Pharmacological and Nursing Implications of Tramadol for Martha's Pain

This assignment examines the use of tramadol for postoperative pain management in the case of Martha Myles, a patient who sustained injuries in a car accident. It details tramadol's therapeutic class as a centrally acting synthetic opioid analgesic and SNRI, its pharmaceutical action involving the inhibition of norepinephrine and serotonin reuptake, and its mechanism of action on opioid, noradrenergic, serotoninergic, and opioid receptor systems. The assignment also outlines crucial nursing responsibilities, including assessing for allergies, medical history, and potential drug interactions; educating the patient about side effects; administering the medication timely; monitoring vital signs; and documenting the effects of tramadol to guide future dosage adjustments. References to relevant research papers are included to support the information provided.

Answer 4a
Tramadol is the choice of intervention for Martha for pain relief postoperatively.
Tramadol
Therapeutic class Tramadol is an agent for controlling moderate to moderately severe
pain. Tramadol is a synthetic opioid analgesic which acts centrally and
also is a SNRI (serotonin/norepinephrine reuptake-inhibitor) (Barakat,
2019).
Pharmaceutical
action
Tramadol is a centrally acting opiate receptor agonist. It acts by
inhibiting the uptake of norepinephrine and serotonin. It indicates that
tramadol works through opioid as well as non-opioid mechanisms of
pain management. Tramadol can generate opioid-like characteristics,
but leads to less respiratory depression as compared to opioid.
Tramadol induces analgesic effects through a variety of different
targets on the noradrenergic system, serotoninergic system and opioid
receptors system (Hitchings, Lonsdale, Burrage, & Baker, 2015).
Tramadol acts as a racemic mixture, the positive enantiomer inhibits
serotonin reuptake while the negative enantiomer inhibits
noradrenaline re-uptake, by binding to and blocking the transporters
(Vazzana, et al., 2015). Tramadol also has an action of releasing
serotonin. Both enantiomers of tramadol are agonists of the μ-opoid

receptor and its M1 metabolite, O-demethylate, is also a μ-opoid
receptor agonist but is 6 times more potent than tramadol itself. These
actions work in synergy to cause analgesia.
Induction of tramadol in human occurs after 60 minutes of oral
administration and it peaks in next one to two hours(WHO, 2014). The
effect of tramadol is dose-dependent (Radbruch, et al., 2013).
Nursing
responsibilities
Nurse must check if Martha has an allergy of Tramadol prior to
administering it. If Martha is hypersensitive to tramadol, it may lead to
serious complications.
Nurse will also assess Marta’ history in terms of current pregnancy,
alcohol consumption, intake of opioids or other centrally acting
analgesics, seizures; intake of any CNS depressants; renal or hepatic
illness.
Nurse will take any history of opioid addiction as tramadol is
contraindicated in people who are opioid dependent or who have a
history of taking opioids for over 7 days as it may lead to withdrawal
symptoms of opioids.
Nurse will regulate Martha’s environment such as temperature,
lighting, if sweating or any CNS effects occur.
Nurse will educate Martha about the side-effects of tramadol. Teaching
Martha about tramadol in a way that she does not panic yet has enough
information to identify the side effects of tramadol.
Nurse will report any episode of extreme nausea, dizziness or

constipation. As they may or may not be associated with tramadol
administration.
Nurse must ensure that Martha is not prescribed any other medications
which may potentially interact with tramadol.
After ensuring its safety, nurse must administer tramadol timely to
Martha as indicated by the doctor.
Nurse must review the vital signs and check for any signs of orthostatic
hypotension or CNS depression.
She must also monitor bowel and bladder function.
Nurse must review ambulation and use suitable safety measures.
Nurse must record and review the effects of tramadol on Martha which
will help the doctor in titrating the dose of the medicine in future.
Reference
Barakat, A. (2019). Revisiting Tramadol: A Multi-Modal Agent for Pain Management. CNS
Drugs, 33(5), 481-5.
Hitchings, A., Lonsdale, D., Burrage, D., & Baker, E. (2015). Top 100 drugs : clinical
pharmacology and practical prescribing. Churchill Livingstone: Elsevier.
Radbruch, Glaeske, Grond, Munchberg, Scherbaum, Storz, . . . Hoffmann-Menzel. (2013).
Topical review on the abuse and misuse potential of tramadol and tilidine in Germany. Subst
Abus, 34(3), 313-320.
WHO. (2014). Tramadol. Geneva: World Health Organisation.

Vazzana, M., Andreani, T., Fangueiro, J., Faggio, C., Silva, C., Santini, A., . . . Souto. (2015).
Tramadol hydrochloride: pharmacokinetics, pharmacodynamics, adverse side effects, co-
administration of drugs and new drug delivery systems. Biomedicine & Pharmacotherapy, 70,
234-8.