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INTRODUCTION

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ranitidine (ra-ni-ti-deen)

Apo-Ranitidine, Zantac, Zantac-C, Zantac 75

Classification

Therapeutic: antiulcer agents

Pharmacologic: histamine H2 antagonists

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Indications
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Short-term treatment of active duodenal ulcers and benign gastric ulcers. Maintenance therapy for duodenal and gastric ulcers after healing of active ulcer(s). Management of gastric hypersecretory states (Zollinger-Ellison syndrome). Treatment of and maintenance 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.

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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, nausea. GU: decreased sperm count, erectile dysfunction. Endo: gynecomastia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, anemia, neutropenia, thrombocytopenia. Local: pain at IM site. Misc: hypersensivity reactions, vasculitis.

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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 or nursing staff immediately if these reactions occur.

  • Be alert for signs of vasculitis, including fatigue, weakness, muscle pain, joint pain, numbness, fever, loss of appetite, and weight loss. Report these signs to the physician.

  • 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 nursing staff, 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.

  • Monitor IM injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

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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 such as severe or prolonged constipation, ...

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