Page 182 - 2022 Ranger Medic Handbook

NAPROXEN (NAPROSYN)
Class: NSAID; anti-inflammatory, analgesic, antipyretic
Action: Propionic acid derivative with properties similar to ibuprofen; inhibits COX-1 and -2 enzymes inhibiting pros-
taglandin synthesis and platelet aggregation; prolongs bleeding time
Dose: 250–500mg PO bid (max: 1,000mg qd)
Onset/Peak/Duration: Onset: 30–60 minutes, Peak: 2–4 hours, Duration: < 12 hours
Indications: For mild to moderate pain management and symptomatic treatment of acute and chronic arthritis
Contraindications: Hypersensitivity; peptic ulcer; history of asthma, rhinitis, urticaria, bronchospasm or shock caused
by aspirin or other NSAIDs; hyperkalemia; liver or renal impairment or disease, recent MI or CABG; pregnancy category
caution advised during 1st trimester and avoid use >19 weeks in pregnancy. Consider shorter acting alterative while
breastfeeding (caution advised in patients trying to conceive)
Adverse/Side-effects: Headache, drowsiness, dizziness, lightheadedness, depression; palpation, dyspnea, periph-
eral edema, CHF, tachycardia; blurred vision, tinnitus, hearing loss; anorexia, heartburn, indigestion, nausea, vomiting,
thirst, GI bleeding, elevated LFTs; thrombocytopenia, leukopenia, eosinophilia, pruritus, rash, ecchymosis, nephrotox-
icity, increased risk of stroke or MI; pulmonary edema
SECTION 4 Interactions: Herbals (feverfew, garlic, ginger, ginkgo) may increase bleeding

NITROFURANTOIN (MACROBID)
Class: Antimicrobial – miscellaneous
Action: Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates that inactivate or alter bacterial
ribosomal proteins leading to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA, and cell wall
synthesis. Nitrofurantoin is bactericidal in urine at therapeutic doses
Dose: PO 100mg bid × 5 days for females, × 7 days for males
Indications: Acute, recurrent, and prophylactic treatment for cystitis; chronic suppression of recurrent UTIs
Contraindications: Hypersensitivity to drug or any component of the formulation; anuria, oliguria, or significant im-
pairment of renal function, pregnancy category consider alternative during 1st trimester and avoid use 38–42 weeks,
but otherwise may use in pregnancy. Avoid use while breastfeeding
Adverse/Side-effects: ECG changes, chills, confusion, depression, drowsiness, headache, malaise, numbness, par-
esthesia, psychotic reaction, alopecia, dermatitis, skin rash; Stevens-Johnsons syndrome; decreased hemoglobin,
hepatitis; candida; weakness; amblyopia; cough; cyanosis; dyspnea; fever, hepatotoxicity
Interactions: Minimal interactions
Mission Impact: GROUNDING medication for personnel on flight status

OFLOXACIN OTIC (FLOXIN)
Class: Antimicrobial – antibiotic, fluoroquinolone
Action: broad-spectrum fluoroquinolone against gram-positive and gram-negative aerobic and anaerobic bacteria.
Inhibits bacterial DNA replication and some aspects of its transcription, repair, recombination, and transposition
Dose: 10gtt in affected ear(s) qd × 7 days
Indications: Otitis externa in adults and pediatric patients (> 6 months) due to Escherichia coli, Pseudomonas aerug-
i nosa, and Staphylococcus aureus
Contraindications: Hypersensitivity to ofloxacin or other quinolone antibacterial agents; tendon pain; lactation; preg-
nancy category may use during pregnancy and while breastfeeding
Adverse/Side-effects: Hypersensitivity; fungal or bacterial superinfection with prolonged use, tendon inflammation/
rupture; pruritis; earache; dizziness; headache; vertigo
Interactions: Minimal prehospital interactions
Mission Impact: GROUNDING medication for personnel on flight status

168 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY