GENERIC NAME: Ranitidine

BRAND NAME: Zantac

CLASSIFICATION
Therapeutic:
Anti-ulcer agents
Pharmacologic:
Histamine H2 antagonists

DOSAGE
20 mg
IV q8h
MECHANISM OF ACTION
• Inhibits the action of histamine at the H2 receptor site located primarily in
gastric parietal cells, resulting in inhibition of gastric acid secretion.
• In addition, ranitidine bismuth citrate has some antibacterial action against
H. pylori.
INDICATION
•Treatment and prevention of heartburn, acid indigestion, and sour stomach.

CONTRA INDICATIONS
Contraindicated in:
•Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain
alcohol and should be avoided in patients with known intolerance.
Use Cautiously in:
• Renal impair- ment
• Geriatric patients (more
susceptible to adverse CNS reactions)
• Pregnancy or Lactation

SIDE EFFECTS/ ADVERSE EFFECTS

• CNS:
Confusion, dizziness, drowsiness, hallucinations, headache
• CV:
Arrhythmias
• GI:
Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced
hepatitis, nausea
• GU:
Decreased sperm count, impotence
• ENDO:
Gynecomastia
• HEMAT:
Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia
• LOCAL:
Pain at IM site
• MISC:
Hypersensitivity reactions, vasculitis
NURSING IMPLICATIONS/RESPONSIBILITIES
• Assess patient for epigastric or abdominal pain and frank or occult blood in
the stool, emesis, or gastric aspirate.
• Nurse should know that it may cause false-positive results for urine protein;
test with sulfosalicylic acid.
• Inform patient that it may cause drowsiness or dizziness.
• Inform patient that increased fluid and fiber intake may minimize
constipation.
• Advise patient to report onset of black, tarry stools; fever, sore throat;
diarrhea; dizziness; rash; confusion; or hallucinations to health
car professional promptly.
• Inform patient that medication may temporarily cause stools and tongue to
appear gray black.

Information on Sodium Bicarbonate

Brand Name: Bakin Soda, Bell-Ans, Citrocarbonate, Neut, Soda Mint
Classification: antiulcer agents, alkalinizing agent
Indications
1. Management of metabolic acidosis
2. Used to alkalinize urine and promote excretion of certain drugs in over dosage situations
3. Used as an antacid
Action
Sodium Bicarbonate acts as an alkalinizing agent by releasing bicarbonate ions. Following oral administration of
this medication, it releases bicarbonate which is capable of neutralizing gastric acid.
Contraindication
1. Metabolic or respiratory alkalosis
2. Hypocalcemia
3. Excessive chloride loss
4. It is not recommended as an antidote following ingestion of strong mineral acids
5. Patients on sodium restricted diet
6. Renal failure
7. Severe abdominal pain of unknown cause especially if associated with fever
Used cautiously in patients with:
1. Congenital heart failure
2. Concurrent corticosteroid therapy
3. Children with diabetic ketoacidosis because taking sodium bicarbonate may increase the risk of cerebral
edema
4. Chronis use as an antacid because it may result to metabolic alkalosis and possible sodium overload
Side effects
1. Edema
2. Flatulence
3. Gastric distention
4. Metabolic alkalosis
5. Hypernatremia
6. Hypocalcemia
7. Hypokalemia
8. Sodium and water retention
9. Irritation at IV site
10. Tetany
Nursing Responsibilities
1. Assess the client’s fluid balance throughout the therapy. This assessment includes intake and output, daily
weight, edema and lung sounds.
2. Symptoms of fluid overload should be reported such as hypertension, edema, difficulty breathing or
dyspnea, rales or crackles and frothy sputum.
3. Sigs of acidosis should be assessed such as disorientation, headache, weakness, dyspnea and
hyperventilation.
4. Assess for alkalosis by monitoring the client for confusion, irritability, paresthesia, tetany and altered
breathing pattern.
5. Hypernatremia clinical manifestations should be assessed and monitored which includes: edema, weight
gain, hypertension, tachycardia, fever, flushed skin and mental irritability.
6. Hypokalemia should also be assessed by monitoring signs and symptoms such as: weakness, fatigue, U
wave on ECG, arrhythmias, polyuria and polydipsia.
7. IV sites should be observed closely. Extravasation should be avoided as tissue irritation or cellulitis may
occur when taking sodium bicarbonate.
8. If infiltration occurs, the physician should be notified immediately. Confer with the doctor or other health care
staff regarding warm compresses and infiltration site with lidocaine or hyaluronidase.
9. Monitor the client’s serum calcium, sodium, potassium, bicarbonate concentrations, serum osmolarity, acid-
base balance and renal function before and throughout the therapy.
10. Tablets must be taken with a full glass of water.
11. For clients taking the medication as a treatment for peptic ulcers it may be administered 1 and 3 hours after
meals and at bedtime.

Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin

Classification: Anti-fibrinolytic, antihemorrhagic
Indications:
Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas:
 Treating heavy menstrual bleeding
 Hemorrhage following dental and/or oral surgery in patients with hemophilia
  Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral
mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures.
 Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid,
lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues.
 Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia
 Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with
hemorrhage
 Effective in promoting hemostasis in traumatic injuries.
 Preventing hemorrhage after orthopedic surgeries.
Mechanism of Action
Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the
reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial
plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin
enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting
factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of
fibrin and effect physiological hemostasis.
Contraindications
1. Allergic reaction to the drug or hypersensitivity
2. Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood
clots
3. Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates
Precautions
1. Pregnancy. Tranexamic acid crosses the placenta.
2. Lactation. Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the
maternal plasma concentration.
3. Contraceptives, estrogen-containing, oral or Estrogens. Concurrent use with tranexamic acid may increase
the potential for thrombus formation.
4. Renal function impairment (medication may accumulate; dosage adjustment based on the degree of
impairment is recommended)
5. Hematuria of upper urinary tract origin (risk of intrarenal obstruction secondary to clot retention in the renal
pelvis and ureters if hematuria is massive; also, if hematuria is associated with a disease of the renal
parenchyma, intravascular precipitation of fibrin may occur and exacerbate the disease)
Nursing Responsibilities
1. Unusual change in bleeding pattern should be immediately reported to the physician.
2. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken
during the menstrual period.
3. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and
effectiveness in these children have not been confirmed.
4. The medication can be taken with or without meals.
5. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing.
6. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next doseat least 6 hours
later. Do not take 2 doses at once.
7. Inform the client that he/she should inform the physician immediately if the following severe side effects
occur:
 Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth,
face, lips or tongue
 Calf pain, swelling or tenderness
 Chest pain
 Confusion
 Coughing up blood
 Decreased urination
 Severe or persistent headache
 Severe or persistent body malaise
 Shortness of breath
 Slurred speech
 Slurred speech
 Vision changes