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INTRODUCTION

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nizatidine (ni-za-ti-deen)

Axid, Axid AR

Classification

Therapeutic: antiulcer agents

Pharmacologic: histamine H2 antagonists

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Indications
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Duodenal ulcers and benign gastric ulcers. Maintenance therapy for duodenal ulcers after healing of active ulcer(s). Gastroesophageal reflux disease (GERD). Treatment/prevention of heartburn, acid indigestion, and sour stomach (OTC use).

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Action
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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.

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Adverse Reactions/Side Effects
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CNS: confusion, dizziness, drowsiness, hallucinations, headache. CV: ARRHYTHMIAS. GI: constipation, diarrhea, drug-induced hepatitis (nizatidine), nausea. GU: decreased sperm count, erectile dysfunction. Endo: gynecomastia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, anemia, neutropenia, thrombocytopenia. Misc: hypersensitivity reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Report signs of agranulocytosis and neutropenia (fever, sore throat, mucosal lesions, signs of infection, bruising), aplastic anemia (unusual fatigue, weakness), or thrombocytopenia (bruising, bleeding gums, nose bleeds).

  • Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat or chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician if these reactions occur.

  • Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor other CNS symptoms such as confusion, hallucinations, and headache. Excessive or prolonged CNS symptoms may require a reduction in dose.

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Interventions
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  • Use caution during aerobic exercise and endurance conditioning because of an increased risk of cardiac arrhythmias. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, etc.), or displays other criteria for exercise termination (See Appendix L).

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Patient/Client-Related Instruction
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  • Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

  • instruct patient to report troublesome GI effects (constipation, diarrhea, nausea) or signs of drug-induced hepatitis (anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, muscle/joint pain).

  • Advise men to consult their physician if they experience erectile dysfunction or breast enlargement (gynecomastia).

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Pharmacokinetics
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Absorption: 70–95% absorbed after oral administration.

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Distribution: Enters breast milk and cerebrospinal fluid.

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Metabolism and Excretion: 60% excreted unchanged by the kidneys; some hepatic metabolism; at least 1 metabolite has histamine-blocking activity.

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Half-life: 1.6 hr.

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