Medications specific to maternal/newborn nursing
Ferrous Sulfate
Antianemics, iron supplements Indications: PO: prevention/treatment of iron-deficency anemia. Treatment of iron-deficency anemia in patients with chronic kidney disease including patients who are not on dialysis. Adverse effects- seizures, dizziness, headache, syncope, hypotension, hypertension, tachycardia, nausea, constipation, dark stools, diarrhea, epigastric pain, GI bleeding. Cough, dyspnea, pain at IM site, skin staining, staining of the teeth, fever, sweating. Route/dosage- PO (adults)- deficiency- 120-240 mg/day (2-3 mg/kg/day) in 2-4 divided doses. Prophylaxis0 60-100 mg/day. PO (neonates, premature) 2-4 mg/kg/day in 1-2 divided doses, maximum 15 mg/day. PO (infants and children)- severe deficiency- 4-6 mg/kg/day in 3 divided doses. Mild to moderate deficiency- 3 mg/kg/day in 1-2 divided doses. Nursing Implications- assess nutritional status and dietary history to determine possible cause of anemia and need for patient teaching. Assess bowel function for constipation or diarrhea.
Hydroxyzine (Vistaril)
Antianxiety agaent, antihistamines, sedative/hypnotics Indications: Treatment of anxiety, preoperative sedation, antiemetic, may be combined with opioid analgesics Adverse effects: drowsiness, agitatino, ataxia, dizziness, headache, weakness, wheezing, dry mouth, bitter taste, constipation, nausea, flushing, pain at IM site Route/Dosage: PO (Adults)- antianxiety= 25-100 mg 4 times/day, not to exceed 600 mg/day. Preop sedation- 50-100 mg single dose. IM (Adults)- preop sedation= 25-100 mg single dose, adjunct to opioid analgesics: 25-100 mg q 4-6 hr as needed. Nursing Implications: assess patient for profound sedation and provide safety precautions as indicated. Assess mental status.
Naloxone (Narcan)
Antidotes for opioids Indications: reversal of CNS depression and respiratory depression because of suspected opioid overdose. Unlabeled us: opioid-induced pruritus (low dose IV infusion. Adverse effects: ventricular arrhythmias, hypertension, hypotension, nausea, vomiting. Route/dosage: Post-op opioid induced respiratory depression: IV (adults)- 0.02-0.2 mg q 2-3 min until response obtained, repeat q 1-2 hr if needed. IM, IV, SQ (Neonates)- 0.01 mg/kg, may repeat q 2-3 min until response obtained. Additional doses may be given q 1-2 hr if needed. Overdose of opioids: IV, IM, SQ (Adults)- pateints not suspected of being opioid dependent= 0.4 mg (10 mcg/kg), may repeart q 2-3 min. Patients suspected to be opioid dependent: initial dose should be decreased to 0.1-0.2 q 2-3 min. Nursing implications: monitor respiratory rate, rhythm, and depth, pulse, ECG, blood pressure, and level of consciousness frequently for 3-4 hr after the expected peak of blood concentrations. Patients who have been receiving opioids for >1 week are extremely sensitive to the effects of Narcan. Dilute and administer carefully. Assess patient for signs and symptoms of opioid withdrawal (vomiting, restlessness, abdominal cramps, increased blood pressure, and temperature). Symptoms may occur within a few minutes to 2 hr.
Dinoprostone (Cervadil, PgE2)
Cervical ripening agent Indications: endocervical gel, vainal insert: used to "ripen" the cervix in preganancy at or near term when induction of labor is indicated. Vaginal Suppository: induction of midtrimester abortion, managemtn of missed abortion up to 28 weeks, managemnt of nonmetastatic gesational trophoblastic disease (benign hydatidiform mole). Adverse effects: Gel and vaginal insert: uterine contractle abnormalities, warm feeling in vagina, back pain, fever. Suppository- headache, drowsiness, syncope, coughing, dyspnea, hypotension, diarrhea, nausea, vomiting, urinary tract infection, allergic reactions, chills, fever Route/Dosage: Cervical Ripening: Vag (Adult, Cervical)- endocervical gel- 0.5mg if response is unfavorable, may repeat in 6 hr (not to exceed 1.5mg/24 hr). Vaginal insert- one 10 mg insert. Abortifacient- Vag (Adults)- one 20 mg suppository, repeat q 3-5 hr (not to exceed 240mg total or longer than 48 hr). Nursing implications: abortifacient= monitor frequency, duration, and force of contrations and uterine resting tone. Opioid analgesics may be administered for uterine pain. Monitor temperature, pulse, and blood pressure periodically throughout therapy. Dinoprostone-induced fever usually occurs within 15-45 min after insertion of suppository. This returns to normal 2-6 hr after dicontinuation or removal of suppository from vagina. Ausculate breath sounds- wheezing and sensation of chest tightness may indicate hypersensitivity reaction. Assess for nausea, vomiting and diarrhea in patients receiving suppository.
Indomethacin (Indocin)
Ductus arteriosus patency adjuncts (IV only), nonsteroidal anti-inflammatory agents Indications: PO= inflammation disorders including: rheumatoid arthritis. IV= alternative to surgery in the management of patent ductus arteriosus (PDA) in premature neonates. Adverse effects: dizziness, drowsiness, headache, psychic disturbances, blurred vision, constipation, dyspepsia, nausea, vomiting, discomfort, renal failure, rashes, hyperkalemia, prolonged bleeding time, phlebitis at IV site Route/Dosage: IV (neonates)= 0.2 mg/kg initially, than 2 subsequent doses at 12-24 hr intervals of 0.1 mg/kg if age < 48hr at time of initial dose; 0.2 mg/kg if 2-7 days at initial dose; 0.25 mg/kg if age>7 days at initial dose. Nursing Implications: patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Monitor for rhinitis, asthma, and urticaria. Monitor respiratory status, heart rate, blood pressure, echocardiogram, and heart sounds routinely throughout therapy.
Hepatitis B Vaccine
Immunization Indications: High-risk patients (e.g. household contacts or sex partners of HBsAg-positive persons, IV drug users, sexually active persons not in a monogamous relationship, men who have sex with men, HIV, STD, hemodialysis, health care workers, inmates); chronic liver disease, all unvaccinated adolescents Adverse effects: Local soreness Route/Dosage: 3 doses of 1 mL IM, given at 0, 1-2, and 4-6 mo Infants born to HBsAg-positive mothers: Administer 0.5mL of hepatitis B immune globin IM and 1st dose of hepatitis B vaccine; give 2nd and 3rd doses of Hepatitis B vaccine at 1 mo and 6 mo, respectively. Nursing Implications: assess previous immunization history and history of hypersensitivity.
Americanine spray/Benzocaine
Indications: Temporarily relieving pain and itching caused by sunburn, insect bites, poison ivy, and other skin condition. Topical anesthetic. Adverse effects: mild stinging or tingling when the medication is first applied. Route/Dosage: Shake the container well. Hold the can 4 to 6 inches away from the skin, pointing the nozzle toward the affected area and away from the eyes. Spray a thin film of medicine over the affected area. Rub in gently if desired. Nursing Implications: Do not use on severe burns or deep puncture wounds.
Tylenol with codeine
Indications: the relief of mild to moderately severe pain. Adverse effects: The most frequently observed adverse reactions include drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea and vomiting. Other adverse reactions include allergic reactions, euphoria, dysphoria, constipation, abdominal pain, pruritus, rash, thrombocytopenia, and agranulocytosis. Route/Dosage: Codeine Phosphate- 15mg-60mg, Acetaminophen 300-1000mg. Doses may be repeated up to every 4 hours. Nursing Implications: Alcohol and other CNS depressants should be avoided, Instruct nursing mothers to watch for signs of morphine toxicity: increased sleepiness, difficulty breastfeeding, breathing difficulties, or limpness.
Bisacodyl (Dulcolax)
Laxative Indications: treatment of constipation, evacuation of the bowel before radiologic studies or surgery. Adverse effects: abdominal cramps, nausea, diarrhea, rectal burning, hypokalemia, muscle weakness, protein-losing enteropathy, tetany. Route/Dosage: PO (Adult/Children >12)- 5-15 mg (up to 30 mg/day) as a single dose. Rect (Adults and Children >12 yr)- 10 mg single dose Nursing Implications: Asess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color. consitency, and amount of stool produced.
Rubella immunization
MMRI vaccine (Measles, Mumps, Rubella Vacines) Indications: high risk groups (e.g. health care workers, college students, international travelers); women of childbearing age (with no evidence of rubella immunity of immunization). Adverse effects: burning, stinging, pain at injection site, arthritis/arthralgia, fever, allergic reactions. Route/Dosage: 0.5mL SQ at 12-15 mo and at 4-6 yr. Nursing Implications: if unusual reactions occur, individual components may be given as separate injections. Immunosuppression may increase antibody response to injection and increase risk of viral transmission.
Morphine Sulfate
Opioid analgesic Indications: severe pain, pulmonary edema, pain associated with MI Adverse Effects: confusion, sedation, dizziness, dysphoria, hallucinations, headache, blurred vision, respiratory depression, hypotension, bradycardia, constipation, nausea, vomiting, flushing, itching Route/Dosage: PO, Rectal (Adults > 50kg)= usual starting dose for moderate to severe pain in opioid naive patients- 30 mg q 3-4 initially or once 24-hr opioid requirement. IM, IV, SQ (Adults >50 kg)= usual starting dose for moderate to severe pain in opioid naive patients- 4-10mg q 3-4 hr, maximum: 15mg/dose Nursing Implications: Assess type, location, and intensity of pain prior to and 1 hr following PO, SQ, IM and 20 min peak following IV administration. Assess LOC, blood pressure, pulse, and respirations before and periodically during administration. Assess bowel function routinely.
Nalbuphine (Nubaine)
Opioid analgesics Indications: moderate to sever pain, also provides: analgesia during labor, sedation before surgery, supplement to balanced anesthesia. Adverse effects: dizziness, headache, sedation, confusion, dysphoria, blurred vision, respiratory depression, hypertension, dry mouth, nausea, vomiting, constipation, clammy feeling, sweating. Route/Dosage: IM, SQ, IV (Adults)- usual dose is 10 mg q 3-6 hr (single dose does not exceed 20 mg, total daily dose not to exceed 160 mg). Supplement to balanced anesthesia: IV (Adults)= initial- 0.3-3 mg/kg over 10-15 min, maintenance 0.25-5 mg/kg as needed. Nursing Implications: assess type, location and intensity of pain before and 1 hour after IM or 30 min after IV administration. Assess blood pressure, pulse and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation.
Hydrocone/acetaminophen (Vicodin)
Opioid analgesics Indications: used mainly in combination with nonopioid analgesics in the management of moderate to severe pain. Adverse effects: confusion, dizziness, sedation, euphoria, hallucinations, headache, blurred vision, respiratory depression, hypotension, bradycardia, constipation, dyspepsia, nausea, vomiting, urinary retention, sweating, physical dependence Route/Dosage: PO (Adults)- analgesic= 2.5-10 mg q 3-6 hr as need; if using combination products, acetaminophen dosage should not exceed 4 g/day and should not exceed 5 tablets/day of ibuprofen-containing products. PO (children)- Analgesic (2-13 yr)- 0.14 mg/kg q 4-6 hr. Nursing Implications: Assess blood pressure, pulse, respirations before and periodically during administration. If respiratory rate <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Assess bowel function routinely. Assess, type, location and intensity of pain prior to and 1 hr (peak) following administration.
Benadryl (diphrenhydrAMINE)
Allergy, cold, and cough remedies, antihistamines, antitussives. Indications: Relief of allergic symptoms, mild nighttime sedation, prevention of motion sickness Adverse reactions: CNS: drowsiness, dizziness, headache, blurred vision, CV: hypotension, palpitations, GI: anorexia, dry mouth, constipation, nausea, GU: frequency, urinary retention. Route/Dosage: PO (Adults and Children >12)= antihistamine- 25-50 mg q 4-6 hr, not to exceed 300 mg/day. Sedative/ hypnotic- 50 mg 20-30 min before bedtime. IM, IV (Adults) 25-50 mg q 4 hr as needed. Nursing Implementation: When used for insomnia, administer 20 min before bedtime and schedule activities to minimize sleep interruption. PO: administer with meals or milk to minimize GI irritation. IM: Administer 50 mg/mL in well developed muscle. Avoid SQ injections.
Lidocaine
Anesthetics Indications: IV: ventricular arrhythmias, Local: infiltration/mucosal/topical anesthetic. Adverse effects: seizures, confusion, drowsiness, blurred vision, dizziness, cardiac arrest, bradycardia, heart block, hypotension, nausea, vomiting. Route/Dosage: IV (Adults)= 1-1.5 mg/kg bolus, may repeat doses of 0.5-0.75 mg/kg q 5-10 min up to a total dose of 3 mg/kg. IM (Adults and children)= 300mg (4.5 mg/kg) may be repeated in 60-90 min. Topical (Adults)- apply to affected area 2-3 times daily. Patch (Adults)- up to 3 patched may be applied once for up to 12 hr in any 24-hr period. Nursing Implications: signs and symptoms of toxicity include confusion, excitation, blurred or double vision, nausea, vomiting, ringing in the ears, tremors, seizures, difficulty breathing.
Metoclopramine (Reglan)
Anitemetics Indications: prevention of chemotherapy-induced emesis. Treatment of postsurgical and diabetic gastric stasis. Unlabeled use: treatment of hiccups. Adjunct management of migraine headaches. Adverse effects: drowsiness, extrapyramidal reactions, restlessness, neuroleptic malignant syndrome, anxiety, depression, irritabiarrhymthiaslity,, hypertension, hypotension, constipation, diarrhea, dry mouth, nausea. Route/dosage: Postoperative nausea and vomiting: IM, IV (Adults and children >14 yr)- 10 mg at the end of surgical procedure, repeat in 6-8 hr if needed. Treatment of hiccups: PO, IM (Adults)- 10-20 mg 4 times daily PO, may be proceeded by a single 10 mg dose IM (unlabeled). Nursing Implications: assess patient for nausea, vomiting, abdominal distention, and bowel sounds before and after administration.
Labetalol
Antianginal, antihypertensive Indications: management of hypertension Adverse effects: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, blurred vision, dry eyes, bronchospasm, wheezing, arrhythmias, bradycardia, CHF, pulmonary edema, orthostatic hypotension, constipation, diarrhea, erectile dysfunction, itching, hyperglycemia, muscle cramps. Route/Dosage: PO (Adults)= 100mg twice daily initially, may be increased by 100 mg twice daily q 2-3 days as needed (usual range 400-800mg/day in 2-3 divided doses; doses up to 1.2-2.4 g/day have been used). IV (Adults)- 20mg (0.25mg/kg)initially, additional doses of 40-80 mg may be given q 10 min as needed (not to exceed 300mg total dose) or 2 mg/min infusion (range 50-300 mg total dose required). Nursing Implications: Monitor blood pressure and pulse frequently during dose adjustment and periodically during therapy. Assess for orthostatic hypotension when assisting patient up from supine position. Monitor intake and output ratios and daily weight. Assess patient routinely for evidence of fluid overload (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular vein distention). PO: take apical pulse before administering. If <50bpm or if arrhythmia occurs, withhold medication and notify physician. Administer with meals or directly after eating to enhance absorption.
NIFEdipine (Procardia)
Antianginals, antihypertensives Indications: management of: Hypertension, angina pectoris, prevention of migraine headaches. Adverse effects: headache, abnormal dreams, anxiety, confusion, dizziness, drowsiness, nervousness, blurred vision, cough, dyspnea, arrhythmias, CHF, chest pain, bradycardia, hypotension, palpitations, constipation, diarrhea, nausea, vomiting, polyuria, flushing, sweating, photosensitivity, hyperglycemia, anemia, thrombocytopenia, weight gain, muscle cramps. Route/Dosage: PO (Adults)- 10-30mg 3 times daily (not to exceed 180 mg/day), or 10-20 mg twice daily as immediate-release form, or 30-90 mg once daily as sustained release form (not to exceed 90-120 mg/day). Nursing Implications: monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy. Monitor ECG periodically during prolonged therapy. Monitor intake and output ratios and daily weight. Angina: assess location, duration, anginal intensity, and precipitating factors of patient's pain. Avoid administration with grapefruit juice. Do not crush, break, open, or chew extended release tablets.
Atarax (hydroOXYzine)
Antianxiety agents, antihistamines, sedative/hypnotics Indications: Treatment of anxiety, preoperative sedation Adverse effects: CNS- drowsiness, agitation, dizziness, headache, weakness, Resp: wheezing, GI: dry mouth, bitter taste, constipation, nausea, GU: urinary retention, Local: pain at IM site. Route/Dosage: PO (adults)= antianxiety: 25-100 mg 4 times/day, do not exceed 600 mg/day. Preop sedation: 50-100 mg single dose. IM (adults)- Preoperative sedation= 25-100 mg single dose. Nursing implementation: IM= administer only IM deep into well-developed muscle, preferably with Z-track technique. Injection is extremely painful, do not use deltoid site.
Vitamin K (Aquameyphton)
Antidotes, vitamins Indications: prevention and treatment of hypoprothrombinemia, why may be associated with: excessive doses of oral anticoagulants, saliclates, nutritional deficiencies, prolonged total parenteral nutrition, prevention of hemorrhagic disease of the newborn. Adverse effects: gastric upset, unusual taste, flushing, erythema, swelling, hyperbilirubinemia (large doses in very premature infants). Route/Dosage: IM (neonates)= 0.5-1 mg, within 1 hr of birth, may repeat in 6-8 hr if needed. May be repeated in 2-3 weeks if mother received previous anticonvulsant/anticoagulant therapy. 1-5 mg may be given IM to mother 12-24 hr before delivery. Nursing Implications: monitor for frank and occult bleeding, monitor pulse and blood pressure. Apply pressure to venipuncture sites for at least 5 min; avoid unnecessary IM injections. Pedi: Monitor for side effects and adverse reactions. Children may be especially sensitive to the effects and side effects of Vitamin K. Neonates, especially premature neonates, may be more sensitive than older children.
Ondansetron (Zofran)
Antiemetics Indications: IM, IV: prevention and treatment of postoperative nausea and vomiting Adverse effects: headache, dizziness, drowsiness, fatigue, weakness, constipation, diarrhea, dry mouth, increase in liver enzymes. Route/Dosage: PO (Adults and Children >11 yr)- 16 mg 1 hr before induction of anesthesia. IM, IV (Adults)- 4mg before induction of anesthesia or postoperatively. IV (Children >40kg)= 4mg Nursing Implications: Assess patient for nausea, vomiting, abdominal distention, and bowel sounds prior to and following administration. May cause transient increase in serum bilirubin, AST, and ALT levels.
Promethazine (Phenergan)
Antihistamines, sedative/hypnotics Indications: treatment of various allergies conditions and motion sickness. Preoperative sedation. Treatment and prevention of nausea and vomiting. Adjunct to anesthesia and analgesia. Adverse effects: neuroleptic malignant syndrome, confusion, disorientaiton, sedation, dizziness, fatigue, blurred vision, diplopia, tinnitus, bradycardia, hypertension, tachycardia, constipation, dry mouth, photosensitivity, rashes. Route/Dosage: sedation during labor: IM, IV (Adults)- 50 mg in early labor, when labor is established, additional doses of 25-75 mg may be given 1-2 times at 4 hr intervals (should not exceed 100 mg/24 hr). Nursing Implications: Monitor blood pressure, pulse and respiratory rate frequently in patients receiving IV doses. Assess level of sedation after administration. Risk of sedation and respiratory depression are increased when administered concurrently with other drugs that cause CNS depression.
Hydralazine
Antihypertensive Indications: moderate to severe hypertension (with a diuretic). Adverse effects: dizziness, drowsiness, headache, tachycardia, edema, diarrhea, nausea, vomiting, rashes, sodium retention, arthritis, drug-induced lupus syndrome. Route/Dosage: PO (Adults)- 10mg 4 times daily initially. After 2-4 days may increase to 25mg 4 times daily for the rest of the 1st week; may then increase to 50mg 4 times daily (up to 300mg/day). Once maintenance dose is established, twice-daily dosing may be used. IM, IV (Adults)- 5-40mg repeated as needed. Nursing Implications: monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. PO: Administer with meals consistently to enhance absorption.
Misoprostol (Cytotec, PgE1)
Antiulcer agents, cytoprotective agents Indications: with mifepristone for termination of pregnancy. Unlabeled use: treatment of duodenal ulcers, cervical ripening and labor induction. Adverse effects: headache, abdominal pain, diarrhea, constipation, dyspepsia, flatulence, nausea, vomiting, miscarriage, menstrual disorders Route/Dosage: PO (Adults) termination of pregnancy- 400 mcg single dose 2 days after mifepristone if abortion has not occurred. Intravaginally (Adults): 25 mcg (1/4 of 100 mcg tablet); may repeat q 3-6 hr, if needed. Nursing implications: assess women of childbearing age for pregnancy. misoprostol is usually begun on 2nd or 3rd day of menstrual period following a negative pregnancy test result. Termination of pregnancy: monitor uterine cramping and bleeding during therapy.
Terbutaline
Bronchodilator Indications: management of reversible airway disease due to asthma or COPD; Unlabeled use: management of preterm labor (tocolytic) Adverse effects: nervousness, restlessness, tremor, headache, insomnia, angina, arrhythmias, hypertension, tachycardia, nausea, vomiting, hyperglycemia. Route/Dosage: PO (Adults and children >15 yr) Bronchodilation- 2.5-5 mg 3 times daily, given q 6 ht (not to exceed 15mg/24 hr). Tocolysis- 2.5-10mg q 4-6 hr until delivery. IV (Adults)- tocolysis- 2.5-10 mcg/min infusion; increase by 5 mcg/min q 10 min until contgractions stop (not to exceed 30 mcg/min). After contractions have stopped for 30 min, lower infusion rate to lowest effective amount and maintain for 4-8 hr. Nursing Implications: Monitor maternal pulse and blood pressure, frequency and duration of contractions, and fetal heart rate. Notify health care professional if contractions persis or increase in frequency or duration or if symptoms of maternal or fetal distress occur. Maternal side effects include tachycardia, palpitations, tremor, anxiety, and headache.
Oxytocin (Pitocin)
Hormones Indications: IV: Induction of labor at term, IV: Facilitation of threatened abortion, IV, IM: Postpartum control of bleeding after expulsion of placenta Adverse effects: Maternal (IV use only)= coma, seizures, hypotension, hyponatremia, water intoxication, increase in uterine motility, painful contractions, abruptio placentae, hypersensitivity. Fetal= intracranial hemorrhage, asphyxia, hypoxia, arrhythmias. Route/Dosage: IV (Adults) 0.5-2.0 milliunits/min, increase by 2-3 milliunits/min q 15-60 min until pattern established (usually 5-6 milliunits/min, maximum 20 milliunits/min). Nursing Implementation: Do not administer oxytocin simultaneously by more than one route.
Erythromycin Opthalmic Ointment (Illotycin)
Indications: For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin. For infants born to mothers with clinically apparent gonorrhea, intravenous or intramuscular injections of aqueous crystalline penicillin G should be given; a single dose of 50,000 units for term infants or 20,000 units for infants of low birth weight. Adverse effects: minor ocular irritations, redness, and hypersensitivity reactions. Route/Dosage: In the treatment of superficial ocular infections, a ribbon approximately 1 cm in length of ILOTYCIN™ Ophthalmic Ointment should be applied directly to the infected structure up to 6 times daily, depending on the severity of the infection. For prophylaxis of neonatal gonococcal or chlamydial conjunctivitis, a ribbon of ointment approximately 1 cm in length should be instilled into each lower conjunctival sac. The ointment should not be flushed from the eye following instillation. A new tube should be used for each infant. Nursing Implications: Drug is contraindicated to patients with history of hypersensitivity to erythromycin.
Eronovine (Ergotrate)
Indications: Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution. Adverse effects: dizziness, headache, tinnitus, dyspnea, arrhythmias, hypertension, palpitations, nausea, vomiting, sweating. Route/Dosage: PO, SL (Adults)- 0.2-0.4 mg q 6-12 hr (usual course is 48 hr). IM, IV (Adults): 200 mcg (0.2 mg) q 2-4 hr for up to 5 doses. Nursing Implementation: PO: Administration is usually limited to 48 hr postpartum, by which time the danger of hemorrhage from uterine atony has passed.
Hemabate (carboprost tromethamine)
Indications: for aborting pregnancy between the 13th and 20th weeks of gestation as calculated from the first day of the last normal menstrual period and in the following conditions related to second trimester abortion. Indicated for the treatment of postpartum hemorrhage due to uterine atony which has not responded to conventional methods of management. Adverse effects: vomiting, nausea, chills, headache, Hiccough, parasthesia, muscular pain, back pain, dystonia, asthma, tinnitus, vertigo, hyperventilation, lethargy, hypertension, tachycardia, pulmonary edema, dyspnea, nose bleed, wheezing, dizziness, blurred vision, syncope, rash, anxiety, chest pain, uterine rupture. Route/Dosage: An initial dose of 1 mL of HEMABATE (carboprost tromethamine) Sterile Solution (containing the equivalent of 250 micrograms of carboprost) is to be administered deep in the muscle with a tuberculin syringe. Subsequent doses of 250 micrograms should be administered at 1½ to 3½ hour intervals depending on uterine response. The total dose administered of carboprost tromethamine should not exceed 12 milligrams and continuous administration of the drug for more than two days is not recommended. For Refractory Postpartum Uterine Bleeding: An initial dose of 250 micrograms of HEMABATE (carboprost tromethamine) Sterile Solution (1 mL of HEMABATE (carboprost tromethamine) ) is to be given deep, intramuscularly. Nursing Implications: You should not receive this medication if you are allergic to carboprost, or have certain conditions such as pelvic inflammatory disease, a breathing disorder, heart disease, liver disease, or kidney disease. Your cervix (opening of the uterus) will need to be checked after you receive carboprost.
Docusate Sodium (Colace)
Laxatives, stool softeners Indications- prevention of constipation (in patients who should avoid straining, such as after MI or rectal surgery). Used as enema to soften fecal impaction. Adverse effects- throat irritation, mild cramps, rashes Route/ dosage- PO (Adults and Children >12 years) 50-400 mg in 1-4 divided doses. PO (Children 6-12) = 40-150mg in 1-4 divided doses. PO (Children 3-6 years) - 30-60 mg in 1-4 divided doses. Rectal (Adults)- 50-100 mg or 1 unit containing 283 mg Docusate sodium, soft soap, and glycerin. Nursing Implications- assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced. This medication does not stimulate intestinal peristalsis. Administer with a full glass of water or juice. May be administered on empty stomach for more rapid results.
Bethamethasone/Dexamethasone
Long acting corticosteroids Indication: Short-term administration to high risk mothers before delivery to prevent respiratory distress syndrome in the newborn. Action: suppress inflammation and the normal immune response. Adverse reactions: CNS= depression, euphoria, headache, personality changes, restlessness, CV: hypertension, GI: anorexia, nausea, vomiting, Derm: decrease in wound healing, petechiae, Hemat: thromboembolism, MS: muscle wasting, osteoporosis, increase susceptibility to infection. Bethamethasone: IM (Adults) 0.5-0 mg as bethamethasone sodium phosphate/acetate suspension. Prevention of respiratory distress syndrome in newborn- 12 mg daily for 2-3 days before delivery. Dexamethasone: PO, IV, IM (Adults) Anti-inflammatory= 0.75-9 mg daily in divided doses q 6-12 hr. Nursing implementation: PO: administer with meals to minimize GI irritation, IM doses should not be administered when rapid effect is desirable.
Magnesium sulfate
Mineral and electrolyte replacements/supplements Indications: treatment/prevention of hypomagnesemia. Treatment of hypertension. Anticonvulsant associated with severe eclampsia. Unlabeled use: preterm labor, treatment of torsade de pointes. Adverse effects: drowsiness, decrease in respiratory rate, arrhythmias, bradycardia, hypotension, diarhea, muscle weakness, flushing, sweating, hypothermia. Route/Dosage: Treament of deficency: IV (neonates)= 25-50 mg/kg/dose q 8-12 hr for 2-3 doses. Torsade de Pointes: IV (infants and children)- 25-50 mg/kg/dose, maximum dose: 2g. Nursing Implications: monitor pulse, blood pressure, respirations, and ECG frequently throughout administration of parenteral magnesium sulfate. Respirations should be at least 16/min before each dose. Monitor newborn for hypotension, hyporeflexia, and respiratory depression if mother has received magnesium sulfate.
Ibuprofen/Motrin
Nonopioid analgesics, nonsterioidal anti-inflammatory agents Indications: IV: treatment of mild to moderate pain, fever. PO: treatment of inflammatory disorders. IV: moderate to severe pain with opioid analgesics Adverse effects: headache, dizziness, drowsiness, blurred vision, tinnitus, edema, hypertension, GI bleeding, hepatitis, constipation, dyspepsia, nausea, vomiting, renal failure, rashes, anemia, prolonged bleeding time. Route/Dosage: PO (adults)= anti-inflammatory, 400-800 mg 3-4 times daily (not to exceed 3200 mg/day). Analagesic/antipyretic- 200-400 mg q 4-6 hr (not to exceed 1200 mg/day). PO (Infants and children)- analgesic- 4-10 mg/kg/dose q 6-8 hr. IV (Adults)- analgesic- 400-800 mg q 6 hr as needed (not to exceed 3200 mg/day); antipyretic= 400 mg q 4-6 hr or 100-200 mg q 4 hr as needed (not to exceed 3200 mg/day). Nursing Implications: pateints who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess patient for skin rash frequently during therapy. Assess for signs and symptoms of GI bleeding, renal dysfunction, and hepatic impairment.
Ketorolac (Toradol)
Nonsteroidal anti-inflammatory agents, nonopioid analgesics Indications: short-term managment of pain (not to exceed 5 days total for all routes combined) Adverse effects: drowsiness, abnormal thinking, dizziness, euphoria, headache, edema, pallor, vasodilation, GI bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia, oliguria, renal toxicity, pruritus, sweating, urticara, prolonged bleeding time, injection site pain, anaphylaxis. Route/Dosage= PO (Adults <65 yr): 20 mg initially, followed by 10 mg q 4-6 hr as needed (not to exceed 40mg/day). IM (Adults <65 yr)= single dose- 60 mg. Multiple dosing- 30mg q 6 hr (not to exceed 120 mg/day). IV (Adults <65 yr)- single dose= 30 mg, multiple dosing- 30 mg q 6 hr (not to exceed 120 mg/day). Nursing Implications: patients who have astham, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. May cause prolonged bleeding time that may persist for 24-48 hr following discontinuation of therapy. Duration of ketorolac therapy, by all routes combined, should not exceed 5 days.
Stadol (Butorphanol)
Opioid analgesics Indications: Management of moderate to severe pain. Analgesia during labor, sedation before surgery. Adverse effects: confusion, dysphoria, hallucinations, sedation, euphoria, headache, blurred vision, respiratory depression, hypertension, nausea, constipation, sweating, vomiting. Route/Dosage: IM (Adults)= 2 mg q 3-4 hr as needed (range 1-4 mg). IV (Adults)- 1 mg q 3-4 hr as needed (range 0.5-2mg). Intranasal (Adults)- 1 mg (1 spray in 1 nostril) initially. An additional dose may be given 60-90 min later. Nursing Implications: assess type, location, and intensity of pain before and 30-60 min after IM, 5 min after IV and 60-90 min after intranasal administration. Assess blood pressure, pulse and respirations before and periodically during administration.
Hydromorphone (Dilaudid)
Opioid analgesics Indications: moderate to severe pain (alone and in combination with nonopioid analgesics); extended release product for opioid-tolerant patients requiring around-the-clock management of persistent pain. Adverse effects: confusion, sedation, dizziness, dysphoria, hallucinations, headache, blurred vision, respiratory depression, hypotension, bradycardia, constipation, dry mouth, nausea, vomiting, urinary retention, physical dependence. Route/Dosage: PO (Adults >50 kg): 4-8 mg q 3-4 hr initially. PO (Adults and Children <50kg)= 0.06 mg/kg q 3-4 hr initially, younger children may require smaller initial doses of 0.03 mg/kg. Maximum dose 5 mg. IV, IM, SQ (Adults >50kg): 1.5 mg q 3-4 hr as needed initially, may be increased. IV, IM, SQ (Adults and Children <50kg)= 0.015 mg/kg mg q 3-4 hr as needed initially, may be increased. IV (Adults)= Continuous infusion, 0.2-30 mg/hr depending on previous opioid use. Rect (Adults)- 3 mg q 6-8 hr initially as needed. Nursing Implications: assess blood pressure, pulse, respirations before and periodically during administration. If respiratory rate is < 10/min, assess level of sedation. Dose may needed to be decreased by 25-50%. Assess bowel function routinely. Assess type, location, and intensity of pain prior to and 1 hr following IM and 5 min (peak) following IV administration.
Fentanyl (Sublimaze)
Opioid analgesics, pharmacologic: opioid agonists. Indications- analgesic supplement to general anesthesia; usually with other agents (ultra- short-acting barbiturates, neuromuscular blocking agents, and inhalation anesthetics) to produce balanced anesthesia. Induction/ maintenance of anesthesia (with oxygen or oxygen/ nitrous oxide and neuromuscular blocking agents). Preoperative and postoperative analgesia. Adverse effects- confusion, postoperative depression, drowsiness, blurred/double vision, apnea, laryngospasm, allergic bronchospasm, respiratory depression, hypotension, nausea/vomiting, facial itching. Route/dosage- preoperative use: IM and IV (adults and children >12 years old) 50-100mcg 30-60 minutes before surgery. Postoperative use- 50-100mcg, may repeat in 1-2 hours. Sedation/ Analgesia: 0.5-1 mcg/kg/ dose, may repeat after 30-60 minutes. Nursing Implications- monitor respiratory rate and blood pressure frequently throughout therapy. Report significant changes immediately. The respiratory depressant effects of Fentanyl may last longer than the analgesic effects. Initial doses of other opioids should be reduced by 25-33% of usually recommended dose. Geriatrics: assess risk and implement fall prevention strategies. Symptoms of toxicity include respiratory depression, hypotension, arrhythmias, bradycardia, and asystole.
Methylergonovine (Methergine)
Oxytocic Indications: Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution. Adverse effects: dizziness, headache, tinnitus, dyspnea, hypertension, arrhythmias, chest pain, nausea, vomiting, cramps, diaphoresis. Route/ Dosage: PO (Adults)- 200-400 mcg (0.4-0.6 mg) q 6-12 hr for 2-7 days IM, IV (Adults)- 200 mcg (0.2 mg) q 2-4 hr for up to 5 doses. Nursing Implementation: IV administration is used for emergencies only. Oral and IM routes are preferred. Monitor blood pressure, heart rate, and uterine response frequently during medication administration.
Rh immune globulin (RhoGam)
Vaccines/ immunizing agents Indications: IM, IV: Administratered to Rh0 (D) negative patients who have been exposed to Rh0 postive blood by: pregnancy or delivery of a Rh0 positive infant, abortion of an Rh0 positive fetus, fetal-maternal hemmorhage due to amniocentesis, other obstertrical manipulative procedures. Adverse effects: dizziness, headache, hypertension, hypotension, rash, diarrhea, nausea, vomiting, anemia, myalgia, pain at injection site. Route/Dosage: Following delivery: IM (Adults)- hyperRHO S/D full dose RhoGAM- 1 vial standard dose (300mcg) within 72 hr of delivery. Before delivery: IM (Adults)- hyperRHO S/D mini dose MICRhoGAM- 1 vial of microdose (50mcg) within 72 hr. Termination of pregnancy: IM (adults)- RhoGAM- 1 vial standard dose (300mcg) within 72 hr. Large fetal-maternal hemorrhag( >15 mL) - IM (adults): RhoGAM-20 mcg/mL of Rh0 (D) positive fetal RBCs. Nursing Implications: assess vital sings periodically during therapy in patients receiving IV Rh0 (D) immune globin. Monitor patient for signs and symptoms of intravascular hemolysis (IVH) (back pain, shaking chills, fever, hemoglobinuria), anemia, and renal insufficency.
