OB MEDS - OB Medications for Simulation PDF

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OB Medications for Simulation...

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Student Name: Allyson Osborn

Date: 11/2/15

Texas A&M University-Corpus Christi College of Nursing & Health Sciences Medication Administration/Worksheet for Common OB Meds

MEDICATIONS

Copy the form below as needed. Submit a separate list (file) for each of the three areas (L&D, postpartum,

newborn) Include the following commonly administered medications in OB: L&D meds: pitocin, cervidil, bupivicaine, ephedrine, stadol, fentanyl, methergine, hemabate, cytotec, terbutaline, Magnesium Sulfate, Ancef, Penicillin G, betamethasone, pepcid, bicitra. Postpartum meds: Simethicone, Motrin, Norco, Ultram, Tylenol # 3, labetelol, Rhogam, depo-provera, MMR, Tdap, Flu vaccine. Newborn: erythromycin ointment, vitamin K, Hepatitis B vaccine, triple dye

Some of these meds are commonly used for medical problems. Think about how they are used in Obstetrics (look them up in your OB textbook or Epocrates to find alternate uses). Generic/Trade name Classification Mechanism of Action

Oxytocin/ Pitocin Oxytocic Hormone Acts directly on myofibrils producing uterine contraction; stimulates breast milk letdown, vasoactive antidiuretic effect.

Dosage and Route

Medication can be administered IV, nasal, and IM.

Is this a Safe Dose?

Appropriate doses are as follows:  IV route: o Labor induction: 1-2 miliunits/minute, increase by 1-2 miliunits Q15-60 minutes until regular contractions occur then decrease the dosage. o Postpartum Hemorrhage: 10-40 units in 1000 mL nonhydrating diluent infused at 20-40 miliunits/ minute. o Incomplete abortion: Incusion of 10 units/500 mL D5W or normal saline, run at 10-20 miliunits/ minute; max 30 units/12 hours.

Medication Sheet for Common OB Medications Page 1 of 40

Student Name: Allyson Osborn

Date: 11/2/15

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o Fetal Stress test: 0.5 miliunits/minute; increase Q20 minutes until 3 contractions occur at 10 minutes. IM Route: o Postpartum Hemorrhage: administer 3-10 units after placenta delivery Nasal route is used primarily to stimulate the letdown reflex. The Nasal spray is usually a 5 mL nasal spray bottle with a concentration of 10 units/ mL.

Drug/food Interactions

Vasopressors cause increased hypertension; ephedra can also cause hypertension

Side Effects / Adverse Reactions

Seizures, tetanic contractions, hypotension, hypertension, dysrhythmias, increased pulse, bradycardia, tachycardia, premature ventricular contractions, anorexia, nausea vomiting, constipation, abruption placentae, decreased uterine blood flow, rash, increased hyperbilirubinemia, asphyxia, water intoxication of mother; adverse effects that the medication could have on the fetus include dysrhythmias, jaundice, hypoxia, and intracranial hemorrhage.

Lab / VS needed prior to administration Nursing Considerations

Maternal and Fetal Vital Signs; assessment of contractions 

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Medication Sheet for Common OB Medications Page 2 of 40

Assess labor contractions: fetal heart tones, frequency, duration, intensity of contractions; if fetal heart tones increase or decrease significantly or if contractions are longer than one minute notify prescriber; turn patient on left side to increase oxygen to the fetus. Assess for water intoxication: confusion, anuria, drowsiness, headache, and notify the prescriber. Watch for fetal distress, acceleration deceleration, fetal presentation, pelvic dimensions Monitor B/P, pulse, respiratory rate, rhythm, depth Monitor I&O ration Provide an environment conducive for the letdown reflex

Student Name: Allyson Osborn

Date: 11/2/15

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Why is this patient taking this?

Is it effective? Provide the evidence. (How would you know if it was effective? What are you looking for?) Generic/Trade name Classification Mechanism of Action Dosage and Route Is this a Safe Dose?

Drug/food Interactions Side Effects / Adverse Reactions

Teach patient to report increased blood loss, abdominal cramps, increased temperature, or foul smelling lochia. Advise patient that contractions will be similar to menstrual cramps, gradually increasing in intensity.

Medication is most often used to induce labor or to help in the ejection of the placenta. Other uses include for a missed or incomplete abortion, stimulation of milk letdown, and for control of bleeding. Medication is effective if labor is successfully induced, postpartum bleeding is decreased, or successful stimulation of milk letdown (nasal route).

Dinoprostone/ Cervidil Oxytocin, abortifacient/ Prostaglandin E2 Stimulates uterine contractions similar to labor by myometrium stimulation, causing abortion; acts within 30 hours for complete abortion. Available forms include 20 mg vaginal suppository, 0.5 mg/3g vaginal gel, and 10 mg vaginal insert All of the above are within the safe dose range. The maximum doses are as follows: vaginal suppository is 240 mg, 1.5 mg/24 hours vaginal gel, one 10 mg vaginal insert should be removed at the onset of active labor or within 12 hours. Alcohol causes decreased oxytoxic effect, and other oxytocics will cause an increased effect  General: Headaches, dizziness, chills, fever, flushing, hypotension, dysrhythmias, DIC, blurred vision, nausea, vomiting, diarrhea, vaginitis, vaginal pain, rash and skin color changes, leg cramps, joint swelling, weakness, anaphylactoid syndrome of pregnancy

Medication Sheet for Common OB Medications Page 3 of 40

Student Name: Allyson Osborn

Date: 11/2/15

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Lab / VS needed prior to administration Nursing Considerations

Insert: Uterine hyperstimulation, fever, nausea, vomiting, diarrhea, abdominal pain Gel: uterine contractile abnormality, GI side effects, back pain, fever Suppository: uterine rupture, anaphylaxis Fetal: bradycardaia

Maternal and Fetal vital signs; contraction assessment

Medication Sheet for Common OB Medications Page 4 of 40

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Cervical ripening: assess dilatation and effacement of the cervix, uterine contractions, fetal heart tones; watch for contractions lasting over 1 min, hypertonus, fetal distress; product should be slowed or discontinued

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Assess for fever that occurs approximately 30 min after supp insertion (abortion)

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Monitor for nausea, vomiting, diarrhea; these may require medication

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Assess for hypersensitivity reaction: dyspnea, rash, chest discomfort

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Assess respiratory rate, rhythm, depth; notify prescriber of abnormalities in pulse, B/P

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Check vaginal discharge; itching, irritation indicates vaginal infection

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Teach patient all aspects of treatment including purpose of medication and expected results

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Tell patient that gel may produce warmth in her vagina

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Caution patient that if contractions are longer than 1 min to notify nurse or

Student Name: Allyson Osborn

Date: 11/2/15

prescriber

Why is this patient taking this?

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Advise patient to notify prescriber of cramping, pain, increased bleeding, chills, increased temp, or foul-smelling discharge; these symptoms may indicate uterine infection

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Advise patient to remain supine 10-15 min after insertion of suppository, 2 hr after insert, 15-30 min after gel

Medication is used to aid in the progression of labor to enhance uterine contractions.

Is it effective? Provide the Medication is effective if contractions increase in duration, frequency, and intensity. evidence. (how would you know if it was effective? What are you looking for?) Generic/Trade name Classification Mechanism of Action

Dosage and Route

Bupivacaine Hydrochloride/ Marcaine Local anesthetic Blocks the generation and conduction of nerve impulses, presumably by increasing the threshold for electrical excitation in the nerve, by slowing propagation of the nerve impulse, and by reducing the rate of rise of action potential. Available in a 0.25%, 0.5%, and 0.75% injection; can be given IM local infiltration, sympathetic block, lumbar epidural, peripheral nerve block, and retrobulbar block

Is this a Safe Dose?

The maximum dose when used for obstetric purposes is a 0.5% injection.

Drug/food Interactions

CNS DEPRESSANTS augment CNS depression; with isoproterenol, ergonovine there is persistent hypertension and a risk of CVA if bupivacaine used with epinephrine; MAO INHIBITORS, TRICYCLIC ANTIDEPRESSANTS, PHENOTHIAZINES cause severe or prolonged

Medication Sheet for Common OB Medications Page 5 of 40

Student Name: Allyson Osborn

Date: 11/2/15

hypotension or hypertension if bupivacaine used with epinephrine Side Effects / Adverse Reactions

Lab / VS needed prior to administration Nursing Considerations

Local anesthetics rapidly cross the placenta. Toxic reactions for the fetus and mother depend on the route and amount of the drug administered but may include alterations in the central nervous system, peripheral vascular tone, and cardiac function. Can result in the slowing of labor and increased incidence of forceps delivery. Other side effects include hypotension, myocardial depression, decreased cardiac output, bradycardia, ventricular arrhythmias, cardiac arrest, urinary retention or incontinence, paralysis or decreased sensation of the lower extremities, depression, excitability, restlessness, anxiety, dizziness, tinnitus, blurred vision, tremors, convulsions, drowsiness, unconsciousness, respiratory arrest, nausea, vomiting, chills, pupil constriction, and hypersensitivity reactions. Maternal and fetal vital signs 

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Why is this patient taking this?

Monitor for toxicity: CNS stimulation (unusual anxiety, excitement, restlessness) usually occurs first, followed by CNS depression (drowsiness, unconsciousness, respiratory arrest). Monitor BP and fetal heart rate continuously during labor because maternal hypotension may accompany regional anesthesia. Place mother on left side with legs elevated. Monitor cardiac and respiratory status continuously After spinal anesthesia, sensation to lower extremities may not return for 2.5-3.5 hours.

For the production of local or regional anesthesia to provide pain relief during labor and obstetrical procedures

Is it effective? Provide the Medication is effective if the patient reports a decreased level of pain evidence. (how would you know if it was effective? What are you

Medication Sheet for Common OB Medications Page 6 of 40

Student Name: Allyson Osborn

Date: 11/2/15

looking for?) Generic/Trade name Classification Mechanism of Action

Fentanyl/ Sublimaze Opioid analgesic Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception by binding to opiate receptors

Dosage and Route

For an adult with moderate to severe pain the medication can be given IM or IV.

Is this a Safe Dose? Drug/food Interactions

The appropriate dose range for moderate to severe pain is 50-100 mcg IM or IV Q1-2 hours. Alcohol: increased respiratory depression, hypotension, increased sedation; Cimetidine, conivaptan, cycloSPORINE, fluconazole, itraconazole, ketoconazole, nefazodone, ranolazine, zafirlukast, zileuton: increased fentaNYL effect, fatal respiratory depression; other opioids and skeletal muscle relaxants will cause increased effects; CNS depressants and sedative hypnotics will cause increased respiratory depression and hypotension.

Side Effects / Adverse Reactions

Dizziness, delirium, euphoria, sedation, bradycardia, cardiac arrest, hypotension, hypertension, blurred vision, miosis, nausea, vomiting, constipation, urinary retention, rash, diaphoresis, muscle rigidity, respiratory depression, respiratory arrest laryngospasm Maternal vital signs

Lab / VS needed prior to administration Nursing Considerations

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Medication Sheet for Common OB Medications Page 7 of 40

Monitor Vital signs Assess for respiratory dysfunction: respiratory depression, character, rate, and rhythm, notify prescriber if respirations are less than 10 breaths per minute Monitor CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction Assess pain before and after administration. Advise patient to report any symptoms of CNS changes, allergic reactions Teach patient that dizziness, drowsiness, and confusion are common and to avoid

Student Name: Allyson Osborn

Date: 11/2/15

getting up without assistance.

Why is this patient taking this? Patient is taking this medication for pain relief related to labor. Is it effective? Provide the Medication is effective if the patient verbalizes a decreased level of pain. evidence. (how would you know if it was effective? What are you looking for?) Generic/Trade name Classification Mechanism of Action

Ephedrine Sulfate Sympathomimetic Stimulates both alpha and beta receptors resulting in an increased heart rate and blood pressure, stimulation of heart muscle, and constriction of arterioles, while relaxing smooth muscle.

Dosage and Route

This medication can be given IV, subcutaneously, or IM.

Is this a Safe Dose?

The appropriate IV dose for an adult patient is 5-25 mg to be administered slowly. The usual parenteral dose is 25-50 mg. The maximum dose is 150 mg/day.

Drug/food Interactions

Using ephedrine with general anesthetics may cause cardiac arrhythmias; MAO inhibitors should not be administered within 14 days of receiving ephedrine because a hypertensive crisis could result; can inhibit the hypotensive effect of any antihypertensive medications Excessive doses may cause a sharp rise in blood pressure that could lead to cerebral hemorrhage. Other side effects include headache, restlessness, anxiety, tension, tremor, weakness, dizziness, confusion, delirium, hallucinations, pallor, respiratory difficulty, palpitation, sweating, nausea and vomiting.

Side Effects / Adverse Reactions

Medication Sheet for Common OB Medications Page 8 of 40

Student Name: Allyson Osborn

Lab / VS needed prior to administration Nursing Considerations

Date: 11/2/15

Maternal and fetal vital signs   

Medication should not be given if maternal blood pressure exceeds 130/80 Continuously monitor fetal heart rate because the medication can cause an acceleration of fetal heart rate. Ephedrine sulfate is excreted in breast milk; breast-feeding may be contraindicated for mothers who have received the medication.

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Why is this patient taking this? To counteract the hypotensive effects of epidural or spinal anesthesia The medication is effective if the maternal blood pressure remains within the appropriate Is it effective? Provide the evidence. (how would you know if range and a hypotensive state does not result from the epidural or spinal block. it was effective? What are you looking for?) Generic/Trade name Classification Mechanism of Action Dosage and Route

Is this a Safe Dose? Drug/food Interactions

Side Effects / Adverse Reactions

Butorphanol/ Stadol Opioid analgesic Stimulates receptors in the brain to increase the threshold to pain and reduce the perception of pain. For labor pain the medication is administered either IV or IM. The initial dose is usually 1-2 mg and may be repeated every four hours as needed. The maximum dose for this medication is 12 mg/day. Administration of this medication with other CNS depressants can lead to increased sedation and confusion; medication should not be administered within 14 days of taking an MAO inhibitor Drowsiness, sedation, headache, vertigo, dizziness, weakness, lethargy, confusion, lightheadedness, insomnia, nervousness, respiratory depression, palpitation, bradycardia,

Medication Sheet for Common OB Medications Page 9 of 40

Student Name: Allyson Osborn

Lab / VS needed prior to administration Nursing Considerations

Why is this patient taking this?

Date: 11/2/15

nausea, clammy skin, tingling sensation, flushing and warmth, cyanosis of extremities, diaphoresis, sensitivity to cold, urticarial, pruritus, difficulty urinating Maternal Vital Signs, especially respiratory rate, and further assessment of respiratory status including character and rhythm  Medication should only be administered if childbirth is expected to be more than four hours away; using it just before childbirth can cause breathing problems for the newborn.  Observe neonate for signs of respiratory depression.  Medication can be passed into breast milk and may harm a nursing baby; health care provider will make appropriate arrangements regarding breast-feeding.  Monitor for respiratory depression; do not administer if respiratory rate is < 12.  Monitor maternal vital signs and report marked changes in blood pressure or bradycardia. Patient is taking this medication to help alleviate the pain associated with early labor.

Is it effective? Provide the Medication is effective if patient’s pain is decreased or remains at a tolerable level. evidence. (how would you know if it was effective? What are you looking for?) Generic/Trade name Classification Mechanism of Action Dosage and Route Is this a Safe Dose?

Methylergonovine/ Methergine Oxytocic; Ergot Alkaloid Stimulates uterine and vascular smooth muscle, causing contractions, decreased bleeding, and arterial vasoconstriction. Medication can be administered PO, IM, and IV. The appropriate doses include PO: 200 mcg tid-qid up to 7 days, and IM/IV: 200 mcg q2-4 hours for 1-5 doses.

Medication Sheet for Common OB Medications Page 10 of 40

Student Name: Allyson Osborn

Drug/food Interactions

Date: 11/2/15

Side Effects / Adverse Reactions

Smoking will cause increased vasoconstriction; CYP3A4 inhibitors will cause increased toxicity; vasopressors, ergots, and regional anesthetics will cause increased vasoconstriction Headache, dizziness, seizures, hallucinations, stroke, hypotension, chest pain, palpitations, hypertensions, dysrhythmias, CVA, tinnitus, nausea and vomiting, cramping, sweating, rash, allergic reactions, leg cramps, dyspnea

Lab / VS needed prior to administration Nursing Considerations

Maternal vital signs and assessment of uterine contractions including intensity, frequency, and duration  Monitor B/P, pulse; watch for change that may indicate hemorrhage

Why is this patient taking this?

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Assess fundal tone, nonphasic contractions; check for relaxation or severe cramping

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Assess for ergotism or overdose: nausea, vomiting, weakness, muscular pain, insensitivity to cold, paresthesia of extremities; product should be decreased or infusion discontinued

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Before administering ergonovine, check calcium levels; if hypocalcemia is present, correction should be made to increase effectiveness of this product

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Monitor prolactin levels for decreased breast milk production

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Inform the patient that abdominal cramps are a side effect of this medication.

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Instruct the patient to notify the prescriber if chest pain, nausea, vomiting, headache, muscle p...