Maternal Medications Chart PDF

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Brittney Jones- Maternal Medications – L&D/Postpartum Name/ Type Brand Name/Generic

Clinical Indications

Contraindications

To induce labor

cephalopelvic disproportion

Drug class / 1° Action/ Fetal response Monitoring for mother & baby

Side-effects/Adverse Patient teaching(lay effects term)

0.5-1mUnit/min IV

Oxytocic agents

titrate 1-2m Unit/min until contraction pattern is similar to normal labor

Acts on GPCRs to trigger inc of calcium in uterine myofibirls

In fetus watch for seizure, jaundice, death, low Apgar score, hypoxia, hypercapnia

Dosage/Interval/ Route/ admin. specifics

Oxytocic Pitocin (Oxytocin) Term pregnancy:

unfavorable fetal position hyperactive or hypertonic uterus vaginal deliveries

dec. dose after contraction is reached and at 56cm dilation

Inc uterine contraction and inc prostaglandin production

Watch fluid intake wait 1 day after you stop taking the drug before breastfeeding.

In mother watch for brady/tachycardia, arrhythmias, brain damage, dec in BP

watch intrauterine pressure, fetal HR Pitocin Postpartum use

Postpartum Hemorrhage to stop bleeding

Same as above

10 units IM

Same as above

Same as above

Pitocin Preterm loss/IUFD

Incomplete or unavoidable abortion

Same as above

10-20 mUnit/min but do not exceed 30 units/12 hr

Same as above

Same as above

Again, watch fluid intake

Cervidil (Dinoprostone)

Initiation or continuation of

Pt already receiving oxytocic drugs

10 mg vaginal insert

Prostaglandin

Abdominal pain

Inform doctor of:

Same as above

Abortifacient

induction of labor HX of c-section or uterine surgery

Methergine Control of uterine (Methylergonovin) hemorrhage after birth.

given once for procedure

If spontaneous labor or vaginal delivery is contraindicated

place 1 insert in the posterior fornix of vagina

Unexplained vaginal bleeding during pregnancy

should not be used without a retrieval system.

Hx. of allergic rxn

IV: 0.2mg after delivery of anterior shoulder, after delivery of placenta, or during puerperium

Preeclampsia Hypertension Pregnancy

Can be repeated every 2-4 hours prn.

Stimulates uterine contractions similar to natural labor

Amniotic fluid embolism Diarrhea DIC Hypotension Hypersensitivity reaction

Allergies Past hx or full term births Vaginal bleeding

Uterine rupture

Ergot Derivative/

Headaches,

Inform doctor of:

Increases rate, tone, and amplitude of uterine smooth muscle contractions

Dizziness

Allergy to methergine

Angina pectoris

Hypertension

AV block

Pregnancy

Prostaglandin

Diarrhea

Warn pt not to share this drug with others.

must have pregnancy test prior to drug therapy for gastric

abdominal pain

Monitor blood pressure. Cytotec (Misoprostol)

Term of intrauterine preg Cervical ripening Labor induction

Hx. of allergic rxn Pregnancy (Category X).

25mcg PO every 2 hrs 25mcg intravaginal every 3 - 6 hrs.

constipation

ulcers. Hemabate (carboprost tromethamine)

Pregnancy termination postpartum hemorrhage

Cardiac, pulmonary, renal, hepatic disease

headache Chest pain, Tachycardia Hot flashes Diarrhea and Vomiting Cervical perforation

hypersensitivity to drug.

250mcg IM that can Prostaglandin, abortifacient; be repeated at 15 90m intervals for a max of 2mg. stimulates uterine contractility 250mcg IM then again at 1.5-3.5 hr Monitor for intervals termination of pregnancy

Hypersensitivity to sympathomimetics

Initiate at 2.5-5 mcg/min IV

Nervousness Restlessness Hyperglycemia Hypokalemia Trembling Tachycardia HTN pounding heartbeat

acute pelvic inflammatory ds

Inform doctor of allergy to this drug any respiratory, cardiac, hepatic, or renal disease.

Uterine Tocolytics: Brethine (Terbutaline)

Preterm labor

Use >72 hr in management or prevention of preterm labor

Magnesium Sulfate Preterm labor use

Preterm labor

Hypersensitivity

beta agonists

Beta adrenergic Increase gradually receptor as tolerated at 20-30 minute intervals stimulator causing bronchial/uterine Continue infusion smooth muscle for 12 hr following relaxation cessation of uterine contractions; not to exceed 48-72 hr Loading dose: 4-6 g IV over 20min

Myocardial damage, diabetic coma, heart maintenance: 2-4 block g/hr IV for 12-24h

Antidysthythmics Depresses CNS blocks peripheral

Protection from light Distributed into breast milk, but in amounts generally considered insufficient to affect nursing infants

Circulatory collapse magnesium is consumed in the diet through the Resp paralysis foods you eat, so make sure your consumption Hypothermia of those foods

Hypermagnesemia Hypercalcemia

Magnesium Sulfate Antieclamptic use

Toxemia of pregnancy

Hypersensitivity Myocardial damage, diabetic coma, heart block Hypermagnesemia Hypercalcemia

as tolerated after contractions cease Do not exceed 5-7 days of continuous treatment

4-5 g (diluted in 250 mL NS/D5W) IV in combination with either

neuromus. Trans.

Pulmonary edema

produces anticonvuls effects

Depressed reflexes Hypotension

dec amount of Ach released at endplate

Hypotension Same as above Flushing Drowsiness

(a) up to 10 g (20 mL of undiluted 50% solution) divided and administered IM into each buttock or

Depressed cardiac function

-Calcium supplement

Hypersensitivity IM/SC administration

-magnesium is consumed in the diet through the foods you eat, so make sure your consumption of those foods

Diaphoresis Hypocalcemia Hypophosphatemia

(b) after initial IV dose, 1-2 g/hr IV;

Calcium Gluconate

Flushing

Calcium Supplement

antidotes/ calcium salts

-Pregnant or

-Bone mineral

Bradycardia

-take into consideration

Hypotension

dietary intake

Ventricular fibrillation during CPR Hypercalcemia

component breastfeeding patient: 1000/day PO divided q8-12hr, Monitoring: preferably 1-2 hours -Heartbeat after meals - for GI symptoms indicate hypercalcemia

Narcan

-opioid overdose

0.4-2 mg IV/IM/SC

suspected paralytic ileus and GI obstruction

Constipation Diarrhea Flatulence Nausea

Abrupt reversal may do not stop drug result in… suddenly after long term competitive opioid use antagonist nausea, vomiting, sweating, -watch for shallow tachycardia, breathing, slow increased blood heartbeat, cold, pressure and clammy skin tremulousness opioid analgesics

Sig RD Acute or severe bronchial asthma

Headache

repeat q2-3min PR not to exceed 10 mg (0.01 mg/kg)

hypersensitivity to oxycodone or naloxone

Opioids: Stadol

Pain from labor

Severe Asthma

Given via IM

Analgesic/Opioid

GI: N/V

Premedication for

Suspected GI

usually 1 to 2 mg

Reassess pain

Neurologic:

avoid activities requiring mental alertness

procedure

obstruction

control

dizziness, insomnia

Do not take alcohol

Sig. respiratory depression

monitor for RD

Resp: congestion

Advise pt of the risk of neonatal opioid withdrawal syndrome

long-term use: RD Nubain

Pain during labor and delivery

Same as above

10 mg IV/IM/subQ every 3- 6hr as needed

Same as above

Black Box Warning Diaphoresis N/V, xerostomia

Post/pre operative pain

Report symptoms of RD, OH, syncope avoid activities requiring mental alertness

Dizziness, headache, vertigo avoid alcohol and other CNS depressants Hypotension Advise pt of the risk of Adrenal insuff neonatal opioid withdrawal syndrome

Morphine (Duramorph)

Pain during labor and delivery

Same as above

Epidural requires adequate pt monitoring

Same as above

GI: N/V Neurologic: dizziness, insomnia

IV: admin slowly Resp: congestion Oral: use the enclosed calibrated oral syringe

long-term use: RD cardiac arrest,shock, syncope, OH

Narcotic

Same as above

enhancers: Phenergan

sedation during labor

Intra-arterial inj

50mg- early labor

Antiemetic agent

RD

SubQ Injection

25-75 mg with reduced dose of narcotic during labor

H1 receptor antagonist which creates sedative, antiemetic, and anticholinergic effects.

Tissue Injury

Hypersens Rxn

Can be repeated once or twice at 4hr interval during normal labor with max dose of 100mg over 24 hours.

Data shows inc risk for intervent with newborn

avoid nursing while taking this drug

Dec seizure thresh. Dec Bone Marrow Neuroleptic malignant syn.

Monitor for tissue injury and RD Steroids: (Betamethasone)

reduces health complications in preterm infants

Hx of Hypersen Rns Given orally Btwn 24-34w: Single course live vaccines Btwn 34-37w: if have not received, Pt with active or suspected infection receive single in womb course Women...