L & D Medications Flashcards
Brand name for ampicillin
Ampicin
What is ampicillin used for?
GBS prophylaxis
Class of ampicillin
Broad spectrum antibiotic
Side effects of ampicillin
Pain at infusion site
Allergic response
Rash
N/v/d
HA
Nursing responsibilities for ampicillin
Assess for previous sensitivity reactions to penicillin’s or other cephalosporins
Assess for S/S of infection
VS
WBC
Obtain hx for GBS status
Assess bowel pattern daily
If severe diarrhea occurs, product should be DC
Patient teaching for ampicillin
Teach why med is being given
Report any adverse symptoms or SE
Brand name of Penicillin G
Pfizerpen
Classification of Penicillin G
Broad spectrum antibiotic
Use of penicillin G
Prevention and treatment of GBS
Side effects of penicillin G
Pain at infusion site
Allergic reaction
Rash
N/v/d
HA
Brand name for oxytocin
Pitocin
*Routes of pitocin
For induction/augmentation: IV titration
For PPH: IV bolus or IM injection
*Use of pitocin
Control PP bleeding
Induction/stimulation of labor
(Stimulates uterine smooth muscle, has vasoactive and anti diuretic properties)
*Side effects of pitocin
*Water intoxication
Tachysystole
Impaired uterine blood flow
Fetal asphyxia
Uterine rupture
Fetal:
Bradycardia
Tachycardia
Reduced variability
Late or prolonged decels
Nursing responsibilities for pitocin
Assess character, frequency, duration, intensity of contractions every 15 min
Stop infusion if: CTX <2 min apart and are >50-65 mmHg, last 60-90 seconds or longer
Assess FHR prior to induction and every 15 min during induction
Assess VS every 15 min
Monitor for water intoxication: drowsiness, listlessness, confusion, HA, anuria)
Monitor I&O
DC or decrease drip for fetal distress or prolonged contractions
Patient teaching for pitocin
Advise pt to expect contractions similar to menstrual cramps that gradually increase in intensity and become strong
Report increased abdominal pain, blood loss, or fever
PP - report boggy uterus or increase in lochia flow
Teach pt to massage their fundus
Brand name for Methylergonovine
Methergine
*Use of methergine
Treat/prevent PPH (or post abortion hemorrhage) cause by uterine atony or subinvolution
(Stimulates sustained CTX of uterus and causes arterial vasoconstriction)
Classification of methergine
Oxytocic
Uterine stimulant
*Routes for methergine
*IM - preferred route for rapid absorption
PO
Intrauterine
(IV use not recommended unless life threatening situation)
*Side effects of methergine
*HTN
N/V
Uterine cramping
Dyspnea
Dysrhythmias
Nursing responsibilities for methergine
Caution in pts with HTN and cardiac disease
Caution to avoid smoking: nicotine causes vasoconstriction
Monitor BP/VS
*Check BP prior to each dose
Monitor vaginal bleeding, uterine tone, height of fundus
*Patient teaching for methergine
*Avoid smoking because nicotine constricts vessels
Abdominal cramps are a SE
Notify prescriber if you have chest pain, N/V, HA, muscle pain, weakness, cold/numb extremities
Teach to massage fundus
Brand name for dinoprostone
Cervidil, prepidil
*Routes for cervidil
*Vaginal suppository (10 mg time release)
Or gel
Classification of cervidil
Prostaglandin oxytocic
Abortifacient
*Use of cervidil
*Cervical ripening/induction
(Stimulates uterine contractions similar to labor by myometrium stimulation, causing abortion)
Acts within 30 hrs for complete abortion
Used for cervical effacement and dilation in term pregnancy when they have not occurred spontaneously
*Side effects of cervidil
*Fever
*Uterine hypertonicity (tachysystole)
HA
Nausea
Uterine rupture
Diarrhea
*Nursing responsibilities of cervidil
*Delay start of pitocin for 30-60 mins after cervidil is removed
Monitor contractions
Cervical ripening: assess dilation and effacement of cervix, uterine CTX, and fetal heart tones
Monitor for CTX lasting more than 1 min, hypertonic, fetal distress
Assess for fever occurring 30 min after administration
Gel should be at room temp
Patient teaching for cervidil
Gel may produce warmth in vagina
Void prior to insertion
Remain supine for 30 mins to 2 hrs after insertion of medication
Report any contractions lasting longer than 1 min
Brand name for carboprost
Hemabate
Route for hemabate
*Deep IM
Maximum total dose of Hemabate
2 mg
Class for hemabate
Prostaglandin
Abortifacient
Oxytocic
*Use of hemabate
*Treat PPH
Stimulates contraction of uterus
*Side effects of hemabate
*Diarrhea
May cause tetanic contractions and laceration or uterine rupture
hypertension/hypotension
Nausea
*Nursing responsibilities for hemabate
*Administer antidiarrheals as ordered
*Monitor fundus and lochia
Should be refrigerated
Rotate sites if repeated
Monitor vitals
Administer antiemetics as ordered
Patient teaching for hemabate
This med almost always causes diarrhea, so we will admin antidiarrheal to avoid this side effect
Expect abdominal cramps similar to menstrual cramps
Change positions slowly
Report any increase in vaginal bleeding
Brand name for misoprostol
Cytotec
*Route for Cytotec
*PO
* PR (preferred route for PPH)
*PV
Classification of Cytotec
Prostaglandin
*Use for Cytotec
*Cervical ripening/induction
*Treatment of PPH
Induces uterine CTX, ripens cervix
Side effects of Cytotec
Uterine cramping
Tachysystole
Uterine rupture
Diarrhea
N/V
Dyspepsia
*Nursing responsibilities for Cytotec
*NOT used in women with previous uterine scar
*DO NOT start pitocin until at least 4 hours after vaginal Cytotec dose (for induction)
*Preferred route is rectal for PPH
Monitor FHR, contraction pattern, cervical dilation/effacement
Monitor bleeding and fundus in PPH pt
Patient teaching for Cytotec
Lie flat for 30 min after insertion of medication
Void prior to insertion of medication
Report CTX lasting >1 min
Report any worsening or increase in vaginal bleeding
Brand name for nalbuphine
Nubian
Route for Nubian
IV (preferred)
IM
SQ
Classification of Nubian
Opioid analgesic
Use of Nubian
Moderate to severe pain
Side effects of Nubian
Sedation
Respiratory depression in mom and neonate
N/V
Dizziness
HA
Nursing responsibilities for Nubian
Assess pain prior to and after giving med
Monitor VS (Don’t give if RR<12)
Monitor fetus (can cause bradycardia, respiratory depression at birth, apnea, cyanosis, and hypotonia)
Don’t give close to delivery d/t fetal effects
Narcan is antidote
Patient teaching for Nubian
Dizziness and drowsiness are common: do not get up without assistance
Risk of baby having resp depression effects if this drug is given too close to delivery
Avoid CNS depressants (alcohol, sedatives) for at least 24 hours after taking this med
Brand name of Butorphanol
Stadol
Route of Stadol
IV (preferred)
IM
Class for Stadol
Mixed opioid analgesic
Use of Stadol
Pain relief during labor
*Side effects of Stadol
*Decreased FHR variability
Respiratory depression or apnea (maternal and fetal)
Sedation/lethargy
N/V
Dizziness
Nursing responsibilities for Stadol
Assess pain before and after giving med
Monitor VS & LOC
Monitor fetus and FHR variability
Have narcan available
Side rails up at all times
Patient teaching for Stadol
Tell pt and family she shouldn’t get out of bed without assistance
Side rails up at all times
Change positions slowly to prevent orthostatic hypotension
Brand name for naloxone
Narcan
Route for narcan
IV (preferred)
IM
SQ
Intra nasal
ET tube
Classification of narcan
Opiate antagonists
*Use of narcan
*Treat maternal opioid overdose and/or treat newborn with severe respiratory depression secondary to maternal opioid dose near delivery
Side effects of narcan
Tachycardia
Tremor
Diaphoresis
HTN
Opioid withdrawal
*Nursing responsibilities for narcan
*Caution may cause withdrawal in opioid addicted patients
Monitor fetus if not delivered
Monitor VS, LOC, and pain
Monitor for respiratory depression
Duration of effect is 20-60 mins. May need to repeat dose. Monitor for withdrawal
Patient teaching for narcan
Explain reason for expected results of medication when pt is alert
This drug used to reverse effects of maternal overdose of opioids and to treat newborns with severe respiratory depression secondary to maternal opioid dose near delivery
Brand name for nifedipine
Procardia
Route for Procardia
PO
Classification of Procardia
Calcium channel blocker
Tocolytic
*Use of Procardia
*Control BP
*Inhibit preterm labor contractions
(Blocks calcium channels and reduces smooth muscle contractions in uterus
Side effects of Procardia
Flushing of skin
HA
Hypotension
N/V/D
Transient increase in maternal and FHR
Nursing responsibilities for Procardia
Monitor VS
Assess status of fetus/contractions
Avoid concurrent use with Mag sulfate b/c skeletal muscle blockade can result
Monitor BS in diabetic pts
Don’t give immediately after Terbutaline b/c of effects on HR and BP
Patient teaching for Procardia
Change positions slowly to prevent orthostatic hypotension
This med can cause dizziness, call for assistance if you need to sit, stand, or walk
Brand name for terbutaline
Bricanyl
Brethine
Route of terbutaline
SQ
Class for terbutaline
Selective B2 agonist
Tocolytic
*Use of terbutaline
*To stop preterm labor contractions *Manage tachysystole
Relaxes uterine smooth muscle by acting on beta2 receptors with less effect on the heart
*Side effects of terbutaline
*Maternal and fetal tachycardia
Dyspnea
Palpitations
Chest pain/discomfort
Restlessness
Tremors
Flushing
Hypokalemia
Nursing responsibilities for terbutaline
Hold dose if maternal HR >120bpm or if systolic BP falls below 80-90 of FHR >180
Monitor VS/HR
*Ensure inderal is available to reverse adverse effects
Caution in women with hx of cardiac diasease
Gestational diabetes: sever gestational HTN, severe pre-eclampsia or eclampsia
Monitor fetus; contraction pattern and dilation/effacement
Patient teaching for terbutaline
Review SE with pt and have her report problems if they occur
Inform her that she will hear the baby’s HR increase on the monitor and that this is an expected SE
Limit caffiene
Drug is only administered at the hospital
Report if symptoms continue once you go home
Brand name for indomathacin
Indocin
Route for indocin
PO
Classification of indocin
NSAID
Prostaglandin synthesis inhibitor
Tocolytic
*Use of indocin
*used to treat preterm labor prior to 32 weeks
Relaxes uterine smooth muscle by inhibiting prostaglandins
Side effects of indocin
N/V
Heartburn
GI bleeding
Increased BP in women with HTN
Fetal: constriction of ductus arteriosus, impaired renal function (reduced amniotic fluid vol = > cord compression)
*Nursing responsibilities for indocin
*Can only be used for 48 hrs due to risk of closing ductus arteriosus
Assess fetal status, FHR, and contractions
Drug can mask maternal fever
Don’t use in women with renal, hepatic, active PUD, poorly controlled HTN, asthma, or coagulation disorders
Must be used prior to 32 weeks gestation
Patient teaching for indocin
Only use drug for 48 hours
Review SE/take drug with food
Caution if mom is sick as drug can mask fever
Report if labor symptoms continue
Route for magnesium sulfate
IV
IM (rarely)
Classification of magnesium sulfate
Anticonvulsant
Tocolytic
*Use of magnesium sulfate
*Patient seizures
*Treatment of preterm labor
(Increases osmotic pressure, draws fluid into colon, neutralizes HCL. Plays important role in neurotransmission and muscular excitability)
Side effects of magnesium sulfate
Dose related depression of DTR
CNS depression
Flushing/sweating
Hypotension
Resp depression
Fetal: Reduced FHR variability, hypotonia
*Nursing responsibilities for magnesium sulfate
*Antidote = Calcium gluconate
Monitor BP closely
Assess VS. RR should be > 12
Monitor I&O. UO should be >30 ml/hr
Keep calcium gluconate in room
Monitor DTR
Assess edema in lower extremities
If pre-eclamptic - seizure precautions
Assess magnesium toxicity
Monitor mg and ca levels
Symptoms of magnesium toxicity
Thirst
Confusion
Decreased DTR
Visual changes: blurred vision, halos
Patient teaching for magnesium sulfate
This med is given to delay preterm labor and to prevent seizures associate with preeclampsia
Need for frequent monitoring
Report SE (family or pt)
Side rails up
OOB with assistance
Brand name for calcium gluconate
Calcinate
Route for calcium gluconate admin
IV
Classification for calcium gluconate
Electrolyte replacement
Calcium product
*Use of calcium gluconate
*Treat hypermagnesemia secondary to magnesium sulfate treatment
*Antidote to magnesium sulfate (Prevents respiratory arrest)
Side effects of calcium gluconate
Pain at IV site
N/V
Flushing
Hypotension
Arrhythmia
Nursing responsibilities for calcium gluconate
Monitor VS
Monitor fetus
Monitor labs (Ca and Mg)
Patient teaching for calcium gluconate
Prevent injuries - side rails up
Assist oob
Teach that this med given when levels of magnesium sulfate become too high in blood, which is more common in preeclampsia than PTL
Brand name for Lebatalol
Trandate
Route for Lebatalol
IV
PO
IM
Classification for Lebatalol
Antihypertensive
Alpha and beta blocker
Use for Lebatalol
Treatment of HTN during pregnancy
Reduces BP associated with preeclampsia/eclampsia and preserves uteroplacental blood flow
Produces decreases in BP without reflex tachycardia or significant reduction in HR through mixture of alpha and beta blocking effects
Side effects of Lebatalol
Orthostatic hypotension
Flushing
Tremulosness
Minimal change in pulse rate
Nursing responsibilities for Lebatalol
Monitor VS
Maintain BR in left lateral position with SR up
Continuous fetal monitoring
Contraindicated in pts with asthma, heart disease, or CHF
Patient teaching for Lebatalol
Change positions slowly to prevent orthostatic hypotension
Explain need for BR and increased monitoring if in labor
Explain reason why receiving med and potential SE
If intrapartum - monitor BP, eat well, keep appointments
Hydralazine brand name
Apresoline
Route for Hydralazine
IV
IM
PO
Classification of hydralazine
Antihypertensive
Vasodilator
Use of hydralazine
Treatment of HTN r/t preeclampsia/eclampsia
Vasodilate arterioles in smooth muscle by direct relaxation
Reduces BP with reflex increases in HR, stroke volume, cardiac output
Side effects of hydralazine
Flushing
Palpitations
Tachycardia
Hypotension
HA
Fetal effects: tachycardia, late decels, bradycardia if diastolic bp >90
Nursing responsibilities for hydralazine
Monitor VS frequently
Monitor fetus
Higher doses are associated with maternal hypotension, HA, and fetal distress
Monitor I&O
Maintain BR in lateral position with SR up
Caution in the presence of tachycardia
Patient teaching for hydralazine
Change positions slowly to prevent orthostatic hypotension
Inform pt of need for drug and frequent monitoring, bedrest and potential SE
Brand name for betamethasone
Celestone Soluspan
*Route for betamethasone
*IM two doses given 24 hours apart
Classification of betamethasone
Corticosteroid
*Use for betamethasone
*Acceleration of fetal lung maturity
Biochemical stimulation of surfactant production
Side effects of betamethasone
Few due to short term use
Pulmonary edema possible secondary to sodium and fluid retention
HTN, hyperglycemia, decreased wound healing
*Nursing responsibilities for betamethasone
Use between 24-32 weeks gestation
*Caution in patients with DM - hyperglycemia
PLTs and WBCs may rise temporarily (72 hrs)
Monitor I&O
Daily weights
Patient teaching for betamethasone
Explain potential benefits of steroid admin to preterm neonate and that drug cannot prevent or lessen the severity of all complications of prematurity
Report CP, heaviness, or dyspnea
Brand name for Tranexamic Acid
Lysteda
Route for tranexamic acid
IV (PO forms available for less emergent situations)
Classification of tranexamic acid
Anti Fibrinolytic agent / hemostatic agent
Use of tranexamic acid
Treatment of PPH
Completely inhibits multiple plasminogen binding sites, decreasing plasmin formation and Fibrinolytic
Side effects of tranexamic acid
HA
Abdominal pain
Musculoskeletal pain
N/V/D
Fatigue
Nursing responsibilities for tranexamic acid
Monitor VS
Monitor fundus/lochia
Weight pads/linens
Discontinue tx if ocular changes occur
Monitor I&Os
Monitor lab results
Prepare for surgical procedures as needed
Patient teaching for tranexamic acid
Explain why med is being given as well as need for frequent intervention (VS, fundal massage, etc.)
Provide comfort and reassurance as much as possible
Keep pt informed as hemorrhage treatment progresses
