OB MEDICATIONS

butorphanol (Stadol) - DOSAGE/ROUTE

DOSAGE: (IV) 0.5 mg - 2 mg (IM) 1mg - 4 mg q 3-4 hr as needed ROUTE: IV/IM

Methergine - DOSAGE/ROUTE

DOSAGE: 0.2 mg ROUTE: IM (intramuscular injection)

Pitocin (oxytocin) - DOSAGE/ROUTE

DOSAGE: Induction: 0.5-1 milliunits/min; increase by 1-2 milliunits/min q 30-60 min until desired contraction pattern established. Postpartum hemorrhage: 10 units infused at 20-40 milliunits/min. 10 units after delivery of placenta ROUTE: IV, IM (after delivery of placenta)

Methergine - DRUG TO DRUG INTERACTION

DRUG TO DRUG INTERACTION: Excesive vasoconstriction may result when used with heavy cigarette smoking (nicotine), other vasopressors such as dopamine, or beta-blockers. Grapegruit juice may increase levels; use with caution.

butorphanol (Stadol) - DRUG TO DRUG INTERACTION

DRUG TO DRUG INTERACTION: use with extreme caution in patients receiving MAO inhibitors (may produce severe, potentially fatal reactions) Additive CNS depression with alcohol, antidepressants, antihistamines, and sedative/hypnotics.

Pitocin (oxytocin) - DRUG TO DRUG INTERACTIONS

DRUG TO DRUG INTERACTIONS: Severe hypertension may occur if oxytocin follows administration of vasopressors.

butorphanol (Stadol) - INDICATION

INDICATION: Analgesia during labor

Methergine - INDICATION

INDICATION: Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution.

Pitocin (oxytocin) - INDICATION

INDICATION: for involution and prevention of hemorrhage, induction and augmentation

Methergine - CLASSIFICATION/MECHANISM OF ACTION

CLASSIFICATION: Oxytocics MECHANISM OF ACTION: Directly stimulates uterine and vascular smooth muscle. Uterine contraction

Pitocin (oxytocin) - CLASSIFICATION/MECHANISM OF ACTION

CLASSIFICATION: Oxytocics MECHANISM OF ACTION: Stimulates uterine smooth muscle, producing uterine contrations similar to those in spontaneous labor.Induction of labor. Control of postpartum bleeding.

butorphanol (Stadol) - CLASSIFICATION/MECHANISM OF ACTION

CLASSIFICATION: opiod analgesics/ opiod agonists/antagonists MECHANISM OF ACTION: Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression.

butorphanol (Stadol) - NURSING CONSIDERATIONS

NURSING CONSIDERATIONS: Assess previous analgesic history. Antagonistic properties may induce withdrawal symptoms (vomiting, restlessness, abdominal cramps, increased BP and temperature) in patients who are physically dependent on opioid agonists. Verify that labor is well established by performing a vaginal exam showing cervical dilation to be at least 4 cm with the fetus engaged. Administer antiemetics as prescribed. Monitor vital signs, uterine contraction pattern, and continuous FHR monitoring.

Pitocin (oxytocin) - NURSING CONSIDERATIONS

NURSING CONSIDERATIONS: 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 frequently throughout administration. If contractions occur <2 min apart and are >50-65 mm Hg on monitor, if they last 60 - 90 sec or longer, or if a 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 frequently and fetal heart rate continuously throughout administration. This drug occasionally causes water intoxication. Monitor patient for signs and symptoms (drowsiness, listlessness, confusion, headache, anuria) and notify physician or other health care professional if they occur.

Methergine - NURSING CONSIDERATIONS

NURSING CONSIDERATIONS: Monitor BP, heart rate, and uterine response frequently during medication administration. Notify health care professional promptly if uterine relaxation becomes prolonged or if character of vaginal bleeding changes. Assess for signs of ergotism (cold, numb fingers and toes, chest pain, nausea, vomiting, headache, muscle pain, weakness). Monitor for manifestations of hypertensive crisis (headache, nausea, vomiting, increased blood pressure).

Pitocin (oxytocin) - PATIENT TEACHING

PATIENT TEACHING: Advise patient to expect contractions similar to menstrual cramps after administration has started.

butorphanol (Stadol) - PATIENT TEACHING

PATIENT TEACHING: Instruct patient on when and how to ask for pain medication. Explain to the client that the medication will cause drowsiness. Instruct the client to request assisstance with ambulation.

Methergine - PATIENT TEACHING

PATIENT TEACHING: Instruct patient to take medication as directed; do not skip or double up on missed doses. If a dose is missed, omit it and return to regular dose schedule. Advise patient that medication may cause menstrual-like cramps. Caution patient to avoid smoking, because nicotine constricts blood vessels. Instruct patient to notify healthcare professional if infection develops, as this may cause increased sensitivity to the medication. Advise patient to notify healthcare professional of all Rx or OTC medications, vitamins, or herbal prod- ucts being taken and to consult with health care professional before taking other medications.

Pitocin (oxytocin) - SIDE EFFECTS/ADVERSE REACTIONS

SIDE EFFECTS: Maternal- hypotension, hypochloremia, hyponatremia, increased uterine motility, painful contractions, abruptio placentae, decreased uternine blood flow, hypersensitivity. ADVERSE REACTIONS: CNS: maternal- coma, seizures, water intoxication, uterine rupture. Fetal - intracranial hemorrhag, asphyxia, hypoxia.

butorphanol (Stadol) - SIDE EFFECTS/ADVERSE REACTIONS

SIDE EFFECTS: confusion, dysphoria, hallucinations, sedation, euphoria, floating feeling, headache, unusual dreams, blurred vision, diplopia, miosis, respiratory depression, hypertension, hypotension, palpations, nausea, constipation, dry mouth, ileus, vomiting, urinary retention, sweating, clammy feeling, physical dependence, psychological dependence, tolerance. ADVERSE REACTIONS: Neonatal depression, tachycardia, hypotension, decreased fetal heart rate variability

Methergine - SIDE EFFECTS/ADVERSE REACTIONS

SIDE EFFECTS: dizziness, headache, tinnitus, dyspnea, arrhythmias, chest pain, palpations, nausea, vomiting, cramps, diaphoresis, parethesia. ADVERSE REACTION: stroke, hypertensive crisis, AV block, allergic reactions