Maternal Meds II

Hemabate

Action: contraction of uterus Side effects: Headache, nausea and vomiting, fever, tachycardia, hypertension, diarrhea contraindications: asthma, hypersensitivity Dosage and Route: 0.25 mg IM or intramyometrially every 15 to 90 minutes up to eight doses Nursing and consideration: continue to monitor vaginal bleeding and uterine tone.

Prostin, prepidil, Cervidil

Action:Prostaglandian E2 (PGE2) ripens the cervix, making it softer and causing it to begin to dilate and efface; it stimulates uterine contractions. Indications: PGE2 is used for preinduction cervical ripening (to ripen cervix before oxytocin induction of labor when the Bishop score is 4 or less) and to induce labor or abortion (abortification agent). Dosage and Route: Place Cervidil insert (10mg dinoprostone gradually released over 12 hours) intravanginally into the posterior fornix. Remove after 12 hours or the onset of labor. Keep insert frozen until ready to use ( no rewarming is needed). Uterine contractions usually begin in 5 to 7 hours. Induction may be initiated if needed, 30 to 60 minutes after placement of the insert. Use Prepidil gel (2.5ml syringe containing 0.5mg of dinoprostone) into cervical canal just below internal cervical os or into posterior fornix; a shield can be used to prevent insertion past internal os. Repeat gel insertion in 6 hours as needed to a maximum of 1.5mg in a 24 hour period. Bring gel to room temperature before administration. Do not force the warming process by using a warm water bath or other source of external heat such as a microwave. Contiune treatment until maximum dosage is administered or until an effective contraction pattern is established(Bishop score of 8 or more), or significant adverse reactions occur. Initiate oxytocin for induction of labor, if needed, within 6 to 12 hours after the last instillation of the gel. adverse Reactions: Potential adverse reactions include headache, nausea, and vomiting, diarrhea, fever, hypotension, tachysystole (12 or more uterine contractions in 20 minutes without alteration of fetal heart rate or pattern), Hyperstimulation of the uterus (tachysystole with nonreassuring fetal heart rate or patterns), or fetal passage of meconium. Adverse reactions are more common with intercervical administration. Nursing considerations: Explain procedure to woman and her family. Ensure that an informed consent has been obtained per agency policy. Assess maternal vital signs and health status, fetal heart rate and pattern, and status of pregnancy, including indications for cervical ripening or induction of labor, signs of labor or impending labor, and the Bishop score. Recognize that a nonreassuring fetal heart rate or pattern; maternal fever, infection, vaginal bleeding, or hypersensitivity; and regular, progressive uterine contractions and hystory of cesarean birth or uterine scar contraindicate the use of dinoprostone. Use caution if the woman has a history of asthma; glaucoma; or renal, hepatic, or cardiovascular disorders. Have woman void before insertion. Assist woman to maintain a supine position with lateral tilt or side-lying position for 30 to 60 minutes after insertion of gel or for 2 hours after placement of insert. Allow woman to ambulate after recommended period of bed rest and observation. Prepare to swab vagina to remove remaining gel using a saline-soaked gauze wrapped around fingers or pull string to remove insert and administer terbutaline, 0.25 mg subcutaneously or intravenously, if significant adverse reactions occur. Initiate oxytocin for induction of labor within 6 to 12 hours after last instillation of gel or at least 30 to 60 minutes after removal of the insert. Follow agency protocal for induction if ripening has occured and labor has not begun. Document all assessment findings and administration procedures. Dinoprostone is the only FDA- approved medication for cervical ripening or labor induction.

Benadryl/Diphenhydramine

H1 antagonists, 1st generation; Used in allergic conditions such as seasonal rhinitis, etc. motion sickness/ nausea; itiching from spinal

Vitamin B6/pyridoxine

Involved in protien metabolism. 2mg day reduces nausea and vomiting.

Folic Acid

Reduces neural tube defects by 50% - spinabifida & anencephaly, 400 micrograms daily - 1 month prior to pregnancy. Oranges

Vistaril

a drug (trade names Atarax and Vistaril) used as a tranquilizer to treat anxiety and motion sickness, Acts as a CNS depressant at the subcortical level of the CNS., Hydroxyzine 50-100mg (QID) (PO, IM)-AVoid eldery,renal C/I: early prego; warn: Glaucoma, BPH, Resp ADR: urinary retent, dizz, drowsiness, dry mouth, blurry vision Histamine H1 antagonist- 1st gen

Procardia

action: Calcium Channel blocker; relaxes smooth muscles, including the uterus by blocking calcium entry dosage and route: Loading 30 mg PO Maintenance dosage 10 to 20 mg PO q4-6h adverse reaction: Maternal reactions include transient tachycardia, palpitations, hypotension, dizziness, headache, nervousness, peripheral edemia, fatigue, nausea, and facial flushing. Fetal and newborn reactions are rare and are related to maternal hypotension, which would affect uteroplacental perfusion. Nursing and considerations: Do not use sublingual route. Avoid use or use caurtiously with magnesium sulfate because severe hypotension can result. Assess woman and fetus according to agency protocol, being alert for adverse reactions.

Cytotec/Misoprostol

action: Prostaglandin E1(PGE1) ripens the cervix, making it softer and causing it to begin to dilate and efface; it stimulates uterine contractions indications: PGE1 is used for preinduction cervical ripening (ripens cervix before oxytocin induction of labor when the Bishop score is 4 or less) and to induce labor or abortion (abortifacient agent) Dosage: Insert 25 to 50mcg (1/4 to 1/2 of a 100mcg tablet) intravaginally into the posterior fornix using the tips of index and middle fingers without use of lubricant. Repeat every 3 to 6 hours as needed to a maximum of 300 to 400 mcg in a 24 hour period or until an effective contraction pattern is established (three or more uterine contractions in 10 minutes), cervix ripens(Bishop score of 8 or higher), or significant adverse reactions occur. administer 50 to 100 mcg PO q4-6 (gastrointestional effects are increased; there are insufficient data to support effectiveness; therefore oral administration is generally not recommended.) Adverse Reactions: Higher dosages are more likely to result in adverse reactions such as nausea and vomiting, diarrhea, fever, tachysystole (12 or more uterine contractions in 20 minutes without alteration of fetal heart rate or pattern), hyperstimulation of the uterus (tachysystole with nonreasurring fetal heart rate patterns), or featal passage of meconium. Risk for adverse reactions reduceded with lower dosages (ie. 25mcg) and longer intervals between doses(ie, q6h) Nursing considerations: Explain the proceedure to the woman and her family. Ensure that an informed consent has been obtained per agency policy. Assess maternal-fetal unit before each insertion and during treatment, following agency protocol for frequency. Assess maternal vital signs and health status, fetal heart rate, pattern and status of pregnancy, including indications for cervical ripening or induction of labor, signs of labor or impending labor, and the Bishop score. Recognize that a nonreassuring fetal heart rate or pattern; maternal fever, infection, vaginal bleeding, or hypersensitivity; and regular, progressive uterine contractions and history of cesarean birth or uterine scar contracte the use of misoprotol. Use caution if the woman has a history of asthma; glaucoma; or renal, hepatic, or cardiovascular disorders. Have woman void before procedure. Assist woman to maintain a supine position with lateral tilt or side-lying position for 30 to 40 minutes after insertion. Prepare to swab vagina to remove unabsorbed medication using saline-soaked gauze wrapped around fingers and to administer terbutaline 0.25mg subcutaneously or intravenously if significant adverse reactions occur. Initiate oxytocin for induction of labor at least 4 hours after last dose of misoprostol was administered, following agency protocal, if ripening has occured and labor has not begun. Document all assessment findings and administered procedures. A nonscored 100mcg tablet must be cut in the pharmacy to ensure dosage acccuracy.

Methergine

action: contraction of uterus side effects: Hypertension, nausea, vomiting, headache contraindication: hypertension, cardiac disease Dosage and Route: 0.2 mg IM every 2 to 4 hours up to five doses; 0.2 mg IV only for emergency Nursing Considerations: Check blood pressure before giving and do not give if more than 140/90 mm Hg; continue monitoring vaginal bleeding and uterine tone.

Nubain

action: mixed agonist-antagonist analgesic; stimulates kappa and opioid receptor and blocks mu opioid receptor Indication labor pain, postoperative pain after cesarean birth dosage and Route 10mg intravenously; 10 to 20 mg intramusculary q3-6hr

Reglan

antiemetic

Clindamycin

broad spectrum antibacterial that blocks protein synthesis; its most serious side effect involves pseudomembranous colitis due to C. difficile overgrowth, resulting in severe diarrhea (once this happens, take pt off this med and put on oral vanco or metronidazole), cleocin

Insulin

control gestional prevent high birth weight, blindness

Motrin

headache relief from spinal block

Morphine sulfate

opioid delivered with spinal block

Azithromycin

used for urethral, cervical, and rectal chlamydial infection 1g orally in single dose

Monostat/Terazol

yeast infection control

Pitocin

Action: contraction of uterus; decreases bleeding side effects: infrequent: water intoxication; nausea and vomiting Contraindications: None for postpartum hemorrhage Dosage and Route 10 to 40 units/L diluted in lactated Ringers' solution or normal saline at 125 to 200 mU/min IV or 10 to 20 units IM Nursing Considerations continue to monitor vaginal bleeding and uterine tone.

Aldomet

action: Postganglionic nerve endings: interfers with chemical neurotransmission to reduce peripheral vascular resistance, causes CNS sedation adverse effects: maternal sleepiness, postural hypotension constipation; rare; drug-induced fever in 1% of women and positive Coombs' Test result in 20% Fetal: after 4 month maternal therapy, positive Coombs' test result in infant. nursing and consideraditions: Assess for effects of medicarions, alert woman and family to expected effects of medications, assess blood pressure frequently because precipitae decrease can lead to shock and perhaps abruptio placentae; assess urinary output; maintain bed rest in a lateral position with side rails up; use with caution in presence of maternal tachycardia.

Valtrax/Zovirax/Acyclovair

herpatic drug to control out breaks

Rocephin

3rd generation parenteral -pretty long half life-kidney doesnt clear as quickly and biliary elimination and reabsorption -penetrates CNS -N. gonorrhea is exquisitely susceptible to rocephin

Methatrexate

Action: Decreases action of dihydrofolic acid reductase enzyme, which stops growth of actively proliferating tissue such as a tumor or fetus immunosuppressant indication: Ectopic pregnancy, rheumatic conditions, psoriasis, chemotherapy Dose: 50 mg/m2 intramuscularly x1: may repeat in 1 week if B-hCG is increased adverse reaction: Thrombocytopenia and other blood related disorders, neurotoxicity, nausea and vomiting, fever, dizziness, diarrhea, pruritus Nursing Considerations: Provide grief support for loss of pregnancy. Counsel woman to report increased abdominal pain, which could indicate tubal rupture. Follow-up care us needed until B hCG levels are nondetectable. If methotrexate treatment fails, surgical intervention may be necessary.

Narcan

Action: Opioid antagonist that blocks both mu and kappa opioid receptors from the effects of opioid agents Indications: Reverses opioid-induced respiratory depression in woman or newborn; may be used to reverse pruritus from epidural opioids. Dosage and Route:adult: opioid overdose 0.4 to 2 mg intravenously,may repeat IV at 2 to 3 minute intervals up to 10 mg; If IV route not available, IM or SC administration may be used. adult: postoperative opioid depression-initial dose 0.1 to 0.2mg IV at 2 to 3 minute intervals up to three doses to desired degree of reversal obtained; may be repeat dose in 1 to 2 hours if needed. newborn: opioid-induced depression- initial dose us 0.1mg/kg intravenously, intramusculary, or subcutaneously; may be repeated at 2 to 3 minute intervals up to three doses until desired degree of reversal is obtained. adverse effects Maternal hypotension and hypertension tachycardia, hyperventilation, nausea and vomiting, sweating, and tremulousness Nursing and considerations: Woman should delay breastfeeding until medication is out of system; do not give to mother or newborn if woman is opioid dependent-may cause abrupt withdrawal in woman and newborn if given to woman for reversal if respiratory depression caused by opioid analgesic; pain will return suddenly.

Vit K (acquamephytin)

Action: This intervention provides vitamin K because the newborn does not have the intestinal flora to produce this vitamin in the first week after birth. Vitamin K promotes formation of clotting factors (II, VII, IX, and X) in the liver. Indication: Vitamin K is used for prevention and treatment of hemorrhage disease in the newborn. Neonatal Dosage: Administer a 0.5 to 1mg. (0.25 to 0.5ml) dose intramusculary within 2 hours of birth; the dose may be repeated if newborn shows bleeding tendencies. Adverse Reactions: Edema, erythea, and pain at injection site may occur rarely; hemolysis, jaundice, and hyperbilirubinemia have been reported, particulary in preterm infants Nursing Considerations: Wear gloves. Administer in the middle third of the vastus lateralis muscle using a 25 gauge, 5/8-inch (22-mm) needle. Inject into skin that has been cleaned, or allow alcohol to dry on puncture site for 1 minute to remove organisms and prevent infection. Stablize leg firmly and grasp muscle between the thumb and fingers. Insert the needle at a 90 degree angle; aspirate and inject medication slowly if there is no blood return. After removing needle, rub gently on the injection site with a dry gauze square to decrease the pain. Observe for signs of bleeding from the site.

Terbutaline

action: B2 adrenergic agonist; relaxes smooth muscles, inhibiting uterine activity and causing bronchodilation Dosage and Route: Subcutaneous injection: 0.25 mg q20-30 min for up to 3 hours (hold for heart rate greater than 120 beats/min) Adverse reactions: Maternal reactions include shortness of breath, coughing, nasal stuffiness, tachypnea, pulmonary edema, tachycardia, palpitations, skipped beats, myocardial ischemia, chest pain, hypotension, fluid retention and decreased urine production, tremors, dizziness, nervousness, muscle cramps and weakness, headache, hyperinsulinemia, hyperglycemia, hypokalemia, hypocalcemia, metabolic acidosis, nausea and vomiting, fever, and altered thyroid function. Fetal reactions include hyperinsulinemia, hyperglycemia, and tachycardia. Neonatal reactions include hypoglycemia, hypocalcemia, hyperbilirubinemia, hypotension, and ileus. Nursing Considerations: Teach woman and family assessment measures (pulse, BP, respiratory effort, insertion site for infection, signs of PTL, and adverse reactions of terbutaline), whom to call if problems or concerns arise, site care and pump maintenance, activity restrictions, and how to arrange for follow-up care.

Magnesium Sulfate

action: Central nervous system depressant; relaxes smooth muscles, including uterus Dosage and Route: Mix 40 g in 1,000 ml intravenous solution, piggyback to primary infusion, and administer using controller pump: Loading dose of 4 to 6 g over 20 minutes. Maintenance dosage: gradually increases from 2 g/hr to 4 g/hr as needed to suppress contractions; contractions; continue until contractions stop (or one contraction or less in 10 to 15 minutes) or intolerable abverse reactions develop Adverse Reaction: Maternal adverse reactions include hot flashes, sweating, nausea and vomiting, drowsiness, blurred vision, diplopia, headache, ileus, generalized muscle weakness, dizziness, hypocalcemia, Shortness of Breath, and transient hypotension. Some may subside when loading dose is completed. Fetal and newborn reactions are uncommon and include decreased breathing movement, reduced Fetal Heart rate variability, nonreactive NST, Hypocalcemia, lethargy, hypotonia, and respiratory depression. Intolerable adverse reactions include respiratiory rate less than 12, pulmonary edema, absent DTRs, chest pain, severe hypotension, altered level of consciousness, exterme muscle weakness, urine output less than 25 to 30 ml/hr or less than 100 ml/4 hr, and serum magnesium level of 10 mEq/L (9mg/dl) or greater. Nursing considerations: Assess woman and fetus to obtain baseline before beginning therapy and then before and after each increment; following frequency of agency protocol. Monitor serum magnesium levels with higher doses; therapeutic range is between 4 and 7.5 mEq/L or 5 and 8 mg/dl. Discontinue infusion and notify physician if intolerable adverse reactions occur. Ensure that calcium gluconate (1 g=10ml of 10% solution) is available for emergency administration to reverse magnesium sulfate toxicity.

Erythromycin ophthalmic solution for newborn

action: Erythromycin and tetracycline antibiotic ointments are both bacteriostatic and bactericidal. They provide peophylaxis against Neisseria gonorrhoease. Topical treatment of neonatal conjuctiv itis caused by Chlamydia trachomatis is not indicated; instead the infant should be treated with a 14 day course of either oral erythromycin or ethylsuccinate (American Academy of Pediatrics, Committee on Infectious Diseases, 2006) Indication: These medications are used for the prevention of ophtalmia neonatorum newborns of mothers who are infected with gonorrhea. Neonatal Dosage: Apply a 1 to 2 cm ribbon of ointment to the lower conjunctival sac of each eye; medicines may also be used in drop form. Adverse Reaction: They may cause chemical conjunctivitis that lasts 24 to 48 hours; vision may be blurred temporarily Nursing considerations Administer within 1 to 2 hours of birth. Wear gloves. Cleanse eyes if necessary before adminstration. Open eyes by putting a thumb and finger at the corner of each lid and gently pressing on the periorbital ridges. Squeeze the tube and spread the ointment from the inner canthus of the eye to the outer canthus. Do not touch the tube to the eye. After 1 minute, excess may be wiped off. Observe eyes for irritation. Explain treatment to parents. Eye prophylaxis for ophthalmia neonatorum is required by law in all states of the united states.

Demerol

action: Opiod agonist analgesics stimulate mu and kappa opiod receptors to decrease transmisson of pain impluses Indication: moderate-to-severe labor pain; postoperative pain after cesarean birth dosage and route Meperidine hydrochloride-25 mg intravenously; 50 to 100 mg intramusculary or subcutaneously; may repeat in 1 to 3 hours Hydromorphone hydrochloride- 1mg IV every 3 hours as needed; 1 to 2 mg IM, may repeat in 3 to 6 hours if needed, or 3 to 4 mg, may repeat in 4 to 6 hours if needed. adverse effects: Nausea and vomiting, sedation, confusion, drowisness, tachycardia or bradycardia, hypotension, dry mouth, pruritus, urinary, retention, respiratory, depression ( woman and newborn), decreased fetal heart Rate (FHR) variability, decreased uterine activity if given in early labor. Nursing Considerations: Assess maternal vital signs, degree of pain, FHR and pattern, and uterine activity before and after administion: observe for respiratory depression, notifiy primary health care provider is maternal respirations are 12 breaths/min or less; encourage voiding every 2 hours and palpate for bladder distention; administer with a phenothiazine or benzodiazepine, if ordered, to potentiate the analgesic effect, enhance sedation, and decrease nausea and vomiting; if birth occurs within 1 to 4 hours of dose, observe newborn for respiratory depression; have naloxone available as antidote; implement safety measures as appropriate, including use of side rails and assistance with ambulation; continue use of nonpharmacologic pain relief measures.

Indiocin (Indomethacin)

action: Prostaglandin synthetase inhibitor; relaxes uterine smooth muscle Dosage and route: loading 50 mg rectally or 50 to 100 mg orally; then 25 to 50 mg orally q6hr for 48 hours adverse reactions: maternal reactions include nausea and vomiting, dyspepsia, pyrosis, dizziness, oligohydramnios, and reduce platelet aggregation increasing risk for hemorrhage. Fetal reactions involve constriction of ductus arteriosus progressing to premature closure. Neonatal reactions include bronochopulmonary dysplasia, respiratory distress syndrome, intracrainal hemorrhage, necrotizing enterocolitis, and hyperbilirubinemia. nursing considerations: Used if gestional age is less than 32 weeks. Administer for 48 hours or less. Do not use for women with bleeding potential (coagulopathy), peptic ulcer disease, or oligohydramnios. Assess woman and fetus according to agency policy, being alert for adverse reactions. Determine amniotic fluid volume and function of ductus arteriosus before initiating therapy and within 48 hours of discontinuing therapy; assessment is critial if therapy continues for more than 48 hours. Administer with food or use rectal route to decrease GI distress. Monitor for signs of postpartum hemorrhage.

Rhogam

action: Suppression of immune response in nonsensitized women with Rh-negative blood who received Rh-positive blood cells because of fetomaternal hemorrhage, transfusion, or accident. Indications: Routine antepartum prevent at 26 to 28 weeks of gestation in women with Rh-negative blood; suppression of antibody formation after birth, miscarrage/pregnancy termination, abdominal trauma, ectopic pregnancy, amniocentesis, version, or chorionic villi sampling. Dosage/Route: Standard dose: 1 vial (300 mcg)IM in deltoid or gluteal muscle; microdose: 1 vial (50 mcg)IM in deltoid muscle; Rho(D) immune globulin (Rhophylac) can be given IM or IV (available in prefilled syringes) adverse effects: Myalgia, lethargy, localized tenderness and stiffness at injection site, mild and transient fever, malaise, headache, rarely nausea, vomiting, hypotension, tachycardia, and allergic response Nursing considerations: Give standard dose to mother at 28 weeks of gestation as prophylaxis or after an incident or exposure risk that occurs after 28 weeks of gestation (e.g. amniocentesis, second-trimester miscarriage or abortion, afterversion) and within 72 hours after birth if baby is Rh positive. Give microdose for first-trimester miscarrage or abortion, ectopic pregnancy, chronic villi sampling. Verify that the woman is Rh negative and has not been sensitized, and if postpartum, that Coombs' test is negative, and the baby is Rh positive. Provide explanation to the woman about the procedure, including the purpose, possible side effects, and effect on future pregnancies. Have the woman sign a consent form if required by agency. Verify correct dosage and confirm lot number and woman's identity before giving injection (verify with another registered nurse or by other procedure per agency policy); document administration per agency policy. Observe patient for at least 20 minutes after administration for allergic response, The medication is made from human plasma ( a consideration if woman is a Jehovah's Witness). The risk of transmitting infectious agents, including viruses, cannot be completely eliminated.

Stadol

action: mixed agonist-antagonist analgesic; stimulates kappa opiod receptor and blocks mu opiod receptor Indication: labor pain; postoperative pain after cesarean birth Dosage and route: 1 mg intravenously q3-4hr; 2 mg intramusculary q3-4hr adverse effects: confusion sedation, sweating; transient sinusoidal-like fetal heart rhythm; less respiratory depression, nausea and vomiting Nursing consideration: see mepridine;may precipitate withdrawal symptoms in opioid-dependent women and their newborns

phenergan

antiemetic

Zofran

antiemtic/CNS 5-HT receptor antagonist. Treat nausea/vomitting post operation; chemo/radiation

Omega 3

essential for normal brain growth and development, prevention of heart disease because clotting, blood pressure, and triglyceride.

Ritodrine

used for cessation of uterine contractions serious side effects no longer marketed, side effects: severe preeclampsia or eclampsia active viginal bleeding, Intrauterine infection (chorioamnionitis), cardiac disease, Medical or obstetric condition that contraindicates continiation of pregnancy. Dilation greater than 6 cm Fetal: Estimated gestational age greater than 34 weeks fetal death, lethal fetal anomaly, acute fetal distress, Chronic intrauterine growth restriction. nursing considerations: Explain the purpose and side and effects of tocolytic therapy to woman and her family. Position woman on her side to enhance placental perfusion and reduce cervical pressure. Monitor maternal vital signs, including lung sounds and respiratory effort, fetal heart rate and pattern, and labor status according to hospital protocol and professional standard. Assess mother and fetus for signs of adverse reactions related to tocolytic being administered. Determine maternal fluid balance by measuring daily weight and intake and output. Limit fluid intake to 1500 to 2500 ml/day, especially if a B adrenergic agonist or magnesium sulfate is being administered. Provide psychosocial support and opportunities for women and family to express feelings and concers. Offer comfort measures as required. Encourage diversonal activities and relaxation techniques.