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Classification
:
GASTROINTESTINAL AGENT; ANTISECRETORY (H2-RECEPTOR ANTAGONIST)
GENERIC NAMEINDICATION AND DOSAGEACTIONCONTRAINDICATIONSIDE EFFECTSNURSINGCONSIDERATION
RanitidineHCL
 
•
 Active Duodenal Ulcer 
Adults: PO 150mg b.i.d. or 300mg at bedtime. Maintenancedose is 150 mg at bedtime.IM/IV/Intermittent IV 50 mg every6 to 8 h.Children 1 mon -16 y/o: PO 2 to 4mg/kg twice daily (max, 300mg/day).•
Maintenance therapy for Duodenal and Gastric Ulcers
Adults: 150mg P.O at bedtimeChildren 1 mon -16 y/o: PO 2 to 4mg/kg daily up to 150mg daily•
Pathologic Hypersecretory Conditions
Adults: PO 150 mg twice daily.Individualize.•
GERD and Erosive Esophagitis
Adults: PO 150mg b.i.d.Children 1 mon -16 y/o: PO 5 to10 mg/kg daily usually given in 2divided doses.
•Erosive Esophagitis:
Maintenance dosage is 150mgP.O. q.i.d.•
Heartburn
Adults and Children 1 mon -12y/o and older: 75mg of Zantac 75P.O. as symptoms occur, up to150mg daily, not to exceed 2•Completelyinhibits action of histamine on theH2 at receptorsites of parietalcells, decreasinggastric acidsecretions•Contraindicatedin patientshypersensitive todrug and thosewith porphyria•Use cautiously inpatients withhepaticdysfunction. Adjustdose in patientswith impaired renalfunction•
CNS
: headache,malaise, vertigo•
EENT
: Blurred vision,•
Hepatic
: jaundice•
Other:
anaphylaxis,angioedema, burningad itching at injectionsite•Instruct patient onproper use of OTCpreparation asindicated.•Assess patient forabdominal pain.Note presence of blood in emesis,stool, or gastricaspirate•Ranitidine may beadded to totalparenteral nutritionsolution•Remind patient totake once dailyprescription drug atbedtime for bestresults•Instruct patient totake without regardto meals becauseabsorption isn’taffected by food• Remind patient notto confuse ranitidinewith rimantadine:don’t confuse Zantacwith Xanax or Zyrtec
 
weeks of continuous treatment.
Classification
: Opioid Agonist-Antagonist
GENERIC NAMEINDICATION ANDDOSAGEACTIONCONTRAINDICATIONSIDE EFFECTSNURSING CONSIDERATION
NalbuphineHCL
•Management of moderate to severe pain•preoperative andpostoperative analgesia•supplement tobalanced anesthesia•obstetrical analgesiaduring labor anddelivery
DOSAGE
Adults Subcutaneous /IM / IV 10 mg per 70 kgq 3 to 6 h as needed.Individualize dosage. Innontolerant patients, donot exceed 20 mg/doseor 160 mg/day•Binds withopiatereceptors inthe CNS,alteringperception of and emotionalresponse topain.•Contraindicated inpatientshypersensitive todrug•Use cautiously inpatients with historyof drug abuse and inthose with emotionalinstability, headinjury, increased ICP,impaired ventilation,MI accompanied byN/V, upcomingbiliary surgery, andhepatic or renaldisease•
CNS
: Sedation,dizziness, vertigo,headache, agitation,confusion, crying,depression, dysphoria,euphoria, faintness,floating feeling,hallucinations, heavinessfeeling, hostility,nervousness, numbness,restlessness, seizures,tingling, unreality,unusual dreams•
CV
: Bradycardia,hypertension,hypotension, tachycardia•
EENT
: Blurred vision, drymouth•
GI
: Nausea, vomiting,biliary tract spasms,constipation cramps,dyspepsia•
GU
: Urinary urgency•
Respiratory:
Respiratory depression,asthma, dyspnea,pulmonary edema
•
Skin: Burning,clamminess, diaphoresis,•Reassess patient’s level of pain at least 15 and 30minutes after parenteraladministration•Nalbuphine acts as anopioid antagonist and maycause withdrawalsyndrome. For patients whohave received log-termopioids, give 25% of theusual dose initially. Watchfor sings of withdrawal.•Alert: Drug causesrespiratory depression,which at 10mg is equal torespiratory depressionproduced by 10 mg of morphine•Monitor circulatory andrespiratory status, bladderand bowel function. If respirations are shallow orrate is below 12breaths/minute, withholddose and notify prescriber•Constipation is oftensevere with maintenancetherapy. Make sure stoolsoftener or other laxative isordered.•Psychological and physicaldependence may occur with
 
pruritus, uticariaprolonged use.• Remind patient not toconfuse Nubain withNavane.
Classification
: Dopamine Antagonist, GI stimulant
GENERIC NAMEINDICATION AND DOSAGEACTIONCONTRAINDICATIONSIDE EFFECTSNURSINGCONSIDERATION
Metoclopramide HCL•
To prevent or reduce nausea and vomiting from emetogeic cancer therapy.
Adults: 1-2mg/kg I.V. 30 mins beforechemotherapy; repet every 2 hoursfor two doses, then every 3 hours for3 doses•
To prevent or reduce postoperativenausea and vomiting.
Adults: 10-20mg I.M. near end of surgical procedure; repeat every 4-6hours, PRN•
To facilitate small-bowel incubation,to aid in radiologic examinations
Adults and Children older than 14y/o: 10mg or 2ml I.V. as a singledose over 1-2 minutes.Children ages 6-14 y/o: 2.5 -5mg or0.5 to 1ml I.V.•
Delayed gastric emptyingsecondary to diabetic gastroparesis:
10 mg PO 30 min before each mealfor mild symptoms. Give slow I.Vinfusion over 12 minutes 30 minutesbefore each meal ad at bedtime for•Stimulatesmotility of upperGI tract,increases loweresophagealsphincter toe,and blocksdopaminereceptors at thechemoreceptortrigger zone•Contraindicated inpatientshypersensitive todrug and those withpheochromocytomaor seizure disorders• Contraindicated inpatientsfor whomstimulation of GImotility might bedangerous•Use cautiously inpatients with historyof depression,Parkinson dse. OrHPN•
CNS
:Restlessness,drowsiness,fatigue, lassitude,insomnia,extrapyramidalreactions,parkinsonism-likereactions,akathisia,dystonia,myoclonus,dizziness, anxiety•
CV
: hypotention, Transienthypertension,bradycardia•
GU:
incontinence,urinary frequency•
GI
:
Nausea,diarrhea, boweld/o
•
Hematologic:
agranulocytosis,•Monitoe bowelsounds.•Safety andeffectiveness of drug haven’t beenestablished fortherapy lastinglonger than 12weeks.•ALERT: Use 24mdiphenhydramineI.V. to counteractExtrapyramidaladverse effectfrom high doses
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