OB Medication Cards Flashcards
betamethasone (Celestone)
- Class
- Indication
- Action
- Route
- Dose
- Corticosteroid
- Acceleration of fetal lung maturity to reduce incidence and severity of RDS
- Reduces incidence of intra-ventricular hemorrhage and neonatal death in the preterm infant
- Reduces inflammation of the bronchial tubes and speeds lung development
- IM: 12 mg 2 doses 24 hr apart
betamethasone (Celestone)
- Best time to give?
- Department it’s used in?
- Greatest benefit accrue if at least 24 hr elapse between initial dose and birth of the preterm infant.
- L&D, NICU
betamethasone (Celestone)
- Contraindications
- Who to give it to?
- Active infection (ie chorioamnionitis)
- NIH recommends use of corticosteroids for women who have preterm rupture (24-32 weeks) of the membranes
betamethasone (Celestone)
- Adverse Reactions
- Drug Interaction
Few side effects if used for short duration.
- Increased risk of CD in women who received > 4 doses
- Pulmonary edema secondary to sodium and fluid retention
- Increased hunger, anxiety, and BP
- Hypoglycemia for baby, hyperglycemia for mom
- May increase need for insulin and hyperglycemic agents
- Increase risk of adverse reaction from live virus vaccines
betamethasone (Celestone)
- Nursing Considerations
- More frequent blood sugar checks in diabetics because sugar can be elevated while on corticosteroids
- Temporary rise in platelet and WBC levels and may last 72 hours
- WBC levels > 20,000 may indicate infection
- Assess lung sounds/report chest pain or heaviness or dyspnea
Calcium Gluconate (10%)
- Class
- Indication
- Antidote
- Mineral and electrolyte replacement
- Reverse magnesium toxicity and prevent respiratory arrest if serum levels become high
- ANTIDOTE for magnesium toxicity
Calcium Gluconate
- Route
- Dose
- IV
- 1-3 g may be administered until response occurs
Calcium Gluconate
- Contraindications
- Side Effects
- Hypercalcemia, renal calculi, ventricular fibrillation can cause:
- Cardiac arrest, syncope, arrhythmias, headache, C/N/V
Calcium Gluconate
- Drug-Drug Interaction
- Assessment
- Concurrent use with diuretics (thiazide) may result in hypercalcemia
- Monitor BP, pulse, and ECG frequently
May cause vasodilation- Hypotension, bradycardia, arrhythmias, and cardiac arrest
Cytotec (Misoprostol)
- Classification
- Indication
- Route/Dosage
- Prostaglandin/Oxytocic
- Used in combination with mifepristone (Mifeprex) for TERMINATION of pregnancy, CERVICAL RIPENING and LABOR INDUCTION - stop postpartum bleeding. Not an AUGMENTOR.
- PO: 400 mcg single dose 2 days after mifeprex for termination
Intravaginally: 25 mcg repeat q 3-6 hr if needed
Cytotec (Misoprostol)
- Usual use in OB
- Pregnancy Category
- Breastfeeding
- Used for elective abortion before 7 weeks
- Pregnancy Category X
- Passes into breastmilk and can cause severe diarrhea in infants
Cytotec (Misoprostol)
- Contraindications
- Side Effects
- Drug Interaction
- Hypersensitivity to prostaglandins and should not be used to prevent NSAID induced gastric injury due to potential fetal death
- Abdominal pain and diarrhea
- Increased risk of diarrhea with magnesium containing antacids
Cytotec (Misoprostol)
- Nursing Assessment
- Nursing Implications
- Where is it used?
- Monitor uterine cramping, fetal HR, and bleeding
- Inform patient that the med will cause spontaneous abortion
- They will feel cramping
- If abortion is incomplete, surgery may be necessary
- Use contraception for one menstrual cycle following treatment
- L&D
Erythromycin Eye Ointment (Ilotycin)
- Classification
- Indication
- Route/Dosage
- Antibiotic
- Prophylaxis against the organism NEISERRIA GONORRHOEAE (Gonorrhea), not for syphillis or chlamydia
- Prevents ophthalmia neonatorum in infants of mother with gonorrhea
- Ribbon of eye ointment applied to lower conjunctival sac
Erythromycin Eye Ointment (Ilotycin)
- Adverse Reactions
- Where is it used?
- Burning, itching
- Irritation may result in chemical conjunctivitis lasting 24-48 hours
- Temporary blurred vision
- L&D, NB
Erythromycin Eye Ointment (Ilotycin)
- Nursing Considerations
- Cleanse infant’s eyes as needed before application
- Hold tube in a horizontal rather than vertical position
- Administer from inner to outer canthus
- Do not touch the tip of the tube to any part of the eye
- Use new tube for each infant
Fentanyl (Sublimaze)
- Class
- Indication
- Route/Dosage
- Opioid analgesics
- Adjunct to epidural analgesia during labor, produces CNS depression and decreases pain
- IV: 25-50 mcg may be repeated q 1 hr or PCA
- IV used during birth
Fentanyl (Sublimaze)
- Adverse Reactions
- Contraindications
- Where is it used?
- Less n/v and respiratory depression than Demerol
- Hypersensitivity or cross-sensitivity or known intolerance
- LD
Fentanyl (Sublimaze)
- Drug-Drug Interactions
- Nursing Assessment
- Avoid in patients who have received MAOI’s within previous 14 days
- Monitor RR and BP frequently for respiratory depression
- Antidote - ATROPINE
HBIG (Hepatitis B Immunoglobulin)
- Classification
- Indication
- Route/Dosage
- Vaccine/immune globulins
- Prevents hepatitis B infection in neonates born to hepatitis B POSITIVE women by providing passive immunity
- ONLY GIVEN IF MOTHER IS HEP B POSITIVE
- IM: 0.5 mL within 12 hr of birth (vastus lateralis for infants)
HBIG (Hepatitis B Immunoglobulin)
- Priority Action
- Effects of Hepatitis B in Pregnancy
- Side Effects
- Give the HBIG vaccine within 12 hr of birth
- Hepatitis B increases incidence of prematurity, low birth weight, and prenatal death
- Pain at injection site and local soreness
HBIG (Hepatitis B Immunoglobulin)
- Nursing Assessment
- Nursing Implications
- Where is it used?
- Monitor infant temperature for s/s of infection
- 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
- PP, NB
Hemabate (Carboprost)
- Classification
- Indication
- Action
- Route/Dose
- Prostaglandin/oxytocic
- Treatment of POSTPARTUM HEMORRHAGE
- Stimulates contraction of the uterus
- Can also be used for abortion
- IM: 250 mcg
- Max dose is 2 mg
Hemabate (Carboprost)
- Side Effects
- Contraindications
- Where is it used?
- DIARRHEA, n/v, tetanic contractions, uterine rupture
- Contraindicated with acute pelvic inflammatory disease, cardiac, pulmonary, renal, or hepatic disease
- LD, PP
Hemabate (Carboprost)
- Nursing Considerations
- Keep refrigerated
- Give via DEEP IM and aspirate carefully to avoid IV injection
- Monitor VS
- Administer **anti-emetics and antidiarrheals **as ordered
Hepatitis B Vaccine (Neonate)
- Vaccine Schedule
- Route/Dosage
- Where is it used?
- 1st dose may be given before discharge or at infants 1st visit to pediatrician, 2nd dose - 2 months, 3rd dose - 6-18 months
- IM
- Adults - deltoid
- Infants - vastus lateralis
- NB
Magnesium Sulfate
- Class
- Indication
- Where is it used?
- Miscellaneous anticonvulsant
- Prevention and control of seizures in severe preeclampsia, prevention of uterine contractions in preterm labor
- LD, PP
Magnesium Sulfate
- Route/Dosage
- IV
- Deep IM
- IM is painful, not recommended
- Loading dose of 4-6 g of mg sulfate in 100 mL IV fluid over 15-20 minutes, then 2 g/hr maintenance dose
Magnesium Sulfate
- Contraindications
- Adverse Reactions
- Contraindicated in persons with myocardial damage, heart block, myasthemia gravis, or impaired renal function
- S/E result from magnesium overdose and include flushing, sweating, hypotension, depressed deep tendon reflexes, and CNS depression, including respiratory depression
Magnesium Sulfate
- Toxicity
- Magnesium toxicity, possibly r/t incomplete renal drug excretion, may be evidenced by:
- Thirst
- Mental confusion
- Decreased reflexes
Magnesium Sulfate
- Nursing Assessment
- RR at least 12/minute
- PSO2 95% or higher
- Presence of deep tendon reflexes
- Urinary output > 30 mL/hr
Magnesium Sulfate
- Breastfeeding
- Drug-Drug Interaction
- Antidote
- Passes into breastmilk
- Do not use within 2 hr of labor to prevent toxicity in the newborn
- May potentiate CCB and neuromuscular blocking agents
- ANTIDOTE - Calcium Gluconate
Methergine (Methylergonovine)
- Classification
- Indication
- Usual use in OB
- Route/Dosage
- Ergot Alkaloid, Uterine Stimulant
- Prevention and treatment of postpartum or post-abortion hemorrhage caused by uterine atony or sub-involution
- Used for uterine contraction during hemorrhage
- Usual dose is 0.2 mg IM q 2-4 hr max 5 doses
- Then PO 0.2 mg 6-7 hrs
- Max 7 days
Methergine (Methylergonovine)
- Contraindication
- Adverse Reactions
- **NEVER **use during pregnancy to induce labor
- Contraindicated in women with HTN, severe renal or hepatic disease, thrombophlebitis, CAD, PVD, or sepsis
- N/V, uterine cramping, HTN, dizziness, headache, chest pain, palpitations, cramping
Methergine (Methylergonovine)
- Nursing Considerations
- Where is it used?
- Assess the BP before administration
- Follow protocol on what BP level to hold medication
- Caution mother to avoid smoking (can constrict vessels)
- LD & PP
Narcan (Naloxone)
- Classification
- Indication
- Route/Dosage
- Opioid antagonists
- 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
- IV: 0.4-2mg
Narcan (Naloxone)
- Adverse Reactions
- Drug Interactions
- Where is it used?
- Ventricular arrhythmias, N/V
- Can precipitate withdrawal in opiate dependent patients
- Don’t give to opioid addicted mother
- LD, ICN, NICU
Narcan (Naloxone)
- Assessment
- Implications
- Assess RR, rhythm, depth (both mother and infant)
- Pulse, BP, LOC for 3-4 hr after peak blood concentrations
- Assess S/S of withdrawal/vomiting, restlessness, increased BP
- Prepare syringe before birth with more than needed
- Remove excess before administering
- Monitor response and be prepared to administer repeated doses
Nifedipine (Adalat, Procardia)
- Classification
- Indication
- Route/Dosage
- CCB
- Reduction of muscle contractions in the smooth muscles such as the uterus in preterm labor
- PO: 10-30 mg 3x/day
Nifedipine (Adalat, Procardia)
- Adverse Effects
- Drug Interactions
- Maternal flushing, dizziness, headache, nausea, tachycardia, hypotension, increased blood glucose
- Additive hypotension with fentanyl, other antihypertensives or nitrates
Nifedipine (Adalat, Procardia)
- Assessment
- Implications
- Where is it used?
- Monitor BP (fetal/maternal), monitor I/O, monitor contractions
- Teach patient to change positions slowly and call for help getting out of bed
- Teach patient to report any dizziness, lightheadedness, or SOB
- LD, MB
Nubain (Nabulphine)
- Classification
- Indication
- Route/Dosage
- Opioid analgesics
- Moderate to severe pain control
- Binds to opioid receptors in the CNS
- Produces generalized CNS depression
- IV: 10-20 mg q 3-6 hr
Nubain (Nabulphine)
- VS. butorphanol
- Where is it used?
- Nubain is the same as Stadol (butorphanol) but has shown lower FHR accelerations and variability and lower neurobehavioral scores in the newborn
- LD, PP
Nubain (Nalbuphine)
- Contraindications
- Drug Interactions
- Hypersensitivity to nalbuphine of bisulfites
- Patient physically dependent on opioids who has not detoxified
- May precipitate withdrawal
- Patient physically dependent on opioids who has not detoxified
- Use extreme caution in patients getting MAOI’s
- Avoid concurrent use with other opioid analgesic agonists
Nubain (Nalbuphine)
- Adverse Effects
- Antidote
- Dizziness, headache, sedation, dry mouth, N/V/C, clammy feeling
- Narcan
Nubain (Nalbuphine)
- Assessment
- Implications
- Assess BP, pulse, RR before and during administration
- Access previous analgesic hx
- Antagonistic properties can cause withdrawal
- Access previous analgesic hx
- Change position slowly to minimize orthostatic hypotension
- Use sugarless gum or candy for dry mouth
- Turn, cough, deep breathe to prevent atelectasis
Pitocin (Oxytocin)
- Class
- Action
- Route/Dosage
- Oxytocic
- Stimulates uterine smooth muscle, resulting in increased strength, duration, and frequency of uterine contractions
- Vasoactive and antidiuretic properties
- IV infusion with various dilutions
Pitocin (Oxytocin)
- Indication
- Induction of augmentation of labor at or near term
- Maintenance of firm uterine contractions after birth to control postpartum bleeding
- Management of inevitable or incomplete abortion
Pitocin (Oxytocin)
- Contraindications
- Adverse Effects
- Where is it used?
- Anticipated nonvaginal delivery
- Coma, maternal seizures, fetal asphyxia, hypoxia, water intoxication, uterine rupture
- LD, PP
Pitocin (Oxytocin)
- Nursing Considerations
- Assess FHR at least 20 min before induction to ID reassuring or non-reassuring patterns
- Observe uterus, lochia, and cramping
- Monitor I/O, breath sounds, bladder distention
Pitocin (Oxytocin)
- Important things to know
- Used for labor induction and augmentation, postpartum hemorrhage, and for abortion
- It is NOT A CERVICAL RIPENER
- Can cause water toxicity and tetanic contractions
RHOGAM (Rho(D)
- Classification
- Indication
- Route/Dosage
- Immunoglobulins
- Adminsitered to Rh- women who have been exposed to Rh+ blood
- Standard dose given IM
RHOGAM (Rho(D)
- Contraindications
- Maternal Considerations
- Women who are Rh+ or women previously sensitized to Rh should not receive Rh(D) immunoglobulin
- Rhogam prevents development of Rh antibodies which might be harmful to subsequent fetuses
RHOGAM (Rho(D)
- Adverse Reactions
- Timing
- Where is it used?
- DIC, intravascular hemolysis, ANEMIA
- If mother is negative for Rh and blood exposure is suspected, RHOGAM should be given within 72 hours
- PP
RHOGAM (Rho(D)
- Coombs Test
- Implications
- Coombs test tells if the mother already has Rh antibodies
- Type and corssmatch 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 deltoid
Rubella Vaccine
- Classification
- Indication
- Route/Dosage
- Where is it used?
- Attenuated live virus vaccine
- **NOT GIVEN DURING PREGNANCY **due to birth defects
- Administered at least 1 month before pregnancy or after childbirth to women who are not immune to rubella
- SC: 0.5 mL
- PP
Rubella Vaccine
- Dose
- Contraindication
- Adverse Effects
- SC: 0.5 mL
- Contraindicated if immunosuppressed, pregnant, egg allergy, respiratory infection, active TB
- Stinging at the site, fever
Rubella Vaccine
- Assessment
- Implications
- Assess allergies to egg and current infection
- Vials should be refrigerated and used immediately after reconstitution
- Protect from light
- Women should avoid pregnancy for at least 1 month
Stadol (Butorphanol)
- Classification
- Indication
- Action
- Route/Dosage
- Opioid agonists, antagonists
- Analgesia during labor
- Binds opiate receptors in CNS and causes generalized CNS depression
- IV: 0.5-2 mg
Stadol (Butorphanol)
- Contraindications
- Adverse Effects
- Hypersensitivity and patient physically dependent on opioids
- Can cause withdrawal
- Confusion, hallucinations, sedation, respiratory depression, N/V/C, dry mouth
Stadol (Butorphanol)
- Drug Interaction
- Assessment
- Antidote
- Use extreme caution in patients on MAOI’s
- Assess BP, pulse, RR, level of sedation, previous analgesic hx
- Lower risk for dependence than other opioids
- Narcan
Stadol (Butorphanol)
- Implications
- Encourage patient to cough, turn, deep breathe q 2 hr to prevent atelectasis
- Use sugarless gum or candy to prevent dry mouth
Terbutaline (Brycanyl)
- Class
- Indication
- Route/Dosage
- Where is it used?
- Beta-adrenergic tocolytic agent
- Stops preterm labor, reduces or stops hypertonic labor contractions, whether natural or stimulated
- IV: 0.01-0.05 mg/min
- LD
Terbutaline (Brycanyl)
- Contraindications
- Hypersensitivity
- Before 20 weeks of gestation and if continuing the pregnancy is hazardous to mother or fetus
- Uncontrolled diabetes, hyperthyroidism, bronchial dysrhythmias, hypovolemia, uncontrolled HTN
Terbutaline (Brycanyl)
- Assessment
- Implications
- Monitor mom for HR of 120, hold med if HR > 120
- Monitor infant’s glucose
- Diagnostic studies such as ECG, blood glucose, electrolytes, urinalysis
- Maintain adequate hydration
- Report HR > 120
Vitamin K
- Classification
- Indication
- Route/Dosage
- Where is it used?
- Fat soluble vitamin, anti-hemorrhagic
- Given to neonate to prevent vitamin K-deficiency bleeding
- Given with 1 hr of birth
- IM: 0.5-1 mg
- LD, ICN/NICU
Vitamin K
- Adverse Reaction
- Nursing Consideration
- Erythema, pain, edema at injection site, hemolysis or **HYPERBILIRUBINEMIA **especially in preterm infant or high doses
- Protect drug from light unjust just before administration
- 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
Motrin
- Classification
- Indication
- Route/Dosage
- Antipyretics, nonopioid analgesic
- Treat mild-mod pain, fever
- PO: 4-10 mg/kg/dose q 6-8 hr
Motrin
- Pregnancy Considerations
- Where is it used?
- Category C - up to 30 weeks gestation
- Category D - starting at 30 weeks gestation
- Do not give to pregnant women after starting 30 weeks
- LD, MB
Motrin
- Adverse Effects
- Headache, dizziness
- GI bleeding, hepatitis, C/N/V
Norco
- Classification
- Indication
- Route/Dosage
- Where is it used?
- Opioid analgesics
- Management of mod-severe pain
- PO: 2.5-10 mg q 3-6 hrs PRN
- PP
Norco
- OB: Lactation
- Adverse Effects
- Avoid chronic use during breastfeeding
- Confusion, dizziness,s edation, hypotension, bradycardia, C/N/V
Norco
- Assessment/Implementation
- Antidote
- Assess BP, pulse, RR before and during administration
- If RR is < 10, assess level of sedation
- Assess bowel function regularly
- Narcan
Mylicon (Simethicone)
- Classification
- Indication
- Route/Dosage
- Antiflatulent
- Relief of painful symptoms of excess gas
- Causes coalescence of gas but does not prevent the formation of gas
- PO: 40-125 mg QID
Mylicon (Simethicone)
- Contraindications
- Adverse Effects
- Where is it used?
- Not recommended for infant colic
- Safe for lactation
- NO ADVERSE EFFECTS
- PP
Mylicon (Simethicone)
- Assessment
- Implementation
- Assess patient for abdominal pain, distention, bowel sounds
- Administer after meals and at bedtime