Viii-pharmacologic-interventions.docx

DRUG NAME (Generic Name/ Brand name, Local Market Price)

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

Epidural block up to a max of 1020mL. Caudal block up to a max of 15—30 mL. Peripheral block up to a max of 5 mL. Retrobulbar block up to a max of 2-4 mL. Sympathetic block up to a max of 2050 mL.

Local or regional anesth or analgesia for surgery, dental & oral surgery procedures, diagnostic & therapeutic procedures & obstet procedures.

DRUG CLASSIFICATION

MECHANISM OF ACTION

PREGNANCY RISK CATEGORY

N01BB01Bupivacaine; Belongs to the class of amides. Used as local anesthetics.

Local anesthetics block the generation and the conduction of nerve impulses.

Category C: Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women.

Generic Name: Bupivacaine Hydrochloride 125% Brand Name: (Marcaine, Sensorcaine) Local Market Price: Php 175.00

SIDE EFFECTS

Feeling anxious, restless, confused, or might pass out, problems with speech or vision, ringing in the ears, metallic taste, numbness or tingling around your mouth, or tremors, seizure (convulsions), weak or shallow breathing, fast heart rate, weak pulse, urinating less than usual or not at all EFFECT ON PREGNANCY

Anaphylactoid reactions (sometimes fatal), anginal pain, anxiety, apprehension, blurred vision, bradycardia

There are no adequate and wellcontrolled studies in pregnant women on the effect of Bupivacaine on the developing fetus.

It is not known whether local anesthetic drugs are excreted in human milk.

VIII- PHARMACOLOGIC INTERVENTIONS

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

EFFECT ON LACTATION

PRE-ADMINISTRATION

INTRA-ADMINISTRATION

POST-ADMINISTRATION

Bupivacaine should be used with caution in patients with known allergies and sensitivities. Bupivacaine should be used with caution, especially in repeat doses in patients with hepatic and renal disease. Explain the effect of the Bupivacaine to the patient. Standard protocol for management should be available. Do not use the solution if its color is pinkish or darker that slightly yellow or if it contains precipitate.

Local anesthetic procedures should be used with caution when there is inflammation and or sepsis in the region of the proposed injection. It is recommended that a test dose containing epinephrine be administered initially when clinical conditions permit and the effects monitored before the full dose is given. Mixing or the prior or intercurrent use of any other local anesthetic with Bupivacaine cannot be recommended because of insufficient data on the clinical use of such mixtures.

Must be store and control the room temperature, between 15°C and 30°C (59°F and 86°F). Careful and constant monitoring f cardiovascular and respiratory vital signs, and the patient’s state of consciousness should be performed after each local anesthetic injection.

DRUG NAME (Generic Name/ Brand name, Local Market Price) Generic Name: Fentanyl citrate

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

Regional anesthesia during labor

Commonly reported side effects of fentanyl include: fever, respiratory depression, nausea, vomiting, and diaphoresis.

Apnea, laryngospasm, itching, respiratory depression

MECHANISM OF ACTION

PREGNANCY RISK CATEGORY

EFFECT ON PREGNANCY

EFFECT ON LACTATION

Synthetic, potent narcotic agonist analgesic with pharmacologic actions qualitatively similar to those of morphine and meperdine.

US FDA pregnancy category: C

Prolonged use of opioids during pregnancy can result in physical dependence in the neonate; women should be advised of the risk of neonatal abstinence syndrome and ensure that appropriate treatment will be available.

This drug excreted into human milk achieves levels in colostrum which are greater than maternal serum levels. No adverse effects have been reported in nursing infants.

Local Market Price: Php 84.00

Narcotic analgesics

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

IM,IV:50-100mcg: 7-15 mins/ 20-30 mins/ 1-2 hrs

Brand Name: (Sublimaze)

DRUG CLASSIFICATION

SIDE EFFECTS

PRE-ADMINISTRATION

INTRA-ADMINISTRATION

POST-ADMINISTRATION

Tell the patient that it may cause lifethreatening withdrawal symptoms in a newborn if the mother has used this medicine during pregnancy. Know the history of allergic reaction. Explain the use of this medicine. Explain the side effects.

Breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while the patient is receiving fentanyl.

Wash hands after using/administering the medicine. Properly dispose the left over medicine. Report any emergency situation after using Fentanyl citrate. Monitor Vital Signs and observe the patient for signs of skeletal and thoracic muscle (depressed respirations). Tell the patient that she should avoid drinking alcohol for several hours after you receive fentanyl.

DRUG NAME (Generic Name/ Brand name, Local Market Price)

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

SIDE EFFECTS

Prevention of chemotherapy induced emesis. Post surgical and diabetic gastric stasis. Post- op n/v.

Local Market Price: Php 2.85

Post-op n/v:IM, IV: 10-20 mg, prn q6-8 hr PO: 30-60 mins/ 1-2 hrs. IM: 10-15 mins/ 1-2 hrs. IV: 1-3 mins/ 1-2 hrs.

DRUG CLASSIFICATION

MECHANISM OF ACTION

PREGNANCY RISK CATEGORY

EFFECT ON PREGNANCY

EFFECT ON LACTATION

Potent central dopamine receptor antagonist. Structurally related to procainamide but has little antiarrhythmic or anesthetic activity. Exact mechanism of action not clear but appears to sensitize GI to effects of acetylcholine.

Pregnancy Category: B No risk in other studies: Animal reproduction studies failed to have demonstrate a risk to a fetus and there are no adequate and wellcontrolled studies in pregnant women OR animal studies have shown an adverse effect.

Use during the first and third trimesters should be avoided when possible. Monitoring for extrapyramidal syndrome is recommended for neonates exposed during third semester.

Variable amounts are excreted in breast milk, with some infants receiving doses that achieve pharmacologically active serum levels, elevated serum prolactin and possible gastrointestinal side effects. This drug is used as a galactagogue.

Generic Name: Metoclopramide Hydrochloride Brand Name: Reglan

Gastrointestinal agent; prokinetic agent (gi stimulant)

Feeling restless, drowsy, tired, or dizzy; headache, sleep, problems (insomnia)’ nausea, vomiting, diarrhea, breast tenderness.

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

Neuroleptic malignant syndrome, drowsiness, EPS, restlessness.

PRE-ADMINISTRATION

INTRA-ADMINISTRATION

POST-ADMINISTRATION

Lab tests: Periodic serum electrolyte. Explain to the patient the use of this drug. Explain to the patient the possible side effects.

Give over 1-2 mins, IV infusion: give over 15 mins. Note: bags of metoclopramide should be protected from the light during IV infusion (use aluminum foil or a thick cotton cover) Be aware that during early treatment period. Serum aldosterone may be elevated; after prolonged administration periods. It returns to pretreatment level. Do not breast feed while taking the drug without consulting a physician.

Discard open ampules; do not store for future use. Report immediately the onset of restlessness, involuntary movements, facial grimacing, rigidity, or tremors. Extrapyramidal symptoms are most likely to occur in children, young adult, and older adult and which highdose treatment vomiting associated with cancer chemotherapy. Symptoms can take months to regress. Avoid driving and other potentially hazardous activities for a few hours after drug administration. Avoid alcohol and other CNS depressants. Report S&S of acute dystonia, such as trembling hands and facial grimacing immediately.

DRUG NAME (Generic Name/ Brand name, Local Market Price) Generic Name: Ibuprofen Brand Name: (Motrin)

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

IV: 500-1500mg, 10 mg/kg. PO Analgesic: 4-10 mg/kg/dose q6-8h, max 40mg/kg/day.

Tx of inflammatory diseases and rheumatoid d/o’s, mild to moderate pain, fever, dysmenorrheal, gout.

MECHANISM OF ACTION

PREGNANCY RISK CATEGORY

Local Market Price: Php 31. 13

DRUG CLASSIFICATION Nonsteroidal inflammatory (NSAID)

antidrug

Nonsteroidal antiinflammatory drugs such as ibuprofen work by inhibiting the cyclooxygenase (COX) enzymes

FDA pregnancy category D

SIDE EFFECTS

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

Chest pain. Weakness, shortness of breath, slurred speech, problems with vision or balance; black, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; swelling or rapid weight gain; urinating less than usual or not at all. EFFECT ON PREGNANCY

GI bleed, hepatitis, headache, allergic reactions, N/V

Taking ibuprofen during the last 3 months of pregnancy may harm the unborn baby.

It is not known whether ibuprofen passes into breast milk or if it could harm a nursing baby.

EFFECT ON LACTATION

PRE-ADMINISTRATION

INTRA-ADMINISTRATION

POST-ADMINISTRATION

Shake the oral suspension (liquid) well just before you measure a dose. Explain the use of this drugs. Explain to the patient that she should not use in larger or smaller amounts or for longer than recommended.

Instruct the patient to take ibuprofen with food or milk to lessen stomach upset. Instruct the client to measure the liquid with a marked measuring spoon or medicine cup, not with a regular tablespoon.

If you take ibuprofen for a long period of time, your doctor may want to check you on a regular basis to make sure this medication is not causing harmful effects. Do not miss any scheduled visits to your doctor. Store at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze.

DRUG NAME (Generic Name/ Brand name, Local Market Price)

DOSAGE/ ROUTE/ FREQUENCY

INDICATIONS/ USES

SIDE EFFECTS

IV: 20-30 ml/kg body weight/hour enters blood immediately.

Isotonic solution for fluid and electrolyte replenishment, usually after blood loss. Contains Na, Cl, K, Ca lactate.

Hives, itching , facial, and/or larynx swelling, coughing, sneezing.

DRUG CLASSIFICATION

MECHANISM OF ACTION

PREGNANCY RISK CATEGORY

EFFECT ON PREGNANCY

Belongs to the class of solutions for parenteral nutrition used in I.V. solutions. Isotonic Crystalloid solution.

Lactated ringers replaces water and electrolytes.

Generic Name: Lactated Ringers Brand Name: Hartman’s solution Local Market Price: Php 186.75

Pregnancy C.

NUTRITIONAL NFJEWNDKASNM

Category

It is also not known whether Lactated ringer’s injection USP can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.

MIDWIFE’S RESPONSIBILITY

ADVERSE EFFECTS

Allergic reactions or anaphylactoid symptoms such as localized or generalized urticarial and pruritus; periorbital, facial, and/or laryngeal edema. EFFECT ON LACTATION It is not known whether this drug is excreted in human milk, because many drugs are excreted in human milk, caution should be exercised when lactated ringer’s injection USP is administered to a nursing woman.

PRE-ADMINISTRATION

INTRA-ADMINISTRATION

POST-ADMINISTRATION

This solution should be used with care in patients with hypervolemia, renal insufficiency, urinary tract obstruction, or impending or frank cardiac decompensation. Care should be exercised in administering solutions containing sodium or potassium to patients with renal or cardiovascular insufficiency, with or without congestive heart failure particularly if they are postoperative.

If administration is controlled by a pumping device, care must be taken to discontinue pumping action before the container runs dry or air embolism may result. When introducing additives, use aseptic techniques.

Do not store after use. Properly dispose after each use. Do not reuse. After administering, check the sites for possible swelling.

Deterred work is a standout among the most widely recognized preventable reasons for maternal and perinatal horribleness and mortality in creating nations. Among the basic causes are cephalopelvic imbalance, malpresentation and malposition. Perceiving the reasons for deterred work is vital if the inconvieniences are to be forestalled. Satisfactory anticipation, be that as it may can be accomplished just through a multidisciplinary approach pointed in the present moment at distinguishing high-chance cases and in the long haul at enhancing sustenance. Early parenthood ought to be debilitated and endeavors are expected to enhance nourishment earliest stages, youth, early adulthood and pregnancy. Enhancing the entrance to and advancing the utilization of regenerative and preventative administrations will help lessen the commonness of this complexity.

Diet tips for Mother after cesarean delivery

Almost 33 percent of mother who gave birth in 2013(2018??) had a cesarean section, reported the Center for disease control and prevention. If youre one of these women, how you treat your body in the days, weeks and months following the birth effects your rate of revery, energy and body shape. A C-section is mahor abdominal surgery, it involves cutting through abdominal wall and uterus to birth a baby. Recovery requires optimal nutrition for healing. Proper nutrition will also help you to drop weight gained during pregnancy – when, of course, your body is ready.

Diet Immediately following a C- section (sleepy na ako ante) You’ll be allowed to consume only ice chips in the hours after a C-section and may experience nausea that can persist for a few days, especially if you had a general

anesthesia. Depending on your progress, your doctor will permit a clear liquid diet and then real food. It’s important that you can pass gas, and indication of a working intestinal tract, before you transition to whole foods. Gentle walking as soon as you are able helps improve circulation and gets the digestive tract working normally. Expect it to take a several days for you to have a bowel movement. Any narcotics given post C- section may also contribute constipation, which may last more than a few day. Focus on high-fiber choices such as whole grains, fresh vegetables and beans when you can eat solid foods. Hydrate thoroughly and have an occasional glass of juice, especially prune juice, to get things moving.

Diet Tips for mothers in first few week after Cesarean It takes about six weeks to completely heal from a c- section -- possibly longer if you experienced complications. At first you may still look slightly pregnant, but your uterus will return to its normal size in time. Don’t try to diet and lose weight, during the first six weeks because your body is till healing. Also, if you’re breastfeeding, your milk supple is just getting established, and you need to adequate calories and nutrients to feed you and your baby. Balanced meals containing lean proteins, plenty of fresh vegetables and fruits – especially those with vitamin C, which helps with healing – low fat dairy and whole grains should comprise most meals. Avoid relying on take-outs, frozen dinners or other processed foods. Instead, prepare easy-to-make meals such as roast chicken, breast, salads, pre-chopped vegetables and whole grain pasta. Enjoy healthy snacks, such as fruit, a handful of nuts or low-fat yogurt.

Nutrition in the months after a cesarean delivery Every woman loses pregnancy weight at a different rate. By six months, much what you gained will probably be gone if you’ve been eating well. If you gained 35

pounds or more, you might need 10 or 12 months to drop the extra weight. Breastfeeding naturally boosts your daily calorie burn to help you lose weight.

Wait on any concentrated effort to lose weight until six weeks after surgery and talk to your doctor before starting any diet. Eating between 500 and 790 calories less than you burn daily will load to a weight loss of 1 to 1 ½ pounds per week. Exercise helps, too. For example, going for a walk with the stroller or hire a sitter while you hit the gym. Avoid fad diets, which compromise your energy, metabolic rate, and your breast milk quality -- if you’re nursing your baby.