Oxytocin

Drug Data Generic Name Oxytocin

Classification Pharmacologic Class Hormone

Trade Name Pitocin

Therapeutic Class Oxytocic

Content Synthetic oxytocin Dosage Adults Induction of labor: initial dose not more than 0.5-2 milliunits/min by IV infusion. Increase the dose of no more than 1-2 milliunits/mion at 30- to 60-min intervals; Control of postpartum bleeding: IV Add 10-40 units to 1000mL of a nonhydrating diluent, infuse at a rate to control uterine atony. IM administer 10 units after delivery of placenta Treatment of incomplete abortion: IV infusion of 10 units of oxytocin with 500mL physiologic saline solution @ 10-20 milliunits/min

Pregnancy category X

Mechanism of Action Synthetic form of an endogenous hormone produced in the hypothalamus and stored in the posterior pituitary; stimulates the uterus, especially the gravid uterus just before parturition, and causes myoepithelium of the lacteal glands to contract, which results In milk ejection in lactating mothers.

Indication - Antepatum: to initiate or improve uterine contractions to achieve early vaginal delivery; stimulation or reinforcement of labor in selected cases of uterine inertia; management of inevitable or incomplete abortion; second trimester abortion - Postpartum: To produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage. - lactation deficiency - Unlabeled use; To evaluate fetal distress (oxytocin challenge test), treatment off breast engorgement

Contraindications - significant cephalopelvic disproportion, unfavorable fetal positions or presentations, obstetric emergencies that favor surgical intervention, prolonged use in severe toxemia, uterine inertia, hypertonic uterine patterns, induction or ougmentation of labor when vaginal delivery is contraindicated, previous cesarean section, pregnancy (nasal)

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 913

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 913

Use cautiously with renal impairment.

Adverse Reaction CV: Cardiac arryhtsmias, PVCs, HPN, subarachnoid hemorrhage Fetal effects: Fetal bradycaria, neonatal jaundice, low Apgar scores GI: nausea, vomiting GU: postpartum hemorrhage, uterine rupture, pelvic hematoma, uterine hypertonicity, spasm, tetanic contraction, rupture of the uterus with excessive dosage, or hypersensitivity Hypersensitivity: Anaphylactic reactions Other: Maternal and fetal deaths when used to induce labor or in 1st or 2nd stages of labor; afibrinogemia; severe water intoxication with seizures and coma, maternal death

Nursing Responsibilities Before - Assess for significant cephalopelvic disproportion, unfavorable fetal positions or presentations, severe toxemia, uterine inertia, hypertonic uterine patterns, previous cesarean section - Assess fetal heart rate, uterine tone - Ensure fetal position and size and absence of complications.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 914

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 914

During - Infuse via constant infusion pump to ensure accurate control of rate; rate determined by uterine response; begin with 1-2mL/min and increase at 16- to 60-min intervals - Do not combine in solution with fibrinolysin or heparin - Monitor maternal BP - Monitor neonate for jaundice - Discontinue drug and notify physician at any sign of hypertensive emergency After - Educate client on the side effects of the medication and what to expect. - Document that drug has been given.

Availability Injection – 10 units/mL Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 913

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 913

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 913