L& D Med Sheet

MEDICATION SHEETS Student name: Allie Jones Date: 09/03/09 REDONE 9/24/2009 Drug name: Oxytocin Drug Classification: Hormone, oxytocics Pregnancy Risk Category: X (intranasal), unknown (IV/IM) Indication for use in this area: induction of labor, or augmentation of labor progressing slowly due to inadequate contractions; enhancement of uterine contractions; postpartum control of bleeding After expulsion of the placenta; evaluation of fetal competence; promote milk letdown in lactating women Route and usual range of dose: IV initial dose 0.5 - 1 milli units/min with increments of 1 to 2 milli units/min, recommended dose increments are Q30 - 60 min as it takes 30-40 min for a steady state of Oxytocin to be reached and full effect of dosage increment to be reflected in more intense, frequent, longer contractions; IM (for postpartum hemorrhage) give 10 units after delivery of placenta; intranasal, 1 spray in 1 or both nostrils 2-3 min prior to breastfeeding or pumping breasts Specific dosing for your patient: prior to delivery: 14 milliunits/hr, titrated 1-2 milliunits/min Q30 min to induce in 0.9% 500 mL NaCl. Postpartum: 30 units IV in 0.9% NaCl 500 mL titrating to keep fundus firm. Potential side effects/adverse reactions/ nursing considerations: High doses given rapidly may cause water intoxication and tumultuous labor with tetanic contractions which could cause premature separation of the placenta, rupture of the uterus, lacerations to the cervix, or post birth hemorrhage. Also the hyperstimulation of the uterus reduces blood flow through the placenta resulting in FHR decelerations, fetal asphyxia, and neonatal hypoxia. Evaluation of Medication: Intensity of contractions results in intrauterine pressures of 40 90 mmHg, contraction durations are 60-90 sec., frequency of contractions is 2 - 3 min intervals. Resting tone of 10 - 15 mmHg, and cervical dilation of 1 cm/hr in active phase; onset of effective contractions, increase in uterine tone, effective letdown reflex Drug name: Terbutaline Drug Classification: adrenergic Pregnancy Risk Category: B Indication for use in this area: management of preterm labor by relaxing the smooth muscles and inhibiting activity of premature contractions. Route and usual range of dose: SQ injection 0.25 mg Q20-30/min for 2 hr then maintenance dose of 0.25 mg Q3-4 hr or SQ pump maintenance dose of 0.03-0.1 mg/hr; PO 2.5 mg Q 4-6 hrs until delivery; IV 10 mcg/min infusion; increase by 5 mcg/min q 10 min until contractions stop then decrease infusion rate after contractions have stopped for 30 min to lowest effective amount and maintain for 4-8 hr. Specific dosing for your patient: not used for my patient. Potential side effects/adverse reactions/ nursing considerations: Maternal side effects include tachycardia, palpitations, tremor, anxiety, and headache, hypoglycemia and hypokalemia; the neonate side effects include hypoglycemia Evaluation of Medication: control of preterm labor in a fetus of 20 - 36 weeks gestational age maternal HR <120. Drug name: Magnesium Sulfate Drug Classification: anti-convulsant, magnesium salt Pregnancy Risk Category: D Indication for use in this area: treatment of preterm labor by slowing contractions until cervix has stopped thinning or effacing; control seizures in preeclampsia and eclampsia Route and usual range of dose: IV: initial dose of 4 to 6 grams over 15 to 30 minutes, then 2 to

3 grams/hr as a maintenance dose; IM: 1 – 4 grams Q4hrs Specific dosing for your patient: not used for my patient. Potential side effects/adverse reactions/ nursing considerations: For the mother, the potential side effects include hypotension, tachycardia, cardiac arrhythmias, drowsiness, hypoglycemia, respiratory paralysis, feeling uncomfortably warm, headache, dry mouth, nausea, and blurred vision. For the baby, initial listless or floppiness at birth may be seen due to relaxation of the muscles from the medication, but it should go away once the drug clears from the baby's system. Evaluation of Medication: contractions slowed, prolonging gestation for 2 - 7 days; control of seizures in PIH pt

Drug name: Hemabate Drug Classification: oxytocics, prostaglandins Pregnancy Risk Category: C Indication for use in this area: Treatment of postpartum hemorrhage by contraction of the uterus by directly stimulating the myometrium Route and usual range of dose: IM 250 mcg; may be repeated every 15–90 min (total dose not to exceed 2 mg). Specific dosing for your patient: not used for my patient. Potential side effects/adverse reactions/ nursing considerations: uterine rupture, nausea, vomiting, fever, diarrhea Evaluation of Medication: control of postpartum bleeding Drug name: Cytotec Drug Classification: cytoprotective agent, prostaglandins Pregnancy Risk Category: X Indication for use in this area: cervical effacement/thinning and induction of labor acting as a cervical ripening agent, also used to treat serious postpartum hemorrhage in the presence of uterine atony Route and usual range of dose: 25 mcg vaginally every 3 to 4 hours (maximum dose, 400 mcg) for induction of labor or initially 50 mcg orally every 4 hours for 2 doses, then 100 mcg every 4 hours until membrane rupture (maximum of 5 doses). Specific dosing for your patient: not used for my patient. Potential side effects/adverse reactions/ nursing considerations: Cardiac dysrhythmia, anemia, abdominal pain, or diarrhea Evaluation of Medication: induction of labor or decrease in bleeding following serious postpartum hemorrhage. Drug name: Methergine Drug Classification: oxytocic, ergot alkaloids Pregnancy Risk Category: C Indication for use in this area: prevention and treatment of postpartum hemorrhage caused by uterine atony or failure of the uterus to return to normal size following childbirth. Route and usual range of dose: 0.2 mg IM/IV (may be repeated at 2 to 4 h intervals up to 5 doses) then 0.2 mg PO 3 to 4 times a day as needed (MAX duration: 7 days); PO, 0.2 mg 34x/day in the puerperium for a maximum of 1 week Specific dosing for your patient: not used for my patient. Potential side effects/adverse reactions/ nursing considerations: Angina, HTN, associated with HA/seizures Evaluation of Medication: shortening of third labor stage and reduction of blood loss causing a rapid and sustained spasmodic uterine contraction by stimulating the rate, tone and amplitude of uterine contraction; hold medication if HTN or if patient is pregnant. Drug Name: Fentanyl Drug Classification: local anesthetic

Pregnancy Risk Category: B Indication for use in this area: decrease pain during vaginal childbirth. Route and usual range of dose: epidural, 5-100 mcg Specific Dosing for your patient: 50 mcg epidural Potential side effects/adverse reactions/nursing considerations: intense itching, increased urination, nausea, vomiting, increased risk of cardiac arrhythmias Evaluation of medication: decrease of pain/increased pain tolerance