Maternity Medications

• 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

• 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

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

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

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