methylergonovine maleate

Methergine

Pharmacologic class: Ergot alkaloid

Therapeutic class: Oxytocic

Pregnancy risk category C

Action

Directly stimulates vascular smooth-muscle contractions in uterus and cervix and decreases bleeding after delivery

Availability

Injection: 0.2 mg/ml

Tablets: 0.2 mg

⊘Indications and dosages

➣ Prevention and treatment of postpartum hemorrhage

Adults: 0.2 mg I.M.; repeat q 2 to 4 hours as needed to a total of five doses. In emergencies, 0.2 mg I.V. over 1 minute. After initial I.M. or I.V.
dose, 0.2 mg P.O. q 6 to 8 hours for 2 to 7 days; decrease dosage if cramping occurs.

Contraindications

• Hypersensitivity to drug
• Hypertension
• Toxemia
• Pregnancy (except during third stage of labor)

Precautions

Use cautiously in:

• severe hepatic or renal disease, vascular disease, jaundice, sepsis
• patients in second stage of labor.

Administration

• Be aware that drug isn't routinely given I.V. because of risk of severe hypertension and cerebrovascular accident (CVA). Monitor blood
pressure and uterine contractions during administration.
• If I.V. use is necessary, give dose over 1 minute. Dose may be diluted in 5 ml of 0.9% sodium chloride injection.
• Be aware that prolonged therapy should be avoided because of ergotism risk.

Route Onset Peak Duration

P.O. 5-10 min 30 min 3 hr
I.V. Immediate Unknown 45 min
I.M. 2-5 min Unknown 3 hr

Adverse reactions

CNS: dizziness, headache, hallucination, seizures, CVA (with I.V. use)

CV: hypertension, hypotension, transient chest pain, palpitations, thrombophlebitis

EENT: tinnitus, nasal congestion

GI: nausea, vomiting, diarrhea

GU: hematuria

Musculoskeletal: leg cramps

Respiratory: dyspnea

Skin: diaphoresis, rash, allergic reactions

Other: foul taste

Interactions

Drug-drug. Dopamine, ergot alkaloids, oxytocin, regional anesthetics, vasoconstrictors: excessive vasoconstriction

Drug-diagnostic tests. Prolactin: increased level

Patient monitoring

☞ Know that if used during third stage of labor, drug increases risk of hemorrhage and infection.
• When giving I.V., closely monitor blood pressure, pulse, uterine contractions, and bleeding.
• Monitor patient for adverse effects.

oxytocin

Pitocin

Pharmacologic class: Posterior pituitary hormone

Therapeutic class: Uterine-active agent

Pregnancy risk category NR

FDA Boxed Warning

• Drug isn't indicated for elective induction of labor (defined as initiation of labor in pregnant woman with no medical indications for induction).
Available data aren't adequate to evaluate benefits versus risk.

Action

Unknown. Thought to directly stimulate smooth muscle contractions in uterus and cervix.

Availability

Injection: 10 units/ml ampule or vial

⊘Indications and dosages

➣ To induce or stimulate labor

Adults: Initially, 1-ml ampule (10 units) in compatible I.V. solution infused at 1 to 2 milliunits/minute (0.001 to 0.002 units/minute). Increase rate
in increments of 1 to 2 milliunits/minute q 15 to 30 minutes until acceptable contraction pattern is established.

➣ To control postpartum bleeding

Adults: 10 to 40 units in compatible I.V. solution infused at rate adequate to control bleeding; or 10 units I.M. after placenta delivery

➣ Incomplete abortion

Adults: 10 units in compatible I.V. solution infused at 10 to 20 milliunits/minute (0.01 to 0.02 units/minute)

Off-label uses

• Antepartal fetal heart rate testing

• Breast enlargement

Contraindications

• Hypersensitivity to drug
• Cephalopelvic disproportion
• Fetal distress when delivery is not imminent
• Prolonged use in uterine inertia or severe toxemia
• Hypertonic or hyperactive uterine pattern
• Unfavorable fetal position or presentation that's undeliverable without conversion
• Labor induction or augmentation when vaginal delivery is contraindicated (as in invasive cervical cancer, active genital herpes, or total placenta
previa)

Precautions

Use cautiously in:

• previous cervical or uterine surgery, history of uterine sepsis
• breastfeeding patients.

Administration

• Reconstitute by adding 1 ml (10 units) to 1,000 ml of normal saline solution, lactated Ringer's solution, or dextrose 5% in water.
☞ Don't give by I.V. bolus injection.
• Infuse I.V. using controlled-infusion device.
• Be aware that drug isn't routinely given I.M.
• Know that drug should be given only to inpatients at critical care facilities when prescriber is immediately available.

Route Onset Peak Duration

I.V. Immediate 40 min 1 hr
I.M. 3-5 min 40 min 2-3 hr

Adverse reactions

CNS: seizures, coma, neonatal brain damage, subarachnoid hemorrhage

CV: premature ventricular contractions, arrhythmias, neonatal bradycardia

GI: nausea, vomiting

GU: postpartal hemorrhage; pelvic hematoma; uterine hypertonicity, spasm, or tetanic contraction; abruptio placentae; uterine rupture (with
excessive doses)

Hematologic: afibrinogenemia
Hepatic: neonatal jaundice

Other: hypersensitivity reactions including anaphylaxis, low 5-minute Apgar score (neonate)

Interactions

Drug-drug. Sympathomimetics: postpartal hypertension

Thiopental anesthetics: delayed anesthesia induction

Vasoconstrictors: severe hypertension (when given within 3 to 4 hours of oxytocin)

Drug-herbs. Ephedra (ma huang): increased hypertension

Patient monitoring

☞ Continuously monitor contractions, fetal and maternal heart rate, and maternal blood pressure and ECG. Discontinue infusion if uterine
hyperactivity occurs.
☞ Monitor patient extremely closely during first and second stages of labor because of risk of cervical laceration, uterine rupture, and maternal
and fetal death.
• When giving drug to control postpartal bleeding, monitor and record vaginal bleeding.
• Assess fluid intake and output. Watch for signs and symptoms of water intoxication.

hydralazine hydrochloride

Apo-Hydralazine (CA), Apresoline, Novo-Hylazin (CA), Nu-Hydral (CA)

Pharmacologic class: Peripheral vasodilator

Therapeutic class: Antihypertensive

Pregnancy risk category C

Action

Relaxes vascular smooth muscles of arteries and arterioles, causing peripheral vasodilation and decreasing peripheral vascular resistance. These
actions decrease blood pressure and increase heart rate, stroke volume, and cardiac output.

Availability

Injection: 20 mg/ml

Tablets: 10 mg, 25 mg, 50 mg, 100 mg

⊘Indications and dosages

➣ Hypertension

Adults: Initially, 10 mg P.O. q.i.d. After 2 to 4 days, may increase to 25 mg P.O. q.i.d. for remainder of first week; may then increase further to
50 mg P.O. q.i.d., up to 300 mg/day. Once maintenance dosage is established, may give in two daily doses.

Children: Initially, 0.75 mg/kg/day P.O. in four divided doses; may increase gradually over 3 to 4 weeks to 7.5 mg/kg or 200 mg/day

Neonates: 0.5 mg/kg P.O., I.M., or I.V. q 4 to 6 hours

➣ Heart failure
Adults: Initially, 50 to 75 mg P.O. q.i.d.; may increase up to 600 mg/day given in three to four divided doses

➣ Eclampsia

Adults: 5 mg I.V., followed by another 5 mg I.V. q 15 to 20 minutes until blood pressure decreases adequately. If no response occurs after a total
dose of 20 mg, prescriber may consider alternative drug.

Contraindications

• Hypersensitivity to drug or tartrazine

• Coronary artery disease
• Mitral valvular rheumatic heart disease

Precautions

Use cautiously in:

• suspected CV or cerebrovascular disease, severe renal or hepatic disease
• pregnant or breastfeeding patients
• children.

Administration

• Administer oral form with food.

☞ Inject I.V. form slowly over 1 minute. Monitor blood pressure response continuously.
• Draw up and use parenteral drug immediately; solution changes color after contact with metal needle.

Adverse reactions

CNS: dizziness, drowsiness, headache, peripheral neuritis

CV: tachycardia, angina, orthostatic hypotension, arrhythmias

EENT: lacrimation, nasal congestion

GI: nausea, vomiting, diarrhea, constipation, anorexia

Metabolic: sodium retention

Musculoskeletal: joint pain, arthritis

Skin: rash, blisters, flushing, pruritus, urticaria

Other: chills, fever, lymphadenopathy, edema, lupuslike syndrome

Interactions

Drug-drug. Antihypertensives, nitrates: additive hypotension

Beta-adrenergic blockers: decreased risk of hydralazine-induced tachycardia

Epinephrine: reduced pressor response to epinephrine

Metoprolol, propranolol: increased blood levels of both drugs

MAO inhibitors: increased hypotension

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive response

Drug-diagnostic tests. Coombs' test: positive result

Granulocytes, hemoglobin, neutrophils, platelets, red blood cells, white blood cells: decreased levels

Drug-behaviors. Alcohol use: additive hypotensive response

Patient monitoring

• Monitor CBC, lupus erythematosus cell studies, and antinuclear antibody titers before and periodically during therapy.
• Monitor blood pressure, pulse rate and regularity, and daily weight.
• To avoid rapid blood pressure drop, taper dosage gradually before discontinuing.
☞ Assess for lupuslike signs and symptoms, including joint pain, fever, myalgia, pharyngitis, and splenomegaly.
• Watch for peripheral neuritis. If it occurs, expect to give pyridoxine

BUSCOPAN
Established Name: N-butylscopolammonium bromide
Proprietary Name: BUSCOPAN Injectable Solution
Dosage Form: Injectable Solution
How Supplied: 50 mL multi-dose vials
Route of Administration: Slow intravenous administration
Pharmacological Category: Anticholinergic, antispasmodic
Indications: BUSCOPAN Injectable Solution is indicated
for the control of abdominal pain (colic)
associated with spasmodic colic, flatulent
colic, and simple impactions in horses.

USES: This medication is used to relieve bladder or intestinal spasms.

SIDE EFFECTS: Constipation, dry mouth, trouble urinating, or nausea could occur. If these continue or are bothersome, notify your doctor
promptly. Very unlikely but report: rash, itching, swelling of the hands or feet, trouble breathing, increased pulse, dizziness, diarrhea, vision
problems, eye pain. If you notice other effects not listed above, contact your doctor or pharmacist.

Contraindications:
Buscopan should not be used in impaction colics associated with ileus or in horses with glaucoma.

Adverse Reactions:
Transient tachycardia and decreased borborygmal sounds lasted approximately 30 minutes following administration. Transient pupillary dilation
may also be observed.