DRUG Guide Maternity PDF

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Guide for OB drugs, includes description, side effects, and antidotes....

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DRUG GUIDE 22.1 Drugs Used to Control Postpartum Hemorrhage Drug Oxytocin (Pitocin) First-line therapy

Misoprostol (Cytotec)

Dinoprostone (Prostin E2)

Methylergonovine maleate (Methergine)

Action/Indication Stimulates the uterus to contract/to contract the uterus to control bleeding from the placental site 20–40 units in a liter IV or 10 units IM

Nursing Implications Assess fundus for evidence of contraction and compare amount of bleeding every 15 minutes or according to orders. Monitor vital signs every 15 minutes. Monitor uterine tone to prevent hyperstimulation. Reassure client about the need for uterine contraction and administer analgesics for comfort. Offer explanation to client and family about what is happening and the purpose of the medication. Provide nonpharmacologic comfort measures to assist with pain management. Set up the IV infusion to be piggybacked into a primary IV line. This ensures that the medication can be discontinued readily if hyperstimulation or adverse effects occur while maintaining the IV site and primary infusion. Stimulates the uterus to Contraindications: Never give undiluted as contract/to reduce a bolus injection IV. bleeding; a prostaglandin As above. Not FDA-approved for this analog indication, but an effective drug therapy 800 mcg per rectum, one for acute postpartum hemorrhage dose (range, 400–1,000 Contraindications: allergy, active mcg) cardiovascular disease, pulmonary or hepatic disease; use with caution in women with asthma Monitor blood pressure frequently since 20 mg vaginal or rectal hypotension is a frequent side effect suppository May be repeated every 2 along with vomiting and diarrhea, hours nausea, temperature elevation Stimulates the uterus to Assess baseline bleeding, uterine tone, and prevent and treat vital signs every 15 minutes or according postpartum hemorrhage to protocol. Offer explanation to client and family about due to atony or what is happening and the purpose of the subinvolution medication. 0.2 mg IM injection Monitor for possible adverse effects, such May be repeated in 5 as hypertension, seizures, uterine minutes cramping, nausea, vomiting, and Thereafter every 2–4 hours palpitations.

Prostaglandin (PGF2α), Carboprost, (Hemabate)

Report any complaints of chest pain promptly. Contraindications: Hypertension Stimulates uterine Assess vital signs, uterine contractions, contractions/to treat client’s comfort level, and bleeding status postpartum hemorrhage as per protocol. due to uterine atony Offer explanation to client and family about when not controlled by what is happening and the purpose of the other methods medication. 0.25 mg IM injection Monitor for possible adverse effects, such May be repeated every 15– as fever, chills, headache, nausea, 90 minutes up to eight vomiting, diarrhea, flushing, and doses bronchospasm. Stimulates uterine Contraindications: asthma or active contractions to reduce cardiovascular disease bleeding when not Same as above controlled by the first-line Contraindications: active cardiac, therapy of oxytocin pulmonary, renal, or hepatic disease

All nurses need to be aware of the contraindications of administering each of the medications used to control postpartum hemorrhage as follows: • Pitocin—never give undiluted as a bolus injection intravenously • Cytotec—allergy, active cardiovascular disease, pulmonary or hepatic disease • Prostin E2—active cardiac, pulmonary, renal, or hepatic disease • Methergine-–if the woman is hypertensive, do not administer • Hemabate—contraindicated with asthma due to risk of bronchial spasm •

DRUG GUIDE 21.1 Medications Used with Preterm Labor

Drug

Action/Indication

Nursing Implications Administer IV with a loading dose of 4–6 g over 15–30 minutes initially, and then maintain infusion at 1–4 g/hr. Assess vital signs and deep tendon reflexes (DTRs) hourly; report any hypotension or depressed or absent DTRs.

Monitor level of consciousness; report any headache, blurred vision, dizziness, or altered level of consciousness. Perform continuous electronic fetal monitoring; report any decreased FHR variability, hypotonia, or respiratory depression. Relaxes uterine muscles to stop irritability and contractions, to arrest Monitor intake and output hourly; report any decrease in output (110 bpm. Monitor for fetal effects such as decreased uteroplacental blood flow manifested by fetal Blocks calcium movement into muscle bradycardia, which can lead to cells, inhibits uterine activity to fetal hypoxia. arrest preterm labor. Monitor for adverse effects, such as flushing of the skin, headache, transient tachycardia, palpitations, postural hypertension, peripheral edema, and transient fetal tachycardia. Contraindicated in women with cardiovascular disease or hemodynamic instability. Promotes fetal lung maturity by Administer two doses stimulating surfactant production; intramuscularly 24 hours apart. prevents or reduces risk of Monitor for maternal infection or respiratory distress syndrome and pulmonary edema. intraventricular hemorrhage in the Educate parents about potential benefits of drug to preterm infant. preterm neonate less than 34 Assess maternal lung sounds and weeks’ gestation. monitor for signs of infection.

DRUG GUIDE 21.2 Drugs Used for Cervical Ripening and Labor Induction Drug

Action/Indication

Directly softens and dilates the cervix Dinoprostone to ripen cervix (Cervidil and induce labor insert; Prepidil gel) FDA-approved for cervical ripening Misoprostol (Cytotec)

Ripens cervix to induce labor

Nursing Implications Provide emotional support. Administer pain medications as needed. Frequently assess degree of effacement and dilation. Monitor uterine contractions for frequency, duration, and strength. Assess maternal vital signs and FHR pattern frequently. Monitor woman for possible adverse effects such as headache, nausea and vomiting, and diarrhea. Instruct client about purpose and possible adverse effects of medication. Ensure informed consent is signed per hospital policy. Assess vital signs and FHR patterns frequently. Monitor client’s reaction to drug. Initiate oxytocin for labor induction at least 4 hours after last dose was administered.

Oxytocin (Pitocin)

Monitor for possible adverse effects such as nausea and vomiting, diarrhea, uterine hyperstimulation, and category II FHR patterns. Administer as an IV infusion via pump, increasing dose based on protocol until adequate labor progress is achieved. Assess baseline vital signs and FHR and then frequently after initiating oxytocin infusion. Determine frequency, duration, and strength of contractions frequently. Notify health care provider of any uterine hypertonicity or Acts on uterine abnormal FHR patterns. myofibrils to contract to initiate Maintain careful intake and output, being alert for water intoxication. or reinforce labor Keep client informed of labor progress. Monitor for possible adverse effects such as hyperstimulation of the uterus, impaired uterine blood flow leading to fetal hypoxia, rapid labor leading to cervical lacerations or uterine rupture, water intoxication (if oxytocin is given in electrolyte-free solution or at a rate exceeding 20 mU/min), and hypotension....