Page 162 - 2022 Ranger Medic Handbook

CIMETIDINE (TAGAMET)
Class: GI agent – antisecretory H 2 -receptor antagonist
Action: Antihistamine with high selectivity for reversible competitive inhibition of histamine H 2 -receptors on parietal
cells of the stomach (minimal effect on H 1 -receptors) and thus decreases gastric acid secretion, raises the pH of the
stomach, and indirectly reduces pepsin secretion
Dose: Oral: 300mg QID or 800mg at bedtime or 400mg bid for up to 8 weeks
Indications: For treatment of duodenal/gastric ulcer, prevention of ulcer recurrence, gastroesophageal reflux, chronic
urticaria, acetaminophen toxicity
Contraindications: H 2 -receptor antagonist hypersensitivity; pregnancy category may use during pregnancy and while
breastfeeding
Adverse/Side-effects: Fever, cardiac arrhythmias and cardiac arrest after rapid IV bolus; diarrhea, constipation,
abdominal discomfort; increased prothrombin time, neutropenia, thrombocytopenia, aplastic anemia, hypospermia,
exacerbation of preexisting arthritis; drowsiness, dizziness, light-headedness, depression, headache, reversible con-
fusion states, paranoid psychosis; rash, Stevens-Johnson syndrome, reversible alopecia, gynecomastia, galactor-
rhea, reversible impotence
SECTION 4 Interactions: Decreases hepatic metabolism of warfarin, phenobarbital, phenytoin, diazepam, propranolol, lidocaine,
theophylline, thus increasing their activity and toxicity; antacids may decrease absorption

CIPROFOXACIN (CIPRO)
Class: Antimicrobial – antibiotic; quinolone. All fluoroquinolones now have a US Black Box Warning due to seri-
ous adverse reactions including tendonitis and tendon rupture, peripheral neuropathy and CNS effects. How-
ever, in some rare cases, benefits may outweigh the risks of fluoroquinolone use. Fluoroquinolones require
prior approval from unit physician or physician assistant
Action: Synthetic broad-spectrum bactericidal agent; inhibits DNA-gyrase, an enzyme necessary for bacterial DNA
replication, transcription, repair, recombination, and transposition; effective against many gram-positive and gram-
negative organisms including Citrobacter diversus, Enterobacter cloacae, Enterobacter aerogenes, Escherichia coli,
Haemophilus influenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Proteus miribilis, Proteus vulgaris, Pseudo-
monas aeruginosa, Serratia marcescens, Staphylococcus aureus, Streptococcus pyogenes, Shigella, and Salmonella;
less active against gram- positive than gram-negative bacteria, although active against many gram-positive aero-
bic bacteria, including penicillinase-producing, non– penicillinase-producing, and methicillin-resistant staphylococci;
however, many strains of streptococci are relatively resistant; inactive against most anaerobic bacteria; resistant to
some strains of methicillin-resistant Staphylococcus aureus (MRSA)
Dose: 250–750mg PO bid or 200–400mg IV q8–12hr
NOTE: Not first-line treatment
Indications: For infections of the lower respiratory tract, skin and skin structures, bone and joints, GI tract, urinary
tract, prostate; also used for nosocomial pneumonia, acute sinusitis, and postexposure prophylaxis for anthrax
Contraindications: Quinolone hypersensitivity; syphilis, viral infection; tendon inflammation or tendon pain; preg-
nancy category consider alternative during pregnancy and avoid while breastfeeding
Adverse/Side-effects: Nausea, vomiting, diarrhea, cramps, gas, pseudomembranous colitis; tendon rupture; head-
ache, vertigo, malaise, peripheral neuropathy, seizures
Interactions: May increase theophylline levels; antacids, sucralfate, iron decrease absorption; may increase PT for
patients on warfarin; may cause false positive on opiate screening tests
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: DO NOT GIVE

148 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY