clopidogrel bisulfate Platelet aggregation inhibitor

pantoprazole sodium Proton pump inhibitor

INDICATIONS
To decrease the rate of combined endpoint of CV death, myocardial infarction (MI), stroke, or refractory ischemia in patients with non-ST-segment elevation ACS (unstable angina [UA]/non-ST-elevation MI [NSTEMI]), including those who are managed medically and those with coronary revascularization. To reduce the rate of death from any cause and the rate of combined endpoint of death, re-infarction, or stroke in patients with ST-elevation MI (STEMI). To reduce the rate of combined endpoint of new ischemic stroke or MI, and other vascular deaths in patients with history of recent MI or stroke, or established peripheral arterial disease (PAD).

INDICATIONS
(Tab/Sus) Short-term treatment (8 weeks) in the healing and symptomatic relief of erosive esophagitis (EE) associated with gastroesophageal reflux disease (GERD) in adults and pediatrics 5 yrs. Maintenance of healing of EE and reduction in relapse rates of daytime and nighttime heartburn symptoms in adults with GERD. Long-term treatment of pathological hypersecretory conditions including Zollinger-Ellison syndrome. (IV) Short-term treatment (7-10 days) of adults with GERD and history of EE. Treatment of pathological hypersecretory conditions including Zollinger-Ellison syndrome in adults.

ADULT DOSAGE
Adults: Recent MI/Stroke or PAD: 75mg qd. UA/NSTEMI: Initial: LD: 300mg. Maint: 75mg qd with aspirin (ASA) (75325mg qd). STEMI: 75mg qd with ASA (75-325mg qd), with or without thrombolytics. May initiate with or without a LD.

ADULT DOSAGE
Adults: (Tab/Sus) Short-Term Treatment of EE Associated with GERD: 40mg qd for 8 weeks. May consider additional 8-week course if no healing after 8 weeks of treatment. Maintenance of Healing of EE: 40mg qd. Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome: Initial: 40mg bid. Adjust to patient's needs and continue for as long as clinically indicated. Max: 240mg/day. If unable to swallow 40mg tab, give two 20mg tabs. (IV) GERD Associated with History of EE: 40mg qd IV infusion for 7-10 days. D/C as soon as the patient is able to receive treatment with tab/sus. Pathological Hypersecretion Including Zollinger-Ellison Syndrome: Individualize dose. Usual: 80mg q12h IV infusion. May adjust frequency based on acid output; may increase to 80mg q8h if higher dosage is needed. Max: 240mg/day. Duration >6 days not studied.

WARNINGS/PRECAUTIONS
Increased risk of bleeding; d/c 5 days before surgery if antiplatelet effect is not desired. Avoid therapy lapses; if need to temporarily d/c, restart as soon as possible. Premature d/c increases risk of CV events. Thrombotic thrombocytopenic purpura (TTP) reported.

ADVERSE REACTIONS
TTP, bleeding, epistaxis, hematuria, bruising, hematoma, pruritus.

WARNINGS/PRECAUTIONS
Symptomatic response does not preclude the presence of gastric malignancy. May increase risk of osteoporosisrelated fractures of hip, wrist, or spine with high-dose and long-term therapy; use lowest dose and shortest duration appropriate to the condition being treated.

ASSESSMENT
Assess for presence of active pathological bleeding, previous hypersensitivity to the drug.

MONITORING
Monitor for signs/symptoms of TTP (eg, thrombocytopenia, microangiopathic hemolytic anemia, neurological findings, renal dysfunction, fever) and bleeding.

ADVERSE REACTIONS
Headache, diarrhea, N/V, abdominal pain, flatulence, dizziness, arthralgia. (Tab/Sus) Fever, upper respiratory infection, rash.

PATIENT COUNSELING
Inform about the benefits and risks of treatment. Instruct to take exactly as prescribed and not to d/c without consulting the prescribing physician. Inform that they may bruise and/or bleed more easily and that bleeding will take longer than usual to stop. Advise to report to physician any unanticipated, prolonged, or excessive bleeding, or blood in stool or urine. Inform that TTP, a rare but serious condition, has been reported; instruct to seek prompt medical attention if unexplained fever, weakness, extreme skin paleness, purple skin patches, yellowing of the skin or eyes, or neurological changes occur. Instruct to notify physician or dentist about therapy before scheduling any invasive procedure.

MECHANISM OF ACTION
Proton pump inhibitor; suppresses final step in gastric acid production by covalently binding to the (H +, K+)-ATPase enzyme system at the secretory surface of gastric parietal cell.

ASSESSMENT
Assess for gastric malignancy, osteoporosis, hypersensitivity, pregnancy/nursing status, and possible drug interactions. Obtain baseline magnesium levels. (IV) Assess for zinc deficiency.

ADMINISTRATION/STORAGE
Administration: Oral route.

MONITORING
Monitor for signs/symptoms of bone fractures, hypomagnesemia, hypersensitivity reactions, and other adverse reactions. Monitor magnesium levels periodically.

ADMINISTRATION/STORAGE
Administration: Oral and IV route.

DOMPERIDONE Indications : This medication increases movement through the digestive system. It is used to treat symptoms of stomach disorders. It may also be used to prevent nausea and vomiting caused by certain medications. SIDE EFFECTS: Headache, dizziness, dry mouth, nervousness, flushing, or irritability may occur the first several days as your body adjusts to the medication. Trouble sleeping, stomach cramps, hot flashes and leg cramps have also been reported. STORAGE: Store at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from heat and light. Do not store in the bathroom.