Common Medications in Maternity Nursing NURS 509

Newborn AquaMehphyton (Vit K) IM

Generic Name Vit K (phytonadione) Trade Name Vitamin K, Aquamephyton, Mephyton Indication Treatment and prevention of acquired factor II deficiency and bleeding issues. Also used for treatment and prevention of hemorrhagic disease in newborns from vitamin K deficiency. Overview of Action Facilitates in hepatic synthesis of clotting factors (II, VII, IX, X) the exact mechanism of this process is unknown. Route-Dose-Frequency For acquired factor II deficiency: 2.5-25 mg IM or IV with maximum of 50 mg in a single dose. OR 2.5-25 mg PO with maximum of 25 mg. (Subsequent doses dependent on INR after 6-8 hours) For anticoagulant-induced: 2.5 -10 mg subcutaneously with maximum of 25-50 mg (Subsequent doses dependent on INR after 6-8 hours) Contraindications Hypersensitivity Caution in neonates. Caution if renal impairment. Maternal Side Effects Neuro: CNS depression CV: shock and cardiac arrest Respiratory: gasping for breath and respiratory arrest Dermatologic: Cutaneous hypersensitivity Endocrine metabolic: metabolic acidosis *IV and IM only used when subcutaneous not feasible. Fetal Effects Crosses the placenta. Evidence of gasping syndrome and death of neonate when administered IV . Preservative-free formulation recommended during pregnancy. Nursing Considerations Patient to report rashes and side effects of diaphoresis, dizziness, cyanosis, flushing, and dyspnea. Consult provider as this medication can cause serious allergic reactions. When on this medication, patient may be scheduled for routine lab work (to check prothrombin time, INR) and patient should be encouraged to keep appointments. If it is to be administered IV, need to dilute in preservative free NS, D5W, or D5NS and infuse slowly (do not exceed 1 mg/min).

Analgesia Butorphanol (Stadol)

Generic name: Butorphanol Trade names: Stadol Indication: Moderate-severe pain relief Overview of Action: a mixed agonist-antagonist that exerts antagonistic or partially antagonistic effects at mu opiate receptor sites, but is thought to exert its agonistic effects principally at the kappa and sigma opiate receptors. Route-Dose-Frequency: 1 mg IV or 2 mg IM with repeated doses every 3 to 4 hours, as necessary. Contraindications: Stadol Injection and Stadol NS are contraindicated in patients hypersensitive to butorphanol tartrate or the preservative benzethonium chloride in Stadol NS or Stadol Injection in the multi-dose vial Maternal Side Effects: Pain at the injection site. Nausea and vomiting. Drowsiness or sedation. Dizziness. Muscle weakness. Itching. Urinary retention. Fetal Effects: rare reports of infant respiratory distress/apnea following the administration of Stadol Injection during labor, small chance of fetal opioid dependence Nursing Considerations: Opioid dependency, Category C

Analgesia Fentanyl

Generic name: Fentanyl Trade names: Sublimaze Indication: Analgesia (only to be used for hospitalized patients and must be d/c before discharge). Overview of Action: Opioid agonists in which the medication interacts with the mu-receptors which are distributed various tissues such as the brain and spinal cord. Route-Dose-Frequency: 1-2 mcg/kg IV bolus or 25-100 mcg/dose PRN or 1-2 mcg/kg/hr by continuous IV infusion or 25-200 mcg/hr Contraindications: Life-threatening hypoventilation Hypersensitivity to fentanyl and/or components GI obstruction (acute or severe) Acute/severe bronchial asthma Known or suspected paralytic ileus Respiratory depression Not to be used for mild or intermittent pain management! Maternal Side Effects: Nausea, vomiting, fatigue, dyspnea weakness, dizziness, hypotension, and anorexia Serious: Anaphylaxis, Serotonin syndrome, bradyarrhythmia, paralytic ileus, coma, seizure, Risk of physical dependence Fetal Effects: Crosses the placenta. Category C. (Monitor for sedation and respiratory depression after delivery. Potential to exhibit withdrawal symptoms (tachypnea, diaphoresis, tremors, diaphoresis, and hyperreflexia). May also exhibit muscular rigidity.) Nursing Considerations: Educate patients to report symptoms of respiratory depression, severe constipation, hypotension, episodes of syncope. Sudden discontinuation of medication can lead to potential withdrawal symptoms. Patient should avoid strenuous activities that increase core body temperature. Medication can lead to dizziness and somnolence therefore patients should not partake in activities requiring mental alertness/coordination. Avoid use with alcohol or other CNS depressants.

Miscellaneous Ferrous sulfate (Claire)

Generic name: Ferrous Sulfate Trade names: Slow FE, Fer-In-Sol, Feratab Indication: Iron supplementation Overview of Action: Directly adds to patient's iron stores by containing iron Route-Dose-Frequency: 325mg tablet PO once daily after a meal Contraindications: Specific contraindications have not been determined Maternal Side Effects: Infant risk through breastfeeding cannot be ruled out, so a provider must be consulted. Fetal Effects: Fetal risk cannot be ruled out by current literature, so the provider must be consulted. Nursing Considerations: Teach them signs of iron overdose: severe vomiting, diarrhea, abdominal pain, dehydration

Miscellaneous Glyburide

Generic name: Glyburide Trade names: Diabeta, Glynase, and Glynase PresTab. Indication: Used for women with gestational diabetes Overview of Action: Glyburide is in a drug class known as sulfonylureas. Glyburide appears to lower the blood glucose acutely by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets. Route-Dose-Frequency: For pregnant women, use 2.5 mg per day PO initially, titrated by no more than 5 mg/day PO each week, up to 20 mg/day PO if necessary Contraindications: Hypersensitivity. Also contraindicated in patients with type 1 diabetes mellitus, and diabetic ketoacidosis. In patients with impaired renal or hepatic function, the initial and maintenance dosing should be conservative to avoid hypoglycemic reactions. Maternal Side Effects: Serious side effects include stomach pain, low grade fever, loss of appetite, dark urine, clay-colored stools, jaundice, pale skin, confusion. Fetal Effects: Risk of hypoglycemia, respiratory distress, birth injury Nursing Considerations: If this drug is used during pregnancy, it should be discontinued at least 2 weeks before the expected delivery date. Monitor patient for adverse effects/hypersensitivity.

Newborn Hepatitis B vaccine (Claire)

Generic name: Hepatitis B vaccine recombinant Trade names: Recombivax HB, Energix B Indication: Prophylaxis against the Hepatitis B virus Overview of Action: This vaccine contains the surface antigen of the Hepatitis B virus, which allows the patient to create antibodies against this disease as a form of active immunity Route-Dose-Frequency: Given IM 0.5mL as a three dose series to newborns at birth, 1 month, and 6 months Contraindications: Severe allergic reaction to any prior doses of the Hepatitis B vaccine or to any vaccine components (yeast) Maternal Side Effects: the WHO states that breastfeeding while getting this vaccine is not associated with any side effects Fetal Effects: Fetal risk cannot be ruled out for mothers taking this vaccine Nursing Considerations: Make sure that the mother is aware of when exactly to bring the infant in for vaccine administration

Postpartum Epifoam (Claire)

Generic name: Hydrocortisone acetate and pramoxine hydrochloride Trade names: Epifoam, pramosone Indication: Minor skin pain, redness, swelling, itching, and discomfort of the skin. Postpartum perineal pain. Overview of Action: Reduces swelling, redness, and itching through its antiinflammatory properties (through decreasing release, formation, and activity of mediators of the inflammatory process), reduces pain, itching and discomfort through its analgesic properties (by decreasing neuronal membrane's permeability to sodium ions) Route-Dose-Frequency: Apply topically to area of interest 3-4 times daily Contraindications: hypersensitivity to pramoxine products, hypersensitivity to hydrocortisone, systemic fungal infection Maternal Side Effects: There is a possibility of this being teratogenic, although there haven't been any adequate studies to show this. Fetal Effects: It is unsure whether topical use would result in a large enough quantity to pass significantly through breast milk, but it should still be used with caution Nursing Considerations: Tell them to contact their provider if there is any local worsening of symptoms.

Analgesia Ibuprofen (Claire)

Generic name: Ibuprofen Trade names: Advil, Motrin Indication: Fever, headache, migraine, osteoarthritis, pain, rheumatoid arthritis Overview of Action: It's a nonsteroidal antiinflammatory drug (NSAID) relieves pain and reduces favor by inhibiting prostaglandin synthesis Route-Dose-Frequency: Oral, 200-400mg every 4-6 hours, not exceeding 1200mg/day Contraindications: Anaphylactic response to any NSAIDs, when undergoing a coronary artery bypass graft surgery, when hypersensitive to ibuprofen Maternal Side Effects: Infant risk while breastfeeding is possible. Milk production may be affected Fetal Effects: Potential risk to the fetus is mother were to take ibuprofen, with fetal abnormalities being shown in the past Nursing Considerations: Concern with using ibuprofen in pregnant women/women trying to conceive (TTC). Should be taken with food in order to reduce risk of gastric ulcers.

Preterm Labor Indomethacin (Indocin)

Generic name: Indomethacin Trade names: Indocin Indication: Generally used to treat pain, fever, inflammation, but for preterm labor it is used to delay contractions. Additionally, indomethacin can be used post-birth to induce closure of the patent ductus arteriosus in a pre-term infant. Overview of Action: Indomethacin is a non-steroidal anti-inflammatory drug. In preterm labor it is used as a tocolytic (medication used to suppress preterm labor). Indomethacin is a Cox-1 and Cox-2 inhibitor, and it reversibly inhibits the synthesis of prostaglandins. The mechanism of action for closing the ductus arteriosus is unknown, but is thought to be related to the supression of prostaglandin synthesis. Route-Dose-Frequency: For treatment of patent ductus arteriosus at birth, indomethacin can be administered orally at a dose of 0.2mg/kg every 24 hours for three doses. Contraindications: history of rectal bleeding, hypersensitivity to NSAIDS or aspirin Maternal Side Effects: Headaches, dizziness, nausea and/or vomiting, stomach upset or heartburn, prolonged vaginal bleeding. Fetal Effects: indomethacin can cause a reduction in urine that the fetus produces, and can change the way the blood circulates through the fetus's body. If the fetus produces a reduced amount of urine, the amount of amniotic fluid in the womb may also be reduced. Nursing Considerations: Educate patient to report symptoms of serious GI issues such as bleeding, ulceration, perforation. Warn patient about risk of serious skin reactions such as Stevens-Johnson Syndrome or toxic epidermal necrolysis that can happen if patient is hypersensitive.

Postpartum Flu vaccine (Claire)

Generic name: Influenza virus vaccine Trade names: Afluria, FluLaval, Flucelvax quadrivalent Indication: Prophylaxis against the influenza virus Overview of Action: Provides additional protection from the influenza virus by allowing the patient's immune system to recognize flu DNA and produce anti-flu antibodies via active immunity. Route-Dose-Frequency: One dose (0.5mL) given IM annually prior to or during flu season (wintertime) Contraindications: history of anaphylaxis to flu vaccines, hypersensitivity to neomycin, allergy to eggs for all except two flu vaccine brands Maternal Side Effects: There are no maternal side effects associated with the flu vaccine (as long as it's not live) although there is inefficient data to say for sure that there is no risk related to breastfeeding or maternity, so a consult with a provider is necessary. Fetal Effects: According to literature, fetal risk cannot be ruled out, so a consult with a provider is required. Nursing Considerations: Ask the patient if she is allergic to age in order to see if she needs one of the two flu shot brands that don't contain egg products.

Miscellaneous Insulin

Generic name: Insulin Trade names: Humulin R, Novolin R Indication: Used for patients with gestational diabetes. Overview of Action: Composition of regular human insulin is structurally the same as the endogenous human insulin where it regulates glucose metabolism. The insulin will bind to insulin receptors located on adipocytes (fat cells) and muscle cells. It will then facilitate uptake of glucose by these cells thereby lowering blood glucose levels. Output of glucose from liver is inhibited as well. Route-Dose-Frequency: Typically, individualized dosage and timing on the needs of the pregnant patient. Generally, three or more doses subcutaneously given 30 minutes before each meal. Daily dose: 0.5-1 units/kg/day. Contraindications: Should not be given during episode(s) of hypoglycemia. Hypersensitivity. Need to exhibit caution in patients with renal and/or hepatic impairments. Also caution in patients with hypokalemia or when administered with potassium lowering medications. Maternal Side Effects: Common side effects include reaction at injection site, lipodystrophy, hypoglycemia, & weight gain. Serious side effects: heart failure, severe hypoglycemia, hypokalemia, and hypersensitivity reaction. Fetal Effects: Does not cross the placenta. No known fetal effects. Nursing Considerations: Need to monitor and instruct patients on identifying symptoms of hypoglycemia and hyperglycemia. If patient faces challenges in glycemic control, need to let health professionals know. Educate patient on common side effects (listed above). Educate patient on the proper injection technique and administer 30 minutes before meals. Emphasize the importance of never sharing insulin needles to avoid risk of the transmission of bloodborne pathogens. Advise patient not to make drastic changes to diet and physical activity patterns without consulting provider as adjustments to dosages might be necessary. Need increased glucose monitoring if patient has either or both renal and hepatic impairments. Adjustments to dosages may be necessary.

Postpartum Lansinoh

Generic name: Lanolin (topical) Trade names: Lansinoh Indication: Lanolin is used to treat or prevent dry skin, itching or other skin irritation caused by conditions such as diaper rash, radiation therapy skin burns, and others. Lanolin topical is also used to treat sore and cracked nipples caused by breast-feeding. Overview of Action: Lanolin is an emollient. Emollients soften the skin by forming an occlusive oil film on the stratum corneum layer of the epithelium, thus decreasing the transepidermal water loss. Route-Dose-Frequency: Apply pea-sized amount of cream topically to nipples after breast-feeding. When using lanolin topical to treat or prevent diaper rash: Clean the diaper area well and allow it to dry thoroughly before applying the medicine. Apply at each diaper change as needed. Contraindications: hypersensitivity to lanolin Maternal Side Effects: may have skin reaction if patient has hypersensitivity Fetal Effects: may have skin reaction if patient has hypersensitivity Nursing Considerations: Stop using lanolin if patient has severe burning, stinging, redness, or irritation where the product was applied.

Postpartum MMR

Generic name: MMRII Trade names: M-M-R® II Indication: Not immune to Rubella Overview of Action: stimulating our immune system to produce antibodies Route-Dose-Frequency: The dosage for MMR vaccine is 0.5 mL by the subcutaneous route. If a second dose is indicated, the minimum interval between the first and second doses should be separated by at least 4 weeks (28 days) Contraindications: history of a severe (anaphylactic) reaction to a previous dose or to any component of the vaccine (such as gelatin or neomycin), pregnancy and immunosuppression. Maternal Side Effects: mild side effects including rash or joint aches. People who have had severe reactions to the antibiotic called neomycin or to the MMR shot in the past should not receive the vaccine Fetal Effects: No known adverse effects Nursing Considerations: Caution should be exercised when M-M-R II is administered to a nursing woman. Recent studies have shown that lactating postpartum women immunized with live attenuated rubella vaccine may secrete the virus in breast milk and transmit it to breast-fed infants

Miscellaneous Depo-Provera

Generic name: Medroxyprogesterone acetate Trade names: Depo-Provera, Depo-SubQ Provera 104, Provera, MPA Indication: Multiple uses: 1. Treatment for abnormal uterine bleeding that is unrelated to menstrual cycle (attributed to hormone imbalance). 2. Contraceptive purpose. Not to be used during pregnancy. Overview of Action: The medication is a progesterone derivative with both androgenic and anabolic effects which takes proliferative endometrium and transform into secretory (in females that have sufficient amount of endogenous estrogen). For parenteral administration, the medication has the ability to block follicular maturation and ovulation by inhibiting the production of gonadotropin. Route-Dose-Frequency: Contraindications: Maternal Side Effects: Fetal Effects: Nursing Considerations:

Labor-induction/augmentation Prostaglandins (Cytotec, Misoprostol, Cervidil)

Generic name: Misoprostol (Cytotec), Dinoprostone (Cervidil) Trade names: Cytotec, Cervidil Indication: Cytotec is also used for post-partum hemorrhage (increases uterine tone and decreases postpartum bleeding). Overview of Action: Cytotec is a synthetic prostaglandin E analog. Cervidil is similar to a natural prostaglandin in the body. Prostaglandins soften the cervix and induce contractions. Administered alone, prostaglandins may induce labor or may be used before giving oxytocin. Route-Dose-Frequency: A gel or vaginal insert of prostaglandin is inserted into the vagina or a tablet is given by mouth. This is typically done overnight in the hospital to make the cervix "ripe" (soft, thinned out) for delivery. Dosing for cervical ripening: insert contents of one syringe (0.5mg) into cervical canal - keep patient supine. A repeat dose may be given after 6 hours, but max dose is 1.5mg/24 hours. For termination of pregnancy, insert 20mg suppository into the vagina. Keep patient supine. Dose may be repeated every 3-5 hours until abortion occurs. Contraindications: prostaglandins can also be used for termination of pregnancy, so it is important to use it only when intending to induce labor or abortion. Maternal Side Effects: nausea, vomiting, diarrhea, fever, chills, stomach or abdominal pain, back pain, flushing (warmth, redness, or tingly feeling) Fetal Effects: prostaglandins can cause abnormal or excessive contractions, which can diminish your baby's oxygen supply and lower your baby's heart rate. Nursing Considerations: Positioning is important - patient must remain in supine position for at least 10 minutes to allow the medication to take action.

Postpartum Prostaglandin F2a (Hemabate) (Kyleigh)

Generic name: Prostaglandin F2a Trade names: Hemabate, Carboprost Indication: postpartum hemorrhage due to uterine atony (not controlled by other methods); abortion at 13-20 weeks gestation Overview of Action: stimulates uterine contractions; causes complete abortion ~16 hours; excreted in urine Route-Dose-Frequency: IM 250 mcg repeated at 15-90 minute intervals for a max dosage of 2 mg (for postpartum hemorrhage) Contraindications: hypersensitivity to benzyl alcohol; severe CV/respiratory/renal/hepatic disease; pelvic inflammatory disease; precautions with asthma, hypo/hypertension, DM Maternal Side Effects: fever, chills, N/V/D, hypertension, uterine rupture, wheezing Fetal Effects: teratogenic; will kill fetus Nursing Considerations: provide antiemetics to prevent N/V; monitor contractions (if >1 minute or absent, watch for S/S of uterine rupture); monitor BP, pulse; report abdominal cramps and increased temperature

Analgesia Morphine

Generic name: Morphine Trade names: Duramorph, infumorph Indication: Duramorph is used for continuous epidural. Can also be used for perioperative analgesia for C-sections. Overview of Action: Binds to Mu-opioid receptors distributed throughout the central nervous system (CNS) and peripheral nervous system (PNS). Route-Dose-Frequency: Epidural morphine can be administered as a single bolus or as a continuous infusion via a catheter. Placing an epidural catheter allows for easier drug titration and seems to induce better quality analgesia. Dosage in clinical practice: 30 to 100 mcg/kg as a bolus or 0.2 to 0.4 mg/hour as a continuous infusion. Contraindications: Should be used with extreme caution in patients with respiratory conditions such as COPD, acute bronchial asthma, or upper airway obstruction due to further respiratory depression. Contraindicated if patient has prior hypersensitivity. Maternal Side Effects: respiratory depression, gastrointestinal effects (constipation, nausea, vomiting), CNS effects (sedation, dizziness), cardiovascular effects (bradycardia, hypotension), urinary retention, and pruritus Fetal Effects: respiratory depression and bradycardia Nursing Considerations: Prolonged use should be avoided. Monitor patient for pruritus, nausea, vomiting, urinary retention, decreased level of consciousness, and respiratory depression.

Analgesia Nalbuphine (Nubain)

Generic name: Nalbuphine Hydrochloride Trade names: Nubain Indication: Used for pain just after childbirth. Overview of Action: synthetic opioid partial agonist. Acts on kappa opioid receptors. Route-Dose-Frequency: Induction doses of NUBAIN range from 0.3 mg/kg to 3 mg/kg intravenously to be administered over a 10 to 15 minute period with maintenance doses of 0.25 to 0.5 mg/kg in single intravenous administrations as required. Contraindications: Drug should be taken only if benefits outweigh the risks. Maternal Side Effects: respiratory depression. Fetal Effects: Prolonged use of nalbuphine hydrochloride injection during pregnancy can result in neonatal opioid withdrawal syndrome. Nursing Considerations: Nalbuphine is the only opioid analgesic that is not a controlled substance in the United States. Fetus should be monitored for respiratory depression, apnea, bradycardia and arrhythmias.

Newborn Narcan (Kyleigh)

Generic name: Naloxone Trade names: Narcan, Evzio Indication: intrauterine exposure to opioids causing cardiorespiratory depression Overview of Action: competes with opioids at opiate receptor sites; metabolized by liver, crosses placenta, excreted in urine and breast milk Route-Dose-Frequency: via umbilical vein <0.4 mg over 15 seconds (undiluted or diluted with sterile water) OR IM with auto injector into outer thigh muscle OR IV 0.01 mg/kg slowly followed by 0.1 mg/kg if needed (all one time!) Contraindications: hypersensitivity; precautions in pregnancy, breastfeeding, children, neonates, CV disease, seizure disorder, drug dependency, hepatic disease Maternal Side Effects: seizures, ventricular tachycardia, fibrillation, hypo/hypertension, cardiac arrest, sinus tachycardia, N/V, pulmonary edema, dyspnea, tremor, withdraw S/S Fetal Effects: unclear and undetermined (need more studies); use if necessary Nursing Considerations: monitor for S/S of withdraw (cramping, hypertension, anxiety, vomiting); monitor for respiratory dysfunction; cautious use in breastfeeding

Preterm Labor Nifedipine (Procardia)

Generic name: Nifedipine Trade names: Procardia XL, Adalat cc, Afeditab cr Indication: Angina, hypertension Overview of Action: calcium channel blocker Route-Dose-Frequency: Route: oral capsule or oral extended release tablet. Dose: For adults the starting dose is 30 mg or 60 mg by mouth once per day. The dosage can be increased every 7 to 14 days until the maximum dosage of 90-120 mg per day is reached. Frequency: Take as directed. Contraindications: Antibiotics (clarithromycin erythromycin quinupristin/dalfopristin, rifampin) Antifungals (fluconazole itraconazole ketoconazole) Maternal Side Effects: swelling. headache. fatigue. dizziness. constipation. nausea. flushing. weakness Fetal Effects: No adverse side effects Nursing Considerations: Assess for anginal pain, including location, intensity, duration, and alleviating and aggravating factors. - Assess cardiac status with BP, pulse, respiration and ECG. - Monitor potassium and liver function tests throughout treatment with nifedipine.

Labor-induction/augmentation Oxytocin

Generic name: Oxytocin Trade names: Pitocin Indication: Used for induction of labor in patients with a medical indication for the initiation of labor, such as Rh problems, maternal diabetes, preeclampsia at or near term, when delivery is in the best interests of mother and fetus. Oxytocin is also the drug of choice for treatment and prevention of post-partum hemorrhage. Overview of Action: Oxytocin creases the sodium permeability of uterine myofibrils, indirectly stimulating contraction of the uterine smooth muscle. The uterus responds to oxytocin more readily in the presence of high estrogen concentrations and with the increased duration of pregnancy. Oxytocin stimulates the upper segment of the myometrium to contract rhythmically, which constricts spiral arteries and decreases blood flow through the uterus. Route-Dose-Frequency: Initial dose: 0.5 to 1 milliunits/minute via IV infusion -Gradually increase dose in increments of 1 to 2 milliunits at 30 to 60 minute intervals until the desired contraction pattern has been established Contraindications: Contraindicated in patients with hypersensitivity to the drug. Maternal Side Effects: abnormal heart rate (either slow or fast). Premature ventricular complexes and other irregular heartbeats (arrhythmias). Permanent central nervous system (CNS) or brain damage, and death secondary to suffocation. Fetal Effects: Adverse effects include neonatal seizure, neonatal yellowing of skin or eyes (jaundice), fetal death. Nursing Considerations: Do not use when induction or augmentation of labor in those cases where vaginal delivery is contraindicated, such as cord presentation or prolapse, total placenta previa, and vasa previa.

Potentiators, anti-emetics, anti-anxiety Promethazine (Phenergan)

Generic name: Promethazine Trade names: Phenergan, Phenadoz, Promethegan Indication: Treats allergy symptoms, prevents motion sickness/nausea/vomiting/pain after surgery. Can also be a sedative/sleep aid. Overview of Action: Anticholinergic Route-Dose-Frequency: Oral, 12.5-25mg q4-6h for nausea/vomiting Contraindications: CNS Depressants, epinephrine, anticholinergics, MAOI, false positives on pregnancy tests, increase in blood glucose Maternal Side Effects: drowsiness, dizziness; ringing in your ears; double vision; feeling nervous; dry mouth; or. tired feeling, sleep problems (insomnia Fetal Effects: Some experts recommend avoiding use 2 weeks prior to delivery due to reports of irritability, excitement, and inhibited platelet aggregation in exposed neonates.-High doses given later in pregnancy have resulted in prolonged neurological/extrapyramidal disturbances in the neonate. Nursing Considerations: IV administration may cause damage to tissue, hypertension, impaired liver function monitor for neuroleptic malignant syndrome, confusion, sedation may cause CNS depression assess sedation level and anticholinergic effects

Postpartum Rhogam (IM)

Generic name: Rho(D) Immune Globulin Trade names: RhoGAM Indication: prevent an immune response to Rh positive blood in people with an Rh negative blood type. Overview of Action: predominantly prevents the antibody response during incompatible pregnancy by accelerating the phagocytosis of RBC's and clearance from the circulation before the recognition by the immune system Route-Dose-Frequency: 1500 international units (300 mcg), IM, at gestational week 26 to 28, or within 72 hours of birth of an RHo (D) positive baby. Contraindications: Individuals known to have had an anaphylactic or severe systemic reaction to human globulin should not receive RhoGAM (rho(d) immune globulin (human)) , MICRhoGAM (rho(d) immune globulin (human)) or any other Rho(D) Immune Globulin (Human). Maternal Side Effects: The most common side effects of RhoGAM are swelling, hardening, redness, and mild pain at the site of the injection. A small number of patients have noted a slight fever. Fetal Effects: No severe adverse effects Nursing Considerations: Be aware that administration of Rho(D) immune globulin (antibody) prevents hemolytic disease of the newborn in a subsequent pregnancy. Obtain history of systemic allergic reactions to human immune globulin preparations prior to drug administration. Send sample of newborn's cord blood to laboratory for cross-match and typing immediately after delivery and before administration of Rho(D) immune globulin. Confirm that mother is Rho(D) and Du-negative. Infant must be Rh-positive.

Postpartum T-dap (Kyleigh)

Generic name: T-dap Trade names: Adacel, Boostrix Indication: prevention of tetanus, diphtheria, and pertussis; protect newborn from pertussis (life-threatening complications for infants) Overview of Action: stimulates immune system to produce antibodies Route-Dose-Frequency: dose varies based on previous immunization doses; ideally one dose IM into the deltoid during the beginning of third trimester (27-36 weeks) Contraindications: younger than 7 years old, hypersensitivity, seizures, GBS, serious illness Maternal Side Effects: pain, redness, swelling, mild fever, headache, fatigue, N/V/D, chills, rash Fetal Effects: positive effects as fetus receives maternal antibodies (predominantly for protection of whooping cough) Nursing Considerations: can be given during or after pregnancy (the vaccine is not live); all pregnant women should be up-to-date and get this during 3rd trimester in order to pass antibodies to infant (postpartum vaccination is not optimal); monitor for S/S; sit or lie down for 15 minutes after receiving to prevent fainting; may take 2 weeks for maternal antibodies to be produced (be careful during this period of time because you can still be exposed and pass to baby)

Postpartum Tucks (Claire)

Generic name: Witch Hazel Trade names: Tucks, hamamelis virginiana Indication: swelling, bleeding, itching, irritation, burning, minor pain, and discomfort caused by minor skin irritations or hemorrhoids Overview of Action: Tucks is a topical astringent (tightens skin), anti-inflammatory, and hemostatic drug (stops bleeding) The tannins in topical witch hazel bind to proteins in the skin and tighten them Route-Dose-Frequency: Witch hazel can be topically applied to the small cut or hemorrhoid 2-6 times per day or after every bowel movement. Contraindications: hypersensitivity to witch hazel, and internal consumption is not recommended Maternal Side Effects: It is not known whether or not witch hazel is passed into breast milk, or if it's dangerous to use during pregnancy, so mothers should consult their doctor before breastfeeding or TTC while on witch hazel. Fetal Effects: Multiple studies have shown no fetal risks. Nursing Considerations: Tell patient to seek immediate medical attention if they have any signs of an allergic reaction (rash, itching, swelling of face/tongue/throat); do not pour witch hazel down sink or toilet

Preterm Labor Betamethasone

Generic name: betamethasone Trade names: Celestone, Celestone Soluspan Indication: Speeds up lung development in preterm fetuses. Releases surfactant which serves as a lubricant for the lungs, enabling them to slide against one another when the preterm infant breathes. Overview of Action: Antenatal Corticosteroid: accelerates the development of type 1 & 2 pneumocytes which improve lung volume, compliance, & gas exchange. Type 2 pneumocytes induces surfactant proteins & enzymes needed for synthesis of phospholipids. Pulmonary beta-receptors induced which contributes to surfactant release and alveolar fluid absorption, fetal lung antioxidant enzymes induced, and increase gene expression of sodium channel (helps with lung fluid absorption after birth). Route-Dose-Frequency: IM: two doses of 12 mg, 24 hours apart. Contraindications: Hypersensitivity to betamethasone or other corticosteroids. Maternal Side Effects: Hypertension, seizures, hypokalemia, N/V, sore throat, fever, headache, vision change, pancreatitis, GI ulcerations, weight gain, swelling in limbs, and allergic reactions (itching and hives). Fetal Effects: Category C for all trimesters, Crosses placenta, Growth Deformities, Neonatal Cushingoid, Syndrome Nursing Considerations: Store at room temperature away from moisture, heat, & direct light. Blood glucose levels monitored and due to immune suppression, take precautions for infection control.

Postpartum Colace (Kyleigh)

Generic name: docusate sodium Trade names: Colace, Corrector, Diocto, Docu, Doculace, Enemeez Indication: constipation (prevention of dry, hard stools postpartum that may be related to iron supplements, dehydration, poor eating habits during labor, hemorrhoids, decreased peristalsis) Overview of Action: increases water and fat penetration in the intestine, allowing for easier passage of stool without strain; onset in 12-72 hours Route-Dose-Frequency: PO 50-400 mg/day in divided doses OR enema 4 ml Contraindications: hypersensitivity, obstruction, fecal impaction, N/V Maternal Side Effects: bitter taste, diarrhea, N, anorexia, cramps Fetal Effects: considered safe to use during pregnancy and breastfeeding (active ingredient is minimally absorbed by the body) Nursing Considerations: swallow tabs whole; dilute oral solution in milk or juice; assess the primary cause of constipation; discontinue if abdominal pain, N/V; monitor for S/S of electrolyte imbalance (cramps, pain weakness, dizziness, excessive thirst); may take up to 3 days to soften stools; increase fluid intake

Newborn Erythromycin ophthalmic ointment

Generic name: erythromycin ophthalmic Trade names: Eyemycin, Ilotycin, Roymicin Indication: Bacterial infections in the eyes Overview of Action: Antibiotic Route-Dose-Frequency: 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 up to 6 times daily depending on severity of infection Contraindications: patients with a history of hypersensitivity to erythromycin. Maternal Side Effects: Because of the low levels of erythromycin in breastmilk and safe administration directly to infants, it is acceptable in nursing mothers Fetal Effects: Eye irritation not present before therapy Nursing Considerations: Monitor the infant for irritability and possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash). One case report and unconfirmed epidemiologic evidence indicates that hypertrophic pyloric stenosis in infants might occur with maternal use of erythromycin during the first two weeks of breastfeeding

Analgesia Hydrocodone (Kyleigh)

Generic name: hydrocodone Trade names: Hycodan, Robidone, Hysingla, Zohydro Indication: moderate to severe pain; only use if benefits outweigh the risks Overview of Action: binds to opiate receptors in CNS to reduce pain; metabolized by liver, excreted in urine, crosses placenta Route-Dose-Frequency: PO 20 mg q24 hr. titrate by 10-20 mg as needed q3-5 days (for those who are not opioid tolerant) Contraindications: hypersensitivity; abrupt discontinuation; GI obstruction; status asthmaticus Maternal Side Effects: drowsiness, nausea, vomiting, anorexia, constipation, seizures, circulatory depression, respiratory depression, pulmonary edema Fetal Effects: neonatal withdraw syndrome (possible if use for prolonged periods) --> irritability, hyperactivity, abnormal sleep, high-pitched crying, tremor, vomiting, diarrhea Nursing Considerations: do not use if breastfeeding (excreted in breast milk); with antiemetic if N/V occurs; monitor respiratory rate; monitor for addiction; check bowel status; change positions slowly; Narcan IV for overdose

Preterm Labor Magnesium Sulfate

Generic name: magnesium sulfate Trade names: Epsom salt. Indication: Treatment & prophylaxis eclampsia; prevent/control seizures associated with eclampsia. Overview of Action: MOA not known; evidence suggest amount of acetylcholine released at myoneuraonal junction may be decreased by magnesium. May also decrease myometrial contractility via the alteration of calcium uptake & binding along with distribution in the smooth muscle cells. Magnesium also helps with vasodilation of uterine vessels and increase uterine blood flow. Route-Dose-Frequency: Initial dose: - IV: 4-5 g via IV infusion diluted in 250 mL NS or D5W OR - IV: 4 g (either diluted to 10% or 20% solution) IV over 3-4 minutes and give with initial IM dose with total initial dose of 10-14 g - IM: 10 g IM dose undiluted 50% solution (5 g given in each buttock) and given with initial IV dosage (total initial dose of 10-14 g) Maintenance dose: - IV: 1-2 g/hr IV until symptoms subside (max in 24 hrs.: 30-40 g) IM: 4-5 g IM undiluted 50% solution alternating buttocks every 4 hrs. as needed until symptoms subside (max in 24 hrs 30-40 g) Contraindications: During the 2 hours prior to delivery in mothers with toxemia of pregnancy. Hypersensitivity, hypermagnesemia, hypercalcemia, myocardial damage, heart block, & diabetic coma. Maternal Side Effects: Cardiac arrest, heart block, shock, hypotension, myocardial dysfunction, sweating, flushing, hyperkalemia, hypocalcemia, hypothermia, CNS depression, visions issues/changes, respiratory tract paralysis, depressed reflexes/hyporeflexia. Fetal Effects: Category D for all trimesters, May cross placenta leading to skeletal demineralization, long term use resulting in rickets, and fetal heart rate variability. Nursing Considerations: Monitor blood serum levels for magnesium toxicity. Conduct assessments for reflexes. Take caution in patients with renal insufficiency and monitor functioning. Monitor for neuromuscular/respiratory depression in newborn, high doses (≥100 g ) associated with risk of spontaneous intestinal perforation & death of very low birth weight infants.

Postpartum Methylergonovine (Methergine) (Kyleigh)

Generic name: methylergonovine Trade names: Methergine Indication: prevention and treatment of postpartum hemorrhage, uterine contractions Overview of Action: stimulates uterine smooth muscle (causing contractions); decreases bleeding through arterial vasoconstriction; metabolized by liver, excreted in urine Route-Dose-Frequency: PO 200 mcg tid-qid for less than 7 days OR IM/IV 200 mcg q2-4 hr for 1-5 doses Contraindications: hypertension, preeclampsia, eclampsia, elective induction of labor, hypersensitivity to ergot preparations Maternal Side Effects: headache, dizziness, seizures, hallucinations, stroke, hypotension, hypertension, dysrhythmias, CVA, nausea, vomiting, cramping Fetal Effects: respiratory depression, convulsions, cyanosis, oliguira Nursing Considerations: should only be used during the 4th stage of labor (should not be used to augment labor); may breastfeed 1 week postpartum; ergot toxicity (tinnitus, hypertension, palpitations, chest pain, N/V, weakness, numb extremities); monitor BP, pulse, and vaginal bleeding; observe for cramping