Maternal Child Drugs

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  1. Pitocin
    • •    Therapeutic: hormones
    • •    Pharmacologic: oxytocics
  2. Pitocin
    Gen/Brand Addtl. Names:
    •    Oxytocin
  3. Pitocin
    Safe Pediatric Dosing Ranges:
    •    N/A
  4. Pitocin
    Routes (How is it given):
    •    IV or IM
  5. Pitocin
    Purpose (What do we use it for?):
    • •    Induction of labor at term
    • •    Facilitation of threatening abortion
    • •    Postpartum control of bleeding after expulsion of placenta.
  6. Pitocin
    Therapeutic Effects (What is the expected benefit?):
    • •    Induction of labor.
    • •    Control of postpartum bleeding
  7. Pitocin
    Contraindications Drug-Drug Food-Drug Other (When should we NOT give the med?):
    • •    Contraindications: Hypersensitivity
    • •    Anticipated non-vaginal delivery.
    • •    Drug-drug: Severe hypertension may occur if oxytocin follows administration of vasopressors. Concurrent use with cyclopropane anesthesia may result in excessive hypotension.
  8. Pitocin
    Most Significant Side Effects (Which side effects may be most likely?):
    • •    Increase in uterine motility
    • •    Painful contractions.
  9. Pitocin
    Monitoring Pharmacokinetics (What labs do we monitor to assure that the med is performing adequately?) Onset, Peak, Duration:
    • •    Monitor maternal electrolytes.
    • •    Water retention may result in hypochloremia or hyponatremia.
    •                       IV             IM
    • Onset:       immediate    3-5 min.
    • Peak:         Unknown      Unknown
    • Duration:    1hr              30-60 min.
  10. Pitocin
    Nursing Considerations (What do we need to assess in the pt? i.e.: vitals, weight, neuros etc):
    • •    Fetal maturity, presentation, and pelvic adequacy should be assessed prior to administration of oxytocin for induction of labor.
    • •    Assess character, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate frequency throughout administration. If contractions occur <2 min apart and are >50-65 mm Hg on monitor, if the last 60-90 sec or longer, or if significant change in fetal heart rate develops, stop infusion and turn patient on her left side to prevent fetal anoxia. Notify health care professional immediately.
    • •    Monitor maternal BP and pulse frequency and fetal heart rate continuously throughout administration
    • •    This drug occasionally causes water intoxication. Monitor patient for signs and symptoms (drowsiness, listlessness, confusion, headache, and anuria) and notify physician or other health care professional if they occur.
  11. Pitocin
    Patient Education (What should we teach the pt. about this med?):
    •    Advise patient to expect contractions similar to menstrual cramps after administration has started.
  12. Demerol
    • •    Therapeutic: opioid analgesics
    • •    Pharmacologic: opioid agonists
  13. Demerol
    Gen/Brand Addtl. Names:
    •    Meperidine
  14. Demerol
    Safe Pediatric Dosing Ranges:
    • •    Analgesia: 1-1.5 mg/kg; q 3-4 hr (should not exceed 100mg/dose).
    • •    Preoperative sedation: 1-2 mg/kg; 30-90 min before anesthesia (not to exceed adult dose).
    • •    Continuous infusion: 0.-1 mg/kg loading dose followed by 0.3mg/kg/hr, titrate to effect p to 0.5-0.7 mg/kg/hr.
  15. Demerol
    Routes (How is it given):
    •    Po, IM, Subcut, or IV
  16. Demerol
    Purpose (What do we use it for?):
    • •    Moderate or severe pain (alone or with nonopioid agents).
    • •    Anesthesia adjunct.
    • •    Analgesic during labor.
    • •    Preoperative sedation.
    • •    Unlabeled use: Rigors
  17. Demerol
    Therapeutic Effects (What is the expected benefit?):
    •    Decrease in severity of pain.
  18. Demerol
    Contraindications Drug-Drug Food-Drug Other (When should we NOT give the med?):
    • •    Contraindications: Hypersensitivity to bisulfites (some injectable products); Recent (within 14 days) MAO inhibitor therapy; Severe respiratory insufficiency; OB: Chronic use may pose risk to fetus including possible addiction; Lactation: excreted in breast milk and can cause respiratory depression in the infant. Use Cautiously in: Head trauma; Increase intracranial pressure; Severe renal or hepatic impairment; Acute asthma attack, COPD, hypoxia, or hypercapnea; Hypothyroidism; Adrenal insufficiency; Alcoholism; Debilitated patients (dose decrease suggested); Undiagnosed abdominal pain or prostatic hyperplasia; Patients with renal impairment, or extensive burns; High-dose or prolonged therapy (>600 mg/day or >2 days; increase risk of CNS stimulation and seizures due to accumulation of normeperidine); Sickle cell anemia (may require decrease initial doses); OB:  Use during labor and delivery can cause respiratory depression in the newborn; Pedi:  Syrup contains benzyl alcohol, which can cause "gasping syndrome" in neonates. Children have increased risk of seizures due to accumulation of normeperidine; Geri:  Appears on Beers list; morphine recommended.
    • •    Drug –drug: Do not use in patients receiving MAO inhibitors or procarbazine (may cause fetal reaction-contraindicated within 14 days of MAO inhibitor therapy.
    • •    Increase CNS depression with alcohol, antihistamines, and sedative/hypnotics.
    • •    Administration of agonist/antagonist opioid analgesics may precipitate opioid withdrawal in physical dependent patients.
    • •    Nalbuphine or pentazocine may decrease analgesia.
    • •    Protease inhibitors may increase effects and adverse reactions (concurrent use should be avoided).
    • •    Phenytoin increase metabolism and may decrease effects.
    • •    Chlorpromazine and thioridazine may increase the risk of adverse reactions (concurrent use should be avoided). May aggravate side effects of isoniazid.
    • •    Acyclovir may increase plasma concentration of meperidine and normeperidine.
    • •    Drug-natural products: concomitant use of kava-kava, valerian, or chamomile can decrease CNS depression.
    • •    St. John’s wort may increase serious side effects, concurrent use is not recommended.
  19. Demerol
    Most Significant Side Effects (Which side effects may be most likely?):
    •    Confusion, sedation, hypotension, constipation, nausea, and vomiting.
  20. Demerol
    Monitoring Pharmacokinetics (What labs do we monitor to assure that the med is performing adequately?) Onset, Peak, Duration:
    • •    May increase plasma amylase and lipase concentration.
    •                PO       IM        Subcut         IV
    • Onset:     15 min  10-15 min  10-15 min     Immediate
    • Peak:       60 min  30-50 min   40-60 min    5-7 min
    • Duration:  2-4 hr    2-4 hr        2-4 hr        2-3 hr
  21. Demerol
    Nursing Considerations (What do we need to assess in the pt? i.e.: vitals, weight, neuros etc):
    • •    Assess type, location and intensity of pain prior to and 1 hr following PO, Subcut, and IM doses and 5 min (peak) following IV administration. When titrating opioid doses, increase of 25-50% should be administered until there is either a 50% reduction in the patient’s pain rating on a numerical or visual analogue scale or the patient reports satisfactory pain relief. A repeat dose can be safely administered at the time of the peak if previous dose is ineffective and side effects are minimal.
    • •    An equianalgesic chart should be used when changing routes or when changing from one opioid to another.
    • •    Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Dose may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use.
    • •    Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives should be administered routinely if opioid use exceeds 2-3 days, unless contraindicated.
    • •    Prolonged use may lead to physical and psychological dependence and tolerance. This should not prevent patient from receiving adequate analgesia. Most patients who receive meperidine for pain do not develop psychological dependence. Progressively higher doses may be required to relieve pain with long-term therapy.
    • •    Monitor patients on chronic or high-dose therapy for CNS stimulation (restlessness, irritability, seizures) due to accumulation of normeperidine metabolite. Risk of toxicity increases with doses >600mg/24 hr, chronic administration (>2 days), and renal impairment.
    • •    GERI: Meperidine has been reported to cause delirium in the elderly; older adults are at increased risk for normeperidine toxicity. Monitor frequently.
    • •    PEDI: Assess pediatric patients frequently; neonates, infants, and children are more sensitive to the effects of opioid analgesics and may experience respiratory complications, excitability and restlessness more frequently.
    • •    TOXICITY and OVERDOSE: If an opioid antagonist is required to reverse respiratory depression or coma, naloxone (Narcan) is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by direct IV push every 2 min. For children and patients weighing<40kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures, and severe pain. In patients receiving meperidine chronically, naloxone may precipitate seizures by eliminating the CNS depressant effects of meperidine, allowing the convulsant activity of normeperidine to predominate. Monitor patient closely.
  22. Demerol
    Patient Education (What should we teach the pt. about this med?):
    • •    Instruct patient on how and when to ask for and take pain medication.
    • •    Instruct patient to take meperidine as directed. If dose is less effective after a few weeks, do not increase dose without consulting health care professional. PEDI: Teach parents or caregivers how to accurately measure liquid medication and to use only the measuring device dispensed with the medication.
    • •    May cause drowsiness or dizziness. Advise patient to call for assistance when ambulating or smoking. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
    • •    Advise patient to change positions slowly to minimize orthostatic hypotension.
    • •    Instruct patient to avoid concurrent use of alcohol or other CNS depressants.
    • •    Advise ambulatory patients that nausea and vomiting may be decreased by lying down.
    • •    Encourage patient to turn, cough, and breathe deeply every 2 hr to p
  23. Lortab
    Opioid Analgesics
  24. Lortab
  25. Lortab
    Safe Pediatric:
    Analgesics between ages 2 to 13 years old  will be 0.14mg/ every 4-6 hours. Antitussive between 6 to 12 years old will be 2.5 mg every 4-6 hours.
  26. Lortab
    by mouth
  27. Lortab
    Used mainly in combination with non-opioid analgesics in the management of moderate to severe pain; antitussive
  28. Lortab
    Therapeutic Effects:
    Decrease severity of moderate pain; suppression of cough reflex
  29. Lortab:
    • Should not take medication during pregnant, or lactation.  Avoid chronic use; Ibuprofen-containing products should be avoided in patients with bleeding disorder or thrombocytopenia.
    • Interactions: Use with extreme caution with patients receiving MAO inhibitors (may produce severe, unpredictable  reactions and the patient is not able to use within 14 days of each other.  Additive CNS depression with alcohol, antihistamines, and sedative/hypnotic.
  30. Lortab
    Side effects:
    confusion, dizziness, sedation, hypotension, constipation, dyspepsia, nausea
  31. Lortab:
    Monitoring Pharmacokinetics:
    May cause increase plasma amylase and lipase concentration need to monitor it
  32. Lortab
    Nursing Consideration:
    Need to assess vital signs, bowel function (prevent constipation), and assess pain level
  33. Lortab
    Patient Education:
    Advise the patient to change positions slowly to minimize orthostatic hypotension and instruct the patient on how and when to ask for and take pain medication
Card Set:
Maternal Child Drugs
2013-09-07 05:28:31
Maternal Child drugs

Maternal Child drugs (Dawn)
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