ONDANSETRON ZUPLENZ, ZOFRAN

GENERIC NAME TRADE NAME

PHARMACOLOGIC CLASS: Selective serotonin (5-HT3) receptor antagonist THERAPEUTIC CLASS: Antiemetics
ACTION: May block 5-HT3 in the CNS in the chemoreceptor trigger zone and in the PNS on nerve terminals of the vagus nerve.

REASON GIVEN (DISEASE STATES): Used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, and
surgery.
NURSING PROCESS

Pre-Administration Assessment: Post Administration Evaluation: Nursing Considerations:

 Assess patient for nausea, vomiting,  Four to eight hours after ondansetron  Drug may increased the risk of prolonged
abdominal distension, and bowel sounds therapy, serum samples were collected to QT interval and torsade de pointes (a
prior to and following administration. remeasure plasma osmolality. potassium, potentially fatal heart rhythm) Monitor
sodium, aldosterone, and creatinine ECG in patients with congenital long QT
 Assess patient for extra pyramidal effects levels. syndrome, in those with HF or
involuntary movements, facial grimacking, bradyarrhythmias, and in those taking
rigidity, shuffling walk, trembling of hands)  Similarly, urine was collected for other medications that can prolong the
periodically during therapy. urinalysis, osmolality. Potassium, sodium, QT interval.
and creatinine.
 Monitor ECG in patients with  Correct electrolytes abnormalities
hypokalemia, hypomagnesemia, HF, (hypokalemia or hypomagnesemia)
bradilyarrhythmias, or patients taking before infusing drug.
concomitant medications that prolong the
QT interval  Monitor LFT results. Dont exceed 8mg in
patients with hepatic impairment.
 Serum samples were obtained to
determine plasma osmolality, potassium,  Dont confused zofran with zosyn, Zantac
sodium, aldosterone, and creatinine levels. and Zoloft.

 Urine samples were obtained within a few  Monitor fluid and electrolyte status.
hours of the serum samples and before diarrhea, which may cause fluid and
 ondansetron administration. electrolyte imbalance, is a potential
 Urine was collected for urinalysis, adverse effect of the drug.
osmolality, potassium, sodium, and
creatinine levels.  Monitor cardiovascular status, especially
in patients with a history of coronary
 Urine volume was measured preceding artery disease. Rare cases of tachycardia
ondansetron administration for 1-8 hours, as and angina have been reported.
well as at least 8 hours after ondansetron
administration.

Lab Test Considerations:

 May cause transient in serum bilirubin,

AST, and ALT levels.

Other:

Contraindications/ Precautions:

 Contraindicated in: Hypersensitivity: Orally disintegrating tablets contain aspartame and should not be used in patients
with phenylketonuria: Congenital long QT syndrome: Concurrent use of apomorphine.
 Use Cautiously in: Hepatic impairment (daily dose not to exceed 8 mg): Abdominal surgery (may mask ileus): OB.
lactation, Pedia: Pregnancy, lactation, or children 3 yr (PO) or 1 mo (parenteral) (safety not established).

Route/ Dosage

 PO (Adults): Prevention of nausea/vomiting associated with highly-emetogenic chemotherapy-24 mg 30 min prior to

chemotherapy.
 PO (Adults and Children 11 yr): Prevention of nausea/vomiting associated with moderately emetogenic chemotherapy-8
mg 30 min prior to chemotherapy and repeated 8 hr later, 8 mg q 12 hr may be given for 1-2 days following chemotherapy.
 Prevention of radiationinduced nausea/vomiting-8 mg 1-2 hr prior to radiation; may be repeated q8 hr, depending on type,
location, and extent of radiation. Prevention of postoperative nausea/vomiting-16 mg 1 hr before induction of anesthesia.
 PO (Children 4-11 yr): Prevention of nausea/vomiting associated with moderately emetogenic chemotherapy-4 mg 30 min
prior to chemotherapy and repeated 4 and 8 hr later; 4 mg q8 hr may begiven for 1-2 days following chemotherapy
 IV (Adults): Prevention of chemotherapy-induced nausea/vomiting-0.15 mg/kg (max dose 16 mg) 30 min prior to
chemotherapy, repeated 4 and 8 hr later.
 IM, IV (Adults): Prevention of postoperative nausea/vomiting-4 mg before induction of anesthesia or postoperatively.
 IV (Children 6 mo- 18 yr): Prevention of chemotherapy-induced nausea/vomiliting-0.15 mg/kg (max dose 16 mg) 30 min
prior to chemotherapy, repeated 4 and 8 hr later.
 IV (Children 1 mo-12 yr and 40 kg): Prevention of postoperative nausea/vomiting-4 mg.•
 IV (Children 1 mo-12 yr and 40 kg): Prevention of postoperative nausea/vomiting-0.1 mg/kg.

Adverse Reaction

 CNS: headache, dizziness, drowsiness, fatigue, weakness.

 CV: TORSADE DE POINTES, QT interval prolongation.
 Gl: constipation, diarrhea, abdominal pain, dry mouth, imcrease liver enzymes.Neuro:extrapyramidal reactions

Patient/ Family Teaching

 Instruct patient to take ondansetron as directed.

 Advise patient to notify health care professional immediately if symptoms of irregular heart beat or involuntary movement of
eyes, face, or limbs occur.

Evaluation/ Desired outcomes

  Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy
 Prevention of postoperative nausea and vomiting.
 Prevention of nausea and vomiting due to radiation therapy.

RANITIDINE ZANTAC

GENERIC NAME TRADE NAME

PHARMACOLOGIC CLASS: Histamine H2, Antagonist THERAPEUTIC CLASS: Anti-ulcer angent

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.

REASON GIVEN (DISEASE STATE): 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.

NURSING PROCESS

Pre-Administration Assessment: Post Administration Evaluation: Nursing Considerations:

 Assess patient for epigastric or abdominal  Monitor serum creatinine, AST,  If antacids or sucralfate are used
pain and frank or occult blood in the stool, ALT alkaline phosphatase and total concurrently for relief of pain,
emesis, or gastric aspirate.
bilirubin. avoid administration of antacids
 Assess geriatric and debilitated patients within 30 min– 1 hr of ranitidine
routinely for confusion. and take sucralfate 2 hr after
ranitidine; may decrease the
  Monitor for bleeding, bruising, absorption of ranitidine.
 Obtain complete health history including including complete blood count.
allergies, drug history and possible drug (Drug may cause
interactions Assess for presence/history thrombocytopenia.)
gastroesophageal reflux disease, gastric
ulcer  Doses administered once daily
should be administered at bedtime
 Obtain vital signs to prolong effect.
 Institute safety procedures to
 Assess liver and kidney function, protect the patient who
 Shake oral suspension before
pregnancy status and complete blood count. experiences dizziness. administration. Discard unused
suspension after 30 days.
Lab Test Considerations:

 CBC with differential should be monitored

periodically 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.

Other:
Contraindications/ Precautions:

 Contraindicated in: Hypersensitivity; Syrup contains alcohol and should be 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; dosage recommended; 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 cause stomach acid in the infant.

Route/ Dosage

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/ Name /bks_53161_deglins_md_disk/ranitidine 02/17/2014 09:42AM Plate # 0-Composite pg 2 # 2 2015 F.A. Davis
Company CONTINUED PDF Page #2 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 (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; CCr10 mL/min—pdose to 25% of dose recommended for
indication; further reductions may be necessary if there is coexistent hepatic impairment.

Adverse Reaction

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.

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.

 Advise patients taking OTC preparations not to take the maximum dose continuously 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.
 LOPERAMIDE IMODIUM

GENERIC NAME TRADE NAME

PHARMACOLOGIC CLASS: Piperidine derivative THERAPEUTIC CLASS: Antidiarrheal

ACTION:   Inhibits peristalsis and prolongs transit time by a direct effect on nerves in the intestinal muscle wall. Reduces fecal volume,
increases fecal viscosity and bulk while diminishing loss of fluid and electrolytes. Therapeutic Effects: Relief of diarrhea.

REASON GIVEN (DISEASE STATE): Adjunctive therapy of acute diarrhea. Chronic diarrhea associated with inflammatory bowel
disease. Decreases the volume of ileostomy drainage.

NURSING PROCESS

Pre-Administration Assessment: Post Administration Evaluation: Nursing Considerations:

 Assess fluid and electrolyte balance  Monitor patient's hydration.

and skin turgor for dehydration.  Monitor children closely for CNS
effects because they may be more
 Asses patient’s diarrhea before starting sensitive than adults.
therapy aand regularly thereafter to  Assess patient's and family's
monitor drug effectiveness. knowledge of drug therapy.  Notify physician promptly if the
patient with ulcerative colitis
 Be alert for adverse reactions. develops abdominal distention or
other GI symptoms (possible signs
 Assess frequency and consistency of of potentially fatal toxic
 Monitor fluid and electrolyte balance.
stools and bowel sounds prior to and megacolon).
during therapy.
 Assess fluid and electrolyte
balance and skin turgor for
 Monitor therapeutic effectiveness.
dehydration.
Chronic diarrhea usually responds
within 10 d. If improvement does not
 occur within this time, it is unlikely that
symptoms will be controlled by further
administration.

Other:

Contraindications/ Precautions:

 Contraindicated in: Hypersensitivity; Patients in whom constipation must be avoided; Abdominal pain of unknown cause,
especially if associated with fever; Alcohol intolerance (liquid only).
 Use Cautiously in: Hepatic dysfunction; Lactation: Usually compatible with breast feeding; OB: Safety not established;
Pedi: Children 2 yr (safety not established); Geri: sensitivity to effects.

Route/ Dosage

Acute and Chronic Diarrhea

PO (Adults and Children 12 yr): 4 mg initially, then 2 mg after each loose stool.

Maintenance dose usually 4– 8 mg/day in divided doses (not to exceed 8 mg/day for

OTC use or 16 mg/day for Rx use).

Acute Diarrhea

PO (Children 9– 11 yr or 30– 47 kg): 2 mg initially; then 1 mg after each loose stool (not to exceed 6 mg/24 hr; OTC use
should not exceed 2 days).

PO (Children 6– 8 yr or 24– 30 kg): 1 mg initially, then 1 mg after each loose stool (not to exceed 4 mg/24 hr; OTC use
should not exceed 2 days).
 PO (Children 2– 5 yr or 13– 20 kg): 1 mg initially, then 0.1 mg/kg after each loose stool (not to exceed 3 mg/24 hr; OTC
use should not exceed 2 days).

Chronic Diarrhea

PO (Children): 0.08– 0.24 mg/kg/day divided 2– 3 times/day (not to exceed 2 mg/ dose).

Adverse Reaction

 CNS: drowsiness, dizziness.

 GI: constipation, abdominal pain/distention/discomfort, dry mouth, nausea, vomiting.
 Misc: allergic reactions.

Patient/ Family Teaching

 Instruct patient to take medication as directed. Do not take missed doses, and do not double doses. In acute diarrhea,
medication may be ordered after each unformed stool. Advise patient not to exceed the maximum number of doses.

 Caution patient to avoid using alcohol and other CNS depressants concurrently with this medication.

 Instruct patient to notify health care professional if diarrhea persists or if fever, abdominal pain, or distension occurs.

 Advise patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may relieve dry mouth.

 May cause drowsiness. Advise patient to avoid driving or other activities requiring alertness until response to drug is known.

Evaluation/ Desired outcomes

 Decrease in diarrhea.
 In acute diarrhea, treatment should be discontinued if no improvement is seen in 48 hr.
 In chronic diarrhea, if no improvement has occurred after at least 10 days of treatment with maximum dose, loperamide is unlikely
to be effective.
 OMEPRAZOLE LOSEC , PRILOSEC, PRILOSEC OTC, ZEGERID

GENERIC NAME TRADE NAME

PHARMACOLOGIC CLASS: Proton Pump Inhibitors (PPIs) THERAPEUTIC CLASS: Anti-Ulcer Drugs

ACTION: Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the
gastric lumen.
REASON GIVEN (DISEASE STATE): GERD/maintenance of healing in erosive esophagitis. Duodenal ulcers (with or without anti-infectives for
Helicobacter pylori). Short-term treatment of active benign gastric ulcer. Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome.
Reduction of risk of GI bleeding in critically ill patients. OTC: Heartburn occurring twice/wk.

NURSING PROCESS

Pre-Administration Assessment: Post Administration Evaluation: Nursing Considerations:

 Assess patient routinely for epigastric or  Monitor bowel function. Diarrhea,  Give medication before meals,
abdominal pain and frank or occult blood abdominal cramping, fever, and bloody preferably in the morning for once-daily
in the stool, emesis, or gastric aspirate. stools should be reported to health care dosing. If necessary, also give an
professional promptly as a sign of antacid, as prescribed.
. pseudomembranous colitis. May begin up
to several weeksfollowing cessation of  If needed, open capsule and sprinkle
Lab Test Considerations: therapy. the granules on applesauce or yogurt
or mix with water or acidic fruit juice,
 Monitor CBC with differential periodically  Monitor patient response to the drug such as apple or cranberry juice. Give
during therapy. (relief of GI symptoms caused by immediately.
hyperacidity, healing of erosive GI
 May cause increase in AST, ALT, alkaline lesions).  To give drug via NG tube, mix granules
phosphatase, and bilirubin. in acidic juice because enteric coating
 Monitor for adverse effects (GI effects, dissolves in alkaline pH.
 May cause serum gastrin concentrations to CNS changes, dermatological effects,
increase during first 1– 2 wk of therapy. respiratory effects).
Levels return to normal after  Because drug can interfere with
 discontinuation of omeprazole.  Monitor the effectiveness of comfort absorption of vitamin B12, monitor for
and safety measures and compliance with anemia.
 Monitor INR and prothrombin time in the regimen.
patients taking warfarin.  Be aware that long-term use of
medication may increase the risk of
May cause hypomagnesemia. Monitor serum gastric carcinoma.
magnesium prior to and periodically during
therapy.

Other:

Contraindications/ Precautions:

 Contraindicated in: Hypersensitivity; Lactation: Discontinue omeprazole or discontinue breast feeding.

 Use Cautiously in: Liver disease (dosepmay be necessary); OB, Lactation, Pedi:Safety not established in pregnant or breast feeding
women, or children 1 yr; Patients using high- doses for 1 year (qrisk of hip, wrist, or spine fractures).

Route/ Dosage
PO (Adults):
 GERD/erosive esophagitis—20 mg once daily. Duodenal ulcers associated with H. pylori—40 mg once daily in the morning with
clarithromycin for 2 wk, then 20 mg once daily for 2 wk or 20 mg twice daily with clarithromycin 500 mg twice daily and
amoxicillin 1000 mg twice daily for 10 days (if ulcer is present at beginning of therapy, continue omeprazole 20 mg daily for 18
more days); has also been used with clarithromycin and metronidazole. Gastric ulcer—40 mg once daily for 4– 6 wk. Reduction of
the risk of GI bleeding in critically ill patients—40 mg Name /bks_53161_deglins_md_disk/omeprazole 02/17/2014 08:27AM Plate
# 0-Composite pg 2 # 2 2015 F.A. Davis Company PDF Page #2 2 initially, then another 40 mg 6– 8 hr later, followed by 40 mg
once daily for up to 14 days. Gastric hypersecretory conditions—60 mg once daily initially; may be increased up to 120 mg 3 times
daily (doses 80 mg/day should be given in divided doses); OTC—20 mg once daily for up to 14 days.

PO (Children 1– 16 yr and 5– 9 kg): GERD/erosive esophagitis—5 mg once daily.

PO (Children 1– 16 yr and 10– 19 kg): GERD/erosive esophagitis—10 mg once daily.

PO (Children 1– 16 yr and 20 kg): GERD/erosive esophagitis—20 mg once daily

Adverse Reaction
CNS: dizziness, drowsiness, fatigue, headache, weakness.

CV: chest pain.

GI: PSEUDOMEMBRANOUS COLITIS, abdominal pain, acid regurgitation, constipation, diarrhea, flatulence, nausea, vomiting.

F and E: hypomagnesemia (especially if treatment duration 3 mo).

Derm: itching, rash.

MS: bone fracture.Misc:allergic reactions.

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.

 May cause occasional drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to
medication is known.

 Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health
care professional before taking any new medications.

 Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.

 Advise patient to report onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache to health care professional promptly.
  Instruct patient to notify health care professional of onset of black, tarry stools; diarrhea; abdominal pain; or persistent headache or if fever
and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care
professional.

 Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/ Desired outcomes

 Decrease in abdominal pain or prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be seen on x-ray examination or
endoscopy.

 Decrease in symptoms of GERD and erosive esophagitis. Therapy is continued for 4– 8 wk after initial episode.