ENERIC NAME: Ranitidine BRAND NAME: Zantac

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

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, thrombocytopeniaLOCAL: 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. Indication for Cefuroxime

Cefuroxime is used to treat otitis media, respiratory tract, genitourniary tract, gynecologic, skin, and bone infections. It is also used in the treatment of speticemia, bacterial meningitis, gonorrhea, and other gonococcal infections.
Cefuroxime can also be used for ampicillin-resistant influenza, perioperative prophylaxis, impetigo, acute bacterial maxillary sinusitis, and early Lyme disease.

Routes and Dosage of Cefuroxime

IM/IV: ADULTS, ELDERLY: 750 mg to 1.5 g every 8 hours. CHILDREN: 75-100 mg/kg/day divided every 8 hours. Maximum: 8 g/day. NEONATES: 50-100 mg/kg/day divided every 12 hours.

PO: ADULTS, ELDERLY: 125-500 mg 2 times a day depending on the infection.

Pharyngitis, Tonsillitis PO: CHILDREN 3 MONTHS-12 YEARS: Tablet: 125 mg every 12 hours. Suspension: 20 mg/kg/day in 2 divided doses.

Acute Otitis Media, Acute Bacterial Maxillary Sinusitis, Impetigo PO: CHILDREN 3 MONTHS-12 YEARS: Tablet: 250 mg every 12 hours. Suspension: 30 mg/kg/day in 2 divided doses.

Bacterial Meningitis IV: CHILDREN 3 MONTHS-12 YEARS: 200-240 mg/kg/day in divided doses every 6-8 hours

Perioperative Prophylaxis IV: ADULTS, ELDERLY: 1.5 g 30-60 minutes before surgery and 750 mg every 8 hours post operative.

IM/IV: NEONATES: 20-100 mg/kg/day in divided doses every 12 hours.

Dosage in Renal Impairment Adult dosage is modified based on creatinine clearance and/or severity of infection.

Action of Cefuroxime

Cefuroxime binds to bacterial membranes. It inhibits synthesis of bacterial cell wall.

Side Effects of Cefuroxime

Discomfort with IM administration Oral candidiasis (mouth and/or tongue sores) Mild diarrhea Mild abdominal cramping Vaginal candidiasis Nausea Serum sickness reaction (joint pain, fever) Allergic reactions Thrombophlebitis Adverse Reactions of Cefuroxime Antibiotic-associated colitis Superinfection Nephrotoxicity Severe hypersensitivity reactions Nursing Considerations for Clients Taking Cefuroxime Question for history of allergies, particularly cephalosporins and penicillins. Give without regards to meals. If GI upset occurs give with food or milk. Avoid crushing tablets due to bitter taste. Suspension must be given with food. Intramuscular injections must be administered deep IM to minimize discomfort. Assess mouth for white patches on mucous membranes and tongue. Monitor bowel activity and stool consistency carefully. Mild GI effects may be tolerable but increasing severity may indicate onset of antibiotic-associated colitis. Monitor input and output and renal function reports for nephrotoxicity. Be alert for superinfection: severe genital or anal pruritus, abdominal pain, severe mouth soreness, moderate to severe diarrhea. Patient Teachings for Clients Taking Discomfort may occur with IM injection. Doses should be evenly spaced. Continue antibiotic therapy for full length of treatment. May cause GI upset (may take with food or milk).