Download ranitidine (ra-ni-ti-deen) - DavisPlus

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TIME/ACTION PROFILE
1
ranitidine (ra-ni-ti-deen)
Acid Reducer, Zantac, Zantac EFFERdose, Zantac 75, Zantac 150
Classification
Therapeutic: antiulcer agents
Pharmacologic: histamine H2 antagonists
ROUTE
ONSET
PEAK
DURATION
PO
IM
IV
unknown
unknown
unknown
1–3 hr
15 min
15 min
8–12 hr
8–12 hr
8–12 hr
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Syrup contains alcohol and should be
Pregnancy Category B
Indications
Short-term treatment of active duodenal ulcers and benign gastric ulcers. Maintentance therapy for duodenal and gastric ulcers after healing of active ulcer(s). Management of gastric hypersecretory states (Zollinger-Ellison syndrome). Treatment of and
maintenace therapy for erosive esophagitis. Treatment of gastroesophageal reflux
disease (GERD). Heartburn, acid indigestion, and sour stomach (OTC use). IV: Prevention and treatment of stress-induced upper GI bleeding in critically ill patients.
Action
Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. Therapeutic Effects:
Healing and prevention of ulcers. Decreased symptoms of gastroesophageal reflux.
Decreased secretion of gastric acid.
avoided in patients with known intolerance.
Use Cautiously in: Phenylketonuric patients (effervescent tablets and granules
contain phenylalanine); Geri: Geriatric patients are more susceptible to adverse CNS
reactions including dizziness and confusion; dosageprecommended; Renal impairment (more susceptible to adverse CNS reactions;qdose interval recommended if
CCr ⬍50 mL/min); Hepatic impairment; Acute porphyria (may precipitate an attack);
OB: Pregnancy; Lactation: Passes into breast milk and can causepstomach acid in
the infant.
Adverse Reactions/Side Effects
CNS: confusion, dizziness, drowsiness, hallucinations, headache. CV: ARRHYTHMIAS.
GI: constipation, diarrhea, nausea. GU:psperm count, erectile dysfunction. Endo:
gynecomastia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, anemia, neutropenia,
thrombocytopenia. Local: pain at IM site. Misc: hypersensivity reactions, vasculitis.
Interactions
Drug-Drug: Maypabsorption of ketoconazole, itraconazole, atazanavir, delavirdine, and geftinib. Mayqabsorption of triazolam and glipizide. Mayqprocainamide levels. Mayqthe effects of warfarin.
Route/Dosage
Pharmacokinetics
Absorption: 50% absorbed after PO administration.
Distribution: Enters breast milk and cerebrospinal fluid.
Metabolism and Excretion: Metabolized by the liver, mostly on first pass; 30%
excreted unchanged by the kidneys after parenteral administration.
Half-life: Neonates (on ECMO): 6.6 hr; Infants: 3.5 hr; Children: 1.8– 2 hr; Adults:
2– 2.5 hr (qin renal impairment to 4.8 hr).
⫽ Canadian drug name.
⫽ Genetic Implication.
PO (Adults): Short-term treatment of active ulcers— 150 mg twice daily or 300
mg once daily at bedtime. Duodenal ulcer prophylaxis— 150 mg once daily at bedtime. GERD— 150 mg twice daily. Erosive esophagitis— 150 mg 4 times daily initially, then 150 mg twice daily as maintenance. Gastric hypersecretory conditions— 150 mg twice daily initially; up to 6 g/day have been used. OTC use— 75 mg
when symptoms occur (up to twice daily).
PO (Children 1 mo-16 yr): Treatment of active ulcers— 2– 4 mg/kg/day divided
twice daily, maximum 300 mg/day. GERD and Erosive esophagitis— 4– 10 mg/kg/
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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● If antacids or sucralfate are used concurrently for relief of pain, avoid administra-
2
day divided twice daily, maximum 300 mg/day for GERD, 600 mg/day for erosive
esophagitis.
PO (Neonates): 2 mg/kg/day divided q 12 hr.
IV, IM (Adults): 50 mg q 6– 8 hr (not to exceed 400 mg/day). Continuous IV infusion— 6.25 mg/hr. Gastric hypersecretory conditions— 1 mg/kg/hr; may beqby
0.5 mg/kg/hr (not to exceed 2.5 mg/kg/hr).
IV, IM (Children 1 mo— 16 yr): Treatment of active ulcers— 2– 4 mg/kg/day
divided q 6– 8 hr, maximum 200 mg/day. Continuous infusion— 1 mg/kg/dose
followed by 0.08– 0.17 mg/kg/hr.
IV (Neonates): 1.5 mg/kg/dose load, then in 12 hr start maintenance of 1.5– 2 mg/
kg/day divided q 12 hr Continuous IV infusion– 1.5 mg/kg/dose load followed by
0.04– 0.08 mg/kg/hr infusion.
Renal Impairment
PO (Adults): CCr10– 50 mL/min—pdose to 50% of dose recommended for indication; CCr⬍10 mL/min—pdose to 25% of dose recommended for indication; further reductions may be necessary if there is coexistent hepatic impairment.
NURSING IMPLICATIONS
Assessment
● Assess patient for epigastric or abdominal pain and frank or occult blood in the
stool, emesis, or gastric aspirate.
● Assess geriatric and debilitated patients routinely for confusion.
● Lab Test Considerations: CBC with differential should be monitored pe-
riodically during therapy.
● Antagonizes effects of pentagastrin and histamine during gastric acid secretion
testing. Avoid administration for 24 hr preceding the test.
● May cause false-negative results in skin tests using allergenic extracts. Histamine
antagonists should be discontinued 24 hr before the test.
● May cause anqin serum transaminases and serum creatinine.
● May cause false-positive results for urine protein; test with sulfosalicylic acid.
Potential Nursing Diagnoses
Acute pain (Indications)
Implementation
● Do not confuse Zantac (ranitidine) with Xanax (alprazolam) or Zyrtec
(cetirizine).
●
●
●
●
tion of antacids within 30 min– 1 hr of ranitidine and take sucralfate 2 hr after ranitidine; may decrease the absorption of ranitidine.
PO: Administer with meals or immediately afterward and at bedtime to prolong effect.
Doses administered once daily should be administered at bedtime to prolong effect.
Shake oral suspension before administration. Discard unused suspension after 30
days.
Remove foil from ranitidine effervescent tablets or granules and dissolve in 6–
8 oz water before drinking.
IV Administration
● pH: 6.7– 7.3.
● Direct IV: Diluent: Dilute each 50 mg in 20 mL of 0.9% NaCl or D5W for injec-
tion. . Concentration: 2.5 mg/mL. Rate: Administer over at least 5 min at a
maximum of 10 mg/min. Rapid administration may cause hypotension and
arrhythmias.
● Intermittent Infusion: Diluent: Dilute each 50 mg in 100 mL of 0.9% NaCl or
D5W. Diluted solution is stable for 48 hr at room temperature. Do not use solution
that is discolored or that contains precipitate. . Concentration: 0.5 mg/mL.
Rate: Administer over 15– 20 min.
● Continuous Infusion: Diluent: D5W. . Concentration: 150 mg/250 mL (no
greater than 2.5 mg/mL for Zollinger-Ellison patients). Rate: Administer at a rate
of 6.25 mg/hr. In patients with Zollinger-Ellison syndrome, start infusion at 1 mg/
kg/hr. If gastric acid output is ⬎10 mEq/hr or patient becomes symptomatic after
4 hr, adjust dose by 0.5 mg/kg/hr increments and remeasure gastric output.
● Y-Site Compatibility: acyclovir, aldesleukin, alfentanil, allopurinol, amifostine,
amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, amsacrine, anikinra, anidulafungin, argatroban, ascorbic
acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan,
cefoxitin, ceftaroline, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol,
chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, cladribine, clindamycin,
cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin,
daptomycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhy䉷 2015 F.A. Davis Company
CONTINUED
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● Advise patients taking OTC preparations not to take the maximum dose continu-
CONTINUED
ranitidine
●
dramine, dobutamine, docetaxel, dopamine, doripenem, doxacurium, doxapram, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, enalaprilat,
ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, fluorouacil, folic acid, foscarnet, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron,
heparin, hydrocortisone, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, indomethacin, irinotecan, isoproterenol, ketamine, ketorolac, labetalol,
levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine,
methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole,
midazolam, milrinone, mitoxantrone, morphine, multivitamins, mycophenolate,
nafcillin, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin,
paclitaxel, palonosetron, pamidronate, pancuronium, papaverine, pemetrexed,
penicillin G, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate,
potassium chloride, procainamide, prochlorperazine, promethazine, propofol,
propranolol, protamine, pyridoxime, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, strepotkinase, succinylcholine,
sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiopental,
thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline,
trastuzumab, trimetaphan, vancomycin, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, warfarin, zidovudine, zoledronic acid.
● Y-Site Incompatibility: amphotericin B cholesteryl, caspofungin, dantrolene,
diazepam, diazoxide, pantoprazole, phenytoin, quinupristin/dalfopristin, trimethoprim/sulfamethoxazole.
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ously for more than 2 wk without consulting health care professional. Notify health
care professional if difficulty swallowing occurs or abdominal pain persists.
Inform patient that smoking interferes with the action of histamine antagonists.
Encourage patient to quit smoking or at least not to smoke after last dose of the
day.
May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known.
Advise patient to avoid alcohol, products containing aspirin or NSAIDs, excessive
amounts of caffeine, and foods that may cause an increase in GI irritation.
Inform patient that increased fluid and fiber intake and exercise may minimize
constipation.
Advise patient to report onset of black, tarry stools; fever; sore throat; diarrhea;
dizziness; rash; confusion; or hallucinations to health care professional promptly.
Evaluation/Desired Outcomes
● Decrease in abdominal pain.
● Prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be
seen by x-rays or endoscopy. Therapy is continued for at least 6 wk in treatment of
ulcers but not usually longer than 8 wk.
● Decreased symptoms of esophageal reflux.
Why was this drug prescribed for your patient?
Patient/Family Teaching
● Instruct patient to take medication as directed for the full course of therapy, even if
feeling better. Take missed doses as soon as remembered but not if almost time for
next dose. Do not double doses.
⫽ Canadian drug name.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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