Postpartum Medications

Question 1

Acetaminophen (Tylenol)

Answer 1

• Pregnancy category B; anemia, lactation
• Nonopioid analgesic
• Inhibits prostaglandin synthesis
• Hepatotoxicity, hepatic seizure (overdose); renal failure; leukopenia, neutropenia, hemolytic anemia (long-term use), thrombocytopenia, pancytopenia; hypersensitivity; toxicity: cyanosis, anemia, neutropenia, jaundice, pancytopenia, CNS stimulation, delirium followed by vascular collapse, convulsions, coma, death
• Monitor liver function studies: AST, ALT, bilirubin; renal function: BUN, urine creatinine, occult blood, albumin (nephritis); blood studies: CBC, pro-time; assess for fever and pain; chronic poisoning: rapid, weak pulse, dyspnea, cold, clammy extremities; hepatotoxicity: dark urine, clay-colored stools, yellowing of the skin and sclera, itching, abdominal pain, fever, diarrhea; allergic reactions: rash, urticarial
• Crushed or whole; with food or milk; 30 mins before or 2 hr after meals; absorption may be slowed
• Do not exceed recommended dosage (>4g/day); recognize signs of chronic overdose: bleeding, bruising, malaise, fever, sore throat

Question 2

Ibuprofen (Advil, Motrin)

Answer 2

• Pregnancy category B; lactation, children
• NSAID, antipyretic
• Inhibits prostaglandin synthesis by ↓ enzyme needed for biosynthesis
• Headache; nausea, anorexia, hepatitis, GI bleeding; nephrotoxicity; blood dyscrasias; necrotizing fasciitis; anaphylaxis, Stevens-Johnson syndrome
• Assess pain; liver function studies; renal function; I&O; blood studies; hepatotoxicity; hx of peptic ulcer disorder; allergic reactions; ototoxicity: tinnitus, ringing, roaring in ears; visual changes; fever; prior drug hx
• Avoid alcohol ingestion, NSAIDs, salicylates: GI bleeding may occur

Question 3

Naproxen (Aleve)

Answer 3

• Pregnancy category B, D; lactation, children

Question 4

Docusate sodium (Colace)

Answer 4

• Pregnancy category C
• Laxative, emollient
• Assess cramping, rectal bleeding, n/v
• Dilute oral solution in juice or other fluid; give tabs or caps with 8 oz of liquid on empty stomach; may take up to 3 days

Question 5

Benzocaine and menthol spray (Dermoplast)

Answer 5

• Pregnancy category C
• Benzocaine is a local anesthetic (numbing medication). It works by blocking nerve signals in your body
• Benzocaine topical is used to reduce pain or discomfort caused by minor skin irritations, sore throat, sunburn, teething pain, vaginal or rectal irritation, ingrown toenails, hemorrhoids, and many other sources of minor pain on a surface of the body
• Headache, tired feeling, confusion; fast heart rate; feeling light-headed or short of breath; and pale, blue, or gray appearance of your skin, lips, or fingernails

Question 6

Medroxyprogesterone (Depo-Provera)

Answer 6

• Pregnancy category X
• Hormone-progestogen; contraceptive; antineoplastic
• Prevents ovulation
• Thromboembolism, stroke, pulmonary embolism, MI; nausea, cholestatic jaundice; gynecomastia, testicular atrophy, impotence, spontaneous abortion; angioedema, anaphylaxis
• Assess for symptoms of severe allergic reaction; BP; I&O; liver function studies; edema, HTN, cardiac symptoms, jaundice; mental status
• With food or milk; give titrated dosage; large muscle mass; use after warming to dissolve crystals
• Avoid sunlight or use sunscreen; cushingoid symptoms: weight gain, moon face, buffalo hump, acne

Question 7

Carboprost tromethamine (Hemabate)

Answer 7

• Pregnancy category C
• Oxytocic, abortifacient; prostaglandin
• Stimulates uterine contractions, causing complete abortion in approximately 16 hr
• Decreases postpartum bleeding
• Fever, chills, n/v, diarrhea
• Monitor BP, P, respiratory status; length and duration of contraction; teratogenic
• IM injection into deep muscle mass; have crash cart available

Question 8

Methylergonovine maleate (Methergine)

Answer 8

• Pregnancy category C
• Oxytocic
• Stimulates uterine and vascular smooth muscle, causing contractions, decreased bleeding; tx of hemorrhage postpartum or after abortion
• Headache, dizziness, seizures; hypotension, HTN, dysrhythmias, CVA (IV); n/v; dyspnea
• Monitor BP, P; assess fundal tone, nonphasic contractions; ergotism or overdose; check calcium levels before administering ergonovine; monitor prolactin levels
• PO preferred; IM large muscle mass; IV if severe, life-threatening hemorrhage, give directly undiluted or diluted with 5 mL of 0.9% NaCl given through a Y-site or 3-way stopcock; give 0.2 mg/min; use clear, colorless solution; store up to 2 months if unused
• Stop smoking; abdominal cramps are a side effect

Question 9

Rho(D) immune globulin (Rho Gam)

Answer 9

• Pregnancy category C
• Immune globulins; suppresses immune response of nonsensitized Rh₀ (D or Dᶸ)-negative patients who are exposed to Rh₀ (D or Dᶸ)-positive blood
• Prevention of isoimmunization in Rh-negative women exposed to Rh-positive blood given after abortions, miscarriages, amniocentesis
• Assess for allergies; intravascular hemolysis: back pain, chills, hemoglobinuria, renal insufficiency, idiopathic thrombocytopenia purpura

Question 10

Rubella vaccine (Meruvax)

Answer 10

• Immunity to rubella by antibody production
• Adult/child ≥1: Subcut 0.5 mL (1000 units)
• Hypersensitivity to eggs, neomycin; cancer, radiation, corticosteroids, pregnancy, immunocompromised patients, blood dyscrasias, active untreated TB

Question 11

Witch hazel (Tucks) pads

Answer 11

• Temporarily relieves the local itching and discomfort associated with hemorrhoids; aids in protecting irritated anorectal areas; temporarily relieves irritation and burning