Perinatal Drugs Flashcards
Butorphanol Tartrate (Stadol)
Classification: Opioid Analgesic
Action: Binds to opiate receptors in CNS
Route: IM (15, 30-60, 180-240)
IV (min, 4-5, 120-240)
Intranasal (15, 60-120, 240-300)
Dosage: 1mg Q3-4H as needed
Side effects/Adverse Reactions: confusion, dysphoria, hallucinations, sedation, nausea, sweating
Contraindications: Hypersensitivity; pt physically dependent on opioids
Nursing Considerations: Assess type, location, and intensity of pain before and peak, assess BP, pulse, and RR before and during, assess analgesic hx, administer IM deep into well-developed muscle (rotate sites)
Interactions Drug-Drug: MAOI, CNS depressants
Interactions Drug-Natural Products: kava-kava, valerian, chamomile, hops
Education: instruct pt when/who to ask for pain meds, do not drive at first, turn, cough and deep breathe Q2H prevent atelectasis, change position slowly, avoid other CNS depressants, good oral hygiene
Fentanyl IV
Classification: opioid analgesic
Route: IM, IV (1-2, 3-5, 30-60)
Dosage: 50-100 mcg
Side effects/Adverse Reactions: apnea, laryngospasm, itching, respiratory distress
Contraindications: hypersensitivity
Interactions Drug-Drug: MAOI, ritonavir, ketoconazole, aprepitant, itraconazole, clarithromycin, nelfinavir, nefazodone, diltiazem, fluconazole, fosamprenavir, verapamil, erythromycin, CNS depressants, nalbuphine, buprenorphine, pentazocine
Interactions Drug-Food: grapefruit juice
Nursing Considerations: monitor RR, BP, assess type, location, and intensity of pain before and peak
Education: discuss use of anesthetic, sensation to expect, explain pain assessment scale, change position slowly, avoid CNS depressants
Meperidine Hydrochloride (Demerol)
Classification: opioid analgesic
Action: binds to opiate receptors in CNS
Route/Dosage: PO (15, 60, 120-240) 50 mg Q3-4H
IM (10-15, 30-50, 120-240) 50 mg Q3-4H
SubQ (10-15, 40-60, 120-240) 50 mg Q3-4H
IV (immediate, 5-7, 120-180) 15-35 mg/hr continuous infusion
Side Effects/Adverse Reactions: confusion, sedation, hypotension, constipation, nausea, vomiting
Interactions Drug-Drug: MAOI, CNS depressants, nalbuphine, pentazocine, protease inhibitors, phenytoin, chlorpromazine, thioridazine, isoniazid, acyclovir
Interactions Drug-Natural Products: kava-kava, valerian, chamomile, St. John’s Wort
Nursing considerations: assess type, location, and intensity of pain before and peak, assess BP, pulse, RR, assess bowel function, dilute sterile water or 0.9% CaCl for INJ, administer slowly over at least 5 min
Education: how/when ask for pain meds, do not drive at first, change position slowly, turn, cough, deep breath Q2H
Morphine Sulfate
Classification: opioid analgesic
Action: bind to opiate receptors in CNS
Route/Dosage: PO (unknown, 60, 240-300) 30 mg Q3-4H >50 kg, 0.3 mg/kg Q3-4H < 50 kg
IM (10-30, 30-60, 240-300) 4-10 mg Q3-4H > 50 kg, 0.05-0.2 mg/kg Q3-4H < 50 kg
SubQ (20, 50-90, 240-300) 4-10 mg Q3-4H > 50 kg, 0.05-0.2 mg/kg Q3-4H < 50 kg
Rectal (unknown, 20-60, 180-420) 30 mg Q3-4H > 50 kg, 0.3 mg/kg Q3-4H < 50 kg
IV (rapid, 20, 240-300) 4-10 mg Q3-4H > 50 kg, 0.05-0.2 mg/kg Q3-4H < 50 kg
Epidural (6-30, 60, up to 24 hr) intermitten 5 mg/day + 1-2 mg (max 10 mg/day)
IT (rapid, unknown, up to 24hr) 0.2-1.0 mg
Side Effects/Adverse Reactions: confusion, sedation, hypotension, constipation
Contraindications: hypersensitivity, products with tartrazine, bisulfites or alcohol, actue/severe bronchial asthma, paralytic ileus
Interactions Drug-Drug: MAOI, CNS depressants, buprenorphine, nalbuphine, butorphanol, pentazocine, warfarin, cimetidine
Interactions Drug-Natural Products: kava-kava, valerian, chamomile
Nursing Considerations: assess type, locations, intensity fo pain before and peak, assess LOC, BP, pulse, RR, assess bowel functions, epidural administer undiluted, if lidocaine test dose administered, flush catheter with 0.9% NaCl, wait 15 minutes, do no admix or administer other medications in epidural space for 48 hr after administration, administer within 4 hr after removing from vial, store in fridge, do not freeze
Nalbuphine Hydrochloride (Nubain)
Classification: opioid analgesic
Action: binds to opiate receptors in CNS
Route/Dosage: IM (<15, 60, 180-360) 10 mg Q3-6H (max 20 mg/dose or 160 mg/day)
SubQ (<15, unknown, 180-360) 10 mg Q3-6H (max 20 mg/dose or 160 mg/day)
IV (2-3, 30, 180-360) 10 mg Q3-6H (max 20 mg/dose or 160 mg/day)
Side Effects/Adverse Reactions: dizziness, headache, sedation, dry mouth, nausea, vomiting, clammy feeling, sweating
Contraindications: hypersensitivity to nalbuphine or bisulfites
Interactions Drug-Drug: MAOI, CNS depressants
Interactions Drug-Natural Products: kava-kava, valerian, skullcap, chamomile, hops
Nursing Considerations: assess type, location, and intensity of pain before and peak, assess BP, pulse, RR, assess analgesic hx, IM administer deep into well-developed muscle, rotate sites
Education: when/how to ask for pain meds, do not drive at first, change position slowly, good oral hygiene, turn a cough, deep breath Q2H, avoid CNS depressants
Dinoprostone (Cervidil) Vaginal Insert
Classification: cervical ripening agent
Action: initiates softening, effacement, and dilation of the cervix
Route/Dosage: insert 0.3 mg/hr over 12 hour period (rapid, unknown, 12 hr)
Side Effects/Adverse Reactions: amniotic fluid embolism
Contraindications: hypersensitivity to prostaglandins, previous cesarean section or uterine surgery, cephalopelvic disproportion, traumatic delivery/difficult labor, more than 6 pregnancies, hyperactive/hypertonic uterus, fetal distress, unexplained vaginal bleeding, placenta previa, vasa previa, active herpes genitalis, obstetric emergency requiring surgical intervention, situations in which vaginal delivery is contraindicated, presence of acute pelvic inflammatory disease or ruptured membranes, concurrent oxytocic therapy
Nursing Considerations: monitor temp, pulse, BP, auscultate breath sounds for wheezing or tightness of chest, assess nausea, vomiting, diarrhea, monitor amount, and type of vaginal discharge, monitor uterine activity, fetal status, and dilation and effacement of cervix continuously, asses for hypertonus, sustained uterine contractility, and fetal distress, administer insert transversely in posterior vaginal fornix, warming/sterile conditions not required, pt should remain supine 2 hr after insertion
Education: explain purpose, inform pt may feel warm feeling in vagina during admin, notify health care provider if contractions become prolonged
Misoprostol (Cytotec)
Classification: prostaglandins
Action: causes uterine contractions
Route/Dosage: PO (30, unknown, 180-360) 25 mg Q3-6H if needed
Side Effects/Adverse Reactions: abdominal pain, diarrhea, miscarriage
Contraindications: hypersensitivity to prostaglandins, OB - should not be used to prevent NSAID-induced gastric injury due to potential for fetal harm or death, Lactation - may cause severe diarrhea in the nursing infant
Interactions Drug-Drug: magnesium-containing antacids
Nursing Considerations: Assess epigastric or abdominal pain, frank or occult blood in stool, emesis or gastric aspirate, assess dialtion of cervix periodically during therapy, admin with meals and bedtime, antacids may be administered before or after
Education: take as directed, full course, do no share, can cause spontaneous abortion, diarrhea may occur, notify if > 1 week, avoid alcohol and foods that cause GI distress
Brethine (Terbutaline)
Classification: bronchodilators
Action: results in accumulation of cAMP at beta-adrenergic receptors
Route/Dosage: SubQ 250 mcg Q1h (15, 30-60, 90-240)
IV 2.5-10 mcg/min infusion +5 mcg/min Q10Min (max 30 mcg/min)
Side Effects/Adverse Reactions: nervousness, restlessness, tremor
Contraindications: hypersensitivity to adrenergic amines
Interactions Drug-Drug: adrenergics, MAOI, beta blockers
Interactions Drug-Natural Product: cola nut, guarana, mate, tea, coffee
Nursing Considerations: monitor maternal pulse, BP, freq/duration contractions, fetal heart rate, assess maternal RR signs pulmonary edema, monitor mother/neonate symptoms hypoglycemia
Education: take as directed, notify SOB, OTC & Rx, notify if labor resumes
Magnesium Sulfate
Classification: mineral and electrolyte replacement/supplement
Action:
Route/Dosage: Loading Dose = 4-6 g IV in 100 ml over 2 mins; Maintenance Dose = 1-4 g/hour titrated to DTR and
serum Mag levels
Side Effects/Adverse Reactions: diarrhea, initially a feeling of warmth, HA, nystagmus, nausea, dry mouth, dizziness; risk of pulmonary edema, sluggishness; in fetus = hypotonia, and lethargy for 1-2 days, hypoG, hypoC
Contraindications: hypermagnesemia, hypocalcemia, anuria, heart block, OB - avoid using more than 5-7 days for preterm labor, avoid continuous use during active labor wor within 2 hr of delivery
Interactions Drug-Drug: calcium channel blocker, neuromuscular blocking agents
Nursing Considerations: monitor newborn for hypotension, hyporeflexia, respiratory depression, monitor I&O
Education: explain purpose of med
Oxytocin (Pitocin)
Classification: hormones
Action: stimulates uterine smooth muscles, producing uterine contractions
Route/Dosage: IV (immediate, unknown, 60) 0.5-1.0 milliunits/min + 1-2 milliunits/min Q30-60Min
Side Effects/Adverse Reactions: Coma, seizure, intracranial hemorrhage, asphyxia, uterine motility, painful contractions
Contraindications: hypersensitivity, anticipated nonvaginal delivery
Interactions Drug-Drug: vasopressors
Nursing Considerations: assess fetal maturity, presentation, pelvic adequacy, character, freq, duration uterine contractions, resting uterine tone, FHR, monitor maternal BP, pulse, S&S water intoxication
Education: Advise pt to expect contraction similar to menstrual cramps after admin started
Carboprost tromethamine (Hemobate)
Classification: abortifactients
Action: causes uterine contractions by directly stimulating the myometrium
Route/Dosage: IM (unknown, 16hr, unknown) 250 mcg Q1.5-3/5H (max 2 days or 12mg)
Side Effects/Adverse Reactions: diarrhea, nausea, vomiting, fever
Contraindications: hypersensitivity, acute pelvic inflammatory disease, active pulmonary, renal or hepatic disease
Interactions Drug-Drug: oxytocic agents
Nursing Considerations: monitor freq, duration and force of contractions and uterine resting tone, monitor temp, pulse, BP, auscultate breath sounds for wheezing and chest tightness, assess nausea, vomiting, diarrhea, monitor amount/type vaginal discharge
Education: notify health care provider immediately if fever/chills, foul-smelling vaginal discharge, lower abdominal pain, or increase bleeding occurs
Methylergonovine Maleate (Methergine)
Classification: oxytocic
Action: directly stimulates uterine smooth muscle
Route/Dosage: PO (5-15, unknown, 180) 200-400 mcg Q6-12H for 2-7 days
IM (2-5, unknown, 180) 200 mcg Q2-4H 5 doses
IV (immediate, unknown, 45-180) 200 mcg Q2-4H 5 doses
Side Effects/Adverse Reactions: nausea, vomiting, cramps, stroke
Contraindications: hypersensitivity, OB - should not be used to induce labor, Lactation - do not breast feed during treatment and for 12 hours after the last does
Interactions Drug-Drug: vasopressors, erythromycin, clarithromycin, troleandomycin, ritonavir, indinavir, nelfinavir, delavirdine, ketoconazole, itraconazole, voriconazole, saquinavir, nefazodone, fluconazole, fluoxetine, fluvoxamine, zileuton, clotrimazole, nevirapine, rifampin, anesthetics, nitrates
Interactions Drug-Natural Product: grapefruit juice
Nursing Considerations: monitor BP, HR, uterine response, assess signs or ergotism
Education: take as directed, may cause menstrual-like cramps, avoid smoking, notify infection develops, OTC & Rx
Promethazine hydrochloride (Phenergan)
Classification: antiemetic
Action: blocks the effects of histamine
Route/Dosage: PO, IM 20 min unknown 4–12 hr
IV 3–5 min unknown 4–12 hr 50 mg in early labor; when labor is established, additional doses of
25– 75 mg may be given 1– 2 times at 4-hr intervals (should not exceed 100 mg/24
hr).
Side Effects/Adverse Reactions: neuroleptic malignant syndrome, confusion, disorientation, sedation
Contraindications: Hypersensitivity; Comatose patients; Prostatic hypertrophy;
Bladder neck obstruction; Some products contain alcohol or bisulfites and should be
avoided in patients with known intolerance; Angle-closure glaucoma
Interactions Drug-Drug: MAOI, CNS depressants, anticholinergics
Nursing Considerations: monitor BP, pulse, RR, assess level of sedation, monitor for EPS, NMS
Education: do no drive at first, good oral hygiene, sunscreen, change positions slowly, avoid CNS depressants, notify sore throat, fever, jaundice, uncontrolled movements
Erythromycin ophthalmic ointment
Classification: anti-infectives
Action: suppresses protein synthesis of bacterial ribosome
Route/Dosage: ophthalmic ointment 0.5 to 1 cm strip along lower conjunctival surface of each eye, inner canthus to outer canthus
Side Effects/Adverse Reactions: Torsade de Pointes, ventricular arrhythmias, pseudomembranous colitis, nausea, vomiting, phlebitis, rash, allergic rxn
Contraindications:
Interactions Drug-Drug: pimozide, diltiazem, verapamil, ketoconazole, itraconazole, nefazodone, and protease inhibitors, ergotamine, dihydroergotamine, amiodarone, dofetilide, sotalol, verapamil, sildenafil, tadalafil
vardenafil, alfentanil, alprazolam, bromocriptine, carbamazepine, cyclosporine,
cilostazol diazepam disopyramide, ergot alkaloids, felodipine, methylprednisolone,
midazolam, quinidine, rifabutin, tacrolimus, triazolam, or
vinblastine, lovastatin, simvastatin, digoxin, theophylline, warfarin
Nursing Considerations: assess for infections, monitor bowel functions, wash hands before applying, apply before 1 hour after birth
Education: notify fever, diarrhea
Vitamin K (Aquamephyton)
Classification: vitamins
Action: required for hepatic syntheses of blood coagulation factors II
Route/Dosage: IM 0.5-1 mg within 1 hr of birth, may repeat in 6-8 hrs if needed (60-120, normal PT achieved 12 to 14 hours)
Side Effects/Adverse Reactions: pain at site, hyperbilirubinemia if dose is too large, kernicterus, rash
Contraindications: Hypersensitivity; Hypersensitivity or intolerance to benzyl alcohol
(injection only)
Interactions Drug-Drug: warfarin, salicylates, anti-infectives, bile acid sequestrants, mineral oil, sucralfate
Nursing Considerations: monitor frank and occult bleeding, monitor
pulse and blood pressure frequently; Apply pressure to all venipuncture sites for at least 5 min; avoid unnecessary IM
injections
Education: report any symptoms of unusual bleeding or bruising, OTC & Rx
