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H2-receptor antagonists

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VOL: 100, ISSUE: 44, PAGE NO: 33

Generic and proprietary drug names

- Cimetidine: available as cimetidine, Dyspamet, Tagamet.

- Famotidine: famotidine, Pepcid.

- Nizatidine: nizatidine, Axid.

- Ranitidine: ranitidine, Zantac.

Action

- Inhibits gastric secretions by inhibiting histamine at H2-receptor sites in the gastric parietal cells.

Indications

- Nurse prescriber: heartburn.

- Other: benign gastric and duodenal ulcer, gastro-oesophageal reflux disease, Zollinger-Ellison syndrome.

Contraindications

- Hypersensitivity.

Cautions

- Children (lt)12 years of age (famotidine, ranitidine).

- Children (lt)16 years (cimetidine).

- Older people (cimetidine).

- Hepatic impairment.

- Lactation.

- Organic brain syndrome (cimetidine).

- Pregnancy.

- Renal impairment.

Common side-effects

- Diarrhoea and other gastrointestinal disturbances.

- Altered liver function tests (rarely liver impairment).

- Headache, dizziness.

- Rash.

- Fatigue.

Interactions

- Avoid cimetidine in patients stabilised on aminophylline, warfarin, phenytoin, theophylline.

Administration

- Nurse prescribers: oral only.

- Intramuscular injection (cimetidine, ranitidine).

- Slow intravenous injection (cimetidine, ranitidine).

- Intravenous infusion (cimetidine, nizatidine, ranitidine).

Nursing considerations

Cimetidine

- Assess: gastric pH (should be five or more); epigastric pain, duration and intensity; aggravating/ameliorating factors.

- Administer with meals for prolonged effect; antacids one hour before or after dose.

Famotidine

- Assess for: epigastric or abdominal pain; frank or occult blood in stools; blood counts (watch for decreased platelets); bleeding, haematuria, haematuresis; thrombocytopaenia, bruising, fatigue, bleeding, poor healing.

- Administer with food or liquid; antacids one hour before or two hours after dose.

Nizatidine

- Assess: Full blood count; gastric pH (should be five or more); fluid balance.

- Administer with meals for prolonged effect; antacids one hour before or after.

Ranitidine

- Assess: gastric pH (should be five or more); fluid balance; mental status; gastrointestinal complaints.

- Administer with meals for prolonged effect; antacids one hour before or after.

Patient teaching

Cimetidine

- Avoid products containing magnesium, calcium, iron or aluminium within two hours.

- Avoid sunlight or use sunscreens.

- Increase fluid intake to 3L/day.

- Complete full course as prescribed.

- Report any adverse reactions.

Famotidine

- Complete full course as prescribed.

- Report bleeding, bruising, fatigue.

- Avoid irritating foods, alcohol, aspirin, smoking, extreme temperatures in foods.

- Avoid driving or other hazardous activities as drowsiness may occur.

- Increase bulk and fluid intake to prevent constipation.

Nizatidine

- Temporary gynaecomastia or impotence may occur.

- Avoid driving or other hazardous activities as dizziness may occur.

- Avoid irritating/spicy foods, alcohol, aspirin, caffeine, extreme temperatures in foods.

Ranitidine

- Complete full course as prescribed.

- Avoid OTC products unless directed.

- Rise to sitting or standing slowly to minimise orthostatic hypotension.

- Report any adverse reactions.

- May cause dizziness or fainting in first few days; may cause rash, impaired perspiration.

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