Maternity Medications

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dsherman
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Maternity Medications
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2011-11-30 14:35:03
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Maternity Medications
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  1. Generic & Trade Name:Betamethasone (Celestone)
    • Classification:
    • Long Acting Glucocorticoid (Anti-inflammatory)

    Action: Decrease Inflammation

    • Purpose (in Pregnancy):
    • Topical severe itching, and inflammation
    • Prevention of neonatal respiratory distress syndrome, ease of restorations decreased inflammation (helps to produce surfactant)

    • Recommended Dose:
    • Adult: PO: 0.6-7.2 mg daily, IM/IV: 0.6-7.2 daily,
    • Topical (cream)
    • Child: PO: 17.5 mcg/kg/ day in 3 divided doses 5.8-8.75 mcg/kg/day in 3 divided doses

    • Side Effects:
    • Mood swings, weight gain, acne, facial flushing, nausea, insomnia, sodium and fluid retention, impaired wound healing, menstrual irregularities, tachycardia, thrombophlebitis, embolism, hemorrhage, thrombocytopenia, may cause stinging, prupura (purplish spots)

    • Nursing Implications:
    • monitor Blood glucose, B/P Q4 hrs. Notify physician if chest pains occur, I&O, for edema or decreasing urine output, symptoms of infection WBC, may mask signs of infection, fatigue, nausea, vomiting depression weakness, hypo/hypotension, mood affect, behavioral changes, aggression Teach: if topical avoid sunlight, may decrease effects of insulin, crosses the placenta, distributed in breast milk, Use spray aprox 12” for 3 sec avoid inhaling
  2. Generic & Trade Name: Magnesium Sulfate
    Classification: Tocolytics (anticonvulsant)

    • Action: depresses the central nervous system, acts as anticonvulsant, decreases frequency and intensity of uterine contractions
    • Purpose (in Pregnancy): prevention and control of seizures, decreases frequency and intensity of uterine contractions

    Recommended Dose: IV for preeclampsia loading dose 4-6 g Magnesium sulfate in 100mL over 15-20 min continuing infusion 2g/hr doses are individualized as needed deep IM is also acceptable but is painful. Administered in smaller doses to stop preterm labor contractions (immediate absorption following IV administration) is excreted by the kidney’s

    • Side Effects: flushing and sweating, hypotension, depressed deep tendon reflexes, and CNS depression including respiratory depression
    • Nursing Implications: do not administer to patients with myocardial damage, heart block, myasthenia gravis, or impaired renal function. Symptoms of toxicity (thirst, mental confusion, decrease in reflexes), monitor B/P, do not administer if respirations are below 12 BPM, O2 less than 95%, urinary output less than 30 mL/hr, or reduced deep tendon reflexes.
    • Have resuscitation equipment (suction, oxygen) available in the room

    Calcium gluconate, acts as an antidote to magnesium
  3. Generic & Trade Name: Terbutaline (Brethine)
    Classification: Tocolytics (Beta-adrenergic agent)

    Action: inhibition (restricts) of uterine muscle activity increases pulse rate and widens pulse pressure

    • Purpose (in Pregnancy): stop preterm labor, reduce or stop hypertonic labor contractions whether natural or stimulated
    • Recommended Dose: IV begins at the ordered rate of approx 0.01-0.05 mg/min, increase rate if needed to stop contractions by 0.01 mg/min at 10-30 minute intervals until contractions stop max. of 0.08 mg/min do not increase if maternal pulse rate is over 120 beats per min. or systolic B/P is below 80-90 mmHg. Maintain dose for 1hr and decrease rate at 20 min intervals to reach minimum maintance dose. Continue for 12 hrs or as ordered after contractions stop. Sub Q 0.25mg every 4 hrs.

    Oral: 2.5-5 mg every 2-4 hrs. give oral dose 30 min before discontinuing IV


    Side Effects: Tachycardia (mother, baby), dysrhythmias, palpitations, chest pain, wide pulse pressure, dyspnea, tremors, restlessness, weakness, dizziness, headache, Hypokalemia, hyperglycemia, nausea, vomiting, constipation, flushing, diaphoresis

    Nursing Implications: Contraindicated before 20 weeks of gestation, premature rupture of membranes, Hemorrhage, uncontrolled diabetes, uncontrolled hypertension, hyperthyroidism, asthma, explain effects, monitor fetal monitoring when drug is initiated, record rate and patterns at recommended intervals, assess maternal VS, monitor Fetal heart rate, encourage urination, notify the physician if maternal HR is >120bpm, respirations >24/min, dyspnea, pulmonary edema, systolic B/P <80 to 90mmHg, Fetal Heart Rate
  4. Generic & Trade Name: Butorphanol (Stadol)
    Classification: Narcotic Agonist (antagonist)

    Action: depress pain impulse transmission at the spinal cord level by interacting with opioid receptors, reduce pain without loss of consciousness (rapid)

    Purpose (in Pregnancy): Pain relief give early stage of labor due to the effects on the fetus

    Recommended Dose: 1mg every 3-4 hrs; range 0.5-2 mg IV; may be given PCA

    • Side Effects: Respiratory depression in neonate, drowsiness, dizziness, light-headedness, euphoria, nausea, clammy skin, sweating, insomnia, abdominal pain, constipation, respiratory depression, shock
    • Nursing Implications: do not give to women with opioid dependency (may participate in withdraw), monitor VS especially respirations, I&O, notify physician if respirations are below 12 bpm
  5. Generic & Trade Name: Nalbuphine (Nalbain)
    Classification: Narcotic Agonist (antagonist)

    Action: binds to opiate sites thus altering pain perception and response

    Purpose (in Pregnancy): reduce itching caused by epidural narcotics

    Recommended Dose: 10 mg every 3-6hrs IV; may be given PCA

    • Side Effects: Respiratory depression in neonate, drowsiness, dizziness, light-headedness, euphoria, nausea, clammy skin, sweating, insomnia, abdominal pain, constipation, respiratory depression, shock
    • Nursing Implications: do not give to women with opioid dependency (may participate in withdraw), monitor VS especially respirations, I&O, notify physician if respirations are below 12 bpm
  6. Generic & Trade Name: Morphine
    Classification: Opioid Agonist

    Action: depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors, produces CNS depression

    Purpose (in Pregnancy): Pain effects in 10-20 min last 2-5 hrs.

    Recommended Dose: SUBCUT/IM 5-20 mg Q4 hrs PRN, IV 4-10 mg diluted over 5 min.

    Side Effects: Respiratory depression, C-section effects last for 24 hours, pruritus, constipation, nausea, sedation, drowsiness, dizziness, Anaphylactic reaction, cardiac arrest, severe respiratory depression or arrest, convulsions, bradycardia

    Nursing Implications: should not be given in latent stage due to the effects on the fetus, do not give to women with opioid dependency (may participate in withdraw
  7. Generic & Trade Name: Naloxone (Narcan)
    Classification: Narcotic Antagonist

    Action: reversed opioid effects in emergency situations

    Purpose (in Pregnancy): reverse opioid-induced respiratory depression, reduce pruritus (itching) from epidural opioid, neonatal resuscitation

    • Recommended Dose:
    • Adult: 0.4-2 mg IV
    • To reverse pruritus 0.04-0.2 mg IV or IV infusion 5-10 mcg/kg/hr
    • Neonate: 0.1 mg/kg/IV (umbilical vein) or intratracheal

    • Side Effects: itself has minimal side effects
    • Nursing Implications: should not be used for respiratory depression not caused by non opioid, action shorter than most narcotics it reverses; must observe for recurrent respiratory depression and be prepared to give additional doses
  8. Generic & Trade Name: Zolpidem (Ambien)
    Classification: Sedatives/Hypnotics

    Action: CNS depression

    Purpose (in Pregnancy): ability to sleep, sedation, insomnia, short-term treatment

    • Recommended Dose: PO 10mg at bed time
    • Side Effects: day time sedation, confusion, amnesia, dizziness, depression, nausea, and vomiting

    Nursing Implications: lactating women should not take, caution when breast feeding; assess mood, affect, and sleep patterns. Observe for dependency, and tolerance
  9. Generic & Trade Name: Promethazine (phenergan)
    Classification: Sedatives/Hypnotics

    Action: acts on chemoreceptor trigger zone to decrease vomiting; increases CNS stimulation

    Purpose (in Pregnancy): absence of nausea and vomiting, sedation

    Recommended Dose: 12.5 mg every 4-6 hrs IV. Dilute in 10-20 mL 0.9% normal saline, administer over 10-20 min

    • Side Effects: blurred vision, dry mouth, respiratory depression
    • Nursing Implications: duration of action is longer than most narcotics; may enhance respiratory depressant effects of narcotics, assess respiratory status, monitor I&O, be alert for urinary retention, frequency, dysuria, monitor CBC, monitor for cardiac status VS, palpitations, increased pulse, hypo/hypertension
  10. Generic & Trade Name: Hydralazine (Atarax, Vistaril)
    Classification: Antihypertensive

    Action: vasodilates arteries in smooth muscle, reduces B/P with reflex increases in heart rate, stroke volume, cardiac output

    Purpose (in Pregnancy): decreases B/P

    Recommended Dose: 25-100 mg IM Z-track only

    • Side Effects: orthostatic hypotension, fluid retention, headache, palpitations
    • Severe hypotension, MI, dysrhythmias, shock, flushing nausea, diarrhea, tachycardia,

    Nursing Implications: duration of action is longer than most narcotics; may enhance respiratory depressant effects of narcotics, assess respiratory status, monitor I&O, be alert for urinary retention, frequency, dysuria, monitor CBC, monitor for cardiac status VS, palpitations, increased pulse, hypo/hypertension
  11. Generic & Trade Name: Methyldopa (Aldomet)
    Classification: Antihypertensive

    Action: decrease sympathetic outflow from the brain with decreased peripheral resistance

    Purpose (in Pregnancy): drug of choice for chronic hypertension

    Recommended Dose: PO 250-500 mg bid. or tid. Then adjust q2 days PRN maintenance does 0.5-2 g/day in 2-4 divided doses, max 3g per day

    Side Effects: peripheral edema, sedation, depression, headache, dry mouth, decreased libido, hepatotoxicity, hemolytic anemia, granulocytopenia

    Nursing Implications: teach to rise slowly (orthostatic hypotension), do not give if B/P is less than 90/60, assess for palpitations, chest pain, dyspnea, take first dose at bedtime and avoid driving and other activities until affect of medication is known
  12. Generic & Trade Name: Oxytocin (Pitocin)
    Classification: Oxytocics (secreted by the posterior pituitary gland)

    Action: stimulates contractions during birth and stimulates postpartum contractions to compress uterine vessels and control bleeding, stimulates letdown, or milk ejection reflex during breastfeeding

    Purpose (in Pregnancy and postpartum): stimulate uterus to contract and prevent hemorrhage, stimulate milk release, stimulate (induce) labor

    Recommended Dose: give IV dilute (10-20 milliunits in 1000cc LR), and piggyback into main IV, must be give via pump

    IV 1-2 milliunit/min increase by 1-2 miliunit/min until regular contractions occur, then decrease dosage

    Postpartum hemorrhage 10-40 units in 1000ml nonhydrating diluents infused at 20-40 mU/min

    Incomplete abortion (miscarriage) IV 10-40 units/500ml D5W

    Side Effects: rapid, painful uterine contractions and fetal tachycardia. Serious complications in mother may be uterine rupture, seizures, or coma. Women who have delivered 5 or more children are more at risk for uterine rupture.

    Nursing Implication: has short half life, solution is started slowly and dose gradually increased (about every 20min) until an adequate contraction pattern (contracting every three mins. With good intensity) is established, then the dose is maintained at that level. Uterine contractions and fetal heart tones must be closely monitored during infusion
  13. Generic & Trade Name: RhoGAM
    Classification: concentrated immunoglobulin’s directed toward the red blood cell antigen Rho (D)

    Action: prevents production of anti-Rho(D) antibodies in Rh-negative women who have been exposed to Rh-positive blood

    Purpose (in Pregnancy): prevents antibody response and subsequently prevents hemolytic disease of the newborn in future pregnancies of women who have conceived an Rh-positive fetus

    Recommended Dose: one standard dose administered intramuscularly

    At 28 weeks of pregnancy and within 72 hours of delivery

    Within 72 hours of termination of pregnancy of 13 weeks or more

    One micro dose within 72 hours following termination of a pregnancy of less than 13 weeks

    Side Effects: pain in on the injection site

    Nursing Implications: type and screen the mother’s blood and cord blood of the newborn must be performed to determine the need for medication.

    If there is any dought as to the fetus blood type after termination the medications should be administered. The Glutus maximus is the preferred site for the IM injection
  14. Generic & Trade Name: Misoprostol (Cytotec)
    Classification: Oxytocics (prostaglandin)

    Action: prostaglandin that increases uterine contraction thus increasing the effectiveness of the pharmacologic abortion

    Purpose (in Pregnancy and postpartum): increase uterine contraction thus preventing hemorrhage, promote cervical ripening, a softening and dilation of the cervix that must occur prior to vaginal delivery, induce a pharmacologic abortion

    Recommended Dose: PO; (if abortion has not occurred) 400mcg

    Side Effects: Nausea, vomiting, diarrhea, abdominal pain, uterine hemorrhage, uterine lacerations or perforation due to intense contractions
  15. Generic & Trade Name: Methlergonovine maleate (Methergine)
    Classification: Oxytocics (Ergot alkaloid)

    Action: Stimulates uterine and vascular smooth muscle, causing contraction, decrease bleeding

    Purpose (in Pregnancy and postpartum): absence of hemorrhage

    Recommended Dose: PO; 0.2-0.4 mg bid-tid

    Side Effects: nausea, vomiting, uterine cramping, shock, severe hypertension, dysrhythmias

    Nursing Implications: monitor B/P, pulse; watch for change that may indicate hemorrhage; check respirations, assess fundal tone, nonphasic contractions, before administering check calcium levels monitor prolactin levels and for decreased breast milk production
  16. Generic & Trade Name: Carboprost tromethamine (Hemabate)
    Classification: Oxytocics

    Action: Stimulates uterine and vascular smooth muscle, causing contraction, decrease bleeding

    Purpose (in Pregnancy and postpartum): increase uterine contraction thus preventing hemorrhage, promote cervical ripening, a softening and dilation of the cervix that must occur prior to vaginal delivery, induce a pharmacologic abortion Recommended

    Dose: IM; initial dose 250 mcg (1mL) repeated a ½-31/2h intervals if indicated by uterine response not to exceed total dose of 12mg or continuous administration for 1mo

    Side Effects: nausea, vomiting, diarrhea, uterine laceration, rupture or hemorrhage
  17. Generic & Trade Name: Ondansetron (Zofran)
    Classification: Serotonin receptor antagonists

    Action: Blocks thought that causes nausea and vomiting (serotonin receptors)

    Purpose (in Pregnancy): nausea and vomiting

    Recommended Dose: PO; 4mg tid prn, IV; 32 mg single dose

    Side Effects: headache, drowsiness, fatigue, constipation, diarrhea, dysrhythmias, extrapyramidal symptoms

    • Nursing considerations:
    • Monitor for extrapyramidal symptoms include parkinsonism, akathisia, dystonia, and tardive dyskinesia), dysrhythmias
  18. Generic & Trade Name: Ketorolac tromethamine (Toradol)
    Classification: NSAID

    Action: inhibits the enzyme responsible for formation of prostaglandins

    Purpose (in Pregnancy): reduce inflammation and pain, fever

    Recommended Dose: PO; mg qid prn max: 40 mg/day

    Side Effects: indigestion, nausea, occult blood loss, anorexia, headache, drowsiness, dizziness aplastic anemia, drug induces peptic ulcer, GI bleeding, agranulocytosis, laryngospasm, laryngeal edema; peripheral edema, anaphylaxis, acute renal failure; vomiting, constipation, diarrhea

    Nursing implications: Monitor for side effects, pain
  19. Generic & Trade Name: Oxycodone (Percocet)
    Classification: Opioid analgesic

    Action: inhibits ascending pain pathways in the CNS, increases pain threshold, alters pain perception

    Purpose (in Pregnancy): Moderate to severe pain relief

    Recommended Dose: PO; 0.05-0.15 mg/kg every 4-6 hrs; maximum dose 5mg/dose onset, 10-20 min

    Side Effects: dizziness, lightheadedness, confusion, hallucinations, mood changes, sedation, respiratory depression, dependence

    Nursing Implications: assess for side effects
  20. Generic & Trade Name: Motrin
    Classification: NSAID

    Action: reduces hormones that cause inflammation and pain

    Purpose (in Pregnancy): reduce fever and treat pain or inflammation, relief of cramping

    Recommended Dose: the maximum amount is 800mg per dose not to exceed 3200 mg per day

    Side Effects: indigestion, nausea, occult blood loss, anorexia, headache, drowsiness, dizziness aplastic anemia, drug induces peptic ulcer, GI bleeding, agranulocytosis, laryngospasm, laryngeal edema; peripheral edema, anaphylaxis, acute renal failure; vomiting, constipation, diarrhea

    Nursing implications: Monitor for side effects, pain
  21. Generic & Trade Name: Rubella
    Classification: attenuated live virus vaccine

    Action: produces a modified rubella (German measles) infection that is not communicable, causing the formation of antibodies against rubella virus

    Purpose (in Pregnancy): administered at least 1 month before pregnancy or after child birth or abortion to women whose antibody screen shows they are not immune to rubella. This vaccine prevents rubella infection and possible severe congenital defects in the fetus during a subsequent pregnancy

    Recommended Dose: 0.5 mL subcutaneously

    Side Effects: transient stinging at site, fever, lymphadenopathy, arthralgia, and arthritis are most common

    Nursing Implications: vials should be refrigerated, reconstitute only with diluents supplied with the vial, use immediately after reconstitution and discard if not used within 8 hours, protect from light, do not give if woman is pregnant, and advise women not to become pregnant for 1 month after administration
  22. Generic & Trade Name: Nifedipine
    Classification: Antihypertensive (calcium channel blocker)

    Action: blocks calcium thus reducing contractions

    Purpose (in Pregnancy): reduce premature contractions

    Recommended Dose: PO; loading dose of 10-20 mg

    Side Effects: maternal flushing, dizziness, headache, nausea transient maternal tachycardia mild hypotension, modest increases in blood glucose levels

    Nursing Implications: monitor for side effects and report maternal pulse greater than 110 bpm. Teach mother to sit or stand slowly and ask for assistance when needed, monitor fetal heart rate
  23. Generic & Trade Name: Labetalol
    Classification: Antihypertensive (Beta blocker)

    Action: inhibition of uterine muscle activity

    Purpose (in Pregnancy): stop pre term labor reduce or stop hypertonic labor contractions

    Recommended Dose: IV begin at the ordered rate, increase rate if needed to stop contractions, subcutaneous, PO

    Side Effects: maternal and fetal tachycardia, palpitations, cardiac dysrhythmias, chest pain, wide pulse pressure, dyspnea, tremors, restlessness, weakness, dizziness, headache, Hypokalemia, hyperglycemia, nausea, vomiting, reduced bowel motility, flushing diaphoresis

    Nursing Implications: explain and monitor for side effects, assess the fetal heart rate, mothers heart rate >120, respirations>24bpm, dyspnea, systolic B/P <80-90 and FHR >160 bpm should be reported
  24. Generic & Trade Name: Dinoprostone (Cervidil)
    Classification: Oxytocics

    Action: promotes cervical ripening (thinning and softening)

    Purpose (in Pregnancy and postpartum): promotes uterine contractions, can be administered to newborn for pulmonary hypertension, intracranial hemorrhage

    Recommended Dose: intravaginal insert suppository high in vagina, repeat every 2-5 hours until abortion occurs or membranes rupture (max. dose 240 mg)

    Side Effects: nausea, heartburn, vomiting, and rash can prolong bleeding time, constriction of the ductus arteriosus, pulmonary hypertension and oligohydramnios (lack of amniotic fluid)

    Nursing Implications: monitor for prolonged bleeding, can mask infection, monitor the fundal height throughout therapy (can help identify reduced amniotic fluid)
  25. Generic & Trade Name: Erythromycin Ointment (use in new born)
    • Classification: antibiotic
    • Action: inhibits protein synthesis in bacteria, bacteriostatic or bactericidal (depending on organism)
    • Purpose (in Pregnancy): prophylaxis against the organisms Neisseria gonorrhea and Chlamydia trachomatis. Prevents ophthalmic neonatorum in infants of mothers with gonorrhea and prevents conjunctivitis in infants of mothers with chlamydial infection. Prophylaxis against gonorrhea is required by law for all infants, regardless of whether the mother is known to be infected
    • Recommended Dose: a ribbon of 0.5% erythromycin ointment. 1-2cm long is applied to the lower conjunctival sac of each eye within 1 hour of birth

    Side Effects: burning, itching, irritation may result in chemical conjunctivitis, lasting 24-48 hours ointment may cause temporary blurred vision

    Nursing Implications: cleanse the infant’s eyes as needed before application. Hold the tube in a horizontal rather than a vertical position to prevent injury to the eye from sudden movement administer from the inner canthus to the outer canthus do not touch the tip of the tube to any part of the eye, this may cause infection to spread to the other eye, do not rinse excess ointment may be wiped away after 1 minute, observe for irritation use a new tube for each infant to prevent spread of infection
  26. Generic & Trade Name: Phytonadione (Vitamin K) Use in new born
    Classification: fat-soluble vitamin, antihemorrhagic

    Action: promotes the formation factors of prothrombin by the liver for clotting. Provides vitamin K, which is not synthesized in the intestines for the first 5-8 days after birth because the newborn lacks intestinal flora necessary for vitamin K production

    Purpose (in Pregnancy): prevention or treatment of vitamin K dependent deficiency bleeding (hemorrhagic disease of the newborn)

    Recommended Dose: 5.0-1 mg given once intramuscularly within 1 hour of birth prophylaxis may be delayed until after the first breastfeeding in the delivery room may be repeated or higher doses used it the mother took anticonvulsants during pregnancy or the infant shows bleeding tendencies

    Side Effects: erthema, pain and edema at injection site. Hemolysis or hyperbilirubinemia, especially in a preterm infant or when large doses are used

    Nursing Implications: protect the drug from light until just before administration because it decomposes and loses potency on exposure to light, Observe all infants for signs of vitamin K deficiency ecchymoses or bleeding from any site. Check to see that the infant had vitamin K before a circumcision is performed
  27. Generic & Trade Name: Hepatitis B Vaccine
    Classification: immune globulin

    Action: provides passive immunity to hepatitis

    Purpose (in Pregnancy): protects infants until they develop their own antibodies and should be given within 12 hours of birth

    Recommended Dose: adults: IM 20 mcg at 0, 1, and 6 months, Child birth to 10 years of age IM 10 mcg at 0, 12, and 24 months

    • Side Effects: local reaction (anorexia, soreness, fatigue), anaphylaxis
    • Nursing considerations: do not use if patient has an allergy to baker’s yeast
  28. Generic & Trade Name: Hepatitis B Immune Globulin
    Classification: immune globulin

    Action: provides passive immunity (temporary)

    Purpose (in Pregnancy): used when have been exposed to Hep B

    Recommended Dose: must be given within 7 days of exposure

    Side Effects: local reaction (anorexia, soreness, fatigue), anaphylaxis

    Nursing Implications: do not use if patient has an allergy to baker’s yeast
  29. Generic & Trade Name: Acetaminophen elixir (New born dose)

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