NURS 333 OB Clinical: Medications on Exam

vasopressors

drugs used to increase blood pressure

pregnancy category b

include prenatal vitamins, acetaminophen and several other medications used routinely and safely during pregnancy

tdap vaccine

- Adacel - vaccine/immunizing agent for prevention of tetanus, diptheria, and pertusis - Pregnancy Category = C - contraindications = previous anaphylaxis or encephalopathy; hypersensitivity - assess pt.'s medical history + current health status... vaccine usually recommended during pregnancy - adverse rxns = sore/swollen joints, hypersensitivity rxns - IM injection in persons 10-64 yrs old

Docusate sodium

- Colace - laxative + stool softener - prevention of constipation (esp. in pts who should avoid straining) + used as enema to soften fecal impaction - contraindications = abdominal pain, N&V, prolonged use - assess abdomen, bowel sounds/function, stool produced - adverse rxns = mild cramps, diarrhea, throat irritation, rash - adults + infants... rectal/PO

fentanyl

- Duragesic, Sublimaze, Actiq - opioid analgesic - Pregnancy category = C - moderate to severe chronic pain; analgesic supplement to general anesthesia; induction/maintenance of anesthesia; supplement to regional/local anesthesia - contraindications = known tolerance, resp. depression, paralytic ileus, acute/severe bronchial asthma... not recommended during labor/delivery - monitor resp. rate + BP + pulse... bowel fxn... may cause sleep related breathing disorders... accidental overdose - adverse rxns = apnea, laryngospasm, resp. depression, sleep related hypoxemia, constipation, central sleep apnea, adrenal insufficiency - adults + neonates (IV)

ephedrine

- Emerphed, Corphedra, Akovaz - vasopressors, adrenergic - Pregnancy category = C - used for hypotension occurring in setting of anesthesia - contraindications = renal impairment... may increase risk of metabolic acidosis in neonates (use only during pregnancy only if maternal benefit justifies risk) - monitor BP + heart rate (hypertension, tachyphylaxis); monitor acid base in newborn if used during delivery administer IV push - adverse rxns = hypertension, tolerance, tachycardia - administered to adults

hepatitis B vaccine

- Energix-B, Recombivax HB - vaccine + immunizing agent - Pregnancy category = C - prevents Hepatitis B infection caused by all subtypes of the virus - contraindications = anaphylactic rxn., caution use in lactation - IM in anterolateral thigh... be aware of maternal hepatitis status at appropriate ages - adverse rxns = anaphylaxis, angioedema - if mother's HBsAg status unknown, administer vaccine within 12 hours of birth

ferrous sulfate

- Feosol, Slow FE - antianemics + iron supplements - prevent + treat iron deficiency anemia - contraindications = anemia not due to iron deficiency, hemochromatosis... caution use in alcoholism, peptic ulcer disease - assess bowel fxn., nutritional status + dietary hx., occult blood - adverse rxns = dark stools, teeth staining, constipation, nausea - Adults + neonates

Toradol

- Ketorolac - nonopioid analgesic + NSAID used for short term management of pain (not to exceed 5 days total for all routes combined) - Pregnancy category = C - Contraindications = active/hx. of GI bleeding/peptic ulcer disease... known alcohol intolerance... cerebrovascular bleeding... preop use... avoid after 30 weeks gestation... advanced renal impairment - assess for rash, signs of DRESS, pain, BP, asthma/rhinitus/urticaria...liver fxn tests... IM or IV initially - adverse rxns = myocardial infarction, stroke, DRESS, exfoliative dermatitis, toxic epidermal necrolysis, GI bleeding

rubella vaccine

- Meruvax II - vaccine/immunizing agent for rubella in persons 12 months or older - Pregnancy category = C - contraindications = immunocompromised status, pregnant females, anaphylactic rxn, active untreated TB - monitor for anaphylaxis... have epinephrine available... vials refrigerated + protect from light + reconstitute only with diluents supplied w/ vial - adverse rxns = transient arthritis, injection site rxn, hypersensitivity

ibuprofen

- Motrin, Advil - Pregnancy Category = B/D - antipyretic... antirheumatic... nonopioid analgesic... NSAID - Mild to moderate pain, Fever, Inflammatory disorders including rheumatoid arthritis and osteoarthritis, Dysmenorrhea, closure of PDA in neonates - contraindicated in = Active GI bleeding or ulcer disease... History of recent MI... severe HF... chronic alcohol use/abuse... renal/hepatic disease... coagulation disorders... avoid use after 30 week gestation... preterm neonates with untreated infection/bleeding - adverse reactions = GI bleeding, hepatitis, stroke, myocardial infarction, headache, constipation, N&V, dyspepsia, DRESS, toxic epidermal necrolysis - watch for signs/symptoms of GI bleeding... signs of DRESS... hypersensivity rxn risk is higher in people with asthma, nasal polyps

oxycodone

- Oxycontin, Roxicodone (Percocet = oxycodone + acetaminophen) - opioid analgesic - Pregnancy category = B - use for moderate-severe pain - contraindications = paralytic ileus, significant resp. depression, acute/severe bronchial asthma - assess respirations, pulse, BP, pain, bowel function, risk for addiction... discontinue gradually... can administer with food/milk to minimize GI upset - adverse rxns = resp. depression, constipation, sedation, confusion

prenatal vitamin

- Prenat - multivitamin + iron product - Pregnancy category = B - Treat/Prevent of vitamin deficiency during pregnancy, due to poor diet, etc. - contraindications = hypersensitivity to colorants, preservatives, additives, aspartame - assess for signs of nutritional deficiency - adverse rxns = (usually rare) allergic rxns to preservatives/colorants/additives - continue taking after birth

rhogam

- Rho (D) immune globulin - vaccine/immunizing agent + immune globins... stops your blood from making antibodies that attack Rh-positive blood cells - Pregnancy category = C - administer to negative patients who have been exposed to positive blood (by pregnancy/delivery of positive infant, abortion of one, or fetal-maternal hemorrhage - contraindications = prior hypersensitivity, RhoD-positive pts. - type/crossmatch of mother + newborns cord blood... infant must be positive and mother must be negative.. if in doubt of infants blood type or if father is positive, medication should be given - adverse rxns = acute renal failure, arthralgia, myalgia - IM before delivery = 1 dose at 26-28 weeks... IM following delivery = 1 dose within 72 hours of delivery

senekot

- Senna, Docusate Sodium - laxative + stool softener - contraindications = abdominal pain, N&V esp. with fever or other signs of an acute abdomen... color, consistency, amount of stool... concomitant use of mineral oil - assess abdominal distention, presence of bowel sounds/usual bowel function... color, consistency, amount of stool... administer with full glass of water/juice preferably in evening, not within 2 hrs of other laxatives esp. mineral oil - adverse rxns = urine discoloration, electrolyte imbalances, cramps

acetaminophen

- Tylenol - pregnancy category = B - antipyretic + nonopioid analgesic - PO: adults 325-650 mg q6 hrs or 1 g 3-4x a day... neonates 10-15 mg/kg/dose q6-8 hr prn - Contraindications = previous hypersensitivity, liver, liver disease, alcohol use - considerations = assess alcohol use, OTC med use, pain prior to and after administration, fever... taken with food or on empty stomach... monitor hepatic + renal function - adverse rxns = hepatotoxicity, neutropenia, renal failure, rash urticaria, pancytopenia, life threatening derm. rxn.

lidocaine

- Xylocaine, Xylocard, Lidoderm - topical/local anesthetic, antiarrhythmic - Pregnancy category = B - (IV) ventricular arrhythmias; (local) infiltration/mucosal/topical anesthetic - contraindications = viscous lidocaine not to be used for teething pain... wolff parkinson white syndrome... children <3 yr at increased risk for seizures/cardiac arrest/death with viscous use... 3rd degree heart block - monitor pain; assess numbness of affected part; inadvertent overdose; monitor ecg, BP, respirations continuously - adverse rxns = seizures, cardiac arrest, anaphylaxis, stinging, paresthesia - female urethra = 3-5 ml of jelly or 20 mg as 2% solution

flu vaccine

- afluria, fluarix, fluzone - vaccine, immunizing agent - prevents influenza (usually 3-4 strains during annual flu season)... recommended for everyone > 6 months old... pregnant women should get shot (not live attenuated vaccine) - contraindications = anaphylactic rxn to previous dose or vaccine component, avoid use in patients with acute neurologic compromise - document administration... consider delaying administration if acute/severe illness - adverse rxns = neurologic toxicity, myalgia, fever, local soreness - age 6-35 months = 1-2 doses of 0.25-0.5 ml IM

dermoplast spray

- benzocaine - topical/local anesthetic - Pregnancy category = C - relief of pruritus or pain associated with minor skin disorders, including hemorrhoids, bruises - contraindications = active/untreated infection of affected area, not to be used in the eye, not to be used in children < 2 yrs old... cross sensitivity with other agents - prolonged use not recommended... assess pain before/after administration (few minutes)... assess skin integrity... avoid overuse + too liberal application - adverse rxns = anaphylaxis

dulcolax

- bisacodyl - laxative - Pregnancy category = C - contraindications = abdominal pain, obstruction, N&V - avoid prolonged use (potential dependence), assess for abdominal distention, bowel sounds, stool produced... take on empty stomach not within 1 hr of milk or antacids - adverse rxns = abdominal cramps, protein losing enteropathy, prolonged use = hypokalemia, muscle weakness, tetany

stadol

- butorphanol - opioid analgesic - Pregnancy Category = C - manages moderate-severe pain; analgesia during labor; sedation before surgery; balanced anesthesia supplement - contraindications = pts. physically dependent on opioids; hypersensitivity - discontinue gradually... ass pain, risk for abuse, BP, pulse, respirations, previous analgesic hx. - adverse rxns = resp. depression, confusion, sedation, hallucinations, sweating, nausea, dysphoria - IM/IV/intranasal Adults

nubaine

- nalbuphine - opioid analgesic - Pregnancy Category = B - use for moderate-severe pain; sedation before surgery; pain control during labor - contraindications = can be used in labor but can cause resp. depression in newborn... prolonged opioid use during pregnancy can result in neonatal opioid withdrawal syndrome - assess respirations, pain, BP, pulse, previous analgesic hx./abuse - adverse rxns = resp. depression, sedation, clammy, sweating, N&V, dizziness

mylicon

- simethicone - antiflatulent + gastrointestinal agent - Pregnancy category = C - contraindications = not recommended for infant colic - assess abdominal pain, distention, bowel sounds... frequency of belching + passing of flatus... administer after meals + at bedtime - adverse rxns = none significant

pregnancy category c

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans - potential benefits may warrant use of the drug in pregnant women despite potential risks