Page 190 - 2022 Ranger Medic Handbook

TRANEXAMIC ACID (TXA) *
Class: Antifibrinolytic agent; synthetic lysine amino acid derivative
Action: Displaces plasminogen from surface of fibrin by binding to high-affinity lysine site of plasminogen, which
diminishes dissolution of hemostatic fibrin, which decreases bleeding
Dose: Administer 2g of TXA IV/IO as soon as possible but not later than 3 hours after injury
Indications: For patients anticipated to need significant blood transfusion presenting with hemorrhagic shock, one or
more major amputations, penetrating torso trauma or evidence of severe bleeding
Contraindications: Active intravascular clotting, pregnancy category consider alternative during pregnancy and while
breastfeeding
Adverse/Side-effects: Blurred vision or impaired color vision; gastrointestinal disturbances (nausea, vomiting, diar-
rhea) may occur but disappear when the dosage is reduced; transient hypotension has been observed when intra-
venous injection is too rapid
Interactions: Should not be administered concomitantly with factor IX complex concentrates or anti-inhibitor coagu-
lant concentrates, as the risk of thrombosis may be increased
SECTION 4 Mission Impact: Store at 25°C (77°F); excursions permitted to 15°–30°C (59°–86°F)

TRIMETHOPRIM-SULFAMETHOXAZOLE (TMP-SMZ, BACTRIM, SEPTRA)
Class: Antimicrobial – antibacterial, sulfonamide
Action: Fixed combination of TMP=SMZ, synthetic folate antagonists and enzyme inhibitors that prevent bacterial
synthesis of essential nucleic acids and proteins; effective against Pneumocystis carinii pneumonitis, Shigellosis en-
teritis, most strains of Entero bacteriaceae, Nocardia, Legionella micdadei, and Legionella pneumophila, and Haemo-
philus ducreyi
Dose: 1 tablet (DS) PO bid × 10 days for cellulitis, 3–5 days for UTI
Indications: For cellulitis, pneumonitis, enteritis, severe complicated UTIs, acute otitis media, acute episodes of
chronic bronchitis, prevention of traveler’s diarrhea, cholera
Contraindications: TMP, SMZ, sulfonamide, or bisulfite hypersensitivity; group A β-hemolytic streptococcal pharyn-
gitis; megaloblastic anemia due to folate deficiency; use caution with severe allergy or bronchial asthma, G6PD defi-
ciency, and sulfonamide derivative drug (acetazolamide, thiazides, tolbutamide) hypersensitivity; pregnancy category
consider alternative during pregnancy and avoid use while breastfeeding
Adverse/Side-effects: Rash, toxic epidermal necrolysis; nausea, vomiting, diarrhea, anorexia, hepatitis, pseudo-
membranous enterocolitis, stomatitis, glossitis, abdominal pain; kidney failure, oliguria, anuria, crystalluria; agranu-
locytosis, aplastic anemia, megaloblastic anemia, hypoprothrombinemia, thrombocytopenia; weakness, arthralgia,
myalgia, photosensitivity, allergic myocarditis.
Interactions: CNS depressants, alcohol, and phenothiazines augment CNS depression; food significantly decreases
extent and rate of absorption, do NOT give with or immediately after a meal
Mission Impact: None

176 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY