Ranitidine(Zantac)

Ranitidine,anH2receptorantagonist,blockshistamineactionattheparietalcellsinthe
stomach,thusinhibitingallphasesofgastricacidsecretion.Ranitidineinhibitsboth
daytimeandnocturnalbasalgastricacidsecretions,aswellasgastricacidsecretion
stimulatedbyfood,betazole,andpentagastrin.Itisusedintreatingthesymptomsof
activeduodenalulcers,benigngastriculcers,GERD,pathologichypersecretory
conditions,endoscopicallydiagnosederosiveesophagitis,andasmaintenancetherapyto
promotehealingoferosiveesophagitis.Ranitidineisavailableinprescriptionandover
thecounter(OTC)formulas.
Ranitidineisgenerallywelltolerated.Administerintravenousranitidinetherapyslowlyto
preventhypotensionandcardiacarrhythmias.Teachthepatienttotakethedrugorally
exactlyasdirectedfortheentirecourseoftherapy;symptomsdisappearbeforetheulcer
willtotallyheal.

Omeprazole(Prilosec)
Omeprazoleisaprotonpumpinhibitorusedinthetreatmentofduodenalulcers
associatedwithH.pylori

,andforthetreatmentofheartburnandothersymptomsof
gastroesophagealrefluxdisease(GERD).Omeprazolesuppressesthelastphaseofgastric
acidproduction.Intheelderly,theactionofprotonpumpinhibitors(PPIs),raisingthepH
decreasestheabsorptionofcalcium,thusthereisanincreasedriskforfractures,
especiallyinthehip.Teachthepatienttotakeomeprazolebeforemeals,fortheentire
timeprescribed,andnottocrushorchewthemedicine.

Metformin(Glucophage)
Metforminisanoralantidiabeticusedintype2diabetes.Itisconsideredaninsulin
sensitizerdrug.Itsuppresseshepaticglucoseproduction,enhancesinsulinsensitivityin
themuscle,andpromotesglucoseuptake.Itrequiressomepancreaticinsulintowork.
Itisfrequentlyprescribedwithotheroralantidiabeticdrugs,especiallyasulfonylureas
drug.Inaddition,metforminlowerstriglyceridelevels,totalandlowdensitylipoprotein
(LDL)cholesterollevels,andpromotesweightloss.

Regularinsulin
Regularinsulinisrapidactingandshortlasting.Itmaybeusedaloneorin
combinationregimenswithlongeractinginsulinsordered.Regularinsulinwill

decreaseacurrentglucoseelevation(i.e.,acorrectionaldose)orpreventan
expectedglucoseriseaftereating(i.e.,anutritionaldose),butbecauseofitsshort
durationofactioncannotbeusedasthesoleinsulintocontrolglucoselevels
throughoutthedayintype1.Allinsulinsaregivensubcutaneously(SC)(rotate
injectionsitesseriallywithinananatomiclocation),butregularinsulinmayalsobe
administeredintravenously(IV)orviaanimplantableinsulinpump
subcutaneously.

Allinsulinsmanagehyperglycemiabypromotingcellularglucoseuptakeand
metabolism.Insulinsvarybyonset,peak,anddurationofaction.Thestandardsourceof
insulinisnowrecombinantDNA,alsoreferredtoashuman.Insulinsareusedintype1
diabetesandsometimesintype2diabetes.Excessiveexogenousinsulinproduces
hypoglycemiaandinsufficientexogenousinsulinproduceshyperglycemia.Patient
teachingaboutinsulinshouldincludehowtoadministeraccurately,dietmodifications,
exercise,testingforbloodglucose,storageofinsulin,anddisposalofusedneedlesand
syringes.

Metoclopramide(Reglan)