Jennifer Nguyen

Norris-32
MEDICATIONS FOR OB
Drug
Oxytocin
Pitocin

meperidine
hydrochloride
(pethidine
hydrocloride)
Demerol

Classificati
on
Oxytocics,
exogenous
hormones

Opioid
analgesic;
Opioid schedule II

Indications

Action

Induce/stimula
te labor;
reduce
postpartum
bleeding after
expulsion of
placenta;
incomplete or
inevitable
abortion

Causes
potent and
selective
stimulation
of the
uterine and
mammary
gland
smooth
muscle.

Moderate to
severe pain;
pre-op
analgesia;
adjunct to
anesthesia;
obstetric
analgesia

Exact
mechanism
unknown.
Binds with
opioid
receptors
in the CNS,
altering
perception
of and
emotional

Route/Dos
e
10 units
(1ml)/1000
ml of IV
solution;
0.51milliunit/mi
n

Adults: 50
to 150 mg
PO, IM or
subcutaneo
us every 3
to 4 hours
p.r.n. Or 10
mg IV slowly
by PCA
pump, 1 to
5 mg per

Side Effects
arrhythmias,
HTN; N/V;
abruptio
placentae,
postpartum
hemorrhage,
uterine rupture;
water
intoxication
Fetal
r/t
hypercontractili
ty decr O2 to
infant = infant
brain damage,
bradycardia,
arrhythmias;
hyperbilirubine
mia, trauma,
low Apgar
scores at 5
minutes, &
death
dizziness,
sedation,
seizures,
hallucinations;
bradycardia,
cardiac arrest,
shock;
constipation,
dry mouth, N/V;
urinary
retention;

Patient
Teaching
-Explain use and
administration of
drug.
-Instruct patient
to report adverse
reactions.

Nursing Implications

-Instruct patient
and family to
immediately
report difficulty
breathing or other
s/sx of adverse
opioid reaction.
-Encourage postop patients to
turn, cough, deepbreathe and use

-Carefully monitor VS,

pain level, respiratory
status (hold if <
12/min) and sedation
level
-May use for pts
allergic to morphine.
-Reassess pain level 15
to 30 minutes after
administration.
-In neonates exposed

-Apply fetal monitor

-Monitor fluid I/O
-Monitor and record
uterine contractions,
HR, BP, intrauterine
pressure, fetal HR, and
character of blood loss
every 15 minutes.
-Have 20% magnesium
sulfate available

Jennifer Nguyen
Norris-32
response to
pain.

butorphanol
tartrate
Stadol

ampicillin
Omnipen

Opioid
analgesic;
opioid
agonistantagonist;
CS schedule
IV

Moderate to
severe pain;

Antibiotic,
aminopenici

gram positive/
negative cocci

Labor pts at
full terms,
early labor

Bind with
opioid
receptors
in CNS,
altering
perception
of and
emotional
response to
pain.
interferes
with the

dose; Or
continuous
IV infusion
of 15 to 35
mg/hour.
Children:
1.1 to 1.8
mg/kg PO or
1.1 to 1.76
mg/kg IM or
subcutaneo
usly every 3
to 4 hours.
Obstetric
analgesia 50 to 100
mg IM or
subcutaneo
usly when
pain
becomes
regular;
may repeat
at 1 to 3
hour
intervals.
1-4mg IM or
0.5-2mg IV
q 3-4hr prn

respiratory
arrest/depressio
n; pain at
injection site,
phlebitis after
IV delivery

incentive
spirometer.
-Caution
ambulatory
patient about
getting out of bed
or walking.
-Avoid alcohol and
sleep aids during
therapy.
-Not intended for
long-term use.

during labor, monitor

respirations, have
resuscitation
equipment and
naloxone available.
-Monitor bladder
function and bowel
movements.

Somnolence,
dizziness, N/V,
constipation

-Caution
ambulatory pt
about getting out
of bed
-Warn to avoid
driving,
hazardous
activities, and
alcohol

-Monitor breastfeeding
mother & infant
-Reassess pain 15-30
min after admin
-Monitor bowel
movement, O2 sat,
respiratory depression

coma
seizures

- tablets may be
crushed

- I&O ratio
- hematuria

1-2mg IV or
IM q 3-4hr
prn

200-500 mg
PO q6h

Jennifer Nguyen
Norris-32
llin

gentamicin
garamycin,
genoptic,
gentak

misoprostol
cytotec

Antibiotic,
aminoglyco
side

Anti-ulcer,
prostaglandi
n E1 analog

and bacilli
infections

cell wall of
susceptible
organisms

Serious
bacterial
infections;
Ophthalmic
external
ocular
infections

Bactericidal
inhibits
protein
synthesis

Prevent
NSAID-induced
gastric ulcer

Replaces
gastric
prostaglan
dins
depleted
by NSAID
therapy,
decreases
basal and
stimulated
gastric
secretion,

2-8 g/day
IV/IM in
divided
doses q4-6h

Adult:
3mg/kg
daily IM or
IV infusion
q8h
Child/neonat
e: 22.5mg/kg IM
or IV
infusion q812h
1-2 drops in
affected eye
q4h
200mcg PO
q.i.d. with
food

StevensJohnson
syndrome
anaphylaxis
nephrotoxicity

- capsules may be
broken and mixed
with H2O
- take on empty
stomach with H2O
- entire
medication course
must be
completed to
ensure organism
death

- watch patients with

compromised renal
function
- CBC
- skin eruptions
- have emergency
equipment available in
case anaphylaxis
occurs

Encephalopathy
, dizziness,
ototoxicity,
tinnitus,
nephrotoxicity,
apnea,
anaphylaxis,
numbness,
tingling, muscle
twitching

-Immediately
report adverse
reactions
-Drink plenty of
fluids
-Avoid hazardous
activities

Black box warnings:

-may cause fetal harm
in pregnant women
-evaluate hearing
before and during tx
-maintain peak &
trough levels
-contraindicated in
renal impair pts
-monitor BUN,
creatinine

HA, abd pain,

diarrhea,
constipation,
dyspepsia,
flatulence, N/V

-Warn of risk
during pregnancy
-Advise not to
begin until 2nd or
3rd day of next
normal menstrual
period
-Warn of diarrhea

Ophthalmicdemonstrate how
to instill drops

-Admin w/ food
-Black box: Contra w/
pregnancy

Jennifer Nguyen
Norris-32

magnesium
sulfate

Vitamin k
phytonadione
(aquamephyto
n)

Electrolyte
replacemen
t, mineral

Mineral

Hypomagnese
mia,
convulsions
(r/t
preeclampsia
& eclampsia),
tetany (muscle
spasms)
Prophylaxis
and tx of
vitamin K
deficiency
bleeding
(VKDB)

and
increases
gastric
mucus and
bicarb
production
Replaces
and
maintains
Mg++
levels

Promotes
clotting
factors

1-5g IM q6h
for 4 doses
4-5g IV in
250ml
solution;
simultaneou
sly, give 810g IM
1x only
0.5-1mg IM,
vastus
lateralis

Diminished
DTR,
arrhythmias,
hypocalcemia,
respiratory
paralysis,
stupor

-Report adverse
effects

-Use IV calcium for OD

-Test reflexes before
each dose
-Monitor Mg++ level,
I&O, renal function
(BUN, Cr)

Pain and edema

at injection site;
rash or hives

-Explain need for

administration
-Report signs of
bleeding (e.g.,
bruising, etc.)

-Protect drug from light

-Observe for signs of
local inflammation,
jaundice or kernicterus
-Give before
circumcision
-Monitor for bleeding

Jennifer Nguyen
Norris-32
Ilotycin
ointment
erythromycin
ointment

Antibiotic,
macrolide

Prophylactic tx
of gonorrhea
(ophthalmia
neonatorum
caused by
Neisseria
gonorrhoeae)

Bacteriosta
tic
inhibits
protein
synthesis

hepatitis b
vaccine
Engerix-B,
Recombivax
hb

Vaccine

Prophylaxis
against all
subtypes of
hepatitis B
virus

Passive
antibodies
against
HBsAG for
newborns

penicillin g

Antibiotic,
penicillin

Prophylactic or
tx of group B
strep (GBS)

Inhibits
synthesis
of bacterial
cell wall

Insulin & oral

hypoglycemic
s

Antidiabetic
, insulins

Diabetes
mellitus

By to
insulin
receptors
to facilitate
take of
glucose

Ribbon of
ointment
approx. 0.5
to 1cm long
along lower
conjunctival
surface of
each eye
shortly after
birth
10mcg IM
shortly after
birth,
10mcg IM
30 days
later, and
10mcg IM 6
months
after initial
dose
150-300K
units/kg/day
in divided
doses q 46h

Sensitivity
reaction,
decrease ability
to focus,
edema,
inflammation

-Need for
prophylaxis
-Report adverse
effects

-Wash hands before

instillation
-wait 1 minute before
wiping excess away
-Observe for
hypersensitivity

Soreness at
injection site,
mild fever

-Importance of
vaccination
-Date of 2nd and
3rd doses and
where to go for
admin

-Delay administration if
active infection
-Give as supplied,
dont dilute
-Monitor for adverse
reactions and fever

Hypersensitivity
reaction,
neutropenia,
electrolyte
imbalance,
superinfection,
neurotoxic
reactions, renal
damage,
thrombophlebiti
s, black tongue

-Monitor for allergic

reaction
-Monitor electrolytes,
WBCs, LFT and BUN,
creatinine
-Monitor neurological
status

Various depends on
exact type
of insulin
and current
status of
glucose

hypoglycemia,
hypokalemia,
allergic
reactions,
peripheral
edema

-Notify provider if
s/sx of an allergic
reaction
-Should be
administered as
directed, do not
miss doses and
do not
discontinue
therapy until all
medication has
been completed
-Order and timing
of insulin admin
-Peak and onset
times
-S/sx of
hypoglycemia &
how to treat it

-Not all insulins can be

mixed
-Get updated glucose
level before
administration
-Consider the onset
and peak when admin

Jennifer Nguyen
Norris-32
level

methylergono
vine maleate
Methergine

Ergot
alkaloid

Used
postpartum to
stimulate the
uterus to
contract

Acts
directly on
the smooth
muscle of
the uterus,
increasing
the
contraction
s thus
shortening
the 3rd
stage of
labor and
reduces
blood loss

IM: 0.2mg
q2-5h prn
PO: 0.2mg
3-4 times
per day for
7 days

-Regularly
monitor HbA1c
-Rotate site of
injection

HTN, seizures,
headache,
hypotension,
abdominal pain,
N/V

-Importance of
not smoking
during admin
-Counsel not to
breastfeed during
treatment and for
at least 12 hrs
after last dose

-Monitor for s/sx of

hypoglycemia, adjust
dose as needed
-Antepartum, a 3-dose
approach is often used
(a combo of insulins at
breakfast and lunch
and then an
intermediate-acting
insulin at bedtime)
-During labor, only
regular insulin should
be used during the first
stage of labor
- Oral hypoglycemics
are typically not given
during pregnancy but 2
have been studied and
may be safe to use
-Monitor fundal height
and consistency and
the amount and
character of the lochia
-Notify provider if
uterus remains boggy
-Assess BP before and
during admin
-Monitor for side
effects

Effects of Drugs on Fetus/Newborn:

Heroin: withdrawal symptoms known as neonatal abstinence syndrome (NAS), including tremors, irritability, sneezing, vomiting, fever,
diarrhea, abnormal respiratory function and potential seizure activity.

Jennifer Nguyen
Norris-32
Methadone: with abrupt maternal termination of the drug, severe withdrawal symptoms can include preterm labor, rapid labor, abruption,
nonreassuring fetal status, and meconium aspiration. Neonates may present with NAS or be small for gestational age.
Cocaine: cerebral infarctions, microcephaly, learning disabilities, poor state organization, decreased interactive behavior, CNS/cardiac/GU
anomalies, and sudden infant death syndrome (SIDS).
Marijuana: no independent effect on prenatal marijuana exposure on growth has been documented throughout early childhood and
adolescence.