Dr Drug Study

Generic Name (Brand Name)

Drug Classification & Indication Methergine PC: Ergot (methylergonovine Alkaloid and maleate) Derivative TC: oxytocic, lactation stimulant Indication: Prevention and treatment of postpartum and postabortion hemorrhage caused by uterine atony or subinvolution

Dosage, Route, Frequency IV: 0.2 mg after delivery of anterior shoulder, after delivery of placenta, or during puerperium; may be repeated as required at intervals of 2-4 hours

Mechanism of Action Methergin ↓ Stimulates uterine smooth muscles ↓ producing sustained contractions ↓ thereby shortens the third stage of labor

Adverse Reaction Cardiovascular: hypertension, temporary chest pain, palpitation

> contraindicated in patients hypersensitive to methylergonovine or any component of the CNSHallucinations, formulation. dizziness, seizure, >ergot alkaloids are headache contraindicated with potent inhibitors of Gastrointestinal: CYP3A4 (includes Nausea, vomiting, protease inhibitors, diarrhea, foul taste azole antifungals, and some macrolide Local: antibiotics); Thrombophlebitis hypertension; toxemia; pregnancy Otic: Tinnitus Renal: Hematuria Respiratory: Dyspnea, nasal congestion Miscellaneous: Diaphoresis

HERRERA, Perry Lee B. BSN III – A3a

Contraindication

Nursing Responsibility >Be alert for adverse reactions and drug interactions. >This drug should be used extremely carefully because of it's potent vasoconstrictor action. I.V. use may induce sudden hypertension and cerebrovascular accidents. As a last resort, give I.V. slowly over several minutes and monitor blood pressure closely.

Generic Name (Brand Name) Oxytocin

Drug Classification & Indication PC: Exogenous Agent TC: oxytocic, lactation stimulant Indication: Induction of labor at term; control of postpartum bleeding; adjunctive therapy in management of abortion

Dosage, Route, Frequency I.V.: 10-40 units by I.V. infusion in 1000 mL of intravenous fluid at a rate sufficient to control uterine atony

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Oxytocin ↓ Causes potent and selective stimulation of uterine and mammary gland smooth muscles ↓ producing sustained contractions ↓ Induces labor and milk ejection and reduces post partum bleeding

Cardiovascular: hypertension; increased heart rate, systemic venous return, and cardiac output, and arrhytmias

> Contraindicated in patients hypersensitive to the drug or any of its component.

> Monitor and record uterine contractions, heart rate, BP, intrauterine pressure, fetal heart rate, and blood loss q15.

CNS: seizures, coma from water intoxication Gastrointestinal: Nausea, vomiting, GU: titanic uterine contractions, abruption placentae, impaired uterine blood flow, pelvic hematoma Hematologic: afibrinogenemia Respiratory: anoxia, asphyxia

HERRERA, Perry Lee B. BSN III – A3a

> Also contraindicated in cephalopelvic disproportion or delivery that requires conversion, as in tranverse lie; in fetal distress when delivery isn’t imminent; in prematurity and in severe toxemia, hypertonic uterine patterns, total placenta previa or vasa previa.

> Also contraindicated in fetal distress.

>Be alert for adverse reaction >Monitor I/O. Antidiuretic effect may lead to fluid overload, seizures, and coma >never give oxytocin simultaneously by more than one route. >have 20% solution magnesium sulfate available for relaxation of the myometrium. >If contractions are less than 2 minutes apart, if they’re above 50mm Hg ,or if they last 90seconds or longer, stop infusion, and turn patient on her side, and notify prescriber

Generic Name (Brand Name) Cefazolin Sodium

Drug Classification & Indication PC: firstgeneration cephalosporin TC: antibiotic Indication: Perioperative prophylaxis in contaminated surgery.

HERRERA, Perry Lee B. BSN III – A3a

Dosage, Mechanism of Route, Action Frequency IV: Cefazolin 250 mg to 2 ↓ g every 6-12 Inhibits cell-wall (usually 8) synthesis hours, ↓ depending Promoting osmotic on severity instability of infection; ↓ maximum Hinders/kills dose: 12 susceptible bacteria g/day

Adverse Reaction

Contraindication

CNS: dizziness, headache, malaise

> contraindicated in >ask patient about patients hypersensitive previous reaction to to cephalosporins cephalosporin or penicillin before starting >use cautiously in the therapy patients with history of sensitivity to >If GI reaction occurs, penicillin because of monitor hydration cross-allergic reaction

GI: nausea, vomiting, diarrhea, glossitis, dyspepsia, Respi: Dyspnea Skin: Erythematous rashes

>use cautiously in pregnant and lactating women

Nursing Responsibility

Generic Name (Brand Name) Hyoscine Butylbromide

Drug Classification & Indication PC: anticholinergic TC: antimuscarinic, antiemetic, antivertigo drug, antiparkinsonism Indication: To reduce secretions perioperatively.

Dosage, Route, Frequency IV: 1 mg/ml

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

HBB ↓ Inhibits muscarinic actions of acetylcholine in the ANS ↓ Affecting neural pathway ↓ Relieves spasticity, nausea and vomittin; reduces secretions; and blocks cardiac vagal reflexes.

CNS: dizziness, headache, restlessness, disorientation, irritability, fever

Contraindicated in patients with angleclosure glaucoma, obstructive uropathy, asthma, COPD, myasthenia gravis, paralytic ileus, intestinal atony, & unstable CV.

>Be alert for adverse reactions and drug interactions.

↓ Promotes cervical effacement

GI: constipation, dry mouth, nausea, vomiting CV: palpitations, tachycardia, flushing EENT: dilated pupils, blurred vision, photophobia, dysphagia GU: urinary hesitancy, urinary retention Skin: rash, dryness

HERRERA, Perry Lee B. BSN III – A3a

>Encourage pt. to void >Monitor BP for possible hypotension. >Monitor cervical effacement and dilatation.

Generic Name (Brand Name) Hydralazine

Drug Classification & Indication PC: peripheral vasodilator TC: antihypertensive Indication: Pre-eclampsia / eclampsia

Dosage, Route, Frequency 5 mg/dose then 5-10 mg every 20-30 minutes as needed.

Mechanism of Action Hydralazine ↓ Directly relaxes arteriolar smooth muscle ↓ Vasodilaion ↓ Lowers Blood Pressure

Adverse Reaction

Contraindication

Nursing Responsibility

CNS: peripheral neuritis, headache, dizziness

Contraindicated to pt.s hypersensitive to the drug and any of its component and in those with coronary artery disease or mitral valvular rheumatic heart disease.

Assess blood pressure before starting therapy and regularly thereafter.

CV: orthostatic hypotension, tachycardia, arrythmias, angina, palpitations. GI: n/v, diarrhea, anorexia Hematologic: neutropenia, leukopenia, agranulocytopenia Metabolic: weight gain, sodium retention Skin: rash

HERRERA, Perry Lee B. BSN III – A3a

Use cautiously in patients with suspected cardiac disease, CVA, or severe renal impairment, and in those taking other antihytensives.

Instruct client to take oral form with meals. Inform client that orthostatic hypotension can be minimized by rising slowly and not changing position suddenly. Tell pt. not to abruptly stop taking drug, but to call prescriber if adverse reaction occurs. Tell client to limit sodium intake.

Generic Name (Brand Name) Magnesium Sulfate

Drug Classification & Indication PC: Magnesium Salt TC: Anticonvulsant, Mineral Indication: 1. Control seizures in preeclampsia and eclampsia 2. To manage preterm labor

Dosage, Route, Frequency I.M.: 1-4 g every 4 hours I.V.: Initial: 4 g, then switch to I.M. or 14 g/hour by continuous infusion

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Magnesium Sulfate ↓ may decrease acetylcholine released by nerve impulses ↓ but anticonvulsant mechanism is unknown. ↓ Control seizures

CNS: drowsiness, depressed reflexes, flaccid paralysis and hypothermia.

Parenteral administration contraindicated in patients with heart block or myocardial damage.

> Assess pt.’s condition before therapy and regularly thereafter to monitor the drug’s effectiveness.

CV: hypotension, flushing, circulatory collapsed, decreased cardiac function and heat block. Metabolic: hypoglycemia Respiratory: Respiratory paralysis Skin: diaphoresis

HERRERA, Perry Lee B. BSN III – A3a

Use cautiously in patients with impaired kidney function.

> BP monitoring, and hold if BP is <80/60 >withhold if urine output is <30 cc/hour >withhold if respiration <12 cpm > Keep I.V. calcium gluconate at all times to reverse magnesium intoxication. (↓ RR, ↓ BP, ↓ UO)