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PHARMACOLOGICAL MANAGEMENT
1. Ranitidine 50 mg IVTT Drug Classes Therapeutic: antiulcer agents Pharmacologic: histamine H2 antagonists Therapeutic Actions Indications Adverse Effects Nursing Consideration 1. Assess for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. 2. Administer over at least 5 minutes. Rapid administration may cause hypotension and arrhythmias. 3. Instruct patient to take medication as directed for the full course of therapy, even if feeling better. 4. It may cause drowsiness or dizziness. Caution patient to avoid activities requiring alertness until response to the drug is known. 5. Instruct patient that increased fluid and fiber intake and exercise may minimize constipation. 6. Advise patient to report onset of black tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly.

Inhibits the action of Short-term CNS: confusion, histamine at the H2treatment of dizziness, receptor site located active duodenal drowsiness, primarily in gastric parietal ulcers and benign hallucinations, cells, resulting in inhibition gastric ulcers. headache. CV: of gastric acid secretion. Prophylaxis of ARRYTHMIAS. GI: In addition, ranitidine duodenal ulcers altered taste, black bismuth citrate has some (at lower doses). tongue (ranitidine antibacterial action Management of bismuth citrate against H. pylori. GERD. Treatment only), constipation, Therapeutic effects: and prevention of dark stools Healing and prevention of heartburn, acid (ranitidine bismuth ulcers. Decreased indigestion, and citrate only), symptoms of sour stomach diarrhea, druggastroesophageal reflux. (OTC use). induced hepatitis Decreased secretion of Cimetidine, (nizatidine, gastric acid. famotidine, cimetidine), and ranitidine: nausea. GU: Management of decreased sperm gastric count, impotence. hypersecretory Endo: states (Zollingergynecomastia. Ellison Hemat:

52

neutropenia. Local: pain at IM site. Cimetidine.induced upper GI bleeding in critically ill patients. Unlabeled uses: Management of GI symptoms associated with the use of NSAIDs. vasculitis . famotidine. 53 agranulocytosis. Ranitidine bismuth citrate: With clarithromycin to eradicate Helicobacter pylori in the treatment of duodenal ulcers (should not be used alone to treat duodenal ulcers).syndrome). thrombocytopenia. Misc: hypersensitivity reactions. ranitidine IV: Prevention and treatment of stress. aplastic anemia.

2. Therapeutic Pharmacologic: effects: Bactericidal secondaction. urinary tract and Adverse Effects Nursing Consideration Bind to bacterial cell wall membrane. appearance of pseudomembranous wound. urticaria. Prevention of acid inactivation of supplemental pancreatic enzymes in patients with pancreatic insufficiency. loose or foulrashes. or loracarbef). Spectrum: generation Similar to that of firstcephalosphorins generation cephalosphorins but have increase activity against several other gram negative 54 CNS: seizures (high 1. sputum. WBC) at beginning jaundice and during therapy. Derm: tongue. stool. 2. urine. causing cell death.Prevention of stress ulceration or aspiration pneumonitis. and colitis. Management of urticaria. (furry overgrowth on the cramps. diarrhea. Instruct patient to notify (increase with health care professional if . Cefoxitin 50 mg IVTT Drug Classes Therapeutic: anti-infectives Therapeutic Actions Indications Treatment of: Respiratory tract infections. skin and skin structure infections. Assess for infection (vital doses). vomiting. Advise patient to report (ceftazidine). GI: signs. bone and joint infections (not cefproxil. signs of superinfection nausea. Hemat: bleeding 3. smelling stools) and allergy.

especially if stool contains blood.Cefotetan gynecologic and and cefoxitin have biliary tract activity against infections. restlessness. Therapeutic Indications Prevention of chemotherapyinduced emesis.pathogens including: gynecologic Haemophilus influenza. Metoclopramide 1mg ANST Drug Classes Therapeutic: antiemetics Therapeutic Actions Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. neuroleptic malignant syndrome. pus or mucus. extrapyramidal reactions. Local: pain at IM site. tardive dyskinesia. Misc: allergic reactions including anaphylaxis and serum sickness. and bowel sounds before and after administration. Cefotetan: Proteus. Facilitation of small bowel cefotetan). resistant staphylococci cefoxitin. phlebitis at IV site. abdominal distention. producing strains). Klebsiella pneumonia. anxiety. cefproxil). Caution patient to avoid other activities requiring alertness until response to medication is 55 . 3. cefuroxime: perioperative prophylaxis. depression. Stimulates motility of the upper GI tract and accelerates gastric emptying. CV: Nursing Consideration 1. irritability. Advise patient not to treat diarrhea without consulting health care professional. catarrhalis. Not Ceforanide. vomiting. superinfection fever and diarrhea develop. or enterococci. Bacteroides fragilis. septicemia (not Neisseria gonorrhoeae cefproxil. infection (not Escherichia coli. (including penicillinaseloracarbef). Adverse Effects CNS: drowsiness. Moraxella intra-abdominal. 2. active against methicillincefotetan. Treatment of postsurgical and diabetic gastric stasis. It may cause drowsiness. Assess patient for nausea.

lips or tongue which may cause difficulty in Nursing Consideration 1. known. swelling of the face. Management of bradycardia). face or limbs occurs. vomiting when Hemat: nasogastric methehemoglobinemia. Easier passage of nasogastric tube into small bowel. involuntary movement of eyes. reflux. intubation in arrhythmias 3. Treatment hypotension. Decreased symptoms of gastric stasis. nausea. It can be used to relieve pain and Adverse Effects Asthma. Adjunct management of migraine headaches. postoperative dry mouth. wheezing or shortness of breath. esophageal hypertension. 3. diarrhea. Assess patient’s pain before therapy and regularly thereafter to monitor drug effectiveness.effects: Decreased nausea and vomiting. nausea and Endo: gynecomastia. Observe the ten rights in administering the medication. suctioning is neutropenia. 4. undesirable. tachycardia. Assess for sensitivity reactions: . GI: and prevention of constipation. 2. Advise patient to notify health radiographic (supraventricular care professional immediately if procedures. Parecoxib 4mg IVTT q12 Drug Classes Therapeutic Actions Centrally acting analgesic Analgesics not chemically related to opioids but binds to muopioid receptors and 56 Indications This medicine is used for the prevention and treatment of pain. Unlabeled uses: agranulocytosis Treatment of hiccups. leucopenia.

swallowing or 4. emesis or gastric aspirate. Assess changes in bowel pattern. Increase diet bulk and oral fluids to prevent constipation. Assess patient routinely for epigastric pain and frank or occult blood in the stool. drowsiness. preventing the final 57 . weakness Nursing Consideration 1. Warn ambulatory patients to be careful (call for assistance) when getting out of bed or walking until CNS effect are known. swelling. euphoria. adverse reactions. hives. reduce inflammation (swelling and soreness) which may occur after surgery. Monitor input-output ratio and dizziness check for decreasing output which may indicate retention. 9. itching or skin 5. peeling of the skin. 7. Adverse Effects CNS: dizziness. drowsiness. pruritus. Monitor for CNS changes: rash. Omeprazole 20 mg PO Drug Classes Therapeutic Actions Indications GERD/ maintenance of healing in erosive esophagitis.inhibits reuptake of norepine-phrine and serotonin.Instruct patient to change positions slowly to prevent orthostatic hypotension 5. Assess patient’s and family’s knowledge on drug therapy. dizziness. rash and urticaria. blistering or hallucinations. 6. headache. 8. Monitor for possible drug induced breathing. Therapeutic: Binds to an ezyme on Anti-ulcer gastric parietal cells in the agents presence of acidic gastric Pharmacologic: Ph. fatigue.

Healing of duodenal ulcers. Reduction of risk of GI bleding in critically ill patients. Therapeutic Effects: Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux. tarry stools. OTC: Heart-burn occurring twice / week. Observe the ten rights in administering the medication. diarrhea. 5.severe pain. Duodenal ulcers CV: chest pain (with or without GI: abdominal anti. DERM: itching. Do not double doses. pylori). gastric ulcer. Nursing Consideration 10. Instruct patient to take as directed for the full course of therapy. confusion. hypersecretory rash MISC: conditions. nausea. active benign flatulence. products containing aspirin or NSAIDS. allergic reactions including Zolinger-Ellison syndrome. Take missed doses as soon as remembered but not if almost time for next dose.infectives for pain. and foods that may cause an increase in GI irritatioin. treatment of diarrhea. 2. May cause occasional drowsiness or dizzinnes. Short term constipation. vomiting Pathologic. 6. Tramadol 50mg IVTT q8 PRN Drug Classes ANALGESICS (Opiates & Therapeutic Actions Indications Adverse Effects Vasodilation. Advise patient to report onset of black. Assess patient’s pain before therapy and regularly thereafter to Centrally acting analgesic Tramadol is used not chemically related to for moderate to opioids but binds to mu. headache.proton-pump inhibitors transport of hydrogen ions into the gastric lumen. Advise patient to avoid alcohol. opioid receptors and 58 . 4. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. even if feeling better. acid Helicobacter regurgitation. 11. 3. dizziness/vertigo. or persistent headache to health care professional promptly. abdominal pain.

19. Visual disturbances. Instruct patient to change positions slowly to prevent orthostatic hypotension 7. 16. 15. 13.Antagonists) inhibits reuptake norepine-phrine serotonin. flatulence. Urinary retention/frequency. Increase diet bulk and oral fluids to prevent constipation. Pruritus. euphoria. 17. 14. Assess changes in bowel pattern. Monitor for CNS changes: dizziness. Monitor for possible drug induced adverse reactions. constipation. seizure. Assess for sensitivity reactions: pruritus. sleep disorder. sweating. anorexia. diarrhea. Tranexamic acid 500g q8 STAT 59 . dry mouth. Warn ambulatory patients to be careful (call for assistance) when getting out of bed or walking until CNS effect are known. hallucinations. abdominal pain. dyspepsia. rash and urticaria. 18. drowsiness. Monitor input-output ratio and check for decreasing output which may indicate retention. vomiting. Nausea. of and nervousness. monitor drug effectiveness. Decreased hemoglobin elevated liver enzymes. Assess patient’s and family’s knowledge on drug therapy. 12. rash.

and the need for periodic monitoring and evaluation. or occasionally orthostatic reactions. Orient patient and offer support and safety measures if hallucinations or psychoses occur. while at the same time the fibrinolytic system removes the fibrin deposits that could cause permanent vascular occlusion once vascular repair has taken place. The coagulation and fibrinolytic system are believed to be in a state of dynamic balance which maintains an intact vascular system. in order to arrange to use comfort and support measures as needed (e. 2. to prevent patient injury. to enhance patient knowledge about drug therapy and to promote compliance with the drug regimen. nausea or diarrhea. Tranexamic acid is a potent antifibrinolytic agent that exerts its effect by blocking lysine binding sites on plasminogen molecules and has the potential to enhance the effectiveness of the patient’s own haemostatic mechanisms. malaise and muscle pain Nursing Consideration 1. warning signs of problems.Drug Classes Therapeutic Actions In the haemostatic process. and safety measures. measures to avoid adverse effects. cramps. coagulation occurs rapidly at the site of a damaged vessel building a tight net of fibrin. dosage prescribed. Antifibrinolytic drug 60 . to help the patient deal with the effects of the drug. Indications It is used to control bleeding by preventing clot breakdown (fibrinolysis) Adverse Effects Headache.g. 5. mouth care. in order to arrange to adjust dosage as needed. positioning. ambulation. weakness. These include small frequent meals. including the name of the drug. fatigue. Monitor clinical response and clotting factor levels regularly. Offer comfort measures. 4. Monitor the patient for any sign of thrombosis. 3. environmental controls. Provide thorough patient teaching. support hose. and exercise).

61 .Consequently. 6. clot breakdown (fibrinolysis) is suppressed and excessive or recurrent bleeding is reduced. Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.

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