Ob Medications

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Celestone
Generic Name: Betamethasone
Indication for usage: To help the fetal lungs develop more quickly. Causes fetus’s lungs to produce surfactant. Decreases the chance the baby will have respiratory distress syndrome when born. Usually used when preterm delivery is a concern. Given within 24-48 hours of birth.
Route: Im Injection and IV
Dosage: 0.5-9 mg/day
Side Effects: Sleepiness, increased blood sugar levels for mother, and decreased fetal movement. Fluid retention and and increased blood pressure for mom.

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Contraindications: Use cautiously with kidney or liver disease, hypothyroidism, ulcerative colitis, diverticulitis, IBD, CHF, hypertension, osteoporosis, seizure disorders, and diabetes mellitus.
Nursing Considerations: Fetal lung maturity testing with an amniocentesis can be used to determine whether antenatal corticosteroid treatment is necessary. Consider fungal infections that may be present, kidney or liver disease. Baseline blood glucose level.

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Benadryl
Generic name: diphenhydramine
Indication for usage: treatment of severe morning sickness
Dose: 25-50mg
Route: Oral
Side Effects: sleepiness, fatigue, dizziness, headache, dry mouth, difficulty urinating. Low Blood pressure, palpitations, increased heart rate, confusion, nervousness, irritability,

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Contraindications: Use with caution in mothers with narrow angle glaucoma, hyperthyroidism, cardiovascular disease, hypertension, and asthma, lactation.
Nursing Considerations: Ambulate because it’s anti-cholinergic Monitor cardiovascular effects. Don’t mix with other CNS depressants. Use caution with breastfeeding. May cause dizziness/drowsiness so warn pt.

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Bicitra
Generic Name: citric acid and codium citrate
Indication for usage: Used in an attempt to minimize the possibility of chemical pneumonia , which can occur if the heavily drugged mother vomits and aspirates . Bicitra can reduce the acidity of the mothers stomach contents.
Route: PO
Dosage: 15ml
Side Effects: N/V/D, stomach pain,Black, tarry stools ,Confusion, Seizures ,trouble breathing

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Contraindications: Renal impairment or sodium restricted diets, electrolyte imbalance. Addison's disease, diabetes, heart or kidney disease, high blood pressure, hypocalcemia, intestinal blockage, or
Nursing Considerations: Monitor for SE’s. Warn it has a sweet/sour taste. Can be mixed with juice for better taste.
Pertinent Lab Values: Monitor serum electrolytes, especially bicarbonate.

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Clindamycin

Generic: clindamycin

Trade: Cleocin, Cleocin Pediatric, Cleocin T, Cleocin Vaginal, Clinda-Derm, Clindagel, Clindamax, Clindesse, Clindets Pledget
Action: Binds to bacterial ribosomal receptor sites, inhibiting protein synthesis of the cell wall.
Rationale in Labor and Delivery: Used in Bacterial Vaginosis due to Strep, Also IV for Group B Strep carrying women. (although may develop resistance to this med)
Dose Range: (ADULTS) IV, IM- 1.2-2.7g per day in 2-4 divided doses, MAX=4.8g/day PO- 150-450 mg q6h, MAX- 1.8 g/day (CHILDREN less than 1mo) IV, IM- 15-20mg/kg/day in 2-3 divided doses
Safe Range:
Route: IV in L&D, IM, PO, Topical, Vaginal Cream or Suppository
Contraindications: History of antibiotic-associated colitis, regional enteritis, ulcerative colitis, hypersensitivity to clindamycin or lincomycin, known allergy to tartrazine dye. Cautions: severe renal/hepatic dysfunction, concomitant use of neuromuscular blocking agents, neonates. Do not apply topical to abraded areas of skin or near eyes.

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Side Effects: (frequent) systemic-abdominal pain, nausea, vomiting, diarrhea, topical-dry, scaly skin, vaginal-vaginitis, pruritus. (occasional) systemic-phlebitis, thrombophlebitis with IV administration, pain, induration at IM injection site, allergic reaction, urticaria, pruritus, topical- contact dermatitis, abdominal pain, mild diarrhea, burning, stinging vaginal-headache, dizziness, nausea, vomiting, abdominal pain. (rare) vaginal-hypersensitivity reaction.
Pertinent Lab Values: WBCs, electrolytes
RN Considerations and Interventions: Ask patient about allergies to clindamycin, lincomycin, and aspirin. Avoid concurrent use of neuromuscular blocking agents. Monitor daily pattern of bowel activity and stool consistency. Report diarrhea promptly due to potential for serious colitis. Assess skin for rash with topical application. With all routes of administration be alert for signs of superinfection: fever, vomiting, diarrhea, anal/genital pruritus, oral mucosal changes (ulceration, pain, erythema).
Pregnancy Category B

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Epogen

Generic: epoetin-alfa
Trade: Epogen, Procrit
Action: Stimulates division, differentiation of erythroid progenitor cells in bone marrow.
Rationale in Labor and Delivery: Treatment for anemia, raise and maintain hemoglobin without transfusion (should not exceed 12g/dl)
Dose Range: ADULTS- start at 150 units/kg 3x/wk, may go up to 300 units/kg 3x/wk or 40,000 units once a week to 60,000 units once a week. CHILDREN- 600 units/kg to 900 units/kg once a week. Max for kids- 60,000 units once weekly.
Safe Range:
Route: IV or Subcutaneous (do not shake vial)

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Contraindications: History of sensitivity to mammalian cell-derived products or human albumin, uncontrolled hypertension. CAUTIONS- Pts with known porphyria (impairment of erythrocyte formation in bone marrow), history of seizures (cancer patients may have tumor growth, shortened survival may occur when Hgb levels of 12g/dl or greater are achieved with epoetin alfa) (Chronic kidney failure patients are at increased risk for serious cardiovascular reactions such as stroke or MI when Hgb levels greater than 12g/dl are achieved with epoetin alfa)
Side Effects: (frequent) fever, diarrhea, nausea, vomiting, edema. (occasional) Asthenia, shortness of breath, paresthesia. (rare) dizziness, trunk pain.
Pertinent Lab Values: Hgb, Hct, CBC, BUN, serum uric acid, creatinine, phosphorus, potassium, serum iron/ferritin
RN Considerations and Interventions: Assess B/P before initiation of drug therapy. There may be a rise in B/P during early therapy. Baseline CBC and serum iron and ferritin should be taken. Especially notice Hct. All patients eventually need supplemental iron therapy.
Pregnancy Category C

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Fentanyl

Generic: fentanyl
Trade: Actiq, Duragesic, Fentora, Onsolis, Sublimaze
Action: Binds to opioid receptors in CNS, reducing stimuli from sensory nerve endings, inhibits ascending pain pathways.
Rationale in Labor and Delivery: May be used in Spinals, used for pain relief.
Dose Range: IV/IM: 50-100mcg/dose q1-2h as needed (adjunct to general anesthesia: 2-50mcg/kg), Buccal (general): 100mcg, Buccal Soluble Film: 200mcg-1200mcg (no more than 4 doses per day, separate by at least 2 hours), Transdermal: 25mcg/hr initially, may increase after 3 days, Transmucosal: 200-400mcg for breakthrough pain, Epidural: Bolus of 100mcg followed by continuous infusion of 10mcg/ml concentration at 4-12ml/hr
Safe Range:
Route: IV, IM, Buccal, Transdermal, Transmucosal, Epidural

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Contraindications: Increased intracranial pressure (ICP), severe hepatic/renal impairment, severe respiratory depression. CAUTIONS- Bradycardia; renal, hepatic, respiratory disease; head injuries; altered LOC; use of MAOIs within 14 days; transdermal not recommended in those younger than 12 yrs or younger than 18 yrs and weighing less than 50kg.
Side Effects: (frequent) IV: postop drowsiness, nausea, vomiting. Transdermal: Headache, pruritus, nausea, vomiting, diaphoresis, dyspnea, confusion, dizziness, drowsiness, diarrhea, constipation, decreased appetite. (occasional) IV: Postop confusion, blurred vision, chills, orthostatic hypotension, constipation, difficulty urinating. Transdermal: Chest pain, arrhythmias, erythema, pruritus, syncope, agitation, skin irritations.
Pertinent Lab Values: Creatinine Clearance
RN Considerations and Interventions: Establish baseline B/P and respirations. Assess type, location, intensity, and duration of pain. Resuscitative equipment and opiate antagonist (naloxone 0.5 mcg/kg) must be available. Assist with ambulation, monitor respiratory rate, B/P, heart rate, O2 Sats. Assess for pain relief.
Pregnancy Category C (or D if used for prolonged periods or at high dosages at term)

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Methergine

Generic: methylergonovine
Trade: Methergine
Action: Stimulates alpha-adrenergic, serotonin receptors, producing arterial vasoconstriction. Causes vasospasm of coronary arteries. Directly stimulates uterine muscle.
Rationale in Labor and Delivery: Prevention or treatment of postpartum or postabortion hemorrhage due to atony, involution (not for induction, augmentation of labor). Off-Label: treatment of incomplete abortion.
Dose Range: PO: 0.2 mg 3-4 times a day, continue for up to 7 days. IV/IM: Initially 0.2 mg after delivery of anterior shoulder, after delivery of placenta, or during puerperium. May repeat q2-4hr as needed.
Safe Range:
Route: PO, IV, IM

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Contraindications: Hypertension, pregnancy, toxemia, untreated hypocalcemia. CAUTIONS- Renal/hepatic impairment, coronary artery disease, occlusive peripheral vascular disease, sepsis.
Side Effects: (frequent) Nausea, uterine cramping, vomiting. (occasional) Abdominal pain, diarrhea, dizziness, diaphoresis, tinnitus, bradycardia, chest pain. (rare) allergic reaction (rash, pruritus), dyspnea, severe or sudden hypertension.
Pertinent Lab Values: May decrease serum prolactin. Serum calcium levels
RN Considerations and Interventions: Determine baseline serum calcium level, B/P, pulse. Assess bleeding before administration. Monitor uterine tone, bleeding, B/P, pulse q15min until stable (about 1-2 hrs). Assess extremities for color, warmth, movement, pain. Report chest pain promptly. Provide support with ambulation if dizziness occurs.
Pregnancy Category C

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Mylicon – Postpartum medication
Generic name: simethicone
Trade name: Gas-X
Action and Rationale: Disperses, prevents gas pockets in HI system; does not decrease gas procuction. It is commonly used to relief postpartum flatulence or bloating.
Dose range: Adult and child >12 years PO 40-100 mg pc, hs; Infants: PO 20 mg qid
Safe range: Chew tabs 40, 80mg; tabs 50, 60, 95, 125mg; drops 40mg/0.6ml; caps 125mg
Route: PO

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Contraindications: Hypersensitivity
Adverse Effect: GI-Belching, rectal flatus
Pertinent lab values: N/A
RN Considerations/Interventions: Asses for excess gas production, decreased bowel sounds, recent surgery, other GI conditions
Pregnancy category: N/A

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Toradol – Postpartum Medication
Generic name: ketorolac
Trade name: Toradol
Action and Rationale: Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis; analgesic, anti-inflammatory, antipyretic effects. It is used for mild to moderate pain
Dose range/ Safe range: Adult multiple dosing: IV BOL/IM 30 mg q6h max 120 mg/day, with transition of 20 mg PO, then 10 mg q4-6h; Single dose: IV BOL/IM 30 mg IV or 60 mg IM, then 20 mg transition dose, not to exceed 40 mg/day then 10 mg q4-6h
Route: IM, IV, Opthalmic solution, PO

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Contraindications: Hypersensitivity, asthma, sever renal disease, severe hepatic disease, peptic ulcer disease, L&D, lactation, CV bleeding.
Adverse Effect: Hypertension, flushing, syncope, pallor, edema, vasodilation, dizziness, drowsiness, tremors, tinnitus, hearing loss, blurred vision, nausea, anorexia, vomiting, diarrhea, constipation, flatulence, cramps, dry mouth, peptic ulcer, GI bleeding, perforation, taste change, neprhotoxicity, dysuria, hamaturia, oliguria, azotemia, blood dyscrasias, prolonged bleeding, purpura, rash pruritus, sweating.
Pertinent lab values: Assess and monitor BUN, creatinine, AST (SGOT), ALT (SGPT) Hbg before treatment, test for occult blood in urine.
RN Considerations/Interventions: Assess eyes for redness, swelling, tearing, itching, bleeding, blurred vision, tinnitus, jaundice, yellow sclera and skin, clay-colored stools, hypertension, cardiac conditions. Administer IM/IV for 5 days or less.
Pregnancy category: Pregnancy (C)

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Tylenol- Postpartum Medication
Generic name: acetaminophen (OTC)
Trade name: Tylenol, Tempra
Action and Rationale: May block pain impulses peripherally that occurs in response to inhibition of prostaglandin syntheses; does not possess anti-inflammatory properties; antipyretic action results from inhibition of prostaglandins in the CNS (hypothalamic heat-regulating center). Relieves mild to moderate pain or fever in postpartum.
Dose range: PO 325-650 mg q4h prn, not to exceed 4g/day; RECT 325-650 mg q4h prn, not to exceed 4g/day.
Safe range:
Route: PO, RECT

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Contraindications: Hypersensitivity, intolerance to tartrazine (yellow dye#4), alcohol, table sugar, sacharin
Adverse Effect: Anaphylaxis, leucopenia, neutropenia hemolytic anemia, thrombocytopenia, pancytopenia, drowsiness, nausea, vomiting, abdominal pain, rash, urticaria, angioedema, cyanosis jaundice, delirium followed by vascular collapse, convulsions, com, death.
Pertinent lab values: AST, ALT, bilirubin, creatitine, BUN,
RN Considerations/Interventions: Assess and monitor liver functions studies: AST, ALT, bilirubin, creatinine; renal function studies: BUN, urine creatinine, occult blood, albumin, if patient is on long-term therapy. Presence or blood or albumin indicates nephritis. Blood studes: CBC, pro-time if patient is on long term.
Pregnancy category: Pregnancy (B)

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Motrin- Postpartum Medication
Generic name: ibuprofen
Trade name: Motrin, Advil, Excedrin
Action and Rationale: Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis; analgesic, anti-inflammatory, antipyretic. It is used dysmenorrheal, fever in postpartum.
Dose range Safe range /: PO 200- 400 mg q4-6h, not to exceed 3.2 g/day
Route: PO (chew tab, suspension, tab)

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Contraindications: Hypersensitivity, asthma, severe renal disease, severe hepatic disease. While lactating.
Adverse Effect: Tachycardia, peripheral edema, palpitations, dysrhythmias, headaches, dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression, blurred vision, nausea, vomiting, diarrhea, jaundice, constipation, flatulence, cramps, dry mouth, peptic ulcer, hematuria, oliguria, purpura, rash pruritus , sweating.
Pertinent lab values: Observe BUN, creatinine, AST (SGOT), ALT (SGPT), Hgb,
RN Considerations/Interventions: Monitor for blurred vision, palpitations, blood pressure, pulse for character, quality, rhythm.
Pregnancy category: Pregnancy (B) 1st and 2nd trimesters

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Generic Name: misoprostol
Trade Name: cytotec
Action: synthetic prostaglandin: ↓gastric acid secretion &pepsin, ↑bicarbonate & mucus
causes uterine contractions
Use in LD: category x, abortion, premature birth
Dose Range: 100- 200 mcg up to 4xs/day
Safe Range: see above
Route: tablet

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Contraindications: prostaglandin allergy, don’t give during lactation (diarrhea in nursing baby), use in pregnancy for ↓risk of gastric ulcers from NSAIDS
S/E: diarrhea, abdominal pain, N&V, gas, dyspepsia, HA, uterine cramping, spotting
Lab Values: obtain negative pregnancy test before safe administration, plasma levels ↓ if take with food
RN Considerations/Interventions: *sound alike drug to mifepristone, metoprolol & cytosar. Give with food to ↓diarrhea, give after meal & at HS, take for duration of NSAID therapy, may increase mucus secretion in stomach, with abortion report ↑ bleed/ pain/ fever.

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Generic Name: meperidine hydrochloride (pethidine hydrochloride)
Trade Name:demeral
Action: narcotic analgesic, 1/10 potency of morphine, psychologic & physiologic dependence, moderate-severe pain

Use in LD: category C, obstetrical analgesia
Dose Range: 50-100 mg Q 3-4 hrs prn (adult), 1.1-1.75 mg/kg Q 3-4 hrs prn up to adult dosage (peds), PCA: 10 mg with range 1-5 mg per incremental dose with lockout 6-10 mins. IM/SC: 50-100 mg 30-90 min before anesthesia. OB: 50-100 mg Q 1-3 hr. IV: 15-35 mg/hr continuous IV. Iv Infusion: 1 mg/ml.
Safe Range: 50-100 mg Q 1-3 hrs
Route: tablet,oral solution, syrup, IM, SC, IV

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Contraindications: hypersensitivity, convulsive states (epileptic), tetanus, child < 6 months, diabetic acidosis, head injury, shock, liver disease, resp depression, ↑ICP, before labor during pregnancy, use with sibutramine.
S/E: constipation, dry mouth, N&V, anorexia,dizzy,fatique,lightheaded, muscle twitch, sweats, itchy, ↓urination, ↓libido.
Not compatible in IV: aminophylline, barbituates, heparin, iodide, methicillin, morphine sulfate, phenytoin, sulfas
RN Considerations/Interventions: syrup with ½ glass water, reduce dose by 50% if used with anti-anxiety meds, compatible with: D5/RL, dextrose-saline, dex 2%, 5%, 10%, RL 0.45%, 0.5% NACL, watch ortho HOTN, no driving (dizzy), watch dependence.

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Generic Name: nalbuphine hydrochloride
Trade Name: nubain
Action: synthetic opioid antagonist analgesic, moderate- severe pain, during labor analgesia

Use in LD: category x, abortion, premature birth
Dose Range: 10 mg for a 70 kg adult, SC IM or IV Q 3-6 hrs prn, 20 mg single dose
Safe Range: maximum daily dose of 160 mg
Route: SC, IM, IV

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Contraindications: hypersensitivity
S/E: allergic reaction, resp depression, ↑↓ HR, cold/clammy skin, confusion, dizzy, weak, lightheaded, n&v, HTN
Lab Values: interferes with opioid drug test
RN Considerations/Interventions: watch resp depression, renal/hepatic patients, can cause withdrawl,

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Generic Name: butorphanol tartrate
Trade Name: stadol
Action: narcotic agonist/antagonist, up to 7xs more potent than morphine,

Use in LD: category c
Dose Range: 2 mg Q 3-4 hr prn IM, 1-4 mg IM, 0.5-2 MG IV q 3-4hrs
Safe Range: 1-2 mg labor IM
Route: parenteral, nasal

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Contraindications: use of nasal form during labor or delivery, child< 18 yrs
S/E: parenteral: somnolence, dizzy, N&V. nasal: congestion, insomnia
Lab Values: interferes with opioid drug test
RN Considerations/Interventions: don’t use Haldol, direct IV less than or equal to 2 mg over 3-5 mins

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Oxytocin
Trade Name: Pitocin
Pregnancy Category X: High Alert Drug- Not expected to present risk of fetal abnormalities. Small amount is present in breast milk, breastfeeding not recommended.
Action & Use in LND: Induces labor at term. Controls postpartum bleeding. Adjunct in management of abortion.
Side Effects: Tachycardia, PVCs, hypotension, n/v Adverse Effects: Maternal: hyperonicity, cervical/vaginal lacerations Fetal: bradycardia, CNS/brain damage, low APGAR scale
Route, Dose Range: IM give 10units/ml IV infuse 10-40units/1-4ml

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Contraindications: Inadequate uterine activity/progress. Not indicated for elective induction
RN Considerations & Interventions: Assess baseline VS and fetal heart rate. Monitor intrauterine pressure and contractions q15min. Notify MD: if contractions last more than 1min, occur more frequently than q2min, or stop. Maintain careful I&O and check for blood loss. Keep Pt and family informed of labor progress.

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Promethazine
Trade Name: Phenergan
Pregnancy Category C: Readily crosses placenta, may inhibit platelet aggregation in neonates if taken within two weeks of birth. May produce jaundice or extrapyramidal symptoms in neonates if taken during pregnancy.
Action & Use in LND: Mild sedation during labor.
Side Effects: Drowsiness, hypotension, disorientation, confusion . Adverse Effects: anxiety, tremor, hyperactive reflexes, seizures.
Route, Dose Range: PO, IV, IM, Rectal 25-50mg

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Contraindications: Should not be used in Pt younger than two years old due to fatal respiratory depression. Sensitivity to phenothiazines.
RN Considerations & Interventions: IV- assess bp/pulse for bradycardia, tachycardia

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Nifedipine
Trade Name: Procardia
Pregnancy Category C: insignificant amount distributed in breast milk.
Action & Use in LND: Calcium channel/beta blocker that inhibits contraction of smooth muscle. Used to treat/delay preterm labor.
Route, Dose Range: PO 10-20mg

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Contraindications: Advanced aortic stenosis, severe hypotension.
RN Considerations & Interventions: Check bp for hypotension

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Terbutaline
Trade Name: Brethine, Bricanyl
Pregnancy Category B: Crosses placenta, distributed in breast milk.
Action & Use in LND: Stimulates beta₂ adrenergic receptors resulting in relaxation of uterine smooth muscle. Delays premature labor in pregnancies between 20-34wks
Route, Dose Range: PO 2.5-10mg q4-6hrs IV 2.5-10mcg/min may increase gradually q15-20min up to 1705-30mcg/min

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Contraindications: Sensitivity to sympathomimetics. Caution! cardiac impairment, DM, hypertension, hyperthyroidism, history of seizures.
RN Considerations: Assess baseline/ diligently monitor: maternal pulse, bp, frequency and duration of contractions, and FHR.

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Generic Name: dinoprostone
Trade Name: PREPIDIL
Action: Produces contractions similar to those that occur during labor by stimulating the myometrium (oxytocic effect). Initiates softening, effacement and dilation of cervix. Also stimulates GI smooth muscle

Use in LD: Preg Cat C - to “ripen” cervix in pregnancy at or near term when induction is indicated. As vaginal suppository:induction of midtrimester abortion up to 28 weeks. Mgmt of nonmetastatic gestional trophoblastic disease.

Dose Range: Cervical ripening: gel-0.5mg: if response unfavorable, may repeat in 6 hr(do not exceed 1.5 mg/24 hr). Abortifacient: one 20mg suppository, repeat q 3-5hr (not to exceed 240mg total or longer than 48hr)
Safe Range Cervical ripening:: if response unfavorable, may repeat in 6 hr(do not exceed 1.5 mg/24 hr). Abortifacient: one 20mg suppository, repeat q 3-5hr (not to exceed 240mg total or longer than 48hr)
Route: Vaginal insert/vaginal suppository .

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Contraindications: Hypersensitivity to prostaglandins or additives in the gel or suppository.Avoid in situations which prolonged uterine contractions should be avoided: previous C-section or uterine surgery, cephalopelvic disproportion, traumatic delivery or difficult labor, multiparity, hyperactive or hypertonic uterus, fetal distress, unexplained vaginal bleeding, placenta previa, vasa previa, active herpes genitalis, obstetric emergency requiring surgical intervention, situations which vaginal delivery in contraindidated, presence of acute PID or ruptured membranes, concurrent oxytocic therapy.
S/E: Gel: urterine contractile abnormalities, warm feeling in vagina. Suppository: headache, drowsy, dizzy, syncope, coughing, wheezing, dyspnea, hypotension, hyprertension, diarrhea, N/V. Allergic reaction:chills, fever, anaphylaxis.
Lab Values: na.
RN Considerations/Interventions: Monitor frequency, force and duration of contractions. Monitor VS. Ausculate breathe sounds! Wheezing and sensation of chest tightness could be sign of allergic reaction. Asses N/V, diarrhea, premedicate pt with antiemetic and antidiarrheal. Monitor amount and type of vaginal discharge. Notify physician IMMEDIATELY if symptoms of hemorrhage occur. Monitor uterine activity, fetal status, and dilation and effacement of cervix continuously throughout therapy. Insert should be removed at the onset of labor.

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Micronor
norethindrone
Progestin-only oral contraceptives

Action: May alter cervical mucus and the endometrial environment, preventing penetration by sperm and implantation of the egg. Ovulation may also be suppressed.

Rational of use: prevention of pregnancy

Dose/Route: PO (Adults): Start on first day of menses. Taken daily and continuously.

Contraindications:
Contraindicated in: OB: Pregnancy: History of thromboembolic disease; Valvular heart disease; Major surgery with extended periods of immobility; Diabetes with vascular involvement; Headache with focal neurological symptoms; Uncontrolled hypertension; History of breast, endometrial, or estrogen-dependent cancer; Abnormal genital bleeding; Liver disease.

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Side Effects
CNS: depression, migraine headache
EENT: contact lens intolerance, optic neuritis, retinalthrombosis
CV: CEREBRAL HEMORRHAGE, CEREBRAL THROMBOSIS, CORONARY THROMBOSIS, PULMONARY EMBOLISM, edema, hypertension, Raynaud’s phenomenon, thromboembolic phenomena, thrombophlebitis
GI: abdominal cramps, bloating, cholestatic jaundice, gallbladder disease, N & V
GU: amenorrhea, breakthrough bleeding, dysmenorrhea, spotting
Derm: melasma, rash
Endo: hyperglycemia

Pertinent lab values:
Monitor hepatic functions periodically during treatment
May cause elevated LDL concentrations
May cause decreased serum alkaline phosphatase and HDL concentrations

RN Considerations
Assess BP before and periodically during treatment
Instruct patient to take oral medication as directed at the same time each day. Pills should be taken in proper sequence and kept inn the original container
Advise patient of the need to use another form of contraception for the first three weeks when beginning to use oral cotaceptives
Advise patient to report S/S of fluid retention, thromboembolitic disorders, mental depression, hepatic dysfunction, dark urine, or abnormal vaginal bleeding
Monitor for breast cancer yearly

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Depo-provera
Medroxyprogesterone
Injectable contraceptive

Action: Mechanism not clearly known. May alter cervical mucus and the endometrial envirinment, preventing penetration by sperm and implantation of egg. Ovulation may also be suppressed.

Rational of use: prevention of pregnancy

Dose/Route: IM (Adults): 150 mg within first 5 days of menses or within 5 days postpartum, if not breastfeeding. If breastfeeding, give 6 weeks postpartum; repeat q3mo
Injectable Subcutaneous: 104 mg/0.65 ml

Safe range: N/A

Contraindicationed in: OB: Pregnancy; History of thromboembolitic disease; Valvular heart disease; Major surgery with extended periods of immobility; Diabetes with vascular involvement; Headache with focal neurological symptoms; Uncontrolled hypertention; Liver disease, Hypersensativity to parabens

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Side effects: Same as for Micronor

Pertinent lab values:
Monitor hepatic function periodically during therapy
May cause false interpretations of thyroid function tests

RN Considerations:
IM: shake vial vigorously just before use to insure uniform suspension. Administer deep IM into gluteal or deltoid muscle. If period between injections is greater than 14 weeks, determine that patient is not pregnant before administering the drug
May lead to bone loss, especially in women younger than 21 years.
Should be used for greater than 2 years only if other methods of contraception are inadequate. If used long term, woman should use supplemental calcium and vitamin D, and monitor bone mineral density

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Dermaplast
Pain Relieving Spray (OTC)

Action: Benzocaine USP 20% and Menthol USP 0.5% work as a topical anesthetic.

Rational: Used to relieve perineal pain and discomfort postpartum especially if the patient underwent an episiotomy.

Dose/Safe Range: spray to affected area not more than 3 to 4 times daily

Route: Topical

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Contraindications: Do not spray in eyes. Do not use with serious/deep cuts

Side effects: N/A

Pertinent lab values: N/A

RN Considerations/Interventions
Instruct patient to keep the perineal area clean.
Contact doctor if condition worsens.

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Prenatal Vitamin
OTC and prescription

Action: Vitamin supplement

Rational of Use: Used for supplementing any nutritional gaps in a pregnant woman’s diet. Also beneficial for women who are breastfeeding or trying to conceive. Prenatal vitamins contain important vitamins and minerals (such as folic acid and DHA) which can help prevent certain birth defects and improve brain and eye development.

Dose: Typically, 1 tablet daily

Safe Range: Varies as per type

Route: PO

Contraindications: Not recommended for children or elderly people.

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Side Effects: Headaches; Intestinal cramps; constipation; Indigestion: Heartburn; Muscle

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Generic Name: dinoprostone
Trade Name: PREPIDIL
Action: Produces contractions similar to those that occur during labor by stimulating the myometrium (oxytocic effect). Initiates softening, effacement and dilation of cervix. Also stimulates GI smooth muscle

Use in LD: Preg Cat C - to “ripen” cervix in pregnancy at or near term when induction is indicated. As vaginal suppository:induction of midtrimester abortion up to 28 weeks. Mgmt of nonmetastatic gestional trophoblastic disease.

Dose Range: Cervical ripening: gel-0.5mg: if response unfavorable, may repeat in 6 hr(do not exceed 1.5 mg/24 hr). Abortifacient: one 20mg suppository, repeat q 3-5hr (not to exceed 240mg total or longer than 48hr)
Safe Range Cervical ripening:: if response unfavorable, may repeat in 6 hr(do not exceed 1.5 mg/24 hr). Abortifacient: one 20mg suppository, repeat q 3-5hr (not to exceed 240mg total or longer than 48hr)
Route: Vaginal insert/vaginal suppository .

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Contraindications: Hypersensitivity to prostaglandins or additives in the gel or suppository.Avoid in situations which prolonged uterine contractions should be avoided: previous C-section or uterine surgery, cephalopelvic disproportion, traumatic delivery or difficult labor, multiparity, hyperactive or hypertonic uterus, fetal distress, unexplained vaginal bleeding, placenta previa, vasa previa, active herpes genitalis, obstetric emergency requiring surgical intervention, situations which vaginal delivery in contraindidated, presence of acute PID or ruptured membranes, concurrent oxytocic therapy.
S/E: Gel: urterine contractile abnormalities, warm feeling in vagina. Suppository: headache, drowsy, dizzy, syncope, coughing, wheezing, dyspnea, hypotension, hyprertension, diarrhea, N/V. Allergic reaction:chills, fever, anaphylaxis.
Lab Values: na.
RN Considerations/Interventions: Monitor frequency, force and duration of contractions. Monitor VS. Ausculate breathe sounds! Wheezing and sensation of chest tightness could be sign of allergic reaction. Asses N/V, diarrhea, premedicate pt with antiemetic and antidiarrheal. Monitor amount and type of vaginal discharge. Notify physician IMMEDIATELY if symptoms of hemorrhage occur. Monitor uterine activity, fetal status, and dilation and effacement of cervix continuously throughout therapy. Insert should be removed at the onset of labor.

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Generic Name: cefazolin
Trade Name: Ancef
Action: binds to bacterial cell wall causing cell death. Bactericidal action against many (not all) gram-positive cocci.
Use in LD: Pregnancy Category B. Genital infections.
Dose Range: skin & soft tissue infections 500mg q 12 hr or 1g q 24 hr. urinary tract infections 500mg-1g q 12 hr or 1-2g q 24 hr.
Safe Range: skin & soft tissue infections 500mg q 12 hr or 1g q 24 hr. urinary tract infections 500mg-1g q 12 hr or 1-2g q 24 hr.
Route: IV or IM

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Contraindications:, Hypersensitivity to cephalosporins or penicillins, Use cautiously in renal impairment.
S/E: seizures, pseudomembranous colitis, diarrhea, nausea, vomiting, cramps, stevens-johnson syndrome, pruritis, uticaria, agranulocytosis, eosinophilia, hemolytic anemia, neutropenia thrombocytopenia, pain at IM site, phlebitis at IV site, allergic reactions including anaphylaxis and serum sickness, superinfection.
Lab Values: Increase serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, creatinine,WBC’s
RN Considerations/Interventions: assess for infection, VS,before initiating therapy: obtain history to determine previous use of and reaction to peniciliins or cephalosporins, C&S, Observe for S&S of allergic reaction, Monitor bowel function (diarrhea, ab cramping, fever and bloody stools should be reported immediately to physician.

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Generic Name: naloxone
Trade Name: Narcan
Action: Blocks effects of opiods
Use in LD: Pregnancy category B. Reversal of CNS depression & respiratory depression, Mgmt of refractory circulatory shock
Dose Range: Adults Postoperative opiod induced resp. depression, IV 0.02-0.2 mg q 2-3 min until response obtained:repeat q 1-2 hr if needed.
Safe Range: is a pure antagonist with no agonist properties and minimal toxicity

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Contraindications: hypersensitivity . in OB may cause acute withdrawal syndrome in mother and fetus if mother is opioid dependent.
S/E: Ventricular arrhythmias, hypertension, hypotension, N/V
Lab Values: NA
RN Considerations/Interventions: Monitor VS, Resp Rate, rhythm, depth, ECG, LOC,assess pain level, Assess for S& S of opioid withdrawal

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Generic Name: bupivacaine
Trade Name: Marcaine, Sensorcaine
Action: Local anesthetic
Use in LD: Pregnancy Category B. Local or regional anesthesia or analgesia for surgical, obstetric procedures.
Dose Range: 10-20ml of 0.25% (partial or moderate block) 0.5% (moderate to complete block), 0.75% (complete block)
Safe Range: Administer in increments of 3-5ml allowing sufficient time to detect toxic S&S.
Route: Epidural.

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Contraindications: Hypersensitivity, lactation, with other anesthetics or anticoagulants.
S/E: Seizures, anxiety, dizzy, headache, irritability, blurred vision, tinnitus, cardiovascular collapse, arrhythmias, bradycardia, hypotension, tachycardia, N/V, urinary retention, pruritus, metabolic acidosis, tingling and tremor.
Lab Values:
RN Considerations/Interventions: Monitor sensations, VS, Orthostatic hypotension, system toxicity, Assess motor and sensory deficit, Notify physician for any abnormal findings in assessment.

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Hemabate=

preg cat: C

- action: produces strong, prompt, contractions of uterine smooth muscle, possibly mediated by calcium and cAMP. used to terminate preganancy betweeen 13-20 weeks gestation. Also used for postpartum hemorrhage from uterine atony.

- dose range: terminate preganacy:250 mcg 1.5-3.5 hours apart. should not exceed 12mg. postpartum hemorrhage: 250 mcg every 15-90 minutes as needed. Max dose is 2 mg.

- nursing considerations: pretreating patient with antiemetics and antidiarrheals decrease risk of GI effects

-Administered: IM injection

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- Side effects: fever, headache, anxiety, arrythimias, chest pain, blurred vision, vomiting, diarrhea, nausea, uterine rupture, endometritis, backache, leg cramps, coughing, wheezing, rash, breast tenderness, chills, hot flashes.

- contraindications: patients with acute pelvic inflammatory disease, cardiac, pulmonary, renal, or hepatic disease.

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Ampicillin=

Preg cat:B

-action: inhibits cell wall synthesis during bacterial multiplication.used to treat respiratory tract and skin infections. GI infections or UTI's. bacterial meningitis or septicemia. uncomplicated gonorrhea.

-dose range: capsules:250-500 mg. injection:250-500 mg, 1-2 g. oral:125mg/5ml or 250mg/5ml.

-nursing consideration:monitor sodium. monitor for bacterial or fungal superinfection. watch for rash, fever, chills which may indicate allergic reaction.

-administered:capsules, injection, or oral suspension.

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-side effects: diarrhea, nausea, pseudomembranous colitis, abd pain, glossitis, vomitting, nephropathy, vaginitis, leukopenia, thrombocytopenia, anemia.

-contraindications: patients with hypersensitivity to penicillins and cephalosporins.

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Penicillin=

preg cat: B

-action:prevents bacterial cell wall synthesis during replication.

-dose range: depends on which type of penicillin is being administered and which route is being used for administrationof med.

-nursing considerations:watch for symptoms of bacterial or fungal superinfections.

- administered: capsules, oral suspension, tablets, injections, IV

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-side effects: watch for hypersensitivity including rash, fever, and eosinophilia. bleeding episodes are seen broad spectrum penicillin and GI effects with ampicillin.

-contraindications: hypersensitivity to drug. use cautiously with patients with history of asthma, electrolyte imbalance, or hemmoraghic condition.

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Vistaril=

preg cat:NR
-action:suppresses activity in certain essential regions of the subcortical area of CNS. antepartum and postpartum adjunctive therapy.

-dose range: 25-100mg

-nursing considerations: watch for oversedation including dizziness, confusion, hypotension, and syncope.

-administered: P.O. , or IM

-side effects: drowsiness, dry mouth, constipation, involuntary motor activity.

-contraindications: patients in early pregnancy and breast-feeding women.

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-contraindications: patients in early pregnancy and breast-feeding women.

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Drug name: Vicodin
Generic name: Hydrocodone bitartrate 5mg, acetaminophen 500mg; scored tablets
Action & Rationale: Relief of moderate to moderately severe pain. Pregnancy category C, D if prolong use
Dose Range: 1-2 tabs q 4-6 h PRN
Safe Range: 8 tabs/24 h
Contraindications: do not use with other narcotic analgesics

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S/E: CNS/respiratory depression, GI upset, constipation, lightheadedness, sedation, drowsiness, facial flushing, diaphoresis
Lab values: serial liver and/or renal function tests for pt with severe hepatic or renal disease
RN Considerations/interventions: obtain VS, if respirations are 12 or less withhold meds, suppresses cough reglex, crosses placenta, found in breast milk, may prolong labor if administered in first stage of labor, respiratory depression in neonate, may cause withdrawl symptoms in neonate if mother used regularly.

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Drug name: Serophene
Generic name: Clomiphene citrate 50mg
Action & Rationale: induction of ovulation, increases FSH & LH levels by blocking estrogen negative feedback. Used as a fertility agent. Pregnancy category X
Dose Range: 50mg daily for 5 days beginning 5th day of menstrual cycle, max 3 doses. May increase to 100mg for 2nd course if ovulation does not occur after 1st course.
Safe Range: Max 100mg/day for 5 days

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Contraindications: primary ovarian failure, ovarian cysts, uterine leiomyomas, abnormal uterine bleeding, thrombophlebitis, liver disease, intracranial lesions, uncontrolled thyroid or adrenal dysfunction, depression
S/E: visual symptoms may occur (bluring or spots or flashes) hot flashes, breast discomfort, HA, insomnia
Lab values: can not find
RN Considerations/interventions: perform initial complete pelvic & endocrinologic exam, discontinue if visual disorders occur, multiple pregnancies

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Drug name: Norco
Generic name: Hydrocodone/acetaminophen 10mg/325 mg
Action & Rationale: Moderate to moderately severe pain
Dose Range: 1 tab every 4–6 hrs as needed
Safe Range: max 6 tabs/day

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Contraindications: do not use with other narcotic analgesics
S/E: CNS/respiratory depression, GI upset, constipation, lightheadedness, sedation, drowsiness, facial flushing, diaphoresis
Lab values: serial liver and/or renal function tests for pt with severe hepatic or renal disease
RN Considerations/interventions: obtain VS, if respirations are 12 or less withhold meds, suppresses cough reglex, crosses placenta, found in breast milk, may prolong labor if administered in first stage of labor, respiratory depression in neonate, may cause withdrawl symptoms in neonate if mother used regularly.

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Generic name: Folic Acid
Action & Rationale: Decreases risk of neural tube defects. Stimulates production of platelets, RBC’s & WBC’s. Pregnancy category A
Dose Range: IM/IV/SQ/PO 0.8mg/daily for pregnant women, 0.4mg/day child-bearing ages
Safe Range: can not find

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Contraindications: hypersensitivity to folic acid
S/E: none known
Lab values: may decrease B12 concentration
RN Considerations/interventions: Greatest impact for prevention of neural tube defects is before pregnancy thru 1st trimester, orofacial clefts in the fetus

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*Note* Zofran has not been approved by the FDA for obstetrical use. All route/dosage information is not necessarily consistent with off-label dosages prescribed by a physician who specializes in obstetrics and gynecology.
generic name: ondansetron (on-dan-se-tron)
trade name: Zofran, Zofran ODT
action: Blocks the effects of serotonin at 5-HT3-receptorsites (selective antagonist) located in vagal nerve terminal and the chemoreceptor trigger zone in CNS.
rationale of use in L&D: hyperemesis gravidarum
route/dosage: (Adults & Children > 11yr): PO: 8 mg Q8-12h IM: 4 mg. IV (Adults): 0.15 mg/kg
safe range: a safe dosage range for pregnancy, lactation, ped. use has not been safely established

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contraindications: Pt. with hypersensitivity to the drug or its components.
adverse effect/side effects: HA, constipation, malaise, arrhythmias, hypotension, extrapyramidal effects
pertinent lab values: ALT (SGPT), AST (SGPT), Bilirubin (direct and total), Chem 10
RN considerations/interventions: Pt with hepatic impairment should not be prescribed a daily dose that exceeds 8 mg.
Pregnancy Category: B

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*Note* Anzemet has not been approved by the FDA for obstetrical use. All route/dosage information is not necessarily consistent with off-label dosages prescribed by a physician who specializes in obstetrics and gynecology.
Anzemet
generic name: dolasetron (dol-a-se-tron)
trade name: Anzemet
action: Blocks the effects of serotonin at receptor sites (selective antagonist) located in vagal nerve terminals and in the chemoreceptor trigger zone in the CNS
rationale of use in L&D: hyperemesis gravidarum
route/dosage: (Adults) PO: 100 mg. given 2 hr. before surgery or 1 hr. with before chemotherapy/ (Children 2-16 yr.) PO: 1.2 mg/kg (up to 100 mg/dose) within 2 hrs. before surgery or1.8 mg/kg within 1 hr. before chemotherapy (not to exceed 100 mg.). (Adults) IV: 12.5 mg. 15 min. before cessation of anesthesia or as soon as N/V begins/ (Children 2-16 yr.) IV: 0.35 mg/kg (up to 12.5 mg) 15 min before cessation of anesthesia or as soon as N/V begins.
safe range: Safety not est. in pregnancy or lactation

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contraindications: hypersensitivity, use cautiously in pt. with prolongination of cardiac conduction intervals (hypokalemia, hypomagnesemia, concurrent diuretic or antiarrhythmic therapy, congenital QT syndrome, cumulative high-dose anthracycline therapy.
adverse effect/side effects: HA, dizziness, fatigue, syncope, bradycardia, ECG changes, hypertenstion, hypotension, tachycardia, diarrhea, dyspepsia, oliguria, pruritus, chills, fever, pain.
pertinent lab values: Chem 10
RN considerations/interventions: Injectable dolasteron may be mixed in apple or apple-grape juice for oral dosing for pediatric patients. May be stored at room temp. for 2 hr before use.
Pregnancy Category: B

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*Note* metoclopramide has not been approved by the FDA for obstetrical use. All route/dosage information is not necessarily consistent with off-label dosages prescribed by a physician who specializes in obstetrics and gynecology.
metoclopramide
generic name: metoclopramide
trade name: Reglan
action: Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motilityof the upper GI tract and accelerates gastric emptying
rationale of use in L&D: hyperemesis gravidarum, GERD, diabetic gastroparesis
route/dosage: (Adults) PO, IM, IV: A single dose of 20 mg. may be given preventatively. Otherwise 10-15 mg. 30 min. AC/HS (not to exceed 0.5/mg/kg/day). (Neonates, Infants, Children) PO, IM ,IV: 0.4-0.8 mg/kg/day in 4 divided doses
safe range: Safety not est. in pregnancy or lactation

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contraindications: hypersensitivity, possible GI obstruction or hemorrhage, HX of seizure disorders, pheochromocytoma, Prakinson’s disease
adverse effect/side effects
pertinent lab values: Chem 10 (hyperemesis/ est. electrolyte values)
RN considerations/interventions: Use cautiously in pt. with hx of depression, diabetes, renal impairment, OB, lactation, neonates ( high risk for methemoglobinemia), elderly (oversedation), pt. taking CNS depressants or with hx of alcohol or drug abuse. Assess respiratory status, look for signs of pyramidal effects.
Pregnancy Category: B

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Flagyl
generic name: metronidazole (me-troe-ni-dazole)
trade name: Flagyl, MetroCream, MetroGel, MetroGelVaginal, MetroLotion
action: disrupts DNA and protein synthesis in susceptible organisms (bactericidal, trichomonacidal, amebicidal).
rationale of use in L&D: Bacterial vaginosis, trichomoniasis
route/dosage: (Adults) PO: Anaerobic infections-7.5 mg/kg q6h (not to exceed 4g/day. Trichomoniasis- 250mg q8h for 7 days or single 2-gm dose or 1 gm bid for 1 day. Bacterial vaginosis-750 mg once daily for 7 days. (Adults) IV: Anaerobic infections-innitial dose 15mg/kg, then 7.5 mg/kg q6-8h (not to exceed 4gm/day). (Neonates 0-4 weeks > 1200gm) IV PO: 7.5mg/kg q48 hr.
safe range: see route/dosage, safety not est. in OB; however, used to treat trichomoniasis in 2nd and 3rd trimester pregnancy- but not as single dose regimen.

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contraindications: hypersensitivity, hypersensitivity to parabens, OB first trimester, use cautiously: hx blood dyscrasias, seizures, neurologic problems
adverse effect/side effects: seizures, dizziness, HA, aseptic meningitis, encephalopathy, optical neuropathy, tearing, abdominal pain, anorexia, N/V/D, dry mouth, furry tongue, glossitis, Stevens-Johnson syndrome, rash, urticaria
pertinent lab values: ALT (SGPT), AST (SGPT), Bilirubin (direct and total), Chem 10
RN considerations/interventions: Pt with hepatic impairment should not be prescribed a daily dose that exceeds 8 mg.
Pregnancy Category: B

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Anzemet
generic name: dolasetron (dol-a-se-tron)
trade name: Anzemet
action: Blocks the effects of serotonin at receptor sites (selective antagonist) located in vagal nerve terminals and in the chemoreceptor trigger zone in the CNS
rationale of use in L&D: hyperemesis gravidarum
route/dosage: (Adults) PO: 100 mg. given 2 hr. before surgery or 1 hr. with before chemotherapy/ (Children 2-16 yr.) PO: 1.2 mg/kg (up to 100 mg/dose) within 2 hrs. before surgery or1.8 mg/kg within 1 hr. before chemotherapy (not to exceed 100 mg.). (Adults) IV: 12.5 mg. 15 min. before cessation of anesthesia or as soon as N/V begins/ (Children 2-16 yr.) IV: 0.35 mg/kg (up to 12.5 mg) 15 min before cessation of anesthesia or as soon as N/V begins.
safe range: Safety not est. in pregnancy or lactation

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contraindications: hypersensitivity, use cautiously in pt. with prolongination of cardiac conduction intervals (hypokalemia, hypomagnesemia, concurrent diuretic or antiarrhythmic therapy, congenital QT syndrome, cumulative high-dose anthracycline therapy.
adverse effect/side effects: HA, dizziness, fatigue, syncope, bradycardia, ECG changes, hypertenstion, hypotension, tachycardia, diarrhea, dyspepsia, oliguria, pruritus, chills, fever, pain.
pertinent lab values: Chem 10
RN considerations/interventions: Injectable dolasteron may be mixed in apple or apple-grape juice for oral dosing for pediatric patients. May be stored at room temp. for 2 hr before use.
Pregnancy Category: B

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Trade name: Narcan
Generic name: naloxone

Action: Competes with opioids at opiate receptor sites

Uses: Respiratory depression induced opioids , asphyxia neonatorum

Dose Range: child<5 or <20kg: IV/SubQ/IM 0.01mg/kg slowly followed by 0.1mg/kg if needed or as INF titrated to response

Side Effects: drowsiness, seizures, rapid pulse, increased BP, ventricular tachycardia, fibrillation, cardiac arrest, sinus tachycardia, hepatotoxicity, pulmonary edema, hypo/hypertension

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Contraindications: Hypersensitivity
Precaution: Pregnancy (C), children, neonates, breastfeeding

Nursing Considerations: Monitor respiratory rate and rhythm, ECG, BP, signs of opioid withdrawl, VS q3-5min, ABGs, pain before and after, LOC, keep in dark storage at room temp.

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Trade name: Cidomycin, Garamycin, gentamicin sulfate, G-mycin
Generic name: gentamicin
Action: Interferes with protein synthesis in bacterial cell by binding to ribosomal subunit, causing misreading of genetic code; inaccurate peptide sequence forms in protein chain, causing bacterial death

Uses: Sever systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues

Dose Range: Neonate/infant: IM/IV 2.5mg/kg q8-12
Neonate <1wk: IV 2.5mg/kg q12-24

Safe Range: blood level should be 2-4 times bacteriostatic level; peak 4-10mcg/ml; trough 0.5-2 mcg/ml

Side Effects: Confusion, depression, numbness, tremors, seizures, neurotoxicity, hypo/hypertension, ototoxicity, oliguria, hematuria, nephrotoxicity, agranulocytosis, thrombocytopenia, rash, urticaria, photosensitivity

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Contraindications: Hypersensitivity to this or other aminoglycosides, fungal/viral/mycobacterial infection
Precaution: neonates, breastfeeding

Lab values: Serum peak, drawn at 30-60 min after IV inf. or 60 min after IM inj., and trough level drawn just before next dose; urine pH if used for UTI, BUN, serum creatinine

Nursing Consideration: Weight before treatment, I&O ratio, VS during inf., assess IV site, serum peak, urine pH, reanl function, C&S before, dehydration, overgrowth of infection, eight cranial nerve dysfunction (ringing, roaring in ears, vertigo, assess hearing before during and after), vestibular dysfunction (N/V, dizziness, HA)

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H-BIG vaccine

Trade name: BayHepB, Nabi-HB
Generic name: hepatitis B immune globulin

Action: Provides passive immunity to hepatitis B

Use: Prevention of hepatitis B virus to exposed patients, including passive immunity in neonates born to HBsAg-positive mother

Dose range: neonates IM 0.5ml within 12 hr of birth

Side effects: HA, dizziness, fever, N/V, soreness, urticaria, erythema, swelling, anaphylaxis, angioedema

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Contraindications: Hypersensitivity to immune globulins, coagulation disorders

Precaution: Pregnancy (C), children, neonates, breastfeeding

Nursing Considerations: Assess for allergic reaction, anaphylaxis, use deltoid for better absorption

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Trade name: Vistaril
Generic name: hydroxyzine pamoate

Action: Depresses subcortical levels of CNS, including limbic system, reticular formation; competes with Hı-receptor sites

Use: Anxiety, postpartum mood disorders, sedation, to potentiate opioid analgesics, pruritis, allergic reaction

Dose range: PO 25-100mg tid-qid, max 600mg/day; IM 50-100mg q4-6hr

Side effects: restless muscle movements in your eyes, tongue, jaw, or neck; tremor (uncontrolled shaking);
confusion; or seizure (convulsions), dizziness, drowsiness, HA, blurred vision, dry mouth, jypotension

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Contraindications: Pregnancy (1st trimester), breastfeeding, hypersensitivity to this product or cetirizine; acute asthma

Precaution: Pregnancy (C), (2nd/3rd trimester), geriatric patients, debilitated, renal/hepatic disease, COPD

Nursing Considerations: BP (lying/standing), pulse; if systolic drops 20mmHg hold, notify prescriber, assess mental status, PO take with food/milk, IM use Z-track method in large muscle, never give IV/subQ, assist with ambulation, safety measure, teach: not to used for daily stress & no longer than 4 mo, avoid OTC unless approved, avoid driving & alcohol, rise slowly, do not stop taking abruptly

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Generic Name: misoprostol
Trade Name: cytotec
Action: synthetic prostaglandin: ↓gastric acid secretion &pepsin, ↑bicarbonate & mucus
causes uterine contractions
Use in LD: category x, abortion, premature birth
Dose Range: 100- 200 mcg up to 4xs/day
Safe Range: see above
Route: tablet

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Contraindications: prostaglandin allergy, don’t give during lactation (diarrhea in nursing baby), use in pregnancy for ↓risk of gastric ulcers from NSAIDS
S/E: diarrhea, abdominal pain, N&V, gas, dyspepsia, HA, uterine cramping, spotting
Lab Values: obtain negative pregnancy test before safe administration, plasma levels ↓ if take with food
RN Considerations/Interventions: *sound alike drug to mifepristone, metoprolol & cytosar. Give with food to ↓diarrhea, give after meal & at HS, take for duration of NSAID therapy, may increase mucus secretion in stomach, with abortion report ↑ bleed/ pain/ fever.

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Labetalol
Trade Name: Normodyne, Trandate
Indications: It has a particular indication in the treatment of pregnancy-induced hypertension which is commonly associated with pre-eclampsia.[2]
It is also used to treat chronic and acute hypertension of pheochromocytoma and hypertensive crisis.[3]
Use in LD: Category C, Compatible with breastfeeding
Dosing: Hypertension: initial, 100mg ORALLY twice daily; titration, may increase dose in increments of 100mg orally twice daily every 2-3 days. Maintenance: 200-400mg orally twice daily. IV to ORAL conversion: initial, 200mg ORALLY, followed in 6-12 hour by 200-400my orally depending on BP response.

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Side effects: Drowsiness, Fatigue, Weakness, Difficulty sleeping, Diminished sexual function, Scalp tingling which passes after time. Drug eruption similar to lichen planus[4] A rare but potentially lethal side effect is respiratory distress.
Contraindications: Labetalol has relative contraindications for use in patients with asthma, congestive heart failure, any degree of heart block, bradycardia, or those in cardiogenic shock.
Nursing considerations: Oral – standing BP for hypotensive response. IV – immediately before and 5-10 min after injection. LFT.

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Magnesium sulfate
Pharmacology and action: Depresses myometrium contractility, relaxes smooth muscle of the uterus.
Dosage and Administration: Continuous IV infusion via a pump, initial loading dose of 4-6 grams in 20 minutes, then 2 g/hr. Therapeutic level at 5-8 mg/dL in maternal serum levels, or as tolerated by the patient.
Maternal Effects: Flushing, drowsiness, HA, lethargy, nausea and vomiting. Respiratory depression can occur with serum levels above 9 mg/dL.

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Fetal effects: none
Nursing Considerations: Monitor FHR and UCs Monitor serum mag levels. Assess lungs for s/s pulmonary edema. I&Os
S/S of toxicity include: Absent DTRs, resp rate <14, hypotension, muscle relaxation, decreased LOC.

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Colace:
Indications: Constipation
Dosage: 50-200mg/day PO, 50 – 100mg rectally as an enema
Pregnancy: A
Adverse Effects: Abnormal taste, bitter, diarrhea, nausea
Mechanism: Stool softner

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None

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Morphine:
Trade Names: Duramorph
Class: Analgesic, opiod
Pregnancy Cat: C
Nursing Considerations: Monitor respiratory status, bowel movements, blood pressure (injection)
Side Effects: dizziness, N/V, HA, confusion, sedation

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None

Front 51

Calcium Gluconate:
Preg Cat: C
Indications: Calcium gluconate is used to treat conditions arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to hypoparathyrodism and hypocalcemia due to rapid growth or pregnancy. It is also used in the treatment of black widow spider bites to relieve muscle cramping and as an adjunct in the treatment of rickets, osteomalacia, lead colic and magnesium sulfate overdosage. Calcium gluconate has also been employed to decrease capillary permeability in allergic conditions, nonthrombocytopenic purpura and exudative dermatoses such as dermatitis herpetiformis and for pruritus of eruptions caused by certain drugs. In hyperkalemia, calcium gluconate may aid in antagonizing the cardiac toxicity provided the patient is not receiving digitalis therapy.

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Usual Dosage
Adults: 500 mg - 2 grams (5-20 mL)
Calcium Gluconate should be administered intravenously either directly or by infusion. The dose is dependent upon the individual requirements of the patient. Calcium Gluconate may also be administered by intermittent infusion at a rate not exceeding 200 mg/min, or by continuous infusion.
SIDE EFFECTS
Patients may complain of tingling sensations, a sense of oppression or heat waves and a calcium or chalky taste following the intravenous administration of calcium gluconate. Rapid intravenous injection of calcium salts may cause vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmias, syncope and cardiac arrest. Use in digitalized patients may precipitate arrhythmias. Local necrosis and abscess formation may occur with intramuscular injection.

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Darvocet – NO LONGER AVAILABLE AFTER NOV 19, 2010 PER FDA
Class: Opioid/Acetaminophen Combination

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NONE

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Percocet – Acetamenophen/oxycodone
Class: Opioid/Acetaminophen combination
Indications: Moderate to moderate/severe pain
Preg Cat: C
Dosage: Acetaminophen 325 mg to 650 mg/oxycodone 2.5mg to 10mg ORALLY every 6 hours as needed; MAX 4000 mg acetaminophen/day

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Adverse Effects: N/V, dizziness, lightheadedness, sedation, somnolence
Nursing considerations: Pain reduction, mental and repiratory status, bowel movements, BP, renal function, LFT, CBC (long term use)

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Percodan – oxycodone/aspirin
Class: Opioid/Salicylate, Aspirin combination
Indications: Pain, moderate to severe
Preg Cat: C
Dosage: 1 tab oxycodone 4.8mg/aspirin 325 mg orally every 6 hours as needed for pain, max 12 tablets in 24 hours.

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Adverse Effects: Pruritus, constipation, heartburn, nausea, stomach ache, vomiting, dizziness, somnolence, euphoria.
Nursing considerations: Pain reduction, mental and repiratory status, bowel movements, BP, renal function, LFT, CBC (long term use)

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Rubella Vaccine
Adverse effects: Erythema at injection site, injection site pain, rash, lymphadenopathy, arthralgia, myalgia, common cold, fever
Pregnancy Cat: C
Contraindications: Active febrile infection, pregnancy, immune-deficiency

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None

Front 56

Rubella Vaccine
Adverse effects: Erythema at injection site, injection site pain, rash, lymphadenopathy, arthralgia, myalgia, common cold, fever
Pregnancy Cat: C
Contraindications: Active febrile infection, pregnancy, immune-deficiency

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None

Front 57

Ferrous Sulfate – Iron supplement

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None

Front 58

Tucks –Active ingredient: Witch hazel
Class: Astingent
Indications: temporarily relieves the local itching and discomfort associated with hemorrhoids,
aids in protecting irritated anorectal areas, temporarily relieves irritation and burning
Directions: Adults:
When practical, clean the affected area with mild soap and warm water, and rinse
thoroughly
Gently dry by patting or blotting with toilet tissue or a soft cloth before applying
Apply externally to the affected area up to 6 times daily or after each bowel movement
After application, discard pad

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None

Front 59

Hep B vaccine
Dose/Route: 5 mcg IM x 3 doses at 0, 1 and 6 mos.
Adverse Effects: Injection site reaction, Diarrhea, Nausea, HA, fatigue

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None

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Indocin
Class: NSAID
Indications: Pain
Pediatric dosing: Patent ductus arteriosus: less than 48 hours old, 0.2mg/kg IV followed by 0.1mg/kg IV every 12 to 24 hours for 2 doses. 2-7 days old, 0.2 mg/kg IV every 12 to 24 hours for 3 doses.

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None

Front 61

Aquamephyton – Vit K
Class: Nutritive Agent
Dose/route: Prophylaxis: 1mg IM soon after birth
Adverse Effects: Skin reaction, anaphylaxis
Monitor: Reduction in bleeding

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None

Front 62

Erythromycin ophthalmic ointment
Pregnancy Cat:B
Indications: For prophylaxis of ophthalmia neonatorum due to N. gonorrhoeae or C. trachomatis.
Dosage/Administation: For prophylaxis of neonatal gonococcal or chlamydial ophthalmia, a ribbon of ointment approximately 1 cm in length should be instilled into each lower conjunctival sac. The ointment should not be flushed from the eye following instillation. A new tube should be used for each infant

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None