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OB FIRST WEEK > Medication Cards > Flashcards

Medication Cards Flashcards

0
Q

Betamethasone (Celstone)

  • Best Time to Give?
  • Dept its used in
A
  1. Greatest benefit accrue if at least 24 hours elapse between initial dose and birth of the preterm infant
  2. L&D & NICU
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1
Q

Betamethasone (Celstone)

  • Class
  • Indication
  • Action
  • Route/Dose
A
  1. Corticosteroid
  2. Acceleration of fetal lung maturity to reduce incidence and severity of respiratory distress syndrome (RDS)
  3. Reduces incidence of intra-ventricular hemorrhage and neonatal death in the preterm infant
  4. Reduces inflammation of the bronchial tubes and speeds lung development

-IM – 12mg 2 doses 24 hours apart

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2
Q

Betamethasone (Celstone)

  • Contraindications
  • Who to give it to?
A
  1. Active infection
    - EX chorioamnionitis
  2. NIH recommends use of corticosteroids for women who have preterm rupture (24-32 weeks) of the membranes
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3
Q

Betamethasone (Celstone)

  • Adverse Reactions
  • Drug Interaction
A

FEW S/E if used for short duration

  1. Increased risk of CD in women who received >4 doses
    - Pulmonary edema secondary to sodium and fluid retention
  2. Increased hunger, anxiety and BP
  3. Hypoglycemia for baby
  4. Hyperglycemia for mom
  5. May increase need for insulin and hyperglycemic agents
  6. Increase risk of adverse reaction from LIVE VIRUS VACCINES
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4
Q

Betamethasone (Celstone)

-Nursing Considerations

A
  1. More frequent blood sugar checks in a diabetic because sugar can be elevated while on corticosteroids
  2. Temporary rise in platelet and WBC levels may last 72 hours
    - WBC levels >20,000 may indicate infection
  3. Assess lung sounds / REPORT chest pain or heaviness or dyspnea
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5
Q 
Calcium Gluconate (10%)
-Class & Indication, ANTIDOTE
A
  1. Mineral & electrolyte replacement
  2. Reverse magnesium toxicity and prevent respiratory arrest if serum levels become high
  3. ANTIDOTE for magnesium toxicity
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6
Q

Calcium Gluconate

-Route/Dose

A
  1. IV – 1-3g may be administered until response occurs
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7
Q

Calcium Gluconate

-Contraindications, S/E

A
  1. Hypercalcemia, Renal calculi, Ventricular Fibrillation
    Can Cause:
  2. Cardiac arrest, syncope, arrhythmias, headache, C/N/V
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8
Q

Calcium Gluconate

-Drug-Drug Interaction / Assessment

A
  1. Concurrent use w/ diuretics (Thiazide) may result in hypercalcemia
  2. Monitor BP, pulse and ECG frequently
  3. May cause vasodilation: Hypotension, bradycardia, arrhythmias and cardiac arrest
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9
Q

Cytotec (Misoprostol)

  • Classification
  • Indication
  • Route/Dose
A
  1. Prostaglandin/Oxytocic
  2. Used in combination w/ mifepristone (Mifeprex) for TERMINATION of pregnancy.. CERVICAL RIPENING and LABOR INDUCTION – stop postpartum bleeding
  3. Not an AUGMENTOR
  • PO: 400 mcg single dose 2 days after mifeprex for termination
  • Intravaginally: 25 mcg repeat q3-6 hrs if needed
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10
Q

Cytotec (Misoprostol)

  • Usual Use in OB
  • Pregnancy Category
  • Breastfeeding
A
  1. Used for Elective abortion before 7 weeks
  2. Pregnancy category X
  3. Passes into breast milk and can cause severe diarrhea in infants
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11
Q

Cytotec (Misoprostol)

  • Contraindications
  • Side Effects
  • Drug Interaction
A
  1. Hypersensitivity to prostaglandins & should not be used to prevent NSAID induced gastric injury due to potential fetal death
  2. Abdominal pain & diarrhea
  3. Increased risk of diarrhea w/ magnesium containing antacids
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12
Q

Cytotec (Misoprostol)

  • Nursing Assessment
  • Nursing Implications
  • Where its Used?
A
  1. Monitor Uterine cramping, Fetal HR, and bleeding
  2. Inform pt that med will cause spontaneous abortion
    - They will feel cramping
    - If abortion is incomplete surgery may be necessary
    - Use contraception for one mentstal cycle following treatment
  3. L&D
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13
Q

Erythromycin Eye Ointment (Ilotycin)

  • Classification
  • Indication
  • Route/Dose
A
  1. Antibiotic
  2. Prophylaxis against the organism NEISSERIA GONORRHOEAE (Gonorrhea) – NOT FOR syphillis or chlamydia
    - Prevents ophthalmia neonatorum in infants of mother with gonorrhea
  3. Ribbon of eye ointment applied to lower conjunctival sac
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14
Q

Erythromycin Eye Ointment (Ilotycin)

  • Adverse Reactions
  • Where Its Used?
A
  1. Burning, itching
  2. Irritation may result in chemical conjunctivitis lasting 24-48 hrs
  3. Temporary blurred vision
  4. L&D, NB
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15
Q

Erythromycin Eye Ointment (Ilotycin)

-Nursing Considerations

A
  1. Cleanse infant’s eyes as needed before application
  2. Hold tube in a horizontal rather than vertical position
  3. Administer from inner to outer canthus
  4. Do not touch tip of tube to any part of the eye
  5. Use new tube for each infant
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16
Q

Fentanyl (Sublimaze)

  • Class
  • Indication
  • Dosing/Route
A
  1. Opioid analgesics
  2. Adjunct to epidural analgesia during labor
  3. Produces CNS depression & decreases pain
  4. 25-50 mcg IV may be repeated q1hr or PCA
    - IV is used during birth
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17
Q

Fentanyl (Sublimaze)

  • Adverse Reactions
  • Contraindications
  • Where It’s Used?
A
  1. Less Nausea, vomiting and respiratory depression than Demerol
  2. Hypersensitivity or cross-sensitivity or known intolerance
  3. LD
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18
Q

Fentanyl (Sublimaze)

  • Drug-Drug Interactions
  • Assessment
A
  1. Avoid in pts who have received MAOI’s w/in previous 14 days
  2. Monitor RR, BP frequently for respiratory depression
    - Use Atropine to reverse Respiratory Depression**
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19
Q

HBIG (Hepatitis B Immunoglobulin)

  • Classification
  • Indication
  • Route/Dose
A
  1. Vaccine / immune globulins
  2. Prevents Hepatitis B infection in neonates born to Hepatitis B POSITIVE women by providing passive immunity
    - ONLY GIVEN IF MOTHER IS HEP B POSITIVE
  3. IM .5 mL w/in 12 hours of birth (Vastus lateralis for infants)
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20
Q

HBIG (Hepatitis B Immunoglobulin)

  • Priority action
  • Effects of Hep B in Pregnancy
  • Side Effects
A
  1. Give the HBIG vaccine w/in 12 hours of birth
  2. Hep B increase incidence of prematurity, low birth weight, and prenatal death.
  3. Pain at injection site and local soreness
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21
Q

HBIG (Hepatitis B Immunoglobulin)

  • Nursing Assessment
  • Nursing Implications
  • Where Its Used?
A
  1. Monitor infant temp for s/s of infection
  2. Teach mother to practice good hygiene including hand washing
    - baby needs 2nd vaccine in 2 months and 3rd in 6 months
    - Household members should be tested and vaccinated
  3. PP, NB
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22
Q

Hemabate (carboprost)

  • Classification
  • Indication
  • Action
  • Route/Dose
A
  1. Prostaglandin / oxytocics
  2. Treatment of POSTPARTUM HEMORRHAGE
  3. Stimulates contraction of the Uterus
    - Can also be used for abortion
  4. IM 250 mcg // Max dose 2 mg
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23
Q

Hemabate (carboprost)

  • Side Effects
  • Contraindications
  • Where Its Used?
A
  1. DIARRHEA**, n/v tetanic contractions, uterine rupture
  2. Contraindicated w/ acute pelvic inflammatory disease, cardiac, pulmonary, renal or hepatic disease
  3. LD, PP
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24
Q

Hemabate (carboprost)

-Nursing Considerations

A
  1. Keep refrigerated
  2. Give via deep IM and aspirate carefully to avoid IV injection
  3. Monitor VS
  4. Administer anti-emetics and antidiarrheals as ordered
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25
Q

Hepatitis B Vaccine (Neonate)

  • Vaccine Schedule Look up more info
  • Route/Dose
  • Where It’s Used?
A

IM injections (deltoid adults) (Vastus Lateralis kids)
Hepatitis B Vaccine (Neonate)
1. 1st does may be given before discharge or at infants first visit to pediatrician / 2nd dose given at 2 months / 3rd dose at 6 to 18 months
2. NB

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26
Q

Magnesium Sulfate

  • Class
  • Indication
  • Where Its Used?
A
  1. Miscellaneous anticonvulsant
  2. Prevention and control of seizures in severe preeclampsia
    &
    -Prevention of uterine contractions in preterm labor
  3. LD & PP
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27
Q

Magnesium Sulfate

-Route/Dose

A
  1. IV or Deep IM (IM is Painful so not recommended)

2. Loading dose of 4 to 6 g of mag sulfate in 100 mL IV fluid over 15 to 20 minutes. then 2g/hr maintenance dose

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28
Q

Magnesium Sulfate

  • Contraindications
  • Adverse Reactions
A
  1. Contraindicated in persons w/ myocardial damage, heart block. myasthenia gravis, or impaired renal function
  2. S/E result from magnesium overdose and include flushing, sweating, hypotention, depressed deep tendon reflexes, & CNS depression, including respiratory depression.
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29
Q

Magnesium Sulfate

-Toxicity

A
  1. Magnesium toxicity, possibly r/t incomplete renal drug excretion, may be evidenced by thirst, mental confusion, or decrease in reflexes
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30
Q

Magnesium Sulfate

-Nursing Assessment **

A
  1. Urinary Output <30mL/h
  2. RR of at least 12 breaths per minute
  3. O2 sat of 95% or higher
  4. Presence of deep tendon reflexes
  5. Urinary output greater than 30 ml/hr
31
Q

Magnesium Sulfate

  • Breastfeeding
  • Drug-Drug interaction
  • Antidote
A
  1. Passes into breastmilk.. do not use w/in 2 hrs of labor to prevent toxicity in the newborn
  2. May potentiate CCB & neuromuscular blocking agents
  3. Calcium gluconate is the antidote
32
Q

Methergine (Methylergonovine)

  • Classification
  • Indication
  • Usual Use in OB
  • Route/Dose
A
  1. Ergot Alkaloid, Uterine Stimulant
  2. Prevention & Treatment of postpartum or post-abortion hemorrhage caused by uterine atony or sub-involution
  3. Used for uterine contraction during hemorrhage
  4. Usual dose is .2 mg IM q2-4 hrs max 5 doses then PO .2 mg 6-8hrs max 7 days
33
Q

Methergine (Methylergonovine)

  • Contraindication
  • Adverse Reactions
A
  1. NEVER use during pregnancy to induce labor.
    - Contraindicated in women with HTN, severe renal or hepatic disease, thrombophlebitis, CAD, PVD, or sepsis
  2. N/V, uterine cramping, HTN, diziness, headache, chest pain, palpitations, cramping
34
Q

Methergine (Methylergonovine)

  • Nursing Considerations
  • Where Its Used?
A
  1. Assess the BP before administration
    - Follow protocol on what BP level to hold medication
    - Caution mother to avoid smoking (can constrict vessels)
  2. LD & PP
35
Q

Narcan (Naloxone)

  • Classification
  • Indication
  • Dose/Route
A
  1. Opioid Antagonists
  2. Reversal of CNS depression and respiratory depression because of suspected opioid overdose. Respiratory depression in the infant when the mother has received narcotics during labor
  3. .4-2mg IV
36
Q

Narcan (Naloxone)

  • Adverse Reactions
  • Drug Interactions
  • Where Its Used?
A
  1. Ventricular arrhythmias, N/V
  2. Can Precipitate withdrawal in opiate dependent patients
    - DON’T GIVE TO OPIOID ADDICTED MOTHER
  3. LD, ICN, NICU
37
Q

Narcan (Naloxone)

  • Assessment
  • Implications
A
  1. Assess RR, rhythm, depth (both mother and infant)
    - Pulse, BP, LOC for 3-4 hours after peak blood concentrations
    - Assess S/S of withdrawal/vomiting, restlessness, increased BP
  2. Prepare syringe before birth w/more than needed
    - Remove excess before administering
    - Monitor response and be prepared to administer repeated doses
38
Q

Nifedipine (Adalat, Procardia)

  • Classification
  • Indication
  • Route/Dose
A
  1. Calcium Channel Blocker
  2. Reduction of muscle contractions in the smooth muscles such as the uterus in Preterm labor
  3. 10-30 mg 3times/day PO
    - PO
39
Q

Nifedipine (Adalat, Procardia)

  • Adverse Effects
  • Drug Interactions
A
  1. Maternal flushing, dizziness, headache, nausea, tachycardia hypotension, increase blood glucose
  2. Additive hypotension w/ fentanyl, other antihypertensives or nitrates
40
Q

Nifedipine (Adalat, Procardia)

  • Assessment
  • Implications
  • Where Its Used?
A
  1. Monitor BP (fetal/maternal), monitor I/O, Monitor contractions
  2. Teach Pt to change positions slowly and call for help getting out of bed. Teach Pt to report any dizziness, Lightheadedness, or SOB
  3. LD, MB
41
Q

Nubain (Nalbuphine)

  • Classification
  • Indication
  • Route/Dose
A
  1. Opioid analgesics
  2. Moderate to severe pain control
    - Binds to opioid receptors in the CNS
    - Produces generalized CNS depression
  3. 10-20mg q 3-6hr IV
42
Q

Nubain (Nalbuphine)

  • Vs. butorphanol
  • Where Its Used?
A
  1. Nubain is the same as Stadol (butorphanol) but has shown lower FHR accelerations and variability and lower neurobehavioral scores in the newborn
  2. LD, PP
43
Q

Nubain (Nalbuphine)

  • Contraindications
  • Drug interactions
A
  1. Hypersensitivity to nalbuphine or bisulfites
    - Pt physically dependent on opioids who has not detoxified (may precipitate withdrawal)
  2. Use extreme caution in pts getting MAOI’s
    - Avoid concurrent use with other opioid analgesic agonists
44
Q

Nubain (Nalbuphine)

  • Adverse Effects
  • Antidote
A
  1. Dizziness, headache, sedation, dry mouth, N/V/C, Clammy feeling
  2. Narcan
45
Q

Nubain (Nalbuphine)

  • Assessment
  • Implications
A
  1. Assess BP, pulse, RR before and during admin
    - Assess previous analgesic hx (Antagonistic properties can cause withdrawal)
  2. Change position slowly to minimize Orthostatic hypotension
    - Use sugarless gum or candy for dry mouth
    - Turn cough and deep breath to prevent atelectasis
46
Q

Pitocin (Oxytocin)

  • Class
  • Action
  • Route/Dose
A
  1. Oxytocic
  2. Stimulates uterine smooth muscle, resulting in increased strength, duration, and frequency of uterine contractions
    - Vasoactive and antidiuretic properties
  3. IV infusion w/ various dilutions
47
Q

Pitocin (Oxytocin)

-Indication

A
  1. Induction or augmentation of labor at or near term.
  2. Maintenance of firm uterine contractions after birth to control postpartum bleeding
  3. Management of inevitable or incomplete abortion
48
Q

Pitocin (Oxytocin)

  • Contraindications
  • Adverse Effects
  • Where Its Used?
A
  1. Anticipated nonvaginal delivery
  2. Coma, maternal seizures, fetal asphyxia, hypoxia, water intoxication, Uterine rupture,
  3. LD, PP
49
Q

Pitocin Oxytocin

-Nursing Considerations

A
  1. Assess FHR for at least 20 min before induction to ID reassuring or non-reassuring patterns.
  2. Observe uterus, lochia, and cramping
  3. Monitor I&O breath sounds, and bladder distention
50
Q

Pitocin (Oxytocin)

-Things to know **

A
  1. Used for labor induction and augmentation, postpartum hemorrhage and for abortion
  2. It is NOT a cervical ripener
  3. Can cause water toxicity and tetanic contractions
51
Q

RHOGAM (Rho(D)

  • Classification
  • Indication
  • Route/Dose
A
  1. Immunoglobulins
  2. Administered to Rh- woman who have been exposed to Rh+ blood
  3. Standard dose given IM
52
Q

RHOGAM (Rho(D)

  • Contraindications
  • Maternal Considerations
A
  1. Women who are Rh+ or women previously sensitized to Rh should not receive Rh(D) immunoglobulin
  2. Rhogam prevents development of Rh antibodies which might be harmful to subsequent fetuses
53
Q

RHOGAM (Rho(D)

  • Adverse Reactions
  • Timing
  • Where Its Used?
A
  1. DIC, Intravascular hemolysis, ANEMIA
  2. If mother is negative for Rh and blood exposure is suspected, RHOGAM should be given w/in 72 hours
  3. PP
54
Q

RHOGAM (Rho(D)

  • Coombs test
  • Implications
A
  1. COOMBS test tells if the mother already has Rh antibodies
  2. Type and crossmatch the mother and newborn cordblood
    - Mother must be Rh - and negative for Rh antibodies.
    - Newborn must be Rh +. Give med by IM to mother in the deltoid
55
Q

Rubella Vaccine

  • Classification
  • Indication
  • Route/Dose
  • Where Its Used?
A
  1. Attenuated Live Virus Vaccine
    - NOT given during pregnancy due to birth defects
  2. Administered at least 1 month before pregnancy or after childbirth to women who are not immune to rubella
  3. .5ml Subcutaneous
  4. PP
56
Q

Rubella Vaccine

  • Dose
  • Contraindication
  • Adverse Effects
A
  1. .5 mL SUBCUTANEOUSLY
  2. Contraindicated if immunosuppressed, pregnant, egg allergy, respiratory infection, active TB
  3. S/E: Stinging at the site / fever
57
Q

Rubella Vaccine

  • Assessment
  • Implications
A
  1. Assess allergies to egg & current infection
  2. Vials should be refrigerated and used immediately after reconstitution
    - Protect from light
    - Women should avoid pregnancy for at least 1 month
58
Q

Stadol (Butorphanol)

  • Classification
  • Indication
  • Action
  • Route/Dose
A
  1. Opioid agonists antagonists
  2. Analgesia during labor
  3. Binds opiate receptors in CNS & causes generalized CNS depression
  4. .5-2 mg IV
59
Q

Stadol (Butorphanol)

  • Contraindications
  • Adverse Effects
A
  1. Hypersensitivity & Pt physically dependent on opioids (can cause withdrawal)
  2. Confusion, hallucinations, sedation, respiratory depression,
    N/V/C & dry mouth.
60
Q

Stadol (Butorphanol)

  • Drug interaction
  • Assessment
  • Antidote
A
  1. Use extreme caution in Pts on MAOI’s
  2. Assess BP, pulse, RR, Level of sedation, previous analgesic hx
    - Lower risk for dependence than other opioids
  3. Narcan
61
Q

Stadol (Butorphanol)

-Implications

A
  1. Encourage Pt to turn, cough and deep breath every 2hrs to prevent atelectasis
  2. Use sugarless gum or candy to lower dry mouth
62
Q

Terbutaline (Bricanyl)

  • Class
  • Indication
  • Route/Dose
  • Where Its Used?
A
  1. Beta-adrenergic tocolytic agent
  2. Stop preterm labor. Reduce or stop hypertonic labor contractions, whether natural or stimulated
  3. .01 to .05 mg/min IV
  4. LD
63
Q

Terbutaline (Brycanyl)

-Contraindications

A
  1. Hypersensitivity
  2. Before 20 weeks of gestation and if continuing the pregnancy is hazardous to mother or fetus
  3. Uncontrolled diabetes, hyperthyroidism, bronchial dysrhythmias, hypovolemia, uncontrolled HTN
64
Q

Terbutaline (Brycanyl)

  • Assessmment
  • Implications
A
  1. Monitor mom for HR of 120. HOLD med if mom has HR >120
    - Monitor baby glucose
  2. Diagnostic studies such as ECG, blood glucose, electrolytes, urinalysis
    - Maintain adequate hydration. Report HR >120
65
Q

Vitamin K

  • Classification
  • Indication
  • Route/Dose
  • Where Its Used?
A
  1. Fat soluble vitamin, Anti-hemorrhagic
  2. Given to neonate to prevent vitamin K-deficiency bleeding
    - Given within 1hr of birth
  3. .5 - 1mg IM
  4. LD, ICN/NICU
66
Q

Vitamin K

  • Adverse Reaction
  • Nursing Consideration
A
  1. Erythema, pain, edema at injection site,hemolysis or HYPERBILIRUBINEMIA especially in preterm infant or high doses
  2. Protect drug from light until just before admin
    - observe all infants for signs of vitamin K deficiency
    - eccymoses or bleeding from any site
    - check to make sure vitamin K was given before circumcision
67
Q

Motrin

  • Classification
  • Indication
  • Route/Action
A
  1. Antipyretics / nonopioid analgesic
  2. Treat mild to moderate pain & fever
  3. PO, 4-10 mg/kg/dose q6-8hrs
68
Q

Motrin

  • Pregnancy considerations
  • Where Its Used?
A
  1. Category C ( up to 30 wk gestation)
  2. Category D (starting at 30 wk gestation)
    - Don’t give to pregnant women starting after 30 weeks
  3. LD, MB
69
Q

Motrin

-Adverse Effects

A
  1. Headache, dizziness,

2. GI bleeding, hepatitis C/N/V

70
Q

Norco

  • Classification
  • Indication
  • Route/Dose
  • Where Its Used?
A
  1. Opioid analgesics
  2. management of moderate to severe pain
  3. PO, 2.5-10mg q3-6 hrs as needed
  4. PP
71
Q

Norco

  • OB: Lactation
  • Adverse Effects
A
  1. Avoid chronic use during breast feeding

2. Confusion, dizziness, sedation, hypotension, bradycardia C/N/V

72
Q

Norco

  • Assessment
  • Implementation
  • Antidote
A
  1. Assess BP, pulse, RR before and during administration
    - If RR is less than 10 assess level of sedation
    - Assess bowel function regularly
  2. Treat overdose w/ narcan
73
Q

Mylicon (Simethicone)

  • Classification
  • Indication
  • Route/Dose
A
  1. Antiflatulent
  2. Relief of painful symptoms of excess gas
    - Causes coalescence of gas but does not prevent the formation of gas
  3. PO, 40-125 mg qid
74
Q

Mylicon (Simethicone)

  • Contraindications
  • Adverse effects
  • Where Its Used?
A
  1. Not recommended for infant colic
    - Safe for Lactation
  2. NO adverse effects
  3. PP
75
Q

Mylicon (Simethicone)

  • Assessment
  • Implementation
A
  1. Assess Pt for abdo pain ,distention, bowel sounds

2. Administer after meals and at bedtime

OB FIRST WEEK (8 decks)

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