Stress Pharmacological.docx

Urdaneta City University 1 San Vicente West, Urdaneta City, Pangasinan 2428

(075) 568-2475 loc. 8110, Fax: (075) 600-1468 E-mail: [email protected]

School of Midwifery Established in 1973 LEVEL II ALCU-COA ACCREDITATION STATUS

MIDWIFERY PHARMACOLOGIC NOTES DRUG NAME (Generic Name/ Brand name, Local Market Price) Generic Name: Methergine Brand Name: Maleate

Methylergonovine

Local Market Price:

DRUG CLASSIFICATION PC: Ergot Alkaloid and Derivative TC: oxytocic, lactation stimulant

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

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

Prevention and treatment of postpartum and post abortion hemorrhage caused by uterine atony or subinvolution

MECHANISM OF ACTION

PREGNANCY RISK CATEGORY

Stimulates uterine smooth muscles, producing sustained contractions and thereby shortens the third stage of labor

Category C: Animal reproductive studies have not been conducted with Methergine. It is also not known whether methylergonovine maleate can cause fetal harm or can affect reproductive capacity.

SIDE EFFECTS

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

most common adverse reaction is hypertension associated in several cases with seizure and/or headache. Hypotension has also been reported. Abdominal pain (caused by uterine contractions), nausea and vomiting have occurred occasionally. EFFECT ON PREGNANCY

hypertension, temporary chest pain, palpitation, dizziness, seizure, headache, nausea, vomiting, diarrhea, foul taste, thrombophlebitis, tinnitus, hematuria, dyspnea, nasal congestion and diaphoresis

Use of Methergine is contraindicated during pregnancy because of its uterotonic effects.

Mothers should not breast-feed during treatment with Methergine and at least 12 hours after administration of the last dose. Milk secreted during this period should be discarded.

EFFECT ON LACTATION

PREADMINISTRATION >Explain the effect of the Methergine to the patient. Standard protocol for management should be available. > Assess history of allergy to the drug. >This drug should be used extremely carefully because of its 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.

INTRAADMINISTRATION > Breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while the patient is receiving Methergine. > Administer by IM injection or orally unless emergency requires IV use. Complications are more frequent with IV use.

POSTADMINISTRATION >Be alert for adverse reactions and drug interactions. > Monitor postpartum women for BP changes and amount and character of vaginal bleeding. > Avoid prolonged use of the drug. > Teach client to report difficulty breathing, headache, numb or cold extremities, severe abdominal cramping

Comment/ Remarks: _____________________________________________________________________________________________________________________________________________________________

NAME of STUDENT: Marge Ysabelle T. De Guzman

RATING:__________________

NAME of CI: Rogelio Villena

Urdaneta City University 1 San Vicente West, Urdaneta City, Pangasinan 2428

(075) 568-2475 loc. 8110, Fax: (075) 600-1468 E-mail: [email protected]

School of Midwifery Established in 1973 LEVEL II ALCU-COA ACCREDITATION STATUS

MIDWIFERY PHARMACOLOGIC NOTES DRUG NAME

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

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

Induction of labor at term; control of postpartum bleeding; adjunctive therapy in management of abortion

Nausea or vomiting, memory problems or confusion, runny nose, sore throat, or coughing, severe headaches, hallucinations, vomiting, confusion, seizures and severe hypertension and irregular heartbeats.

DRUG CLASSIFICATION

MECHANISM OF ACTION

PREGNANCY RISK CATEGORY

EFFECT ON PREGNANCY

PC: Exogenous Agent TC: oxytocic, lactation stimulant

Causes potent and selective stimulation of uterine and mammary gland smooth muscles, producing sustained contractions, induces labor and milk ejection and reduces postpartum bleeding

Oxytocin has been assigned to a pregnancy category X by the FDA. There are no known indications for use in the first trimester of pregnancy other than in relation to spontaneous or induced abortion. It would not be expected to present a risk of fetal abnormalities.

Oxytocin is indicated during pregnancy to induce labor; it precipitates uterine contractions and abortion.

(Generic Name/ Brand name, Local Market Price) Generic Name: Oxytocin Brand Name: Pitocin

Local Market Price:

SIDE EFFECTS

NAME of STUDENT: Marge Ysabelle T. De Guzman

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

cardiac arrhythmias, PVCs, hypertension, subarachnoid hemorrhage Fetal effects: fetal bradycardia, neonatal jaundice, low Apgar scores nauseas, vomiting, postpartum hemorrhage, uterine rupture, pelvic hematoma, uterine hypertonicity, spasm EFFECT ON LACTATION

PREADMINISTRATION > Monitor and record uterine contractions, heart rate, BP, intrauterine pressure, fetal heart rate, and blood loss q15. >never give oxytocin simultaneously by more than one route.

INTRAADMINISTRATION >Monitor BP during administration >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

It has been used in mothers having difficulty with engorgement and breast-feeding. Because several small studies have failed to show a beneficial effect, oxytocin is not used for this indication. Oxytocin is excreted in the breast-milk, but is not expected to have adverse effects in the infant.

RATING:__________________

NAME of CI: Rogelio Villena

POSTADMINISTRATION > Be alert for adverse reaction >Monitor I/O. Antidiuretic effect may lead to fluid overload, seizures, and coma > Regulate rate of oxytocin delivery; monitor rate and strength of contractions >Ensure fetal position and size and absence of complications that are contraindicated with oxytocin therapy > Ensure continuous observation for induction of labor; fetal monitoring is preferred.

Urdaneta City University 1 San Vicente West, Urdaneta City, Pangasinan 2428

(075) 568-2475 loc. 8110, Fax: (075) 600-1468 E-mail: [email protected]

School of Midwifery Established in 1973 LEVEL II ALCU-COA ACCREDITATION STATUS

MIDWIFERY PHARMACOLOGIC NOTES DRUG NAME (Generic Name/ Brand name, Local Market Price) Generic Name: Lozartan Potassium Brand Name: Cozaar Local Market Price:

DRUG CLASSIFICATION cardiovascular agent; angiotensin II receptor antagonist; antihypertensive

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

The usual starting dose is 50 mg, but people treated with diuretics may be started off with 25 mg, once or twice daily. For pediatric hypertensive patients older than 6, the recommended starting dose is 0.7 mg, once daily, up to 50 mg.

Treatment of hypertension, alone or in combination with other antihypertensive Agents. Treatment of diabetic neuropathy with an elevated serum creatinine and proteinuria in patients with type 2 (non– insulin-dependent) diabetes and a history of hypertension PREGNANCY RISK CATEGORY Pregnancy [category C (first trimester), category D (second and third trimesters)]

MECHANISM OF ACTION Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the renin-angiotensin system as well as the release of aldosterone leading to decreased blood pressure.

SIDE EFFECTS

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS PREADMINISTRATION

upper respiratory infection, dizziness, stuffy nose, back pain

EFFECT ON PREGNANCY Losartan can harm your unborn baby causing injury and even death. Stop taking losartan if you become pregnant and call your doctor right away.

NAME of STUDENT: Marge Ysabelle T. De Guzman

Headache, dizziness, syncope, insomnia, hypotension, rash, urticaria, pruritus, alopecia, dry skin, diarrhea, abdominal pain, nausea, constipation, dry mouth, URI symptoms, cough, sinus disorders, back pain, fever, gout, muscle weakness EFFECT ON LACTATION Unknown.

>Assess patient’s health history. >Assess patient’s blood pressure. > Assess patient’s renal function

RATING:__________________

INTRAADMINISTRATION

POSTADMINISTRATION

> Monitor patient’s intake and output. > Administer drug at daytime.

> Be alert for adverse reaction. > Monitor patient’s sleeping pattern.

NAME of CI: Rogelio Villena

Urdaneta City University 1 San Vicente West, Urdaneta City, Pangasinan 2428

(075) 568-2475 loc. 8110, Fax: (075) 600-1468 E-mail: [email protected]

School of Midwifery Established in 1973 LEVEL II ALCU-COA ACCREDITATION STATUS

MIDWIFERY PHARMACOLOGIC NOTES DRUG NAME (Generic Name/ Brand name, Local Market Price) Generic Name: Omeprazole Brand Name: Losec (CAN)

Local Market Price:

DRUG CLASSIFICATION Antisecretory drug Proton pump inhibitor

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

SIDE EFFECTS

10mg to 20mg a day for indigestion 20mg to 40mg a day for acid reflux 20mg to 40mg a day for stomach ulcers 20mg to 120mg a day for Zollinger-Ellison syndrome, a condition where the body produces a lot more stomach acid than is needed.

Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Abdominal pain, constipation, diarrhea, flatulence, gastrointestinal disturbances, headache, nausea, vomiting

MECHANISM OF ACTION Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

PREGNANCY RISK CATEGORY Epidemiologic studies have demonstrated that major malformities risks with use in pregnant patients are unlikely.

EFFECT ON PREGNANCY In most cases, omeprazole is safe to take during pregnancy or while breastfeeding. When you’re pregnant, it’s better to treat indigestion without taking a medicine.

NAME of STUDENT: Marge Ysabelle T. De Guzman

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

Diarrhea, nausea, fatigue, constipation, vomiting, flatulence, acid regurgitation, taste perversion, arthralgia, myalgia, urticaria, dry mouth, dizziness, headache, paranesthesia, abdominal pain, skin rashes, weakness, back pain, upper respiratory infection, cough. EFFECT ON LACTATION In most cases, omeprazole is safe to take during pregnancy or while breastfeeding.

PREADMINISTRATION

INTRAADMINISTRATION

POSTADMINISTRATION

>Take the drug before meals. >Assess Vital Signs > Check for abdominal Pain, emesis, Diarrhea or constipation. >Tell patient to take 30-60 minutes before a meal, preferably in morning.

>Evaluate fluid and intake > Watch for elevated liver function test results >Instruct patient to swallow capsules or tablets whole and no to chew or crash them.

>Have regular medical follow-up visits. >Caution patient to avoid driving and other hazardous activities until he know drug effects concentration and alertness

RATING:__________________

NAME of CI: Rogelio Villena

Urdaneta City University 1 San Vicente West, Urdaneta City, Pangasinan 2428

(075) 568-2475 loc. 8110, Fax: (075) 600-1468 E-mail: [email protected]

School of Midwifery Established in 1973 LEVEL II ALCU-COA ACCREDITATION STATUS

MIDWIFERY PHARMACOLOGIC NOTES DRUG NAME (Generic Name/ Brand name, Local Market Price) Generic Name: Hyoscine Butylbromide Brand Name: Buscopan

Local Market Price:

DRUG CLASSIFICATION Antispasmodic; Anticholinergic

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS / USES

SIDE EFFECTS

Oral Adult: 30 mg / day in 3 divided doses if needed dose can be increased to 80 mg / day in 4 divided doses. Injection: 20 mg IV/IM if needed same dose can be repeated. Maximum dose: 100 mg / day Children: 30 mg / day in 3 divided doses Infants: 15 mg / day in 3 divided doses

Buscopan Tablets are indicated for the relief of spasm of the genitourinary tract or gastro- intestinal tract and for the symptomatic relief of Irritable Bowel Syndrome

Dry mouth, constipation, blurred vision, decreased sweating, urinary hesitancy, urine retention, tachycardia, drowsiness

MECHANISM OF ACTION

PREGNANCY RISK CATEGORY Category C: Either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or animals are not available.

EFFECT ON PREGNANCY

Buscopan does not readily pass the blood-brain barrier. It’s a competitive antagonist of the actions of acetylcholine and other muscarinic agonists. The receptors affected are those of peripheral structures that are either stimulated or inhibited by muscarine, ie. smooth and cardiac muscle

There are limited data from the use of hyoscine butylbromide in pregnant women. As a precautionary measure It is not recommended during pregnancy.

NAME of STUDENT: Marge Ysabelle T. De Guzman

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

dizziness, anaphylactic reactions, anaphylactic shock, disorientation, restlessness, irritability, drowsiness, confusion, hallucination, delirium, impaired memory, hypotension, tachycardia, palpitations, flushing, dry mouth, constipation, nausea, epigastric distress, flushing, urinary retention, dyspnea, bronchial plugging, depressed respiration, mydriasis, dilated pupils, difficulty of swallowing. EFFECT ON LACTATION

PREADMINISTRATION

INTRAADMINISTRATION

POSTADMINISTRATION

>Assess for eye pain >Assess for urinary hesitancy >Assess for constipation. >Avoid strict heat >Raise side rails as a precaution because some patients become temporarily excited or disoriented and some develop amnesia or become drowsy.

> Encourage patient to void. Monitor BP for possible hypertension. >For pregnant women, monitor cervical effacement and dilatation. >Drug compatibility should be monitored closely in patients requiring adjunctive therapy

> Monitor urine output >Be alert for adverse reactions and drug interactions. > Overdose may cause curare-like effects, such as respiratory paralysis. Keep emergency equipment available. > Avoid driving & operating machinery after parenteral administration.

There is insufficient information on the excretion of hyoscine butylbromide and its metabolites in human milk. A risk to the breastfeeding child cannot be excluded. Use of Buscopan during breastfeeding is not recommended

RATING:__________________

NAME of CI: Rogelio Villena

Urdaneta City University 1 San Vicente West, Urdaneta City, Pangasinan 2428

(075) 568-2475 loc. 8110, Fax: (075) 600-1468 E-mail: [email protected]

School of Midwifery Established in 1973 LEVEL II ALCU-COA ACCREDITATION STATUS

NAME of STUDENT: Marge Ysabelle T. De Guzman

RATING:__________________

NAME of CI: Rogelio Villena