DRUG Generic Name: Ranitidine Hydrochloride Brand Name: Zantac Class: Histamine2 antagonists

DOSE 50 mg q 8 hrs

ROUTE IV

INDICATIONS Short-term treatment of active duodenal ulcer Short-term treatment of active, benign gastric ulcer Maintenance therapy for duodenal ulcer at reduced dosage. Short-term treatment for GERD. Pathologic hypersecretory conditions (Zollinger-Ellison syndrome) Treatment of erosive esophagitis Treatment of heartburn, acid indigestion, sour stomach

CONTRAINDICATION Contraindicated with allergy to ranitidine, lactation Use cautiously with impaired renal or hepatic function, pregnancy

ACTION Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin.

SIDE EFFECT CNS: headache, malaise, dizziness, somnolence, insomnia, vertigo CV: tachycardia, bradycardia Dermatologic: rash, alopecia GI: constipation, diarrhea, nausea and vomiting, abdominal pain, hepatitis GU: impotence or decreased libido Hematologic: leucopenia, granulocytopenia , thrombocytopeni a, pancytopenia

NURSING CONSIDERATIONS Assessment: 1. History: allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy. 2. Physical: skin lesions, orientation, affect, liver evaluation, abdominal examination, normal output, renal function tests, CBC Interventions: 1. Administer oral drug with meals and at bedtime. 2. Decrease doses in renal and liver failure. 3. Provide concurrent antacid therapy to relieve pain. 4. Administer IM dose undiluted, deep into large muscle group. 5. Arrange for regular follow-up including blood test, to evaluate effects.

DRUG Generic Name: Metoclopramide Brand Name: Maxolon Class: Antiemetic, GI stimulant

DOSE 1 amp q 8 hrs

ROUTE IV

INDICATIONS Disturbances of GI motility Relief of symptoms of acute and recurrent diabetic gastroparesis Nausea and vomiting Metabolic diseases Short-term therapy for adults with symptomatic gastroesophageal reflux who fail to respond to conventional therapy. Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable.

CONTRAINDICATIONS Contraindicated with allergy to metoclopramide GI hemorrhage Mechanical obstruction or perforation Epilepsy Use cautiously with previously detected breast cancer, lactation, pregnancy, fluid overload, renal impairment

ACTION Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin

SIDE EFFECT CNS: restlessness, drowsiness, fatigue, insomnia, dizziness, anxiety CV: transient hypertension GI: nausea and diarrhea

NURSING CONSIDERATIONS Assessment: 1. History: allergy to metoclopramide, GI hemorrhage, mechanical obstruction or perforation, depression, epilepsy, lactation, previously detected breast cancer 2. Physical: orientation, reflexes, affect, bowel sounds, normal output, EEG Interventions: 1. Monitor BP carefully during IV administration. 2. Monitor diabetic patients, arrange for alterations in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption.

DRUG Generic Name: Ketorolac Tromethamine Brand Name: Toradol Class: Antipyretic NSAID

DOSE 1 AMP q 6 hrs and PRN for pain

ROUTE IV

INDICATIONS Short-term management of pain (up to 5 days) Ophthalmic: relief of ocular itching due to seasonal conjunctivitis and relief of postoperative inflammation after cataract surgery.

CONTRAINDICATIONS Contraindicated with significant renal impairment, during labor and delivery, lactation, aspirin allergy, recent GI bleed or perforation Use cautiously with impaired hearing; allergies; hepatic conditions

ACTION Antiinflammatory and analgesic activity; inhibits prostaglandins and leukotriene synthesis

SIDE EFFECT CNS: headache, dizziness, somnolence, insomnia, fatigue, dizziness, tinnitus, ophthalmologic effects

NURSING CONSIDERATIONS Assessment: 1. History: renal impairment, impaired hearing, allergies, hepatic, lactation, pregnancy 2. Physical: skin color and lesions, orientation, reflexes, peripheral sensation, clotting times, CBC, adventitious sounds Interventions: 1. Be aware that patient may be at risk for CV events, GI bleeding, renal toxicity, monitor accordingly. 2. Do not use during labor, delivery, or while nursing. 3. Keep emergency equipment readily available at time of initial dose, in case of severe hypersensitivity reaction. 4. Protect drug vials from light. 5. Administer every 6 hrs to maintain serum levels and control pain.

DRUG Generic Name: Omeprazole Brand Name: Tansinel Class: Antisecretory drug

DOSE 20 mg 1 cap for two weeks

ROUTE Oral

INDICATIONS Short-term treatment of active duodenal cancer Short-term treatment of active benign gastric ulcer Eradication of Helicobacter Pylori First-line therapy for treatment of heartburn or symptoms of GERD.

CONTRAINDICATIONS Contraindicated with hypersensitivity to omeprazole or its components. Use cautiously with pregnancy, lactation.

ACTION Gastric-acid pump inhibitor: suppresses gastric acid secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

SIDE EFFECT CNS; headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities Dermatologic: rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis

NURSING CONSIDERATIONS Assessment: 1. History :hypersensitivity to omeprazole or any of its components; pregnancy, lactation 2. Physical: skin lesions; reflexes; urinary output; abdominal examination; respiratory auscultation Interventions: 1. Administer before meals. 2. Administer antacids with, if needed. 3. Have regular medical follow-up visits. 4. Report severe headache, worsening of symptoms, fever, chills.

DRUG Generic Name: metronidazole Brand Flagyl Name:

DOSE capsule 375mg tablet 250mg 500mg Tablet, extendedrelease 750mg infusion solution 500mg/ 100mL

ROUTE Oral ivtt

INDICATIONS Amebicide in the management of amebic dysentery

CONTRAINDICATIO NS hypersensitivity

ACTION Disrupts DNA and protein synt hesis in susceptible organisms Bactericidal, or amebicidal action.

Class: Anti-protozoals Anti-infectives,

SIDE EFFECT CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting

NURSING CONSIDERATIONS
Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Instruct patient to take medication exactly as directed evenly spaced times between dose, even if feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not almost time for next dose. May cause dizziness or light-

headedness. Caution patient or other activities requiring alertness until response to medication is known. Inform patient that medication may cause an unpleasant metallic taste. Inform patient that medication may cause urine to turn dark.

Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop).