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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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Clindamycin
Generic: clindamycin
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
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IV or SC 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)
Side Effects: (frequent) fever, diarrhea, nausea, vomiting, edema. (occasional) Asthenia, shortness of breath, paresthesia. (rare) dizziness, trunk pain.
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Fentanyl
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.
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).
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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
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Tylenol- Postpartum Medication
Generic name: acetaminophen (OTC)
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.
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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,
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Motrin- Postpartum Medication
Generic name: ibuprofen
Action and Rationale: Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis; analgesic, anti-inflammatory, antipyretic. It is used dysmenorrheal, fever in postpartum.
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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,
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Generic Name: Misoprostol
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
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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)
Action: narcotic analgesic, 1/10 potency of morphine, psychologic & physiologic dependence, moderate-severe pain
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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
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Generic Name: Nalbuphine hydrochloride
Action: synthetic opioid antagonist analgesic, moderate- severe pain, during labor analgesia
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Contraindications: hypersensitivity
S/E: allergic reaction, resp depression, ↑↓ HR, cold/clammy skin, confusion, dizzy, weak, lightheaded, n&v, HTN
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Oxytocin
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.
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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
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)
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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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
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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
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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.
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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.
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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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.
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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
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Metoclopramide
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
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C/I: hypersensitivity, possible GI obstruction or hemorrhage, HX of seizure disorders, pheochromocytoma, Prakinson’s disease
adverse effect/side effects
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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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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Labetalol
Indications: It has a particular indication in the treatment of pregnancy-induced hypertension which is commonly associated with pre-eclampsia.
It is also used to treat chronic and acute hypertension of pheochromocytoma and hypertensive crisis.
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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. 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.
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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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