TRANEXAMIC ACID

Name of Drug Indication Contraindications Mechanism of Side Effects Nursing

Actions Responsibilities
Name of Drug Short term Hypersensitivity. Pharmacodynamics: Nausea Monitor blood pressure,
usage only (2-8 pulse, and respiratory
Tranexamic acid
days) for status as indicated by
inhibits fibrinolysis
Tranexamic Acid patients Active Vomiting severity of bleeding.
by blocking the
suffering from thromboembolic
binding of
hemophilia in disease (e.g.
plasminogen and
Generic Name order to reduce pulmonary Diarrhea Monitor for overt
plasmin to fibrin,
or prevent embolism, DVT), bleeding every 15–30
thus preventing
hemorrhage, to history of venous min.
dissolution of the
Tranexamic Acid lessen the need or arterial Hypotension
hemostatic plug.
for replacement thrombosis
therapy during (including retinal Assess for
Brand Name and after vein or artery Thromboembolic thromboembolic
extraction of Pharmacokinetics:
occlusion), (e.g., arterial, complications.(especially
tooth, and for disseminated Absorption: venous, embolic) in patients with history).
Cyklokapron heavy intravascular Absorbed from the Notify physician of
menstrual, coagulation, gastrointestinal tract. positive Homans’ sign,
surgery, or fibrinolytic Bioavailability: Neurologic (e.g., leg pain hemorrhage,
trauma bleeding conditions after Approx. 45% (oral). visual impairment, edema, hemoptysis,
Classification
cases. consumption Time to peak plasma convulsions, dyspnea, or chest pain.
coagulopathy, concentration: 2.5 headache, mental
history of hours after oral status changes;
Antifibrinolytics
convulsions. administration myoclonus) Monitor platelet count
(range: 1-5 hours). and clotting factors prior
to and periodically
Rash throughout therapy in
Dosage (Adult) Concomitant use Metabolism: Only a patients with systemic
with hormonal small fraction of the fibrinolysis.
Short-term
contraceptives. drug is metabolized
management of
(less than 5%).
hemorrhage.
Instruct patient to notify
Localized
Severe renal the nurse immediately if
hemorrhage: 1-
impairment. Distribution: Widely bleeding recurs or if
1.5 g bid or tid.
distributed thromboembolic
throughout the body. symptoms develop.
It crosses the
Route
placenta and enters
Per Orem breast milk. Volume Caution patient to make
of distribution: 9-12 position changes slowly
L. Plasma protein- to avoid orthostatic
Pregnancy binding: Approx. 3%, hypotension.
Classification mainly to
plasminogen.
Category B

Excretion: Via urine

(>95%, as unchanged
drug). Elimination
half-life: Approx. 2-
11 hours.
 RANITIDINE
Name of Drug Indication Contraindication Mechanism of Action Side Effects Nursing
Responsibilities
Generic Name Active Duodenal Contraindicated Pharmacodynamics CNS: malaise, Assess for
and Gastric Ulcer in patients vertigo abdominal pain.
Antiulcer action:
hypersensitive to Note for any
Adults: 150 mg
Ranitidine drug and in those Ranitidine presence of blood
P.O b.i.d or 300 mg
Hydrochloride with acute competitively inhibits EENT: blured in emesis, stool, or
daily after evening
porphyria the action of histamine vision gastric aspirate.
meal or at bedtime.
at H2-receptors in
Or 50 mg I.V. or
Brand Name gastric parietal cells.
I.M. every 6 to 8
Use cautiously in This reduces basal and Hematoloaic: rever Drug may be added
hours. Maximum
patients with nocturnal gastric acid sible leukopenia to total parental
daily I.V. dose, 400
Zantac75, hepatic secretion as well as that pancvtopenia, nutrition solutions.
mg. Or, 150 mg by
Zantac100, Zantac dysfunction. caused by histamine, aranulocvtopenia,
continuous infusion
300 Adjust dosage in food, amino acids, thrombocytopenia
at 6.25 mg/hour
patients with insulin, and High doses (100
over 24 hours.
impaired renal pentagastrin. mg or more) or
Classification function. Hepatic: Jaundice prolonged I.V.
theraphy (5 days or
Histamine H2- Maintenance
Pharmacokinetics longer) may
receptor antagonist therapy for
Rarely, drug may Skin: burning and increase ALT level.
duodenal or Absorption
cause confusion; itching at injection Monitor ALT level
gastric ulcer risk is greater in daily for remainder
About 50% to 60% of site
Dosage Adults: 150 mg elderly or an oral dose is of treatment
P.O. at bedtime severely ill absorbed; food doesn’t
Capsules: 150 mg,
300 mg patients and in significantly affect Other:
Pathologic those with renal absorption. After I.M. anaphylaxis, Don’t confuse
hypersecretory injection, drug is angioedema ranitidine with
conditions, such rimantadine. Don’t
Injection: 25 as Zollinger- or hepatic absorbed rapidly from confuse Zantac
mg/ml Ellison syndrome impairment. parenteral sites. with Xanax or
Adults: 150 mg Zyrtec.
Syrup: 15 mg/ml P.O. b.i.d; doses up
Tablets: 75 mg, to 6 g or more Prolonged Distribution
150 mg, 300 mg frequent intervals treatment (atleast
may be need Distributed to many
2 years) may lead
needed in patients body tissues and
to vitamin B12
with severe disease. appears in CSF and
Route malabsorption
Or, infuse breast milk. Drug is
and deficiency.
Per Orem continuously at about 10% to 19%
The magnitude of
1mg/kg/hour. After protein-bound.
Intravenous deficiency is dose
4 hours, if patient related and
Intramuscular remains association is
symptomatic or stronger in Metabolism
gastric acid output woman and those Metabolized in the
is greater 10 younger that age liver.
mEq/hour, increase 30.
Pregnancy
does in increments
Classification
of 0.5 mg/kg/hour
Excretion
Category A and recheck gastric
acid output. Doses Excreted in urine and
up to 2.5 feces. Half-life is 2 to 3
mg/kg/hour and hours.
infusion rates up tp
220 mg/hour have
been used.
GERD
Adults: 150 mg
P.O. b.i.d

Erosive
esophagitis
Adults: 150 mg
P.O. q.i.d
maintenance
dosage is 150 mg
P.O. b.i.d

Heartburn
Adults and children
age 12 and older:
75 to 150 mg
(OTC) only P.O.
30 to 60 minutes
before food or
beverages that
cause heartburn or
as symptoms occur,
up to 300 mg daily.
Don’t use more
than twice daily or
exceed 2 weeks of
continuous
treatment.
 OMEPRAZOLE

Name of Drug Indication Contraindication Mechanisms of Side Effects Nursing

Action Responsibilities
Generic Name Symptomatic Contraindicated In CNS: Give omeprazole
GERD without patients before meals,
Pharmacodynamics Agitation, asthenia,
esophageal lesions hypersensitive to preferably in the
dizziness,
omeprazole drug or its It interferes with morning for OD.
drowsiness, fatigue,
components and in gastric acid secretion
headache, psychic
Erosive esophagitis patients receiving by inhibiting the
disturbance
Brand Name rilpivirine- hydrogen potassium- If needed, open
containing products adenosine CV: capsule and
Pathologic triphosphate enzyme sprinkle enteric-
Chest pain, HPN,
Prilosec OTC, hypersecretory system or proton coated granules on
peripheral edema
Prilosec Packets conditions Use cautiously in pump in gastric applesauce or
(Zollinger-Ellison patients with with patrietal. EENT: yogurt then mix
syndrome) hypokalemia and Omeprazole blocks with water.
Classification respiratory the final step in acid Anterior ischemic
alkalosis and production, thus optic neuropathy,
patients in low reducing gastric optic atrophy,
Duodenal ulcer To give via NG
sodium diet acidity cell. neuritis, stomatitis.
Therapeutic class : (short treatment) tube, mix granules
Antiulcer drugs ENDO: in acidic juice to
Hypoglycemia dissolve.
Helicobacter pylori
GI:
Pharmacologic infection and
class: PPIs duodenal ulcer Abdominal pain, Monitor patient for
diseases, to constipation, macrocytic anemia
Dosage (Adult) Pharmacokinetics diarrhea, dyspepsia,
Symptomatic eradicate H.pylori Absorption elevated liver
GERD without with clarithromycin function, flatulence,
Rapid but variably Beware for long
esophageal lesions; hepatic
absorbed from the use of omeprazole,
20 mg P.O., as dysfunction,
gastrointestinal tract. it can develop risk
delayed –release Helicobacter pylori indigestion, nausea,
Bioavailability: for gastric
form or oral infection and pancreatitis,
Approx 30-40%. carcinoma.
suspension, daily duodenal ulcer vomiting.
Time to peak plasma
for 4 weeks for diseases, to
concentration: 0.5- GU: Interstitial
patients who eradicate H.pylori
3.5 hours. nephritis Assess patient for
respond poorly to with clarithromycin
customary medical the signs and
and amoxicillin MS: Back pain
treatment usually symptoms of
including and Distribution RESP: Cough cyanocobalamin
adequate course of deficiency because
Short-Term Enters breast milk. Skin:
H2- receptor long term therapy
treatment of active Plasma protein
Erythema may cause vitamin
benign gastric ulcer binding: Approx
multiforme, 12 absorption
95%.
photosensitivity, problems
Erosive
esophagitis; 20 mg pruritus, rash,
Frequent heartburn Monitor patient for
P.O., daily for Steven-Johnson
Metabolism signs and
recurrent EE or syndrome, toxic
symptoms of acute
GERD signs and Metabolised in the epidermal
interstitial nephritis
symptoms, treat for liver primarily by necrolysis,
up to 12 months. CYP2C19 urticarial
isoenzyme to
Others:
hydroxyl-
Anaphylaxis,
Zollinger-Ellison omeprazole; and
angioedema,
syndrome; Initially, lesser extent by
hyponatremia
60 mg daily, adjust CYP3A4 to
as required. Usual omeprazole sulfone.
dose: 20-120 mg
daily. Dose >80 mg Excretion
should be given in
Mainly via urine
2 divided doses
(approx 77% as
metabolites, small
amount as
Duodenal Ulcer
unchanged drug);
(Short term
faeces (small
treatment); 20 mg
amount).
P.O., as delayed –
Elimination half-
released form or
life: 0.5-3 hour.
oral suspension,
daily for 4 weeks.

Eradication of H.
pylori associated
with peptic ulcer
disease
Adult: 20 mg bid
for 1 week in
combination with
clarithromycin and
with either
amoxicillin or
metronidazole.
Alternatively, 40
mg once daily for 1
week in
combination with
amoxicillin and
metronidazole.
Eradication of H.
pylori associated
with peptic ulcer
disease, Gastric and
duodenal ulcers,
Gastro-oesophageal
reflux disease,
NSAID-associated
ulceration
Adult: 40 mg once
daily given via
infusion over 20-30
minutes until oral
administration is
possible.

I.M
Zollinger-Ellison
syndrome
Adult: Initially, 60
mg daily via
infusion over 20-30
minutes, adjust
dose according to
response. Daily
doses >60 mg
should be given in
2 divided doses.
Route

Per Orem
Intravenous
Pregnancy
Classification

Category C
 CLARITHROMYCIN
Name of Drug Indication Contraindications Mechanism of Side Effects Nursing
Actions Responsibilities
Generic Name To reduce risk of Severe acute Pharmacodynamics Diarrhea Tell patient to take
duodenal ulcer hypersensitivity drugs as prescribed,
Clarithromycin Clarithromycin, a
recurrence in H. reactions, including even after feeling
macrolide antibiotic,
pylori infection. anaphylaxis, Nausea better.
binds to the 50S
Stevens-Johnson
Brand Name subunit of bacterial
syndrome, toxic
ribosomes, blocking
Biaxin epidermal necrolysis, Vomiting Advice patient to
protein synthesis. It’s
drug rash with report all adverse
bacteriostatic or
eosinophilia, and reactions.
bactericidal,
Classifications Henoch-Schönlein Stomach pain
depending on the
purpura, have been
Therapeutic class: concentration.
reported. Advise patient of
Antibiotic
Heartburn the importance of
Pharmacologic taking immediate-
Pharmacokinetics
class: Macrolides Contraindicated in release product
patients Absorption: Rapidly Change in taste every 12 hours.
hypersensitive to absorbed from the GI
Dosage (Adult) clarithromycin, tract; absolute
erythromycin, or bioavailability is Headache Inform patient that
other macrolides and about 50%. Although immediate-release
H. pylori infection in those receiving food slightly delays form may be taken
W/ another primozide or other onset of absorption, with or without
Rash
antibacterial and drugs that prolong clarithromycin may food but extended-
either a PPI or H2 QT interval or cause be taken without release form should
antagonist: 500 mg cardiac arrhythmias. regard to meals be taken with food.
bid for 7-14 days. because food doesn’t
Route Contraindicated in alter the total amount
patients with history of drug absorbed.
Per Orem
of cholestatic
jaundice or hepatic
impairment Distribution: Widely
Pregnancy associated with prior distributed; because it
Classification use of readily penetrates
Category C clarithromycin. cells, tissue
concentrations are
higher than plasma
Patients with levels. Plasma half-
ongoing life is dose-
proarrhythmic dependent; half-life is
conditions such as 3 to 4 hours at doses
uncorrected of 250 mg q 12 hours
hypokalemia or and increases to 5 to
hypomagnesemia or 7 hours at doses of
clinically significant 500 mg q 12 hours.
bradycardia, and in
patients receiving
Class IA or Class III Metabolism:
antiarrhythmics. Clarithromycin’s
major metabolite, 14-
hydroxy
clarithromycin, has
significant
antimicrobial activity.
It’s about twice as
active against H.
influenzae as the
parent drug.

Excretion: In
patients taking 250
mg q 12 hours, about
20% is eliminated in
the urine unchanged;
this increases to 30%
in patients taking 500
mg q 12 hours. The
major metabolite
accounts for about
15% of drug in the
urine. Elimination
half-life of the active
metabolite is dose-
dependent: 5 to 6
hours with 250 mg q
12 hours; 7 hours
with 500 mg q 12
hours.
 NEXIUM
Name of Drug Indication Contraindication Mechanism of Side Effects Nursing
Action Responsibilities
Name of Drug Gastroesophageal Contraindicated in Pharmacodynamics: Headache Give drug at least
reflux disease patients 1 hour before
Esomeprazole is a
(GERD) to heal hypersensitivity to meals. If patient
proton pump
Nexium erosive drug or Diarrhea has difficulty
inhibitor that
esophagitis components of swallowing the
suppresses gastric
esomeprazole or capsule, contents
acid secretion by
Generic Name omeprazole Nausea of the capsule can
specific inhibition of
Short-term be emptied and
the H+/K+- ATPase
treatment (Up to mixed with 1
in the gastric parietal
Esomeprazole Magnesium 10 days) of GERD Use cautiously in Gas tablespoon of
cell.
in patients with a patients with appleasauce and
history of erosive hepatic swallowed
Brand Name esophagitis who insufficiency and Abdominal (without chewing
Pharmacokinetics: the enteric-coated
can’t take drug in pregnant or Pain
orally breastfeeding Absorption pellets).
Nexium women. It’s
unknown if this Oral administration
peak occur at Constipation
Reduce risk of drug appears in Antacids can be
breast milk, but approximately 1.5 used while taking
Classification gastric ulcers in
omeprazole does. hours .Bioavailability drug, unless
patients receiving
is approximately 90% Dry Mouth otherwise directed
continuous
compared to 64% by prescriber.
Proton Pump Inhibator NSAID theraphy
after a single dose of
40 mg. Drowsiness

Long-term Monitor patient

treatment of for rash or signs
pathologic
Dosage (Adult) hypersecretory Metabolism of symptoms of
conditions, hypersensitivity.
P.O.: Metabolized in the
including
liver by the
Gastroesophageal reflux Zollinger-Ellison
cytochrome P450
disease (GERD) to heal Syndrome Monitor GI
(CYP) enzyme
erosive esophagitis symptoms
system.
for improvement
20 or 40 or 24.65 or 49.3
To eliminate or worsening.
(strontium) daily for 4 to 8
Helicobacter
weeks Excretion
pylori
Elimination half-life
Monitor liver
of esomeprazole is
functions test,
Reduce risk of gastric approximately 1-1.5
Reduction of risk especially in
ulcers in patients receiving hours. Approximately
of rebleeding of patients with
continuous NSAID 80% excreted as
gastric or preexisting
theraphy inactive metabolites
duodenal ulcers hepatic disease.
in the urine and
20 or 40 mg or P.O. once after therapeutic
feces.
daily for up to 6 months. endoscopy
Long term
theraphy with
Distribution
Long-term treatment of omeprazole may
pathologic hypersecretory The apparent volume cause atrophic
conditions, including of distribution at gastritis.
Zollinger-Ellison steady state in
Syndrome healthy volunteers is
approximately 16 L.
40 mg or 49.3 mg
(strontium) P.O. bid.
To eliminate Helicobacter
pylori
40 mg or 49.3 mg
(strontium) P.O. daily
1,000 mg amoxicillin P.O.
bid, and 500 mg
clarithromycin P.O. bid
given together for 10 days

I.V. (Adult)
Short-term treatment (Up
to 10 days) of GERD in
patients with a history of
erosive esophagitis who
can’t take drug orally
20 or 40 mg with 5 ml of
D5W, NSS

Reduction of risk of
rebleeding of gastric or
duodenal ulcers after
therapeutic endoscopy
80 mg I.V. over 30 minutes
Route
Per Orem or Intravenous

Pregnancy Classification
Category B
 AMOXICILIIN
Name of Drug Indication Contraindications Mechanism of Side Effects Nursing
Actions Responsibilities
Amoxicillin Adults with GFR Contraindicated in Pharmacodynamics: Nausea If large doses are
of less than 30 patients given or if therapy
Amoxicillin binds to Vomiting
ml/minute hypersensitive to is prolonged,
penicillin-binding
Generic Name shouldn’t receive drug or other bacterial or fungal
protein 1A (PBP-1A) Diarrhea
the 875mg tablet. penicillins superinfection may
located inside the
Adults with GFR occur, especially in
bacterial cell wall to Stomach pain
Amoxicillin of 10-30ml/ minute elderly, debilitated
inhibit cell wall
should receive 250 Use cautiously in or
mucopeptide Vaginal itching or
or 500 mg every 12 patients with other immunosuppressed
synthesis and prevent discharge
Brand Name hours depending drug allergies patients.
cross-linking of
on the infection. (especially to
peptidoglycan Headache
Adults with GFR cephalosporins)
Amoxil of less than because of possible CDAD, ranging
10ml/minute Rash,
cross-sensitivity. from mild diarrhea
should receive 250 Pharmacokinetics:
to fatal colitis, has
Swollen, black, or
Classification or 500 mg every 24 Absorption: been reported with
"hairy" tongue.
hours depending Use cautiously in Amoxicillin is stable nearly all
on the severity of those with in the presence of antibacterial agents,
the infection. mononucleosis gastric acid and is including
Aminopenicillins
Adults on because of high risk rapidly absorbed after amoxicillin.
hemodialysis of maculopapular oral administration. Evaluate patient if
should receive 250 rash. The effect of food on diarrhea occurs.
Dosage (Adult)
or 500 mg every 24 the absorption of
Mild to moderate hours with an extra amoxicillin from the
infections of the dose both during tablets and Amoxicillin usually
ear, nose, and suspension of causes fewer cases
throat; skin and AMOXIL has been
skin structure; or and at the end of partially investigated; of diarrhea than
GU tract. 500 mg dialysis. 400-mg and 875-mg ampicillin.
P.O. every 12 hours formulations have
or 250 mg P.O. been studied only
every 8 hours. when administered at Look alike, sound
the start of a light alike. Don’t
meal. confuse amoxicillin
Route with amoxapine.
Per Orem Metabolism and
Excretion: The half-
life of amoxicillin is
Pregnancy 61.3 minutes.
Classification Approximately 60%
of an orally
Category B administered dose of
amoxicillin is
excreted in the urine
within 6 to 8 hours.
Detectable serum
levels are observed
up to 8 hours after an
orally administered
dose of amoxicillin.
Since most of the
amoxicillin is
excreted unchanged
in the urine, its
excretion can be
delayed by
concurrent
administration of
probenecid

Distribution:
Amoxicillin diffuses
readily into most
body tissues and
fluids, with the
exception of brain
and spinal fluid,
except when
meninges are
inflamed. In blood
serum, amoxicillin is
approximately 20%
protein-bound.
Following a 1-gram
dose and utilizing a
special skin window
technique to
determine levels of
the antibiotic, it was
noted that therapeutic
levels were found in
the interstitial fluid.