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Classification: Gastric Antisecretory Drug – H2 Receptor Antagonist

Action: Inhibits histamine at H2 receptor site in the gastric parietal cells, which inhibits gastric acid secretion.

Indication: Used in the management of various gastrointestinal (GI) disorders such as dyspepsia, gastroesophageal reflux disease (GERD), peptic ulcer and Zollinger-Ellison syndrome. Prophylaxis of GI hemorrhage from stress ulceration and in patients at risk of developing acid aspiration during general anesthesia; prophylaxis of Mendelson syndrome.

Adverse Reaction: Cardiac arrhythmias, bradycardia. headache, somnolence, fatigue, dizziness, hallucinations, depression, insomnia, Alopecia, rash, erythema multiforme.  Nausea, vomiting, abdominal discomfort, diarrhea, constipation, pancreatitis. Agranulocytosis, autoimmune hemolytic or aplastic anemia, thrombocytopenia, granulocytopenia. Cholestatic or hepatocellular effects. Hypersensitivity reactions.

Nursing Considerations

Assessment

  • Use caution in presence of renal or hepatic impairment
  • Assess potential for interactions with other pharmacological agents patient may be taking (e.g. increased or decreased levels/effects and toxicity)
  • Monitor AST, ALT, serum creatinine; when used to prevent stress-related GI bleeding, measure the intragastric pH and try to maintain pH > 4; signs and symptoms of peptic ulcer disease, occult blood with GI bleeding, monitor renal function to correct dose; monitor for side effects
  • Evaluate results of laboratory tests, therapeutic effectiveness, and adverse reactions (e.g., bradycardia, PVCs, tachycardia, CNS changes [depression, hallucinations, confusion, malaise], rash, gynecomastia, GI disturbances, hepatic failure)
  • Assess knowledge/teach patient appropriate use, possible side effects/appropriate interventions, and adverse symptoms to report.

Nursing Diagnoses

  • Pain, chronic (uses)
  • Knowledge-deficit (teaching)

Planning

  • Oral route
    • May be given with our without meals
    • Give antacids 1 hour before or 1 hour after this drug
  • IV route (direct IV)
    • Give by direct IV after diluting 50 mg/20 mL of 0.9% D5W, NaCl over 5 mins or more

Implementation

  • Do not take any new medication during therapy without consulting physician
  • Take exactly as directed; do not increase dose – may take several days before noticeable relief
  • Allow 1 hour between any other antacids (if approved by physician) and ranitidine
  • Avoid excessive alcohol
  • Follow diet as physician recommends
  • May cause drowsiness, dizziness, or fatigue (use caution when driving or engaging in tasks requiring alertness until response to drug is known)
  • Report chest pain or irregular heartbeat; skin rash; CNS changes (mental confusion, hallucinations, somnolence); unusual persistent weakness or lethargy; yellowing of skin or eyes; or change in color of urine or stool
  • Consult physician if breast-feeding

Evaluation

  • Decreased pain in abdomen
  • Healing of ulcers
  • Absence of gastroesophageal reflux