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Homework Nursing 359 For each medication listed : Dose, route, frequency Action Side Effects Contraindications How

it is used in OB Betamethasone Dose/Frequency/ Route : Betamethasone (12 mg) given


intramuscularly 24 hours apart for two doses

Action: Controls the rate of protein synthesis; depresses the migration of polymorphonuclear leukocytes, fibroblasts; reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation. Side Efffects :fluid retention and increased blood pressure in the infant include: psychomotor delays and behavioral Contraindications:s contraindicated in patients who are hypersensitive to
betamethasone dipropionate, to other corticosteroids, or to any ingredient in this preparation.

USED :Betamethasone and dexamethasone are corticosteroids, also


called glucocorticoids, that are given before birth (antenatally) to speed up a preterm fetus's lung development. Either is used when a mother is in preterm labor and birth may occur in 24 to 48 hours. This helps prevent respiratory distress syndrome produces serfactant

Cervidil Dose/frequency/route :10mg,designed to be released at approximately 0.3


mg/hour over a 12 hour period. Cervidil (dinoprostone) should be removed upon onset of active labor or 12 hours after insertion. Vaginal Insert the initiation of labor . It is known that PGE2 stimulates the production of PGF2 which in turn sensitizes the myometrium to endogenous or exogenously administered oxytocin. Although PGE2 is capable of initiating uterine contractions and may interact with oxytocin to increase uterine contractility, the available evidence indicates that, in the concentrations found during the early part of labor, PGE2 plays an important role in cervical ripening without affecting uterine contractions

Action: Cervidil

allows

Side Effects: nausea, stomach pain; back pain; or feeling of warmth in the vaginal
area.

Contraindications: Cients with known hypersensitivity to prostaglandins.


Patients in whom there is clinical suspicion or definite evidence of fetal distress where delivery is not imminent.Patients with unexplained vaginal bleeding during this pregnancy.Patients in whom there is evidence or strong suspicion of marked cephalopelvic disproportion. Patients in whom oxytocic drugs are contraindicated or when prolonged contraction of the uterus may be detrimental to fetal safety or uterine integrity,

Used: Is indicated for the initiation and/or continuation of cervical ripening in


patients at or near term in whom there is a medical or obstetrical indication for the induction of labor.

Erythromycin Opthalmic Ointment Dose/frequency/Route: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. Action :Erythromycin Ophthalmic Ointment belongs to the macrolide group of antibiotics. It is basic and readily forms a salt when combined with an acid. The base, as crystals or powder, is slightly soluble in water, moderately soluble in ether, and readily soluble in alcohol or chloroform. Erythromycin inhibits protein synthesis without affecting nucleic acid synthesis.
Side Effects: Conjunctivitis or Blepharitis, which is characterized by
redness, itching, tearing and light sensitivity.

Contraindications: hypersensitivity to erythromycin. Used :For prophylaxis of ophthalmia neonatorum due to N. gonorrhoeae or C. trachomatis. Hepatitis B vaccine Dosage/Frequency/Route:1st Dose: Birth 2nd Dose: 1 to 2 month of
age 3rd Dose: 6 to 18 months of age.5 mL peds vacc (10 mcg) IM: 0, 1, 6 mth. Anterolateral thigh preferred for neonates/infants/small children

Action:surface antigen (HBsAg) which stimulates active immunity

Side Effects:Hives Itching, especially of the feet or hands


Muscle weaknes Numbness or tingling of the arms and legs Reddening of the skin, especially around the ears Sweating Swelling of the eyes, face, or inside of the nose Unusual tiredness or weakness.Temperature of 99.9 F Contraindications:Hypersensitivity to yeast Used: Routine immunization against hepatitis B; also protects against hepatitis D which always occurs in the presence of hep B.Infants born to HbsAg+ mothers

Magnesium Sulfate Dosage/Frequency/Route: may receive a loading (big) dose through

an IV of 4 to 6 grams and a continuous dose of 1-2 grams per hour. She may receive these doses before giving birth and sometimes for at least 24 hours after giving birth. If a woman is having convulsions from eclampsia, she may receive a single dose of 4 to 6 grams to try to stop the convulsions.Short periods of time (24 to 48 hours) until the baby or babies can be delivered, which is the only "cure" for pre-eclampsia
Action: Acts both through a central depressant effect by affecting
acetylcholine release and sensitivity at the motor end plate and a local effect by decreasing smooth muscle contractility.

Side effects:Flushing Nausea Vomiting Palpitations Headache

General muscle weakness Lethargy Constipation


Contraindications: Used: to treat Pre-eclampsia consists of high blood pressure,

protein in the urine and edema (swelling). It can rapidly become

severe pre-eclampsia, with very high blood pressure.Magnesium


sulfate is usually given through a vein (intravenously) until contractions have slowed and the mother's cervix has stopped thinning (effacing) or opening (dilating).

Methergine Dosage/frequency/Route:Methergine is available in sterile ampuls of 1 mL,


containing 0.2 mg methylergonovine maleate for intramuscular or intravenous injection and in tablets for oral ingestion containing 0.2 mg methylergonovine maleate. Action:acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic contractions. Thus, it induces a rapid and sustained tetanic uterotonic effect which shortens the third stage of labor and reduces blood loss. The onset of action after I.V. administration is immediate; and after I.M. administration, 2-5 minutes.

Side Effects: Increased blood pressure (severe headache, blurred vision);


seizure (convulsions); feeling light-headed, fainting;pounding heartbeat; chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling. Contraindications: Hypertension; toxemia; pregnancy; and hypersensitivity.

Uses:Methylergonovine is used to prevent or treat bleeding from the uterus


that can happen after childbirth or an abortion.

Nubain Dosage/frequency/route: Induction doses of NUBAIN (nalbuphine


hydrochloride) range from 0.3 mg/kg to 3 mg/kg intravenously to be administered over a 10 to 15 minute period with maintenance doses of 0.25 to 0.5 mg/kg in single intravenous administrations as require Action:ts analgesic potency is essentially equivalent to that of morphine on a milligram basis. Receptor studies show that NUBAIN (nalbuphine hydrochloride) binds to mu, kappa, and delta receptors, but not to sigma receptors. NUBAIN (nalbuphine hydrochloride) is primarily a kappa agonist/partial mu antagonist analgesic. Side Effects:sedation,sweaty/clammy, nausea/vomiting, dizziness/vertigo, dry mouth , and headache

Contraindications:patients who are hypersensitive to nalbuphine


hydrochloride, or to any of the other ingredients in NUBAIN (nalbuphine hydrochloride) .

Uses:for obstetrical analgesia during labor and delivery. Narcan

Dosage/frequency/route:The most rapid onset of action is achieved by


intravenous administration.In addition of 2 mg of NARCAN (naloxone) in 500 mL of either solution provides a concentration of 0.004 mg/mL. Mixtures should be used within 24 hours. After 24 hours, the remaining unused mixture must be discarded. The rate of administration should be titrated in accordance with the patient's response Action: Narcan is an essentially pure opioid antagonist, NARCAN (naloxone) prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension. Also, NARCAN (naloxone) can reverse the psychotomimetic and dysphoric effects of agonist-antagonists such as pentazocine.

Side effects:chest pain or fast or irregular heartbeats; feeling light-headed, fainting;


seizure (convulsions); or difficulty breathing Contraindications: is contraindicated in patients known to be hypersensitive to

naloxone hydrochloride or to any of the other ingredients in NARCAN (naloxone) Use: indicated for the complete or partial reversal of opioid depression, including respiratory depression, induced by natural and synthetic opioids, including propoxyphene, methadone and certain mixed agonist-antagonist analgesics: nalbuphine, pentazocine, butorphanol, and cyclazocine. NARCAN (naloxone) is also indicated for diagnosis of suspected or known acute opioid overdosage.

Pitocin Dosage/Frequency/route:he dosage of oxytocin is determined by the uterine


response and must therefore be individualized and initiated at a very low level. Pitocin (oxytocin injection) is prepared by adding the contents of one 1- mL vial containing 10 units of oxytocin to 1000 mL of 0.9% aqueous sodium chloride or Ringer's lactate. The combined solution containing 10 milliunits (mU) of oxytocin/mL is rotated in the infusion bottle for thorough mixing.Attach (piggyback) the Pitocin (oxytocin injection) containing bottle with the infusion pump to the infusion line as close to the infusion site as possible.3-6 mL of the dilute oxytocin solution per hour). At 30-60 minute intervals the dose should be gradually increased in increments of 1-2 mU/min until the desired contraction pattern has been established. Once the desired frequency of contractions has been reached and labor has progressed to 5-6 cm dilation, the dose may be reduced by similar incremen Action:Oxytocin has specific receptors in the myometrium and the receptor concentration increases greatly during pregnancy, reaching a maximum in early labor at term. The response to a given dose of oxytocin is very individualized and depends on the sensitivity of the uterus, which is determined by the oxytocin receptor concentration. is distributed throughout the extracellular fluid. Small amounts of the drug probably reach the fetal circulation. Side Effects:Anaphylactic reactionPostpartum hemorrhageCardiac arrhythmia h a

Fatal afibrinogenemiaHypertensive episodesNauseaVomitingPremature ventricular contractionsPelvic hematomaSubarachnoid hemorrhageHypertensive h episodesRupture of the uterus

Contraindications: Where there is significant cephalopelvic disproportion;


In unfavorable fetal positions or presentations, such as transverse lies, which are undeliverable without conversion prior to delivery;In obstetrical emergencies where the benefit-to-risk ratio for either the fetus or the mother favors surgical intervention; In fetal distress where delivery is not imminent; Where adequate uterine activity fails to achieve satisfactory progress; Where the uterus is already hyperactive or hypertonic;In cases where vaginal delivery is contraindicated, such as invasive cervical carcinoma, active herpes genitalis, total placenta previa, vasa previa, and cord presentation or prolapse of the cord; In patients with hypersensitivity to the drug.

Use:Antepartum: Pitocin (oxytocin injection) is indicated for the initiation or


improvement of uterine contractions, where this is desirable and considered suitable for reasons of fetal or maternal concern, in order to achieve vaginal delivery. It is indicated for (1) induction of labor in patients with a medical indication for the initiation of labor2) stimulation or reinforcement of labor, as in selected cases of uterine inertia; (3) as adjunctive therapy in the management of incomplete or inevitable abortion. Postpartum: Pitocin (oxytocin injection) is indicated to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.

AquaMephyton Dosage/Frequency/Route: 0.5 to 1 mg IM within 1 hour of birthVitamin K1


Injection 1 mg should be given either subcutaneously or intramuscularly. Higher doses may be necessary if the mother has been receiving oral anticoagulants. Actions: Parental injection, possesses the same type and degree of activity as does naturally-occurring vitamin K, which is necessary for the production via the liver of active prothrombin (factor II), proconvertin (factor VII), plasma thromboplastin component (factor IX), and Stuart factor (factor X). Side Effects: Pain, swelling, and tenderness at the injection site may occur. Contraindictions:Hypersensitivity to any component of this medication. Use: Prophylaxis and therapy of hemorrhagic disease of the newborn

RHoGAM

Dosage/Frequency/Route:For intramuscular use only.50 g is contained in


each prefilled syringe of MICRhoGAM (rho(d) immune globulin. This dose will suppress the immune response to 2.5 mL of Rh-positive red blood cells. MICRhoGAM (rho(d) immune globulin.is therefore indicated within 72 hours after termination of pregnancy up to and including 12 weeks' gestation. At or beyond 13 weeks' gestation, RhoGAM (rho(d) immune globulin (human)) should be administered instead of MICRhoGAM. Actions:act by suppressing the immune response of Rh-negative individuals to Rh-positive red blood cells Side Effects: skin reactions, such as swelling, induration, redness and mild pain at the site of injection Contraindications: Individuals known to have had an anaphylactic or severe systemic reaction to human globulin should not receive RhoGAM Use: Pregnancy/delivery of an Rh-positive baby irrespective of the ABO groups of the mother and baby.Abortion/threatened abortion at any stage of gestation Ectopic pregnancy .Antepartum fetal-maternal hemorrhage (suspected or proven) resulting from antepartum hemorrhage (e.g., placenta previa), amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure (e.g., version) or abdominal trauma Transfusion of Rh incompatible blood or blood products

Cytotec Dosage/frequency/Route:Routes of misoprostol administration

include oral, vaginal, sublingual, buccal, or rectal.00 g of oral misoprostol 48 hours later for pregnancies up to 49 days of gestation.21 However, there is excellent evidence of efficacy up to 63 days of gestation using the regimens of 200 mg of mifepristone orally followed by home administration of either 800 g of buccal misoprostol in 24 to 36 hours or 800 g of vaginal misoprostol in 6 to 48 hours.22,23 Women then return 4 to 14 days later for a clinical evaluation to document complete abortion. Actions:Misoprostol is a synthetic prostaglandin E1 analogue marketed as an oral preparation used to prevent and treat gastroduodenal damage induced by nonsteroidal antiinflammatory drugs (NSAIDs). However, misoprostol is used offlabel for a variety of indications in the practice of obstetrics
Side Effects:Spotting,cramps , hypermenorrhea , menstrual disorder and
dysmenorrhea ( Postmenopausal vaginal bleeding may be related to Cytotec (misoprostol) administration

Contraindications:Cytotec (misoprostol) should not be taken by anyone with a


history of allergy to prostaglandins. Pregnant woman passed 49 days of gestation.

Use: Medication abortion, medical management of miscarriage,

induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage.
Colace Dosage/frequency/route:100 mg twice a day, Orally Actions:acilitates mixture of stool fat and water (stool softener) Side Effects:Rectal bleeding or irritation; numbness or a rash around your rectum; severe diarrhea or stomach cramps; or continued constipation. Contraindications:hypersens. to drug/class/compon.fecal impaction mineral
oil use appendicitis acute abdomen GI obstruction caution if nausea/vomiting