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Nursing 5 - OB > OB Medication Cards > Flashcards

OB Medication Cards Flashcards

1
Q

betamethasone (Celestone)

  1. Class
  2. Indication
  3. Action
  4. Route
  5. Dose
A
  1. Corticosteroid
  2. Acceleration of fetal lung maturity to reduce incidence and severity of 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
  5. IM: 12 mg 2 doses 24 hr apart
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2
Q

betamethasone (Celestone)

  1. Best time to give?
  2. Department it’s used in?
A
  1. Greatest benefit accrue if at least 24 hr elapse between initial dose and birth of the preterm infant.
  2. L&D, NICU
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3
Q

betamethasone (Celestone)

  1. Contraindications
  2. Who to give it to?
A
  1. Active infection (ie chorioamnionitis)
  2. NIH recommends use of corticosteroids for women who have preterm rupture (24-32 weeks) of the membranes
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4
Q

betamethasone (Celestone)

  1. Adverse Reactions
  2. Drug Interaction
A

Few side effects 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, hyperglycemia for mom
  4. May increase need for insulin and hyperglycemic agents
  5. Increase risk of adverse reaction from live virus vaccines
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5
Q

betamethasone (Celestone)

  1. Nursing Considerations
A
  1. More frequent blood sugar checks in diabetics because sugar can be elevated while on corticosteroids
  2. Temporary rise in platelet and WBC levels and 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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6
Q

Calcium Gluconate (10%)

  1. Class
  2. Indication
  3. Antidote
A
  1. Mineral and electrolyte replacement
  2. Reverse magnesium toxicity and prevent respiratory arrest if serum levels become high
  3. ANTIDOTE for magnesium toxicity
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7
Q

Calcium Gluconate

  1. Route
  2. Dose
A
  1. IV
  2. 1-3 g may be administered until response occurs
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8
Q

Calcium Gluconate

  1. Contraindications
  2. Side Effects
A
  1. Hypercalcemia, renal calculi, ventricular fibrillation can cause:
  2. Cardiac arrest, syncope, arrhythmias, headache, C/N/V
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9
Q

Calcium Gluconate

  1. Drug-Drug Interaction
  2. Assessment
A
  1. Concurrent use with diuretics (thiazide) may result in hypercalcemia
  2. Monitor BP, pulse, and ECG frequently
    May cause vasodilation
    • Hypotension, bradycardia, arrhythmias, and cardiac arrest
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10
Q

Cytotec (Misoprostol)

  1. Classification
  2. Indication
  3. Route/Dosage
A
  1. Prostaglandin/Oxytocic
  2. Used in combination with mifepristone (Mifeprex) for TERMINATION of pregnancy, CERVICAL RIPENING and LABOR INDUCTION - stop postpartum bleeding. Not an AUGMENTOR.
  3. PO: 400 mcg single dose 2 days after mifeprex for termination
    Intravaginally: 25 mcg repeat q 3-6 hr if needed
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11
Q

Cytotec (Misoprostol)

  1. Usual use in OB
  2. Pregnancy Category
  3. Breastfeeding
A
  1. Used for elective abortion before 7 weeks
  2. Pregnancy Category X
  3. Passes into breastmilk and can cause severe diarrhea in infants
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12
Q

Cytotec (Misoprostol)

  1. Contraindications
  2. Side Effects
  3. Drug Interaction
A
  1. Hypersensitivity to prostaglandins and should not be used to prevent NSAID induced gastric injury due to potential fetal death
  2. Abdominal pain and diarrhea
  3. Increased risk of diarrhea with magnesium containing antacids
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13
Q

Cytotec (Misoprostol)

  1. Nursing Assessment
  2. Nursing Implications
  3. Where is it used?
A
  1. Monitor uterine cramping, fetal HR, and bleeding
  2. 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
  3. L&D
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14
Q

Erythromycin Eye Ointment (Ilotycin)

  1. Classification
  2. Indication
  3. Route/Dosage
A
  1. Antibiotic
  2. Prophylaxis against the organism NEISERRIA 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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15
Q

Erythromycin Eye Ointment (Ilotycin)

  1. Adverse Reactions
  2. Where is it used?
A
  1. Burning, itching
    • Irritation may result in chemical conjunctivitis lasting 24-48 hours
    • Temporary blurred vision
  2. L&D, NB
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16
Q

Erythromycin Eye Ointment (Ilotycin)

  1. Nursing Considerations
A
  • 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
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17
Q

Fentanyl (Sublimaze)

  1. Class
  2. Indication
  3. Route/Dosage
A
  1. Opioid analgesics
  2. Adjunct to epidural analgesia during labor, produces CNS depression and decreases pain
  3. IV: 25-50 mcg may be repeated q 1 hr or PCA
    • IV used during birth
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18
Q

Fentanyl (Sublimaze)

  1. Adverse Reactions
  2. Contraindications
  3. Where is it used?
A
  1. Less n/v and respiratory depression than Demerol
  2. Hypersensitivity or cross-sensitivity or known intolerance
  3. LD
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19
Q

Fentanyl (Sublimaze)

  1. Drug-Drug Interactions
  2. Nursing Assessment
A
  1. Avoid in patients who have received MAOI’s within previous 14 days
  2. Monitor RR and BP frequently for respiratory depression
    • Antidote - ATROPINE
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20
Q

HBIG (Hepatitis B Immunoglobulin)

  1. Classification
  2. Indication
  3. Route/Dosage
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: 0.5 mL within 12 hr of birth (vastus lateralis for infants)
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21
Q

HBIG (Hepatitis B Immunoglobulin)

  1. Priority Action
  2. Effects of Hepatitis B in Pregnancy
  3. Side Effects
A
  1. Give the HBIG vaccine within 12 hr of birth
  2. Hepatitis B increases incidence of prematurity, low birth weight, and prenatal death
  3. Pain at injection site and local soreness
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22
Q

HBIG (Hepatitis B Immunoglobulin)

  1. Nursing Assessment
  2. Nursing Implications
  3. Where is it used?
A
  1. Monitor infant temperature 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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23
Q

Hemabate (Carboprost)

  1. Classification
  2. Indication
  3. Action
  4. Route/Dose
A
  1. Prostaglandin/oxytocic
  2. Treatment of POSTPARTUM HEMORRHAGE
  3. Stimulates contraction of the uterus
    • Can also be used for abortion
  4. IM: 250 mcg
    • Max dose is 2 mg
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24
Q

Hemabate (Carboprost)

  1. Side Effects
  2. Contraindications
  3. Where is it used?
A
  1. DIARRHEA, n/v, tetanic contractions, uterine rupture
  2. Contraindicated with acute pelvic inflammatory disease, cardiac, pulmonary, renal, or hepatic disease
  3. LD, PP
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25
**Hemabate (Carboprost)** 1. Nursing Considerations
* Keep refrigerated * Give via **DEEP IM** and aspirate carefully to avoid IV injection * Monitor VS * Administer **anti-emetics and antidiarrheals **as ordered
26
**Hepatitis B Vaccine (Neonate)** 1. Vaccine Schedule 2. Route/Dosage 3. Where is it used?
1. 1st dose may be given before discharge or at infants 1st visit to pediatrician, 2nd dose - 2 months, 3rd dose - 6-18 months 2. IM * Adults - deltoid * Infants - vastus lateralis 3. NB
27
**Magnesium Sulfate** 1. Class 2. Indication 3. Where is it used?
1. Miscellaneous anticonvulsant 2. Prevention and control of seizures in severe preeclampsia, prevention of uterine contractions in preterm labor 3. LD, PP
28
**Magnesium Sulfate** 1. 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
29
**Magnesium Sulfate** 1. Contraindications 2. Adverse Reactions
1. Contraindicated in persons with myocardial damage, heart block, myasthemia gravis, or impaired renal function 2. S/E result from magnesium overdose and include flushing, sweating, hypotension, depressed deep tendon reflexes, and CNS depression, including respiratory depression
30
**Magnesium Sulfate** 1. Toxicity
* Magnesium toxicity, possibly r/t incomplete renal drug excretion, may be evidenced by: * Thirst * Mental confusion * Decreased reflexes
31
**Magnesium Sulfate** 1. Nursing Assessment
* RR at least 12/minute * PSO2 95% or higher * Presence of deep tendon reflexes * Urinary output \> 30 mL/hr
32
**Magnesium Sulfate** 1. Breastfeeding 2. Drug-Drug Interaction 3. Antidote
1. Passes into breastmilk * Do not use within 2 hr of labor to prevent toxicity in the newborn 2. May potentiate CCB and neuromuscular blocking agents 3. ANTIDOTE - Calcium Gluconate
33
**Methergine (Methylergonovine)** 1. Classification 2. Indication 3. Usual use in OB 4. Route/Dosage
1. Ergot Alkaloid, Uterine Stimulant 2. Prevention and 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 0.2 mg IM q 2-4 hr max 5 doses * Then PO 0.2 mg 6-7 hrs * Max 7 days
34
**Methergine (Methylergonovine)** 1. Contraindication 2. Adverse Reactions
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, dizziness, headache, chest pain, palpitations, cramping
35
**Methergine (Methylergonovine)** 1. **​**Nursing Considerations 2. Where is it used?
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
36
**Narcan (Naloxone)** 1. Classification 2. Indication 3. Route/Dosage
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. IV: 0.4-2mg
37
**Narcan (Naloxone)** 1. Adverse Reactions 2. Drug Interactions 3. Where is it used?
1. Ventricular arrhythmias, N/V 2. Can precipitate withdrawal in opiate dependent patients * **Don't give to opioid addicted mother** 3. LD, ICN, NICU
38
**Narcan (Naloxone)** 1. Assessment 2. Implications
1. 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 2. Prepare syringe before birth with more than needed * Remove excess before administering * Monitor response and be prepared to administer repeated doses
39
**Nifedipine (Adalat, Procardia)** 1. Classification 2. Indication 3. Route/Dosage
1. CCB 2. Reduction of muscle contractions in the smooth muscles such as the uterus in preterm labor 3. PO: 10-30 mg 3x/day
40
**Nifedipine (Adalat, Procardia)** 1. Adverse Effects 2. Drug Interactions
1. Maternal flushing, dizziness, headache, nausea, tachycardia, hypotension, increased blood glucose 2. Additive hypotension with fentanyl, other antihypertensives or nitrates
41
**Nifedipine (Adalat, Procardia)** 1. Assessment 2. Implications 3. Where is it used?
1. **​**Monitor BP (fetal/maternal), monitor I/O, monitor contractions 2. Teach patient to change positions slowly and call for help getting out of bed * Teach patient to report any dizziness, lightheadedness, or SOB 3. LD, MB
42
**Nubain (Nabulphine)** 1. Classification 2. Indication 3. Route/Dosage
1. Opioid analgesics 2. Moderate to severe pain control * Binds to opioid receptors in the CNS * Produces generalized CNS depression 3. IV: 10-20 mg q 3-6 hr
43
**Nubain (Nabulphine)** 1. VS. butorphanol 2. Where is it used?
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
44
**Nubain (Nalbuphine)** 1. Contraindications 2. Drug Interactions
1. Hypersensitivity to nalbuphine of bisulfites * Patient physically dependent on opioids who has not detoxified * May precipitate withdrawal 2. Use extreme caution in patients getting MAOI's * Avoid concurrent use with other opioid analgesic agonists
45
**Nubain (Nalbuphine)** 1. Adverse Effects 2. Antidote
1. Dizziness, headache, sedation, dry mouth, N/V/C, clammy feeling 2. Narcan
46
**Nubain (Nalbuphine)** 1. Assessment 2. Implications
1. Assess BP, pulse, RR before and during administration * Access 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, deep breathe to prevent atelectasis
47
**Pitocin (Oxytocin)** 1. Class 2. Action 3. Route/Dosage
1. Oxytocic 2. Stimulates uterine smooth muscle, resulting in increased strength, duration, and frequency of uterine contractions * Vasoactive and antidiuretic properties 3. IV infusion with various dilutions
48
**Pitocin (Oxytocin)** 1. Indication
1. Induction of 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
49
**Pitocin (Oxytocin)** 1. Contraindications 2. Adverse Effects 3. Where is it used?
1. Anticipated nonvaginal delivery 2. Coma, maternal seizures, fetal asphyxia, hypoxia, water intoxication, uterine rupture 3. LD, PP
50
**Pitocin (Oxytocin)** 1. 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
51
**Pitocin (Oxytocin)** 1. 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
52
**RHOGAM (Rho(D)** 1. Classification 2. Indication 3. Route/Dosage
1. Immunoglobulins 2. Adminsitered to Rh- women who have been exposed to Rh+ blood 3. Standard dose given IM
53
**RHOGAM (Rho(D)** 1. Contraindications 2. Maternal Considerations
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
54
**RHOGAM (Rho(D)** 1. Adverse Reactions 2. Timing 3. Where is it used?
1. DIC, intravascular hemolysis, **ANEMIA** 2. If mother is negative for Rh and blood exposure is suspected, RHOGAM should be given within 72 hours 3. PP
55
**RHOGAM (Rho(D)** 1. Coombs Test 2. Implications
1. Coombs test tells if the mother already has Rh antibodies 2. 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
56
**Rubella Vaccine** 1. Classification 2. Indication 3. Route/Dosage 4. Where is it used?
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. SC: 0.5 mL 4. PP
57
**Rubella Vaccine** 1. Dose 2. Contraindication 3. Adverse Effects
1. SC: 0.5 mL 2. Contraindicated if immunosuppressed, pregnant, egg allergy, respiratory infection, active TB 3. Stinging at the site, fever
58
**Rubella Vaccine** 1. Assessment 2. Implications
1. Assess allergies to egg and current infection 2. Vials should be refrigerated and used immediately after reconstitution * Protect from light * Women should avoid pregnancy for at least 1 month
59
**Stadol (Butorphanol)** 1. Classification 2. Indication 3. Action 4. Route/Dosage
1. Opioid agonists, antagonists 2. Analgesia during labor 3. Binds opiate receptors in CNS and causes generalized CNS depression 4. IV: 0.5-2 mg
60
**Stadol (Butorphanol)** 1. Contraindications 2. Adverse Effects
1. Hypersensitivity and patient physically dependent on opioids * Can cause withdrawal 2. Confusion, hallucinations, sedation, respiratory depression, N/V/C, dry mouth
61
**Stadol (Butorphanol)** 1. Drug Interaction 2. Assessment 3. Antidote
1. Use extreme caution in patients on MAOI's 2. Assess BP, pulse, RR, level of sedation, previous analgesic hx * Lower risk for dependence than other opioids 3. Narcan
62
**Stadol (Butorphanol)** 1. Implications
* Encourage patient to cough, turn, deep breathe q 2 hr to prevent atelectasis * Use sugarless gum or candy to prevent dry mouth
63
**Terbutaline (Brycanyl)** 1. Class 2. Indication 3. Route/Dosage 4. Where is it used?
1. Beta-adrenergic tocolytic agent 2. Stops preterm labor, reduces or stops hypertonic labor contractions, whether natural or stimulated 3. IV: 0.01-0.05 mg/min 4. LD
64
**Terbutaline (Brycanyl)** 1. 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
65
**Terbutaline (Brycanyl)** 1. Assessment 2. Implications
1. Monitor mom for HR of 120, hold med if HR \> 120 * Monitor infant's glucose 2. Diagnostic studies such as ECG, blood glucose, electrolytes, urinalysis * Maintain adequate hydration * Report HR \> 120
66
**Vitamin K** 1. Classification 2. Indication 3. Route/Dosage 4. Where is it used?
1. Fat soluble vitamin, anti-hemorrhagic 2. Given to neonate to prevent vitamin K-deficiency bleeding * Given with 1 hr of birth 3. IM: 0.5-1 mg 4. LD, ICN/NICU
67
**Vitamin K** 1. Adverse Reaction 2. Nursing Consideration
1. Erythema, pain, edema at injection site, hemolysis or **HYPERBILIRUBINEMIA **especially in preterm infant or high doses 2. 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
68
**Motrin** 1. Classification 2. Indication 3. Route/Dosage
1. Antipyretics, nonopioid analgesic 2. Treat mild-mod pain, fever 3. PO: 4-10 mg/kg/dose q 6-8 hr
69
**Motrin** 1. Pregnancy Considerations 2. Where is it used?
1. Category C - up to 30 weeks gestation * Category D - starting at 30 weeks gestation * *Do not give to pregnant women after starting 30 weeks* 2. *​*LD, MB
70
**Motrin** 1. Adverse Effects
* Headache, dizziness * GI bleeding, hepatitis, C/N/V
71
**Norco** 1. Classification 2. Indication 3. Route/Dosage 4. Where is it used?
1. Opioid analgesics 2. Management of mod-severe pain 3. PO: 2.5-10 mg q 3-6 hrs PRN 4. PP
72
**Norco** 1. OB: Lactation 2. Adverse Effects
1. Avoid chronic use during breastfeeding 2. Confusion, dizziness,s edation, hypotension, bradycardia, C/N/V
73
**Norco** 1. Assessment/Implementation 2. Antidote
1. Assess BP, pulse, RR before and during administration * If RR is \< 10, assess level of sedation * Assess bowel function regularly 2. Narcan
74
**Mylicon (Simethicone)** 1. Classification 2. Indication 3. Route/Dosage
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
75
**Mylicon (Simethicone)** 1. Contraindications 2. Adverse Effects 3. Where is it used?
1. Not recommended for infant colic * Safe for lactation 2. **NO ADVERSE EFFECTS** 3. PP
76
**Mylicon (Simethicone)** 1. Assessment 2. Implementation
1. Assess patient for abdominal pain, distention, bowel sounds 2. Administer after meals and at bedtime

Nursing 5 - OB (2 decks)

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