not to exceed
more than 400mg/day
Common Side Effects
Sedation, nausea, vomiting,
constipation, urinary retention,
decreased blood pressure, orthostatic
hypotension
Boxed warning: respiratory
depression, coma, death, neonatal
opioid withdrawal syndrome,
dependence and addiction
Nursing Considerations
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Vital signs
Pain assessment
Pain management goal
Medical and medication history
Monitor for side effects
Reassessment for therapeutic effect
Level of consciousness
Hold medication if respiratory rate is less than 12
breaths per minute or for hypotension
• Monitor for side effects; e.g., sedation, respiratory
depression, urinary retention
• Institute fall precautions
• Have naloxone readily available
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Patient Education
Non-Pharmacological pain management
methods
Management of side effects
Take exactly as prescribed
Sedation: caution with activities that require
alertness; avoid alcohol
Hypotension: sit or lie down if dizzy; make
position changes slowly
Constipation: increase fluid and fiber intake
Urinary retention: empty bladder every four
hours
Turn, cough, deep breathe regularly
Generic Name
naloxone
Brand Name
Narcan
Classification
opiate antagonist
Therapeutic Uses
reverses the effect of opiates, including
respiratory depression, sedation, and
hypotension
Administration
IV/intranasal
Mechanism of Action
analog of oxymorphone
Normal Dose Range
IV: 0.4-2mg, may be repeated q23min up to 10mg if necessary
intranasal: 0.4mg over 10-15 seconds
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Common Side Effects
tremors
hyperventilation
sweating
hypertension
tachycardia
N/V
elevated PTT
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Nursing Considerations
Observe patient closely; duration
of action of some narcotics may
exceed that of naloxone
Monitor respirations and other
vital signs
Monitor closely for bleeding,
naloxone has been associated
with abnormal coag results
Patient Education
Report pain that emerges after
administration of this drug to
physician.
Generic Name
acetaminophen
Classification
non-opioid analgesic
Administration
PO/PR
Normal Dose Range
PO/PR: 325-650mg q4hr not to
exceed 4g/day
Brand Name
Tylenol
Therapeutic Uses
Headache; muscle and neuropathic
pain; pain related to trauma/fractures
Mechanism of Action
COX inhibition (central) →
↓ production of prostaglandins
Common Side Effects
Hepatotoxicity
Nursing Considerations
Vital signs
Pain assessment
Pain management goal
Medical and medication history
Monitor for side effects
Reassessment for therapeutic effect
Baseline labs: Liver function
Patient Education
Non-pharmacological pain
management methods
Management of side effects
Take with or without food
Avoid alcohol
Do not exceed 4 grams / 24 hours
Report nausea, vomiting, abdominal
pain
Generic Name
cimetidine
Brand Name
Tagamet
Therapeutic Uses
Classification
Histamine H2 receptor agonist
Administration
PO
Normal Dose Range
Ulcers:
400mg q12hr
GERD:
800mg q12hr
Zollinger-Ellison Syndrome:
300mg q6hr with meals and at
bedtime
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Peptic ulcers
Gastroesophageal reflux disease (GERD)
Zollinger-Ellison syndrome
Prophylaxis of stress-induced ulcers
Mechanism of Action
Block H2 receptors in parietal cells of
the stomach → decrease
gastric acid
Com
secretion
Common Side Effects
CNS: dizziness, somnolence, confusion,
headache, hallucinations
Skin: pruritus, rash
CV: hypotension, cardiac, dysrhythmias
GI: diarrhea, constipation, decreased gastric acid
Pulmonary: aspiration pneumonia
Sexual: decreased libido, impotence
Prolonged use: vitamin B12 deficiency,
antiandrogenic effects (gynecomastia,
galactorrhea)
Nursing Considerations
Assessment and monitoring: all
Histamine H2 receptor antagonists
Baseline assessment: Vital signs,
neurological status, gastrointestinal
status, radiological or endoscopic
results, hepatic function, ECG,
vitamin B12
Patient Education
Reason and length of prescribed
treatment
Timing of oral administration
Side effects: gynecomastia and impotence
Increase fluid intake and dietary Vitamin
B12
Avoid alcohol, aspirin, NSAIDs, caffeine,
spicy foods
Notify healthcare provider about adverse
effects
Generic Name
omeprazole
Brand Name
Prilosec
Therapeutic Uses
Classification
Proton Pump Inhibitor
Administration
PO
Normal Dose Range
Ulcers:
40mg qd x4-8 weeks
H.Pylori:
20mg q12hr x10 days with amoxicillin 1000mg
q12hr and clarithromycin 500mg q12hr x10-14
days
GERD:
20mg qd x4-8 weeks
Zollinger-Ellison Syndrome:
60mg qd, titrate up to 120mg q8hr
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Peptic ulcers
GERD
Zollinger-Ellison syndrome
Combination treatment for H. pylori infection
Mechanism of Action
Inhibit H+/K+-ATPase on parietal cells in
the stomach → decrease gastric acid
secretion
Common Side Effects
Headaches, dizziness, fatigue
Blurred vision
Dry mouth
Increased thirst
Hiccups
Increased or decreased appetite, nausea, abdominal
pain, constipation, or diarrhea
Skin rash
Osteoporosis
Decreased absorption of iron, calcium, magnesium,
vitamin B12
Increased risk of Clostridioides difficile infection,
pneumonia
Nursing Considerations
Baseline assessment: Vital signs,
neurological status, respiratory
status, gastrointestinal status,
radiological or endoscopic results,
CBC, hepatic function, electrolytes,
vitamin B12 level
Monitor for therapeutic effect,
adverse effects, changes in the
client’s condition
Patient Education
Reason and length of prescribed treatment; follow up
with healthcare provider is symptoms don’t resolve
Administration
• Oral: before meals
Do not crush, split or chew; sprinkle granules on one
teaspoon applesauce or apple juice (only), mix, swallow
immediately, then take several sips of water
Increase dietary vitamin B12
Avoid alcohol, aspirin, NSAIDs, caffeine, spicy foods
Notify healthcare provider about adverse effects
Generic Name
misoprostol
Classification
gastric mucosal protective agents
Administration
PO
Normal Dose Range
NSAID induced ulcers:
200mcg q6hr w/food and at bedtime
Ulcers:
100-200mg q4-6hr
Brand Name
Cytotec
Therapeutic Uses
• Peptic ulcers
• NSAID-induced ulcers
Mechanism of Action
Stimulates production of gastric mucus and
bicarbonate
Decreases gastric acid secretion
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Common Side Effects
Nausea, vomiting, diarrhea
Diaphoresis
Headaches
Cardiac arrhythmias
Thrombotic events
Nursing Considerations
Assess current symptoms: Pain location, quality,
duration and severity, triggers; nausea, bloating, reflux;
Epigastric tenderness
Laboratory test results: CBC, Stool testing for occult
blood
Diagnostic test results: Upper gastrointestinal
endoscopy
Monitor: Symptom resolution, Side effects, Signs of
worsening condition; e.g., increased pain, and
indications of gastric bleeding
Baseline laboratory test results: Hepatic function, Renal
function, Negative pregnancy test for your female
clients
Patient Education
Lifestyle modifications: Avoid alcohol, spicy or greasy
foods, excessive caffeine, and tobacco products
Report increasing abdominal pain, bloody or coffeeground emesis, black or tarry stools, feeling dizzy, fast
heartbeat
Medication stimulates production of gastric mucus and
bicarbonate
Take four times each day with meals and at bedtime
Side effects: report stomach cramps, nausea, diarrhea;
pregnancy loss
Female clients: reliable form of birth control required;
provide both verbal and written information
Generic Name
calcium carbonate
Brand Name
Tums
Classification
antacids
Therapeutic Uses
GI disorders associated with
hyperactivity
Administration
PO
Mechanism of Action
gastric acid-neutralizing agent; reacts
with excess acid in the stomach,
reducing acidity
Normal Dose Range
Chew 2-3 tablets PRN for no more
than 2 weeks. Do not take more than
6 tablets within 24hrs (pregnancy: no
more than 4 tablets within 24hrs)
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Common Side Effects
constipation
flatulence
diarrhea
gastric distention
hypercalcemia
metabolic alkalosis
Nursing Considerations
All antacids should be administered and
taken on a regular schedule
Antacids that come in liquid form need to
be shaken before taken
If administering an antacid via nasogastric
tube (NGT), be sure to flush with water
following the medication
Use with caution in lactating women
Patient Education
• Keep out of reach of children
• Should not be taken with milk
products or vitamin D
supplements