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HOME » NOTES » NURSING PHARMACOLOGY » HISTAMINE-2 ANTAGONISTS

Histamine-2 Antagonists
UPDATED ON MAY 6, 2023 BY MATT VERA BSN, R.N.

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Histamine-2 (H2) receptor antagonists block the release of acid in response to gastrin or
parasympathetic release.

1. Histamine-2 Antagonist: Generic and Brand Names

2. Description
3. Therapeutic actions
4. Indication
5. Pharmacokinetics
6. Contraindications and Cautions
7. Adverse effects
8. Interactions
9. Nursing Considerations
9.1. Nursing Assessment
9.2. Nursing Diagnosis
9.3. Nursing Care Plans and Interventions
9.4. Evaluation
10. Practice Quiz
11. Recommended Resources
12. See Also
13. References

Histamine-2 Antagonist: Generic and Brand

Names
Here is a table of the most commonly used H2 antagonists.

Histamine-2 antagonists (ends in -tidine)

cimetidine (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
nizatidine (Axid)

Description
Histamine-2 antagonists block the release of hydrochloric acid in response to gastrin.

These drugs include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and
nizatidine (Axid).

Therapeutic actions
The desired actions of H2 antagonists include the following:
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Selectively block H2 receptors located on the parietal cells.

Prevents the release of gastrin, a hormone that causes local release of histamine (due to
stimulation of histamine receptors), ultimately blocking the production of hydrochloric acid.
Decreases pepsin production by the chief cells.

Indication
Histamine-2 antagonists are indicated for the following:

Short-term treatment of active duodenal ulcer or benign gastric ulcer.

Treatment of pathological hypersecretory conditions such as Zollinger-Ellison syndrome
(blocking the overproduction of hydrochloric acid that is associated with these conditions).
Prophylaxis of stress-induced ulcers and acute upper GI bleeding in critical patients
(blocking the production of acid protects the stomach lining, which is at risk because of
decreased mucus production associated with extreme stress).
Treatment of erosive gastroesophageal reflux (decreasing the acid being regurgitated into
the esophagus will promote healing and decrease pain).
Relief of symptoms of heartburn, acid indigestion, and sour stomach.

Pharmacokinetics
Cimetidine, ranitidine, and famotidine are available in oral and parenteral forms

Route Onset Peak Duration

Oral Varies 1-1.5 h 4-5 h

IM, IV Rapid 1-1.5 h 4-5 h

T 1/2: 2 hours

Metabolization: Liver

Excretion: Urine

Contraindications and Cautions

The contraindications and cautions when using H2 antagonists include:

Allergy. The H2 antagonists should not be used with known allergy to any drugs of this
class to prevent hypersensitivity reactions.
Pregnancy or lactation. Caution should be used during pregnancy or lactation because of
the potential for adverse effects on the fetus or nursing baby.
Hepatic or renal dysfunction. Caution should be used in patients with hepatic or renal
dysfunction, which could interfere with drug metabolism and excretion.
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Prolonged or continual use. Care should also be taken if prolonged or continual use of
these drugs is necessary because they may be masking serious underlying conditions.

Adverse effects
The adverse effects associated with H2 antagonists are:

CNS: Dizziness, confusion, headache, somnolence.

Cardio: Cardiac arrhythmias, cardiac arrest.
GI: Diarrhea.
Reproductive: Impotence.
Skin: Rash.
Misc: Gynecomastia.

Interactions
Cimetidine, famotidine, and ranitidine can slow down the metabolism of the following drugs,
leading to increased serum levels and possible toxic reactions:

Warfarin.
Anti-coagulants.
Phenytoin.
Beta-adrenergic blockers.
Alcohol.
Quinidine.
Lidocaine.
Theophylline.
Chloroquine.
Benzodiazepines.
Nifedipine.
Pentoxifylline.
TCAs.
Procainamide.
Carbamazepine.

Nursing Considerations
Nursing considerations for a patient using H2 antagonists include the following:

Nursing Assessment
Nursing assessment for a patient using H2 antagonists include:

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Assess for possible contraindications and cautions: history of allergy to any H2 antagonists
to prevent potential allergic reactions; impaired renal or hepatic function, which could affect
the metabolism and excretion of the drug; a detailed description of the GI problem,
including length of time of the disorder and medical evaluation to evaluate the appropriate
use of the drug and possibility of underlying medical problems; and current status of
pregnancy and lactation because of the potential for adverse effects on the fetus or
newborn.
Perform a physical examination to establish baseline data before beginning therapy,
determine effectiveness of the therapy, and evaluate for any adverse effects associated with
drug therapy.
Inspect the skin for evidence of lesions or rash to monitor for adverse reactions.
Evaluate neurological status, including orientation and affect, to assess CNS effects of the
drug and to plan for protective measures.
Assess cardiopulmonary status, including pulse, blood pressure, and electrocardiogram (if
IV use is needed), to evaluate the cardiac effects of the drug.
Perform abdominal examination, including assessment of the liver, to establish a baseline
and rule out underlying medical problem.
Monitor the results of laboratory tests, including liver and renal function tests, to predict
changes in metabolism or excretion of the drug that might require dose adjustment.

Nursing Diagnosis
Nursing diagnosis related to the drug therapy might include the following:

Acute pain related to CNS and GI effects.

Disturbed sensory perception (kinesthetic, auditory) related to CNS effects.
Decreased cardiac output related to cardiac arrhythmias.
Risk for injury related to CNS effects.
Deficient knowledge regarding drug therapy.

Nursing Care Plans and Interventions

Nursing interventions for patients using H2 antagonists include:

Ensure therapeutic levels. Administer drug with or before meals and at bedtime (exact
timing varies with product) to ensure therapeutic levels when the drug is most needed.
Prevent serious toxicity. Arrange for decreased dose in cases of hepatic or renal dysfunction
to prevent serious toxicity.
Monitor IV doses carefully. Monitor the patient continually if giving IV doses to allow early
detection of potentially serious adverse effects, including cardiac arrhythmias
Assess for potential drug-drug interactions. Assess the patient carefully for any potential
drug-drug interactions if given in combination with other drugs because of the drugs
effects on liver enzyme systems.
Provide patient’s comfort. Provide comfort, including analgesics, ready to access bathroom
facilities, and assistance with ambulation, to minimize possible adverse effects.

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Reorient patient thoroughly. Periodically reorient the patient and institute safety measures if
CNS effects occur to ensure patient safety and improve and improve patient tolerance of
the drug and drug effects.
Attend regular follow-ups. Arrange for regular follow-up to evaluate drug effects and the
underlying problems.
Provide support. Offer support and encouragement to help patients cope with the disease
and the drug regimen.
Educate the client. Provide patient teaching regarding drug name, dosage, and schedule for
administration; importance of spacing administration appropriately as ordered; need for
readily available access to bathroom; signs and symptoms of adverse effects and measures
to minimize or prevent them.

Evaluation
Evaluation of a patient using H2 antagonists include:

Monitor patient response to the drug (relief of GI symptoms, ulcer healing, prevention of
progression of ulcer).
Monitor for adverse effects (dizziness, confusion, hallucinations, GI alterations, cardiac
arrhythmias, hypotension, gynecomastia).
Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse
effects to watch for, and specific measures to avoid them).
Monitor the effectiveness of comfort measures and compliance with the regimen.

Practice Quiz

Recommended Resources
Our recommended nursing pharmacology resources and books:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small
commission from your purchase which will help support us. Thank you! For more information, check out our privacy
policy.

Pharm Phlash! Pharmacology Flash Cards #1 BEST SELLER!

Test-yourself review cards put critical clinical information for nearly 400 of the
top generic medications at your fingertips. And, you can count on them for
accuracy, because each card is based on content from Davis’s Drug Guide for
Nurses. Increase your test scores in pharmacology class.

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Focus on Pharmacology (8th Edition)

Focus on Nursing Pharmacology makes challenging concepts more
approachable. Engaging learning features cultivate your clinical application,
critical thinking and patient education capabilities. This updated 8th edition
builds on your knowledge of physiology, chemistry and nursing fundamentals
to help you conceptualize need-to-know information about each group of
drugs.

Pharmacology Made Incredibly Easy (Incredibly Easy! Series®)

Nursing pharmacology guide offers step-by-step guidance so you can grasp
the fundamentals in enjoyable Incredibly Easy style. This is the perfect
supplement to class materials, offering solid preparation for NCLEX® as well as
a handy refresher for experienced nurses. Colorfully illustrated chapters offer
clear, concise descriptions of crucial nursing pharmacology concepts and
procedures.

Lehne’s Pharmacology for Nursing Care (11th Edition)

The Eleventh Edition of Lehne’s Pharmacology for Nursing Care provides a
thorough understanding of key drugs and their implications for nursing care.
This text, written by renowned nursing educators, helps you comprehend and
apply pharmacology principles. A clear and engaging writing style simplifies
complex concepts, making even the most challenging pharmacology content
enjoyable. We recommend this book if you want a comprehensive nursing
pharmacology guide.

Nursing Drug Handbook

Nursing2023 Drug Handbook delivers evidence-based, nursing-focused drug
monographs for nearly 3700 generic, brand-name, and combination drugs.
With a tabbed, alphabetical organization and a “New Drugs” section, NDH2023
makes it easy to check drug facts on the spot.

Pharmacology and the Nursing Process

The 10th edition of Pharmacology and the Nursing Process offers practical,
user-friendly pharmacology information. The photo atlas contains over 100
unique illustrations and photographs depicting drug administration techniques.
Updated drug content reflects the most recent FDA drug approvals,
withdrawals, and therapeutic uses.

Mosby’s Pharmacology Memory NoteCards: Visual, Mnemonic, and

Memory Aids for Nurses
The 6th edition of Mosby’s Pharmacology Memory NoteCards: Visual,
Mnemonic, & Memory Aids for Nurses incorporates illustrations and humor to
make studying easier and more enjoyable. This unique pharmacology review
can be utilized as a spiral-bound notebook or as individual flashcards, making it
ideal for mobile study.

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See Also
Here are other nursing pharmacology study guides:

Nursing Pharmacology – Study Guide for Nurses

Our collection of topics related to nursing pharmacology
Pharmacology Nursing Mnemonics & Tips
These nursing mnemonics aim to simplify the concepts of pharmacology through the use of
a simple, concise guide.
Generic Drug Name Stems Cheat Sheet
Learn about these generic drug name stems to help you make sense of drugs easier!
Common Drugs and Their Antidotes
A guide to drug antidotes that nurses should be familiar about.
IV Fluids and Solutions Guide & Cheat Sheet
Get to know the different types of intravenous solutions or IV fluids in this guide and cheat
sheet.
Drug Dosage Calculations NCLEX Practice Questions (100+ Items)
Care to take the challenge? This quiz aims to help students and registered nurses alike
grasp and master the concepts of medication calculation.

Drug Guides NEW!

Aspirin Nursing Considerations & Patient Teaching Drug Guide

Atorvastatin (Lipitor) Nursing Considerations & Patient Teaching Drug Guide
Acetaminophen (Tylenol) Nursing Considerations & Patient Teaching Drug Guide
Enoxaparin (Lovenox) Nursing Considerations and Patient Teaching Drug Guide
Hydromorphone (Dilaudid) Nursing Considerations & Patient Teaching Drug Guide
Lisinopril Nursing Considerations and Patient Teaching Drug Guide
Metoprolol Nursing Considerations & Patient Teaching Drug Guide

Gastrointestinal System Drugs

Antacids
Histamine-2 Antagonists
Proton Pump Inhibitors

Respiratory System Drugs

Antihistamines
Bronchodilators and Antiasthmatics
Decongestants
Expectorants and Mucolytics
Inhaled Steroids
Lung Surfactants

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Endocrine System Drugs

Adrenocortical Agents
Antidiabetic Agents
Glucose-Elevating Agents
Hypothalamic Agents
Insulin
Parathyroid Agents: Bisphosphonates, Calcitonins
Pituitary Drugs
Sulfonylureas
Thyroid Agents

Autonomic Nervous System Drugs

Adrenergic Agonists (Sympathomimetics)

Adrenergic Antagonists (Sympatholytics)
Anticholinergics (Parasympatholytics)
Cholinergic Agonists (Parasympathomimetics)

Immune System Drugs

Antiarthritic Drugs
Immunostimulants
Immunosuppressants
Nonsteroidal Anti-Inflammatory Drugs
Salicylates

Chemotherapeutic Agents

Anthelmintics
Anti-Infective Drugs
Antibiotics
Antifungals
Antineoplastic Agents
Antiprotozoal Drugs
Antiviral Drugs

Reproductive System Drugs

Male Reproductive System Drugs

Female Reproductive System Drugs

Nervous System Drugs

Antidepressants
Antiparkinsonism Drugs
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Antiseizure Drugs
Anxiolytics and Hypnotic Drugs
General and Local Anesthetics
Muscle Relaxants
Narcotics, Narcotic Agonists, and Antimigraine Agents
Neuromuscular Junction Blocking Agents
Psychotherapeutic Drugs

Cardiovascular System Drugs

Antianginal Drugs
Antiarrhythmic Drugs
Antihyperlipidemic Drugs
Antihypertensive Drugs
Cardiotonic-Inotropic Drugs
Diuretics
Drugs Affecting Coagulation

References
Suggested reading and references for this Histamine 2 Receptor Antagonist Nursing
Pharmacology Guide:

Lam, J. R., Schneider, J. L., Zhao, W., & Corley, D. A. (2013). Proton pump inhibitor and
histamine 2 receptor antagonist use and vitamin B12 deficiency. Jama, 310(22), 2435-2442.
[Link]
Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer
Health/Lippincott Williams & Wilkins. [Link]
Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing
care.
Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical
nursing. Philadelphia: JB Lippincott.

Notes, Nursing Pharmacology

Drugs Affecting the Gastrointestinal System
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Celebrating Nurses Week 2019

Matt Vera BSN, R.N.

Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing
topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking

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down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future
healthcare providers.

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