Narcotan - Concise Prescribing Information

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See related Narcotan inj informationAbbreviation Index Manufacturer Troikaa Pharma Distributor Contents Indications Pharmasan Naloxone HCl Used to reverse opioid central depression, including resp depression, induced by natural or synthetic opioids in the following situations: Treatment of known or suspected opioid overdose. Post-op following the use of opioids during surgery. In neonates following the administration of opioid analgesics to the mother during labor. Dosage Opioid overdose Initially, 0.4-2 mg IV repeated at intervals of 2-3 min if necessary. Childn 10 mcg/kg body wt IV then up to 100 mcg/kg if necessary. Doses may be administered via IM or SC. Post-op 100-200 mcg (1.5-3 mcg/kg) IV at 2-min intervals. Opioid-induced depression Neonates 10 mcg/kg

IV, IM or SC inj then repeat at intervals of 2-3 min or a single IM dose of 60 mcg/kg. Special Precautions Adverse Drug Reactions Pregnancy Category (US FDA) Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no Physically-dependent or recipient of large doses of opioids. Cardiac problems or patients receiving cardiotoxic drugs. Nausea, vomiting, hypotension, HTN, cardiac arrhythmias, pulmonary edema, seizures. View ADR Monitoring Form

OxyContin - Concise Prescribing Information

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See related OxyContin PR tab informationAbbreviation Index Manufacturer Distributor Contents Indications Mundipharma Zuellig Oxycodone HCl Moderate to severe pain. Click to view OxyContin detailed prescribing infomation Dosage Individualize treatment using a progressive plan of pain management eg outlined by WHO. To be swallowed whole & not to be broken, chewed or crushed. Opioid-naive adult Starting dose: 10 mg 12 hrly. Click to view OxyContin detailed prescribing infomation Overdosage Administration View OxyContin overdosage for action to be taken in the event of an overdose. May be taken with or without food (Swallow whole, do not break/chew/crush. Taking broken, chewed or crushed tab leads to rapid release & absorption of a potentially fatal dose of oxycodone.). Contraindications Significant resp depression, acute or severe bronchial asthma or hypercarbia. Patient w/ or suspected of having paralytic ileus. Lactation. Click to view OxyContin detailed prescribing

infomation Warnings For additional cautionary notes to warn of the potential risk of using the medicine... click to view OxyContin detailed prescribing infomation Special Precautions The 80-mg tab is for opioid-tolerant patients only. Acute alcoholism, adrenocortical insufficiency, CNS depression or coma, delirium tremens, debilitated patients, kyphoscoliosis associated w/ resp depression, myxedema or hypothyroidism, prostatic hypertrophy or urethral stricture, severe hepatic, pulmonary or renal impairment, toxic psychosis & patients taking MAOIs. May obscure the diagnosis or clinical course in patients w/ acute abdominal conditions. May aggravate convulsions in patients w/ convulsive disorders or seizures in some clinical settings. Pregnancy & childn. Click to view OxyContin detailed prescribing infomation Adverse Drug Reactions Resp depression & arrest, apnea, circulatory depression, hypotension or shock. Constipation, nausea, somnolence, dizziness, vomiting, pruritus, headache, dry mouth, sweating, asthenia. View ADR Monitoring Website Drug Interactions Additive effects w/ sedatives or hypnotics,

general anesth, phenothiazines, tranquilizers, neuroleptics, antidepressants & alcohol. Agonist/antagonist analgesics ie pentazocine, nalbuphine, butorphanol, buprenorphine.

Silgram - Concise Prescribing Information

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See related Silgram informationAbbreviation Index Manufacturer Distributor Contents YSS Cathay Drug Per 375 mg vial Ampicillin 250 mg, sulbactam 125 mg. Per 750 mg vial Ampicillin 500 mg, sulbactam 250 mg. Per 1.5 g vial Ampicillin 1 g, sulbactam 500 mg Indications Treatment of upper & lower resp tract infections, gynecological infections & as a prophylaxis to

reduce the risk of infections following surgery caesarian & birth. Dosage Adult 1.5-3 g 6 hrly. Acute pelvic inflammatory disease 3 g 6 hrly in conjunction w/ doxycycline (100 mg 12 hrly by oral or IV). Parenteral regimen may be discontinued 24 hrs after clinical improvement; oral doxycycline should be continued to complete the 14 days of therapy. Childn 1 yr 300 mg/kg daily by IV infusion in equally divided doses 6 hrly; 1 mth Mild to moderate infection 100-150 mg/kg daily in 4 divided doses. Contraindications Hypersensitivity. Special Precautions Adverse Drug Reactions Patients w/ mononucleosis. Superinfections involving pseudomonas & candida (discontinue the drug). Serious anaphylactoid reactions. View ADR Monitoring Form View more drug interactions with Silgram Pregnancy Category (US FDA) Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an

Drug Interactions Probenecid, allopurinol, aminoglycosides.

adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no MIMS Class ATC Classification evidence of a risk in later trimesters). Penicillins J01CR04 - Sultamicillin ; Belongs to the class of penicillin combinations, including betalactamase inhibitors. Used in the

Delivery room

Comxytocin - Concise Prescribing Information

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See related Comxytocin infusion informationAbbreviation Index Manufacturer Distributor Contents Indications Rotexmedica Commerz Oxytocin Induction or stimulation of labor in hypotonic uterine inertia. Prevention & treatment of postpartum uterine atony & hemorrhage. Early stages of pregnancy as an adjunctive therapy for the management of incomplete, inevitable or missed abortion. Dosage Induction or enhancement of labor IV drip infusion 10 iu added to 1 L physiologic saline electrolyte soln. For patients whom infusion of NaCl must be avoided use 5% dextrose soln as diluent. Initial infusion rate 1-4 mU/min (2-8 drops/min). Gradually increase at intervals not <20 min, until a contraction pattern similar to that of normal labor is established. Max rate: 20 mU/min (40 drops/min). Caesarean section 5 iu by slow IV inj immediately after delivery. Prevention of post-partum uterine hemorrhage 5 iu slow IV after delivery of the placenta. Treatment of post-partum uterine hemorrhage 5-10 iu IM or 5 iu slow IV followed

in severe cases by IV infusion of 5-20 iu of oxytocin in 500 mL of non-hydrating diluent. Missed abortion 5 iu IM or slowly IV. If necessary, follow by IV infusion 20-40 mU/min. Contraindications Hypertonic uterine contraction, mechanical obstruction to delivery, fetal distress. Significant cephalopelvic disproportion, fetal malpresentation, placenta previa, placental abruption, cord presentation or prolapse, overdistension or impaired resistance of the uterus to rupture as in multiple pregnancy, polyhydramnios, grand multiparity & in uterine scar. Do not use for prolonged period in patients w/ oxytocin-resistant uterine inertia, severe preeclamptic toxemia or severe CV disorder. Special Precautions Administration should only be under hospital condition & qualified medical supervision. For induction & enhancement of labor administer only as an IV infusion. Carefully monitor fetal heart rate & uterine motility. Caution use in borderline cephalopelvic disproportion, secondary uterine inertia, mild to moderate degrees of pregnancy-induced HTN or cardiac disease & patients >35 yr or w/ history of loweruterine-segment Caesarean section. Avoid tumultous labor in fetal death in utero &/or

meconium-stained amniotic fluid. For the prevention & treatment of uterine hemorrhage, avoid rapid IV inj. Adverse Drug Reactions Uterine spasm in low doses. High doses may result in uterine overstimulation that may cause fetal distress, asphyxia & death, or may lead to hypertonicity, tetanic contractions, soft tissue damage or rupture of the uterus. Rapid IV bolus inj may cause short-lasting hypotension accompanied w/ flushing & reflex tachycardia. View ADR Monitoring Form Drug Interactions prostaglandin, inhalation anesthetics eg cyclopropane or halothane, sympathomimetic vasoconstrictor agent. View more drug interactions with Comxytocin

Medisyl - Concise Prescribing Information

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See related Medisyl inj informationAbbreviation Index

Manufacturer Korea United Pharma Distributor Contents Indication & Dosage Pregnancy Category (US FDA) Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the MIMS Class ATC foetus. Drugs Acting on the Uterus G02AB01 - Methylergometrine ; Belongs to the class augment labour and to minimize blood loss from the placental site. Poison Schedule
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Scheeling Pharma Care Link Methylergometrine maleate Click to view methylergometrine information For details on therapeutic uses and relevant dosage relating to the methylergometrine ... Click to view methylergometrine

Classification of ergot alkaloids. Used to induce abortion or

Rx

Presentation/Packing Form Packing/Price Photo Medisyl injection Medisyl 200 mcg/1 mL x 10's (P916.5)

Manufacturer: Korea United Pharma Distributor: Scheeling Pharma Care Link Related Medisyl inj information: Drugs interacting with Medisyl Find Medisyl in other countries Search Medisyl in Google Search Medisyl in PubMed

Oxitone - Concise Prescribing Information

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See related Oxitone infusion informationAbbreviation Index Manufacturer Harson

Distributor Contents Indications

Phil Pharmawealth Oxytocin Induction of labor, stimulation of labor in hypotonic uterine inertia; management of missed & incomplete abortion; postpartum hemorrhage in patients who do not respond to ergometrine.

Dosage

IV drip infusion 1 u of oxytocin in 1 L 5% dextrose soln delivers approx 1 milliunit/min when infused at a rate of 1.5 drops/min. Induction or stimulation of labor Physiological oxytocin infusion: 2-5 milliunits/min. Pharmacological oxytocin infusion: Initially 1.53 milliunits/min adjusted gradually until contractions occur every 2-5 min; infusion rate: Max 12 milliunits/min. Oxytocin titration: Initially 1 milliunit/min, then double the rate of flow every 20 min, until contractions last 40-50 sec occurring at intervals of 2-3 min. Doses of oxytocin up to 128 milliunits/min have been used. Missed abortion 10-20 u/500 mL of 5% dextrose soln increasing by 10-20 u/500 mL every hr to a max of 100 u/500 mL if necessary. Infusion rate: 10-30 drops/min.

Contraindications Hypertonic uterine inertia, mechanical obstruction to delivery, failed trial labor, severe

toxemia, predisposition to amniotic fluid embolism, fetal distress & placenta previa. Special Precautions Adverse Drug Reactions Caution should be exercised in patients with parity & previous caesarian section. CV disorders. Uterine spasm, very high dose may cause violent uterine contractions leading to uterine rupture, tissue damage & asphyxia of the fetus. View ADR Monitoring Form Drug Interactions Prostaglandins may potentiate the effects of oxytocin. View more drug interactions with Oxitone Pregnancy Category (US FDA) Category X: Studies in animals or human beings have demonstrated foetal abnormalities or there is evidence of foetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may MIMS Class ATC Classification Poison Schedule become pregnant. Drugs Acting on the Uterus H01BB02 - Oxytocin ; Belongs to the class of oxytocin and analogues. Used in posterior pituitary lobe hormone preparations. Rx

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Presentation/Packing

Roxipan - Concise Prescribing Information

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See related Roxipan inj informationAbbreviation Index Manufacturer Distributor Contents Indications Panpharma-Meinz Panpharma-Meinz Oxytocin Induction & augmentation of labor, to control postpartum bleeding & uterine hypotonicity in the 3rd stage of labor & to promote lactation in cases of faulty milk ejection. Click to view Roxipan detailed prescribing

infomation Dosage Induction or enhancement of labor Drip infusion Initially, 1-4 milliunits/min (2-8 drops/min). May be gradually increased at intervals not <20 min, until a contraction pattern similar to normal labor is established. Caesarean section 5 iu by slow IV inj immediately after delivery. Prevention of postpartum uterine hemorrhage 5 iu by slow IV after delivery of the placenta. Treatment of postpartum uterine hemorrhage 5-10 iu IM or 5 iu slow IV, followed in severe cases by IV infusion of 5-20 iu in 500 mL of non-hydrating diluent at the rate necessary to control uterine atony. Incomplete, inevitable or missed abortion 5 iu IM or slow IV if necessary followed by IV infusion at the rate of 20-40 milliunits/min. Click to view Roxipan detailed prescribing infomation Overdosage View Roxipan overdosage for action to be taken in the event of an overdose. Contraindications Do not administer by IV bolus. Prolonged use in patients w/ oxytocin-resistant uterine inertia, severe preeclamptic toxemia or severe CV disorders. Hypertonic uterine contractions,

mechanical obstruction to delivery, fetal distress. Significant cephalopelvic disproportion, fetal malpresentation, placenta praevia & vasa praevia, placental abruption cord presentation or prolapse, overdistention or impaired resistance of the uterus to rupture as in multiple pregnancy, polyhydramnios, grand multiparity & presence of a uterine scar. Infusion via the same apparatus as blood or plasma. Click to view Roxipan detailed prescribing infomation Warnings For additional cautionary notes to warn of the potential risk of using the medicine... click to view Roxipan detailed prescribing infomation Special Precautions Careful monitoring of fetal heart rate & uterine motility. Caution in the presence of borderline cephalopelvic disproportion, secondary uterine inertia, mild to moderate degrees of pregnancyinduced HTN or cardiac diseases, 35 yr or w/ a history of lower-uterine-segment cesarean section. Water intoxication w/ prolonged administration of high doses. Avoid rapid IV inj. Careful monitoring in the concomitant administration w/ prostaglandins. Click to view Roxipan detailed prescribing infomation

Adverse Drug Reactions

Uterine spasm at low doses. Fetal distress, asphyxia & death, hypertonicity, tetanic contractions, soft tissue damage or rupture of the uterus at high doses. Water intoxication (headache, anorexia, nausea, vomiting & abdominal pain), lethargy, drowsiness, unconsciousness & grand mal type seizure, low blood electrolyte conc. Acute short-lasting hypotension w/ flushing & reflex tachycardia w/ rapid IV bolus inj. View ADR Monitoring Website

Drug Interactions Prostaglandins. Inhalation anesth eg cyclopropane or halothane. Sympathomimetic vasoconstrictor agents. Soln containing Na metabisulfite. View more drug interactions with Roxipan

DRUG STUDY 1. Generic Name: Methylergonovine maleate

Brand Name: Methergine Classification: Oxytocic Therapeutic Actions: A partial agonist or antagonist at alpha receptors; as a result, it increases the strength, duration, and frequency of uterine contractions. Indications: Routine management after delivery of the placenta. Treatment of postpartum atony and hemorrhage; subinvolution of the uterus. Uterine stimulation during the second stage of labor following the delivery of the anterior shoulder, under strict medical supervision. Contraindications Contraindicated with allergy to methylergonovine, hypertension, toxemia, lactation, pregnancy. Adverse Effects: CNS: Dizziness, headache, tinnitus, diaphoresis CV: Transient hypertension, palpitations, chest pains, dyspnea GI: Nausea and vomiting Nursing Considerations: Assess history of allergy to the drug. Administer by IM injection or orally unless emergency requires IV use. Complications are more frequent with IV use. Monitor postpartum women for BP changes and amount and character of vaginal bleeding. Avoid prolonged use of the drug. Teach client to report difficulty breathing, headache, numb or cold extremities, severe abdominal cramping.

Generic Name:Dinoprostone (prostaglandin E2) Brand Name: Cervidil

Classification: Prostaglandin; abortifacient Therapeutic Actions:

Stimulates the myometrium of the pregnant uterus to contract; similar to the contractions of the uterus during labor, thus evacuating the contents of the uterus. Indications:

Termination of pregnancy 12-20 wks from the first day of the LMP.

Evacuation of the uterus in the management of missed abortion or intrauterine fetal death up to 28 wk gestational stage

Initiation of cervical ripening before induction of labor Contraindications:

Contraindicated with allergy to prostaglandins; acute PID; active cardiac hepatic; pulmonary, renal disease; women in whom prolonged uterine contractions are inappropriate. Adverse Effects: CNS: Headache, paresthesias, anxiety, weakness, syncope, dizziness CV: Hypotension, arrthymias, chest pain Fetal: Abnormal heart rates GI: vomiting, diarrhea, nausea Respiratory: Coughing, dyspnea Nursing Considerations:

Monitor uterine tone and vaginal discharge throughout the procedure and several days after the procedure.

Ensure adequate hydration throughout the procedure. Be prepared to support patient through labor. Give oxytocin infusion 6-

12 hr after dinoprostone.

Teach client to report severe pain, difficulty breathing, palpitations, eye pain, rash. 3. Generic Name:Oxytocin Brand Name: Pitocin Classification: Oxytocic; hormone Therapeutic Actions:

Synthetic form of an endogenous hormone produced in the hypothalamus and stored in the posterior pituitary; stimulates the uterus, especially the gravid uterus just before parturition, and causes myoepithelium of the lacteal glands to contract, which results in milk ejection in lactating women. Indications:

Antepartum: to initiate or improve uterine contractions to achieve early vaginal delivery; stimulation or reinforcement of labor in selected cases of uterine inertia; management of inevitable or incomplete abortion; 2nd trimester abortion

Postpartum: to produce uterine contractions during the third stage of labor to control postpartum bleeding or hemorrhage

Lactation defieciency Contraindications:

Significant cephalopelvic disproportion, unfavorable fetal positions or presentations, obstetric emergencies that favor surgical intervention, prolonged use in severe toxemia, uterine inertia, hypertonic uterine patterns, induction or augmentation of labor when vaginal delivery is

contraindicated, previous cesarian section. Adverse Effects: CV: cardiac arrhythmias, PVCs, hypertension, subarachnoid hemorrhage Fetal effects: fetal bradycardia, neonatal jaundice, low Apgar scores GI: nauseas, vomiting GU: postpartum hemorrhage, uterine rupture, pelvic hematoma, uterine hypertonicity, spasm Nursing Considerations:

Ensure fetal position and size and absence of complications that are contraindicated with oxytocin therapy

Ensure continuous observation for induction of labor; fetal monitoring is preferred.

Regulate rate of oxytocin delivery; monitor rate and strength of contractions

Monitor BP during administration 4. Generic Name:Lidocaine hydrochloride Brand Name: Dilocaine Classification: Local anesthetic Therapeutic Actions:

Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity Indications:

Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia

Contraindications:

Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF cardiogenic shock, 2nd or 3rd degree AV blocks Adverse Effects: CNS: headache, backache, septic meningitis, persistent sensory CV: hypotension Dermatologic: urticaria, pruritus, erythema, edema GU: urinary retention, urinary or fecal incontinence Nursing Considerations:

Check drug concentrations carefully Establish safety precautions if CNS changes occur Teach client to report difficulty speaking, thick tongue, numbness, tingling, difficulty breathing, pain or numbness at site, swelling or pain at site 5. Generic Name:Terbutaline Sulfate Brand Name: Brethine Classification: Tocolytic Therapeutic Actions: - In low doses, acts relatively selectively at beta 2-adrenergic receptors to cause bronchodilation and relax the pregnant uterus; at higher doses, beta 1 selectivity is lost and the drug acts at beta 2 receptors to cause typical sympathomimetic cardiac effects Indications: - Tocolytic to prevent preterm labor Contraindications: - Contraindicated with hypersensitivity to terbutaline, tachyarrythmias, tachycardia, hypertension, lactation. Adverse Effects:

CNS: restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesias, insomnia, tremors CV: cardiac arrhythmias, palpitations, angina pain, changes in BP and ECG GI: Nausea, vomiting, heartburn, unusual or bad taste Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm Nursing Considerations: - Use minimal doses for minimal periods of time; drug tolerance can occur - Maintain a beta-adrenergic blocker on standby in case cardiac arrhythmias occur - Teach client to report chest pain, dizziness, insomnia, weakness, tremor 6. Generic Name:Carboprost tromethamine Brand Name: Hemabate Classification: Prostaglandin; Abortifacient Therapeutic Actions: Stimulates the myometrium of the pregnant uterus to contract; similar to the contractions of the uterus during labor, thus evacuating the contents of the uterus. Indications: - Termination of pregnancy 13-20 wk from the first day of the LMP - Evacuation of the uterus in instance of missed abortion or intrauterine fetal death in the 2nd trimester - Postpartum hemorrhage due to uterine atony unresponsive to conventional methods

Contraindications: - Contraindicated with allergy to prostaglandin preparations, acute PID; active cardiac,hepatic, pulmonary, renal disease Adverse Effects: CNS: headache, paersthesias, flushing, anxiety, weakness, syncope, dizziness CV: hypotension, arrhythmias, chest pain GI: vomiting, diarrhes, nausea Nursing Considerations: - Assess allergy to the drug - Monitor uterine tone and vaginal discharge during procedure and several days after to assess drug effects and recovery - Ensure adequate hydration Generic Name:Nalbuphine hydrochloride Brand Name: Nubain Classification: Narcotic agonisy-antagonist analgesic Therapeutic Actions: - Nalbuphine acts as an agonist at specific opioid receptors in the Cns to produce analgesia, sedation but also acts to cause hallucinations and is an antagonist at mu receptors Indications: - Relief of moderate to severe pain - For obstetric analgesia during labor and delivery Contraindications: - Contraindicated with hypersensitivity to nalbuphine, sulfites; lactation Adverse Effects: CNS: sedation, clamminess, sweating, headache, nervousness, restlessness, depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations,

euphoria, blurred vision CV: hypotension, hypertension, bradycardia, tachycardia Dermatologic: itching, burning, urticaria GI: N/V, cramps, dyspepsia, bitter taste, dry mouth GU: Urinary urgency Respiratory: Respiratory depression, dyspnea, asthma Nursing Considerations: - Assess hypersensitivity to the drug - Provide narcotic antagonist, facilitates for assisted or controlled respiration on standby in case of respiratory depression - Reassure patient about addiction liability; most patients who receive opiates for medical reasons do not develop dependence syndrome - Inform clients about these side effects: dizziness, sedation, drowsiness, impaired visual acuity, nausea, loss of appetite 8. Generic Name:Magnesium sulfate Brand Name: Epsom salt Classification: electrolyte; anticonvulsant; laxarive Therapeutic Actions: - Cofactor of many enzyme systems involved in neuromuscular transmission and muscular excitability Indications: - Preeclampsia/eclampsia - Inhibition of premature labor Contraindications: - Contraindicated with allergy to magnesium product; heart block, myocardial damage, abdominal pain, N/V, acute surgical abdomen, fecal impaction, hepatitis. DO NOT GIVE 2 HR PRECEEDING DELIVERY BECAUSE OF RISK OF MAGNESIUM TOXICITY IN THE NEONATE.

Adverse Effects: CNS: weakness, dizziness, fainting, sweating CV: palpitations GI: excessive bowel activity, perianal irritation Metabolic: Magnesium intoxication, hypocalcemia with tetany Nursing Considerations: - Assess history of allergy to the drug and other contraindications - Reserve IV use in eclampsia for immediate life- threatening situations - Monitor magnesium levels during parenteral therapy - Monitor knee-jerk reflex before repeated parenteral administration, if happens, do not administer because respiratory failure may occur
- Do not give orally with abdominal pain, N/V

Generic Name: Butorphanol tartrate Brand Name: stadol Classification: Narcotic agonist- antagonist analgesic Therapeutic Actions: - Acts as an agonist at opioid receptors in the CNS to produce analgesia, sedation, but also acts to produce hallucinations; has low abuse potential Indications: - Relief of moderate to severe pain - To supplement balances anesthesia and to relieve prepartum pain Contraindications: - Contraindicated with hypersensitivity to butorphanol, physical dependence on a narcotic analgesic, pregnancy lactation Adverse Effects: CNS: sedation, clamminess, sweating, headache, vertigo, dizziness, lethargy, confusion, unusual dreams, agitation, euphoria, hallucinations

CV: Palpitations, increase or decrease in blood pressure Dermatologic: Ras, hives, pruritus, flushing, warmth, sensitivity to cold EENT: diplopia, blurred vision GI: N/V Respiratory: slow, shallow respiration Nursing Considerations: - Assess history of allergy to butorphanol , depression DM, lactation, and dependence - Monitor diet for presence of caffeine- containing foods that may contribute to overdose - Inform patients that these side effects may occur: diuresis, restlessness, insomnia, muscular tremors, light- headedness, nausea, abdominal pain - Remind patient to report abnormal heart rate, dizziness, palpitations 10.Generic Name:Misoprostol Brand Name: Cytotec Classification: Prostaglandin Therapeutic Actions: - A synthetic prostaglandin E1 analog; inhibits gastric acid secretion and increases bicarbonate and mucus production, protecting the lining of the stomach Indications: - With mifepristone as an abortifacient - Cervical ripening and labor induction Contraindications: - History of allergy to prostaglandins; pregnancy; lactation Adverse Effects: GI: nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, constipation

GU: Miscarriage, excessive bleeding, spotting, cramping, menstrual disorders Nursing Considerations: - Assess history of allergy to the drug - Report severe diarrhea, spotting, or menstrual pain, severe menstrual bleeding

Generic Name: Midazolam hydrochloride Brand Name: Versed Classification:Benzodiazepine (short-acting); CNS depressant Therapeutic actions: Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation; potentiates the effects of GABA, an inhibitory neurotransmitter; anxiolytic and amnesia effects occur at doses below those needed to cause sedation, ataxia; has little effect on cortical function. Indications - IV or IM: Sedation, anxiolysis, and amnesia prior to diagnostic, therapeutic, or endoscopic procedures or surgery - Induction of general anesthesia - Continuous sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in the critical care setting - Unlabeled uses: Treatment of epileptic seizure or refractory status
-

epilepticus Contraindications and cautions - Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis have been reported when used in first trimester; neonatal withdrawal syndrome reported in infants); neonates. - Use cautiously in elderly or debilitated patients; with impaired liver or kidney function, lactation. Adverse effects CNS: Transient, mild drowsiness (initially); sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions (during first 2 wk of treatment), visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitations, edema

Dermatologic: Urticaria, pruritus, skin rash, dermatitis GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, elevations of blood enzymes: LDH, alkaline phosphatase, AST, ALT, hepatic dysfunction, jaundice GU: Incontinence, urinary retention, changes in libido, menstrual irregularities Hematologic: Decreased Hct, blood dyscrasias Other: Phlebitis and thrombosis at IV injection sites, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain, burning, and redness after IM injection Dependence: Drug dependence with withdrawal syndrome when drug is discontinued (more common with abrupt discontinuation of higher dosage used for longer than 4 mo) Nursing considerations - History: Hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication withdepression of vital signs; elderly or debilitated patients; impaired liveror kidney function; pregnancy, lactation Generic Name:Fresofol Brand Name: Propofol Classification:sedative hypnotic; anesthetic agent Therapeutic Actions: - Propofol is a short-acting hypnotic. Its mechanism of action has not

been well-defined. Indications: - induction of general anesthesia in adults and in pediatric patients greater than 3 years of age - maintenance of anesthesia utilizing balanced techniques with other appropriate agents such as opioids and inhalation anesthetics in adults and pediatric patients greater than 2 months of age - produce sedation or amnesia as a supplement to local or regional anesthetics Contraindications: - Contraindicated in pediatric patients for monitored anesthesia care (MAC) sedation or for sedation in intensive care; epileptics; use cautiously in lactation Adverse Effects: CV: Arterial hypotension; decreased systemic vascular resistance, myocardial blood flow, and oxygen consumption, palpitations, tachycardia Respiratory: apnea, hyperventilation, bradypnea, dyspnea, wheezing, swelling of throat CNS: increased ICP, lethargy, drowsiness, euphoria, hallucinations, blurred vision, anxiety, tension, seizure, lightheadedness, fainting DERM: skin rash, flushing, urticaria Nursing Considerations: - Assess history of allergy to the components of the drug. - Use safety precautions after administration. - Advise patient that mental alertness, coordination, and physical

dexterity may be impaired for some time after administration. - For IV, do not mix with other therapeutic agents prior to administration. Avoid mixing blood or plasma in same IV catheter. - Minimize pain associated with administration by infusing into larger veins. - Should be administered only by personnel who are trained in administration of general anesthesia and familiar with drug. - Shake well before use. Do not use if there is evidence of separation of phases of emulsion. Generic Name:Hyoscine-N-butylbromide Brand Name: Buscopan Classification:Antispasmodic; Anticholinergic Therapeutic Actions: - acts by interfering with the transmission of nerve impulses by acetylcholine in the parasympathetic nervous system. Indications: - Buscopan Tablets are indicated for the relief of spasm of the genitourinary tract or gastro- intestinal tract and for the symptomatic relief of Irritable Bowel Syndrome Contraindications: - Buscopan Tablets should not be administered to patients with myasthenia gravis, megacolon and narrow angle glaucoma. In addition, they should not be given to patients with a known hypersensitivity to hyoscine-N-butylbromide or any other

component of the product. Adverse Effects: CNS: dizziness, anaphylactic reactions, anaphylactic shock, increased ICP, disorientation, restlessness, irritability, dizziness, drowsiness, headache, confusion, hallucination, delirium, impaired memory CV: hypotension, tachycardia, palpitations, flushing GI: Dry mouth, constipation, nausea, epigastric distress DERM: flushing, dyshidrosis GU: Urinary retention, urinary hesitancy Resp: dyspnea, bronchial plugging, depressed respiration EENT: mydriasis, dilated pupils, blurred vision, photopobia, increased intraocular pressure, difficulty of swallowing. Nursing Considerations: - Drug compatibility should be monitored closely in patients requiring adjunctive therapy - Avoid driving & operating machinery after parenteral administration. - Avoid strict heat