Medication: L&D/Antepartum Flashcards
Normal Dose and Route:
IV: 1mg
IM: 2mg
Intranasal: 1mg
Indication in Obstetrics:
Management of moderate to severe pain. Analgesia during labor.
Side Effects:
Confusion, dysphonia, hallucinations, sedation, euphoria, floating feeling, headache, crazy dreams, nausea, sweating, meiosis if given in high doses, blurred vision, diplopia
What is the name of this medication?
Butorphanol/Stadol
Normal Dose and Route:
PO:
If given to terminate pregnancy: 400mcg single dose is given 2 days after the patient was given Mifepristone if the abortion has not occurred yet.
Given ALONE: If given to ripen the cervix: 25mcg Q3-6 hours PRN
Indication in Obstetrics:
This given with Mifepristone for the termination of pregnancy. It is used alone to ripen the cervix and induce labor.
Side Effects:
Abdominal pain, diarrhea, nausea, vomiting, flatulence, dyspepsia, headaches, miscarriage, menstrual disorders, and constipation
What is the name of this medication?
Cytotec/Misoprostol
Normal Dose and Route:
IV: 2.5-10 mcg/min infusion which will be increased by 5 mcg/min Q10 minutes until contractions stop. NOT to exceed 30 mcg/min.
SubQ: 250 mcg
IM: This is NOT used for prevention and or treatment of preterm labor because it is related to causing maternal cardiovascular defects and death.
Indication in Obstetrics:
Used to control and stop preterm labor it has a tocolytic effect.
Side Effects:
Tremor, pulmonary edema, angina, headache, arrhythmias, hypertension, myocardial ischemia, tachycardia, nausea, vomiting, hyperglycemia, hypokalemia, anxiety
What is the name of this medication?
Brethine/Terabutaline
Study Tip:
Tocolytics also called anti-contraction medications or labor repressants are medications used to suppress premature labor (from the Greek tokos, childbirth, and lytic, capable of dissolving). They are given when delivery would result in premature birth.
Nursing Implications:
- Respirations should be at least 16 beats per minute before each dose.
- Monitor blood pressure, pulse, respiratory rate, and EKG frequently.
- Assess neurological status and institute seizure precautions.
- Test the patellar reflex (knee jerk) before each dose. If the response is absent DO NOT give the medication until you get a positive response.
- Monitor intake/output. Urine output must be a minimum of 100mL/hr.
- Monitor the baby for decreased respirations, hypotension, and hyporeflexia.
What is the name of this medication?
Magnesium Sulfate /MgSO4
U
Ephedrine
Normal Dose and Route:
IM: 12mg/day for 2-3 days before the delivery date.
Indication in Obstetrics:
Short term therapy for high risk mothers before delivery to prevent respiratory distress syndrome in the newborn.
Side Effects:
Peptic ulcer ration, thromboembolism, depression, euphoria, hypertension, decreased want to healing, hirsutism, nausea, vomiting, anorexia, osteoporosis, appearance, muscle pain, weight gain
What is the name of this medication?
Betamethasone/Celestone
Normal Dose and Route:
PO: 200-400mcg Q6-12 hours for 2-7 days.
IV/IM: 200 mcg Q2-4 hours for up to 5 doses.
Indication in Obstetrics:
Given to prevent and treat postpartum post abortion hemorrhage caused by uterine autony or subinvolution.
Side Effects:
Stroke, hypertension, nausea, vomiting, chest pain, headache, tinnitus, cramps, diaphoresis, paresthesia
What is the name of this medication?
Methylergonovine/Methergine
Normal Dose and Route:
IV: 0.5-1 milliunit/min increased by 1-2 milliunits/min q 30-60 min until desired contraction pattern established. Dose may be decreased after desired frequency of contractions is reached and labor has progressed to 5-6cm dilation.
IM: 10 units
This medication should not be given simultaneously by multiple routes.
Indication in Obstetrics:
IV: Induction of labor at term.
IV: Aids in facilitating inevitable abortions.
IV/IM: Post Partum - Used to control bleeding after expulsion of the placenta.
Side Effects:
Mom: Coma, seizures, hypotension, decreased blood flow, hyponatremia, hypochloremia
Fetus: Intracranial hemorrhage, asphyxia, hypoxia, arrhythmias
Side effects occur with IV use only.
What is the name of this medication?
Oxytocin/Pitocin
Nursing Implications:
- Monitor mothers electrolytes.
Ex. H20 retention
- Assess fetal maturity, presentation, and pelvic adequacy before giving to induce labor.
- Monitor mom’s Blood Pressure and Pulse and Monitor fetal Heart Rate continuously.
- Assess resting uterine tone.
- Assess character, frequency, and duration of uterine contractions.
Ex. If contractions are
Oxytocin/Pitocin
Nursing Implications:
- Assess pain 30 - 60 minutes after giving via IM. Assess pain 5 minutes after giving via IV. Assess pain 60 - 90 minutes after giving via intranasal.
- Assess blood pressure, pulse, and respirations both before and after administering.
Ex. Respirations
Stadol/Butorphanol
Nursing Implications:
- Monitor mom’s pulse, blood pressure, frequency, duration of contractions, and fetal heart rate.
- Notify the Dr. If contractions persist, increased frequency, increased duration of contractions, or if fetal distress occurs.
- Assess mom for pulmonary edema.
Ex. Increased respiratory rate, dyspnea, rales, crackles, and frothy sputum.
Monitor mom and baby for s/sx of hypoglycemia.
- Assess mom for hypokalemia and decreased blood sugar.
What is the name of this medication?
Terbutaline/Brethine
Normal Dose and Route:
Given IV first then IM.
4-6 g by IV infusion given concurrently with 5 g IM injections into both butt cheeks.
This is followed by either 4-5 g given IM Q4 hours or 4 g IV infusion at 1-2 g/hr continuously.
Indication in Obstetrics:
Used to prevent seizures related to severe eclampsia and pre-eclampsia. Used to prevent pre-term labor.
Side Effects:
Drowsiness, decreased respiratory rate, bradycardia, hypotension, diarrhea, muscle weakness, sweating, flushing, hypothermia, arrhythmias
What is the name of this medication?
Magnesium Sulfate (MgSO4)
Nursing Implications:
- Monitor labs including: blood sugar, electrolytes, and CBC.
- This medication can increase blood in urine glucose.
- This medication decreases potassium levels causing hypokalemia.
- This medication increases both calcium levels and increased sodium levels.
- This medication may decrease white blood cells which increases the patient’s risk for infection.
- Assess guiac stools.
- Assess level of consciousness frequently. - Assess for peripheral Adema.
- Monitor intake/output.
- Assess the patient for adrenal insufficiency.
What is the name of this medication?
Betamethasone/Celestone
Nursing Implications:
- Termination of Pregnancy:
Monitor uterine cramping and bleeding during therapy.
- Cervical Ripening:
Assess dilation of cervix periodically during therapy.
What is the name of this medication?
Cytotec/Misoprostol
Nursing Implications:
- Monitor blood pressure, heart rate, and uterine response frequently.
- Notify Dr. if you don’t relaxation becomes prolonged or if character of vaginal bleeding changes.
- Assess prolactin levels.
- Assess for signs of ergotism.
Ex. coldness, numbness ect.
- if patient is not responding to the medication check their calcium levels. There is decreased effectiveness when giving this medication if the patient has hypocalcemia.
What is the name of this medication?
Methylergonovine/Methergine
