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OB Meds Worksheet
OB Meds Worksheet
NURSING PROCESS II
OB Rotation Maternal and Newborn Medications
Nursing
Medications for: Action Dosage Side Effects
Implications
(trade/generic) (range and routes)
Induction/augmentation
Pitocin/oxytocin Binds to oxytocin IV: Start- 0.5-2 Nausea, vomiting, Electronic fetal
receptors in milliunits/min IV, uterine hypertonicity monitoring.
myometrium, increasing incr. 1-2 Black Box:
intracellular Ca and milliunits/min q15- Not indicated for elective
stimulating uterine 40min until labor induction since
contractions contraction pattern inadequate data to
est. evaluate benefit vs risk;
elective induction
defined as labor initiation
w/o medical indications.
Cervidil/dinoprostone Exact mechanism of 10 mg PV x1 Abdominal cramps, Observe patient
action unknown; PGE2 info: releases 0.3 uterine contractions, carefully, after
induces cervical mg/h over 12 h; nausea, headache, back insertion of the
softening, effacement, insert transverse in pain, diarrhea, back drug. Rupture of
and uterine contraction. posterior vaginal pain, diarrhea, vomiting, the membranes is
fornix; remain uterine hypertonicity, not a
supine x2h; remove fetal distress, fever contraindication to
at 12 h, at onset of drug, but be aware
active labor, or if that profuse
uterine bleeding may
hyperstimulation result in expulsion
of the suppository.
Report wheezing,
chest pain,
dyspnea, and
significant
changes in BP
and pulse to the
physician.
Monitor uterine
contractions and
observe for and
report excessive
vaginal bleeding
and cramping
pain. Keep pad
count. Save all
clots and tissues
for physician
inspection and
laboratory
analysis.
Cytotec/misoprostol Selectively stimulates 2.5-5 mg PO tid Nervousness, tremor, Monitoring
beta-2 adrenergic SC;IV headache, somnolence, bronschospasm:
receptors, relaxing palpitations,tachycardia, Cr tocolysis:
airway smooth muscle. dizziness, nausea, maternal HR,
hypotension,anaphylaxis glucose, K; fetal
. HR; neonatal
glucose
Analgesia
Life Threatening:
Resp. Depression
Anaphylaxis
Seizures
Inc cranial pressure
morphine sulfate Depresses pain impulse Adult 10-30mg q3- Sedation, seizures, Gradually taper to
transmission at the 4hr as needed shock, cardiac arrest, prevent withdrawal
spinal cord level by tachycardia, respiratory symptoms; Assess
interacting with opioid depression respiratory
receptors dysfunction:
depression,
character, rate,
rhythm.
Stadol/butorphanol Depresses pain impulse IM: 1-4 mg q 3-4 hr Drowsiness, dizziness, Assess for
tartrate transmission at the prn; IV 0.5-2 mg q 3- confusion, headache, decreasing output;
spinal cord level by 4 hr prn. Intranasal: sedation, euphoria, may indicate
interacting with opioid 1spray in 1 nostril, weakness, urinary retention,
receptors may give another hallucinations, for withdrawal
dose 1-1.5 hr later. insomnia.hypotension, symptoms in
Repeat if needed 3- nausea, vomiting, opioid-dependent
4 hr after last dose anorexia, constipation, patients; PE,
cramps. Life threatening: vascular
bradycardia, respiratory occlusion,
depression. abscesses,
ulcerations, CNS
changes, allergic
reactions,
respiratory
dysfunction, need
for pain meds.,
safety measures.
Evaluate decrease
in pain. Teach
patient: report any
symptoms of CNS
changes, allergic
reactions, that
physical
dependency may
result when used
for extended
periods, that
withdrawal
symptoms may
occur, how to use
nasal product,
avoid hazardous
activities
Anesthesia
Marcaine/bupivacaine Inhibits initiation and Epidural: Only 0.5% Adverse: apnea, Assess for
conduction of sensory and 0.25% arrhythmia exacerbation, systemic toxicity:
nerve impulses by concentrations AV block, bradycardia, circumoral tingling
altering the influx of should be used; cardiac arrest, fetal and numbness,
sodium and efflux of 0.5% solution should death, laryngeal edema, ringing in ears,
potassium in neurons, be administered in 3 malignant hyperthermia, metallic taste,
slowing or stopping to 5 mL increments muscle paralysis, dizziness, blurred
pain transmission. not exceeding 50 to respiratory arrest, vision, tremors,
100 mg at any seizures, ventricular slow speech,
dosing interval fibrillation, ventricular irritability,
tachycardia. twitching,
Spinal anesthesia seizures, cardiac
for Cesarean Side effects: anxiety, dysrhythmias;
Section: 7.5 to 10.5 back pain, blurred vision, report to physician
mg (1 to 1.4 mL) chills, decreased uterine or other health
contractility, dizziness, care professional.
drowsiness, dysgeusia, Monitor BP, HR,
erythema, fecal and respiratory
incontinence, fetal rate continuously
acidosis, fetal while patient is
bradycardia, fever, receiving this
headache, medication.
hyperhidrosis, Monitor for return
hypotension, of sensation after
hypoventilation, injection procedure.
site reaction, meningitis,
metallic taste, miosis,
nausea, palpitations,
paresthesias, pruritus,
restlessness, shivering,
sinus tachycardia,
sneezing, syncope,
tinnitus, tremor, urinary
incontinence, urinary
retention, urticaria,
vomiting, weakness.
magnesium sulfate depresses the CNS and Mild: 1-2g IV Drowsiness, impaired Monitor Mg, urine
blocks peripheral cardiac function, output if renal
neuromuscular Moderate: 2-4g IV flushing, pulmonary impairment,
transmission edema, diaphoresis patellar reflexes,
Severe:4-8g IV serum
creatinie/BUN
calcium gluconate Acute hypocalcemia IV (Calcium Frequent: PO: Chalky Assess B/ P, EKG
(e.g., neonatal Gluconate): taste. Parenteral: Pain, and cardiac
hypocalcemic tetany, ADULTS, rash, redness, burning at rhythm, renal
alkalosis), electrolyte ELDERLY: 1 2 g injection site; flushing, function, serum
depletion, cardiac arrest over 2 hrs. May nausea, vomiting, magnesium,
(strengthens myocardial repeat q60 min until diaphoresis, phosphate,
contractions), level resolved. hypotension. potassium.
hyperkalemia (reverses CHILDREN: 200 Occasional: Monitor serum
cardiac depression), 500 mg/ kg/ day in 4 PO: Mild constipation, BMP, calcium,
hypermagnesemia (aids divided doses. fecal impaction, ionized calcium,
in reversing CNS NEONATES: 200 peripheral edema, magnesium,
depression). 800 mg/ kg/ day in 4 metabolic alkalosis. phosphate; B/ P,
divided doses. cardiac rhythm,
renal function.
Monitor for signs
of hypercalcemia.
Normodyne/labetalol Produces decreases in Hypertension: PO Dizziness, fatigue, Assess:
hydrochloride B/P without reflex 100 mg BID; max orthostatic hypotension, Hypertension: B/P
tachycardia or significant 2400mg/day bradycardia, tinnitus, during beginning
reduction in heart rate nausea, vomiting, treatment,
through mixture of alpha Hypertensive crisis: diarrhea periodically
blocking and beta IV intermittent 20mg Life threatening: thereafter; note
blocking effects; over 2 min; may CHF, ventricular pulse, rate,
elevated plasma renins repeat 20-80mg dysrhythmias, rhythm, quality;
are reduced over 2 min q 10 min, hepatotoxicity, apical/radial pulse
200mg agranulocytosis, before
thrombocytopenia, administration;
purpura, and notify prescriber of
bronchospasm any significant
changes
CHF: I&O, daily
weight, fluid
overload: weight
gain, jugular
venous distention,
edema, crackles in
lungs
*Abrupt
discontinuation:
product should be
tapered to prevent
adverse reactions
Baseline/ hepatic
studies before
therapy begins
Lasix/furosemide Inhibits loop of Henle PO: 4-120mg/day *Black Box Warning* Monitor BUN/cr,
and proximal and distal fluid and electrolyte serum CO2,
convoluted tubule depletion. Urinary electrolytes, blood
sodium and chloride frequency, dizziness, glucose,
resorption IM/IV: start 20-40 weakness, muscle audiometry
mg IM/IVx1 cramps, blurred vision,
tinnitus, hypokalemia
Apresoline/hydralazi Vasodilates arteriolar Hypertension-Adult Headache, tremors, Assess: cardiac
ne hydrochloride smooth muscle by direct PO 10mg qid 2-4 dizziness, anxiety, status,
relaxation; reduction in days, then 25mg for palpitations, reflex electrolytes, blood
BP with reflex increases rest of 1st wk, then tachycardia, angina, studies, weight
in HR, SV, CO 50mg qid shock, N/V, anorexia, daily, I&O, edema,
individualized to diarrhea, hepatotoxicity, crackles, dyspnea,
desired response, leukopenia, orthopnea, IV site
max 300mg/day agranulocytosis, for extravasation,
Hypertensive crisis- thrombocytopenia, rate, mental status
adult IV BOL 10- lupuslike symptoms
20mg q4-6hr, IM 10-
50mg q4-6hr
CHF-adult PO 10-
25mg tid, max
100mg tid
Preterm labor
ampicillin works by killing sensitive 250 milligram (mg) Eosinophilia Assess patient for
bacteria by interfering and 500 mg tablets, Skin rash previous
with formation of the syrup of 125 mg/5ml Nausea sensitivity
bacteria's cell wall or 250 mg/5ml Vomiting reactions to
Diarrhea penicillin. Assess
for signs and
symptoms of
infection. Assess
for allergic
reactions: rash,
urticaria, pruritis,
chills, and fever.
Cleocin/clindamycin Binds to 50S subunit of PO 150-450 mg Nausea, vomiting, Assess patients
bacterial ribosomes; q6hr, max 1.8 g/day abdominal pain, with compromised
supresses protein IM/IV 1.2-2.7 g/day diarrhea, renal system;
synthesis (Absence of in 2-4 divided doses pseudomembranous product is
infection) q6-12-hr, max colitis, vaginitis, excreted slowly in
2700mg/day Stevens-Johnson poor renal system
syndrome, exfoliative function; toxicity
dermatitis may occur rapidly
Assess patients
for signs and
symptoms of
infection including
characteristics of
wound
Assess for allergic
reactions; rash,
urticaria, chills,
pruritus
Identify urine
output; if
decreasing, notify
prescribers, look
for increased BUN
and creatinine
Monitor blood
studies
Monitor
electrolytes:
potassium,
sodium, chloride
monthly if patient
on long term
therapy
Assess bowel
pattern daily; if
severe diarrhea
occurs, product
should
discontinued
Ancef/cephalzolin Bactericidal; inhibits cell Adult: mild infection Diarrhea, rash, vomiting, Assess sensitivity
wall 250-500 mg IM/IV nausea, abdominal pain, to penicillin and
**discontinued in the mucopeptidesynthesis q8h anorexia, alt, ast other
US, alternative is Peds: neonates elvated, urticaria, cephalosporins,
cefazolin** 40mg/kg/day im/iv thrombophlebitis monitor for
q12h max 6g/day nephrotoxicity:
Infants: 25-100 increased BUN,
mg/kg/day im/iv q6- creatinine; urine
8h output; if
decreasing, notify
prescriber. I&O
daily, monitor
electrolytes.
Monitor for
anaphylaxis.
Monitor for
bleeding of gums,
stool guaiac
Pre-op meds
Bleeding
Methergine/methyler Acts directly on the Adult IM- 1 mL, 0.2 Abdominal pain, Monitor fundal
gonovine maleate smooth muscle of the mg dizziness, hypertension, height and
uterus and increases the hypotension, N/V, consistency and
tone, rate, and amplitude IV-1 mL, 0.2 mg, anaphylaxis, the amount and
of rhythmic contractions. administered slowly vasoconstriction, character of the
Thus, it induces a rapid over a period of no vasospasm, coronary lochia.
and sustained tetanic less than 60 arterial spasm,
uterotonic effect which seconds bradycardia, Assess the blood
shortens the third stage tachycardia, dyspnea, pressure before
of labor and reduces PO-0.2 mg, 3 or 4 hematuria,thrombophlebi and routinely
blood loss. times daily in the tis, water intoxication, throughout drug
puerperium for a hallucinations, leg administration.
maximum of 1 week. cramps,
dizziness,tinnitus, nasal Observe for
congestion, diarrhea, adverse effects or
diaphoresis, palpitation, symptoms of ergot
rash, and foul taste toxicity(ergotism)
such as nausea
and
vomiting,headach
e,muscle pain,cold
or numb fingers
and toes,chest
pain and general
weakness
Hemabate/prostaglan Synthetic analog of Adult: IM Initial: 250 Fever, flushing, chills, Monitor uterine
din F naturally occurring mcg (1 mL) cough, headache, pain contractions and
prostaglandin F2 alpha repeated at 1 3 (muscles, joints, lower observe and
with longer duration of -h intervals if abdomen, eyes), report excessive
biologic activity. indicated by uterine hiccups, breast vaginal bleeding
Stimulates myometrial response. Dosage tenderness, Nausea, and cramping
contractions of gravid may be increased to diarrhea, vomiting pain. Save all clots
uterus; contractions are 500 mcg (2 mL) if and tissue for
qualitatively similar to uterine contractility physician
those occurring at term is inadequate after inspection and
labor. several doses of 250 laboratory
mcg (1 mL), not to analysis.
Effectively stimulates exceed total dose of
uterine contraction and 12 mg or continuous Check vital signs
is used to induce administration for at regular
abortion over a wide more than 2 d. intervals.
range of gestational age. Carboprost-
Useful in treatment of induced febrile
postpartum hemorrhage reaction occurs in
due to uterine atony more than 10% of
patients and must
unresponsive to usual be differentiated
measures. from endometritis,
which occurs
around third day
after abortion.
Newborn meds
Narcan/naloxone Opioid antagonist; Intranasal: 1 spray Serious: VFib, Cardiac Caution in patients
hydrochloride reverses the effects of (4mg) into each Arrest, Seizure with renal
opioids by competing for nostril. Common: Tachycardia impairment,
the same receptor sites, ETT: 0.8-5mg ETT HTN,Hypotension, N/V, hepatic
including respiratory q2-3 min tremor, withdrawl impairment, cardio
depression, sedation, SC/IM/IV: 0.4-2mg q sx,diaphoresis,pulmonar disorders, opiod
and hypotension. It can 2-3 min prn y edema. addiction.
also reverse the Alternate: 0.005 Monitor respiratory
psychotomimetic and mg/kg IV x 1, then status and neuro
dysphoric effects of 0.0025-0.16 mg/kg. checks
agonist-antagonists (eg, May repeat if
pentazocine). symptoms recur
Ilotycin/erythromycin Macrolide antibiotic Moderate to Severe GI: Nausea, vomiting, Report onset of GI
ophthalmic ointment produced by a strain of Infections abdominal cramping, symptoms after
Streptomyces erythreus. Adult: PO 250500 diarrhea, heartburn, PO administration
0.5% Bacteriostatic or mg q6h; 333 mg q8h anorexia. Body as a to physician.
bactericidal, depending Child: PO 3050 Whole: Fever, These are dose
on nature of organism mg/kg/d divided q6h eosinophilia, urticaria, related; if
and drug concentration Topical Apply skin eruptions, fixed symptoms persist
used. ointment to infected drug eruption, after dosage
eye 1 or more anaphylaxis. reduction,
times/d Superinfections by physician may
Neonate: PO 7 d, nonsusceptible bacteria, prescribe drug to
10 mg/kg q12h; >7 yeasts, or fungi. Special be given with
d, 10 mg/kg q812h Senses: Ototoxicity: meals in spite of
Topical 0.51 cm in reversible bilateral impaired
conjunctival sac hearing loss, tinnitus, absorption.
once vertigo.Digestive: Monitor for
(Estolate) Cholestatic adverse GI
Chlamydia hepatitis syndrome. effects.
trachomatis Skin: (topical use) Pseudomembrano
Infections Erythema, us enterocolitis
Adult: PO 500 mg desquamation, burning, (see Appendix F),
q.i.d. or 666 mg q8h tenderness, dryness or a potentially life-
Child: Topical Apply oiliness, pruritus threatening
0.51 cm ribbon in condition, may
lower conjunctival occur during or
sacs shortly after after antibiotic
birth therapy.
Observe for S&S
of superinfection
by overgrowth of
nonsusceptible
bacteria or fungi.
Emergence of
resistant
staphylococcal
strains is highly
predictable during
prolonged therapy.
Lab tests: Periodic
liver function tests
during prolonged
therapy.
Monitor for S&S of
hepatotoxicity.
Premonitory S&S
include:
Abdominal pain,
nausea, vomiting,
fever,
leukocytosis, and
eosinophilia;
jaundice may or
may not be
present.
Symptoms may
appear a few days
after initiation of
drug but usually
occur after 12 wk
of continuous
therapy.
Symptoms are
reversible with
prompt
discontinuation of
erythromycin.
Monitor for
ototoxicity that
appears to
develop most
frequently in
patients receiving
4 g/d or more,
older adults,
female patients,
and patients with
kidney or liver
dysfunction. It is
reversible with
prompt
discontinuation of
drug.
Recombivax HB, Suspension of Hepatitis B Body as a Whole: Mild Note: The ACIP
Energix- inactivated and purified Prophylaxis local tenderness at recommends
hepatitis B surface Adult: IM injection site, local serologic
B/recombinant antigen (HBsAg) derived Recombivax 1 mL inflammatory reaction confirmation of
hepatitis B vaccine from human plasma of (10 mcg) at 0, 1, and (swelling, heat, redness, postvaccination
screened asymptomatic 6 mo; Engerix-B 1 induration, pain); fever, immunity in
HBsAg-positive carriers mL (20 mcg) at 0, 1, malaise, patients
of hepatitis B virus. and 6 mo or 0, 1, 2, fatigue,headache, undergoing
Hepatitis B vaccine and 12 mo dizziness, faintness, leg dialysis and in
recombinant is the first Child: IM cramps, myalgia, immunodeficient
vaccine produced by Recombivax 0.5 mL arthralgia. GI: Nausea, patients.
gene splicing. No human (5 mcg) at 0, 1, and vomiting, diarrhea. Skin: Monitor
plasma is used in its 6 mo; Engerix-B 0.5 Rash, urticaria, pruritus. temperature.
production. mL (10 mcg) at 0, 1, Some patients
and 6 mo or 0, 1, 2, develop a
and 12 mo temperature
elevation of 38.3
Dialysis and C (101 F)
Immunodeficient following
Patients vaccination that
Adult: IM may last 1 or 2 d.
Recombivax 2 mL
(20 mcg) at 0, 1, and
6 mo Engerix-B 2
mL (40 mcg) at 0, 1,
and 6 mo or 0, 1, 2,
and 12 mo
HBIG/hepatitis B Provides passive IM 0.5 mL within 12 Headaches, dizziness, Assess for skin
Immune Globulin immunity to hepatitis hrs of birth. nausea, vomiting, reactions.
immunity. soreness at injection Assess for
site. sneezing,
dysphagia,
vomiting,
angiodema.
Assess for
anaphylaxis.
Bacitracin Interferes with bacterial Apply enough Rash,urticaria, scaling, Assess for allergic
ointment/triple protein synthesis. medication to cover redness. reaction: burning,
lesions completely stinging, swelling,
antibiotic ointment after cleansing with redness.
soap and water. Assess for signs
of nephroxicity or
ototoxicity.
Postpartum meds
Colace/docusate Increases water, fat Adult: PO 50-300 Bitter taste, throat Assess for
sodium penetration in intestine; mg/day. irritation, nausea, cramping, rectal
allows for easier anorexia, cramps, bleeding, nausea,
passage of stool. diarrhea, rash. vomiting. If
symptoms occur
then discontiune.
Identify cause of
constipation;
identify fluids,
bulk, or exercise is
missing from
lifestyle.
Meruvax II, Prevention of measles, Subcut 1 vial; 2 vials Redness or pain at Contraindications:
MMR/rubella mumps, and rubella seperated by 1 mo, injection site; hypersensitivity,
in person born after noncontagious rash; blood dyscrasias,
virus vaccine, live 1957 joint pain anemia, active
Child>15 mo and infection,immunos
adult: Subcut. 0.5ml Life threatening: uppression;
Allergic reaction febrile egg/chicken
seizures, allergy;
encephalopathy, mild pregnancy, febrile
meningitis illness, neomycin
allergy, neoplasms
Iron sulfate Ferrous sulfate: Iron Deficiency GI: Nausea, heartburn, Lab tests: Monitor
Standard iron Adult: PO Sulfate anorexia, constipation, Hgb and
preparation against (30% elemental diarrhea, epigastric pain, reticulocyte values
which other oral iron iron) 7501500 abdominal distress, during therapy.
preparations are usually mg/d in 13 divided black stools. Special Investigate the
measured. Corrects doses; Fumarate Senses: Yellow-brown absence of
erythropoietic (33% elemental discoloration of eyes and satisfactory
abnormalities induced by iron) 200 mg t.i.d. or teeth (liquid forms.) response after 3
iron deficiency but does q.i.d.; Gluconate Large Chronic Doses wk of drug
not stimulate (12% elemental in Infants Rickets (due treatment.
erythropoiesis. May iron) 325600 mg to interference with Continue iron
reverse gastric, q.i.d., may be phosphorus absorption). therapy for 23
esophageal, and other gradually increased Massive Overdosage mo after the
tissue changes caused to 650 mg q.i.d. as Lethargy, drowsiness, hemoglobin level
by lack of iron. Ferrous needed and nausea, vomiting, has returned to
gluconate:Claimed to tolerated abdominal pain, normal (roughly
cause less gastric Child: PO Sulfate diarrhea, local corrosion twice the period
irritation and be better (30% elemental of stomach and small required to
tolerated than ferrous iron) <6 y, 75225 intestines, pallor or normalize
sulfate. mg/d in divided cyanosis, metabolic hemoglobin
doses; 612 y, 600 acidosis, shock, concentration).
mg/d in divided cardiovascular collapse, Monitor bowel
doses; Fumarate convulsions, liver movements as
(33% elemental necrosis, coma, renal constipation is a
iron) 3 mg/kg t.i.d.; failure, death. common adverse
Gluconate (12% effect.
elemental iron) <6
y, 100300 mg/d in
divided doses; 612
y, 100300 mg t.i.d.
Iron Supplement
Adult: PO Sulfate
Pregnancy, 300600
mg/d in divided
doses; Fumarate
200 mg once/d;
Gluconate 325600
mg once/d
Child: PO Fumarate
3 mg/kg once/d;
Gluconate <6 y,
100300 mg/d in
divided doses; 612
y, 100300 mg
once/d
Infant: PO
Fumarate Low birth
weight, 2 mg/kg/d up
to 15 mg/d; 3 y, 1
mg/kg/d (max: 15
mg/d)
Dermaplast Inhibits conduction of Can be used Rash, irritation, Assess:
nerve impulses from topically and sensitization Pain: location,
sensory nerves rectally; TOP- apply duration,
four times a day characteristics
RECT- insert three before and after
times a day and administration
after each BM For infection:
redness, drainage,
inflammation; this
product should not
be used until
infection is treated
Tucks Relieves using witch- Pre-medicated Rash, hives, itching, Do not place
hazel to relieve topical pads difficulty breathing, directly in rectum.
discomfort following tightness in the chest, Stop use/contact
childbirth, rectal/vaginal swelling of the mouth, provider if rectal
surgery, and decreases face, lips, or tongue. bleeding occurs or
pain from hemorrhoids Bleeding from rectum; condition does not
increase irritation, pain, approve in 7 days.
redness, swelling, or
other symptoms.
Lansinoh/lanolin Prevent rough, dry, scaly Medicated cream Rash, itching, hives, Hypoallergenic
cream skin. Relief of nipple OTC burning, stinging and safe for both
pain during redness mother and baby.
breastfeeding Additive, pesticide,
and preservative
free.
Other