OKLAHOMA CITY COMMUNITY COLLEGE

NURSING PROCESS II
OB Rotation Maternal and Newborn Medications

****This worksheet is to be completed prior to first OB clinical shift and must be

with student at each OB clinical shift****

Nursing
Medications for: Action Dosage Side Effects
Implications
(trade/generic) (range and routes)

Induction/augmentation

Pitocin/oxytocin Binds to oxytocin IV: Start- 0.5-2 Nausea, vomiting, Electronic fetal
receptors in milliunits/min IV, uterine hypertonicity monitoring.
myometrium, increasing incr. 1-2 Black Box:
intracellular Ca and milliunits/min q15- Not indicated for elective
stimulating uterine 40min until labor induction since
contractions contraction pattern inadequate data to
est. evaluate benefit vs risk;
elective induction
defined as labor initiation
w/o medical indications.
Cervidil/dinoprostone Exact mechanism of 10 mg PV x1 Abdominal cramps, Observe patient
action unknown; PGE2 info: releases 0.3 uterine contractions, carefully, after
induces cervical mg/h over 12 h; nausea, headache, back insertion of the
softening, effacement, insert transverse in pain, diarrhea, back drug. Rupture of
and uterine contraction. posterior vaginal pain, diarrhea, vomiting, the membranes is
fornix; remain uterine hypertonicity, not a
supine x2h; remove fetal distress, fever contraindication to
at 12 h, at onset of drug, but be aware
active labor, or if that profuse
uterine bleeding may
hyperstimulation result in expulsion
of the suppository.
Report wheezing,
chest pain,
dyspnea, and
significant
changes in BP
and pulse to the
physician.
Monitor uterine
contractions and
observe for and
report excessive
vaginal bleeding
and cramping
pain. Keep pad
count. Save all
clots and tissues
for physician
inspection and
laboratory
analysis.
Cytotec/misoprostol Selectively stimulates 2.5-5 mg PO tid Nervousness, tremor, Monitoring
beta-2 adrenergic SC;IV headache, somnolence, bronschospasm:
receptors, relaxing palpitations,tachycardia, Cr tocolysis:
airway smooth muscle. dizziness, nausea, maternal HR,
hypotension,anaphylaxis glucose, K; fetal
. HR; neonatal
glucose
Analgesia

Demerol/meperidine supresses pain impulse, Labor Common Threats: Monitor RR,

hydrochloride depresses entire CNS Subcut/IM respiratory depression, Assess pain, I&O,
50-100mg drowsiness, dizziness, renal fx.
q1-3hr prn confusion, HA, sedation, Constipation, CNS
euphorium changes

Life Threatening:
Resp. Depression
Anaphylaxis
Seizures
Inc cranial pressure
morphine sulfate Depresses pain impulse Adult 10-30mg q3- Sedation, seizures, Gradually taper to
transmission at the 4hr as needed shock, cardiac arrest, prevent withdrawal
spinal cord level by tachycardia, respiratory symptoms; Assess
interacting with opioid depression respiratory
receptors dysfunction:
depression,
character, rate,
rhythm.
Stadol/butorphanol Depresses pain impulse IM: 1-4 mg q 3-4 hr Drowsiness, dizziness, Assess for
tartrate transmission at the prn; IV 0.5-2 mg q 3- confusion, headache, decreasing output;
spinal cord level by 4 hr prn. Intranasal: sedation, euphoria, may indicate
interacting with opioid 1spray in 1 nostril, weakness, urinary retention,
receptors may give another hallucinations, for withdrawal
dose 1-1.5 hr later. insomnia.hypotension, symptoms in
Repeat if needed 3- nausea, vomiting, opioid-dependent
4 hr after last dose anorexia, constipation, patients; PE,
cramps. Life threatening: vascular
bradycardia, respiratory occlusion,
depression. abscesses,
ulcerations, CNS
changes, allergic
reactions,
respiratory
dysfunction, need
for pain meds.,
safety measures.
Evaluate decrease
in pain. Teach
patient: report any
symptoms of CNS
changes, allergic
reactions, that
physical
dependency may
result when used
for extended
periods, that
withdrawal
 symptoms may
occur, how to use
nasal product,
avoid hazardous
activities
Anesthesia

Marcaine/bupivacaine Inhibits initiation and Epidural: Only 0.5% Adverse: apnea, Assess for
conduction of sensory and 0.25% arrhythmia exacerbation, systemic toxicity:
nerve impulses by concentrations AV block, bradycardia, circumoral tingling
altering the influx of should be used; cardiac arrest, fetal and numbness,
sodium and efflux of 0.5% solution should death, laryngeal edema, ringing in ears,
potassium in neurons, be administered in 3 malignant hyperthermia, metallic taste,
slowing or stopping to 5 mL increments muscle paralysis, dizziness, blurred
pain transmission. not exceeding 50 to respiratory arrest, vision, tremors,
100 mg at any seizures, ventricular slow speech,
dosing interval fibrillation, ventricular irritability,
tachycardia. twitching,
Spinal anesthesia seizures, cardiac
for Cesarean Side effects: anxiety, dysrhythmias;
Section: 7.5 to 10.5 back pain, blurred vision, report to physician
mg (1 to 1.4 mL) chills, decreased uterine or other health
contractility, dizziness, care professional.
drowsiness, dysgeusia, Monitor BP, HR,
erythema, fecal and respiratory
incontinence, fetal rate continuously
acidosis, fetal while patient is
bradycardia, fever, receiving this
headache, medication.
hyperhidrosis, Monitor for return
hypotension, of sensation after
hypoventilation, injection procedure.
site reaction, meningitis,
metallic taste, miosis,
nausea, palpitations,
paresthesias, pruritus,
restlessness, shivering,
sinus tachycardia,
sneezing, syncope,
tinnitus, tremor, urinary
incontinence, urinary
retention, urticaria,
vomiting, weakness.

Fentanyl/sublimaze Inhibits ascending pain Anesthetic, IV 50- Adverse: bradycardia, Adverse:

pathways in CNS, 100 mcg/kg over 1-2 cardiac arrest, bradycardia,
increases pain minutes. respiratory depression, cardiac arrest,
threshold, alters pain respiratory arrest, respiratory
perception by binding to Anesthesia laryngospasm depression,
opiate receptors supplement, IM/IV respiratory arrest,
2-20 mcg/kg, IV Side Effects: dizziness, laryngospasm
INFUSION 0.025- delirium, euphoria,
0.25 mg/kg/min. sedation, confusion, Side Effects:
weakness, dizziness, dizziness,
Moderate/severe hypo/hypertension, delirium, euphoria,
pain, IV/IM 50-100 blurred vision, miosis, sedation,
mcq q1-2hr. nausea, vomiting, confusion,
constipation, urinary weakness,
 retention, rash, dizziness,
Transdermal: 25 diaphoresis, muscle hypo/hypertension
mcg/hr rigidity. , blurred vision,
miosis, nausea,
Nasal spray: 100 vomiting,
mcg constipation,
urinary retention,
rash, diaphoresis,
Sublingual spray: muscle rigidity.
100 mcg
Lidocaine/xylocaine Increases electrical IV: BOL 50-100 mg Headache, dizziness, Assess for
stimulation threshold of (1-1.5 mg/kg) 25-50 drowsiness, oxygenation or
ventricle and His- mg/min, repeat q3-5 hypotension, perfusion deficit:
Purkinje system, which min, max 300mg in bradycardia, seizures, increased BP,
stabilizes cardiac 1 hour; heart block, chest pain,
membrane and cardiovascular collapse, dizziness, loss of
decreases (Decreases IM: 200-300mg arrest, respiratory arrest, consciousness
Ventricular (4.3mg/kg) in deltoid nausea, vomiting Assess respiratory
dysrhythmias) muscle, may repeat status: auscultate
in 1- 1.5 hour if lung fields for
needed bibasilar crackles
in patients with
advanced CHF
Assess for urinary
retention
Monitor I&O,
electrolytes; watch
for decreased
urinary output
Monitor liver
function tests
Ephedrine Ephedrine works by Oral: Common side effects Ascultate lungs;
turning on and Initial dose: 25 to 50 include trouble sleeping, monitor pulse, BP
adrenergic receptors. mg orally every 3 to anxiety, headache, respiration, and
4 hours. hallucinations, high obtain sputum
Ephedrine provides relief Maximum dose: blood pressure, fast (color/character);
of SOB & Bronchial 150 mg per day in heart rate, loss of monitor pulmonary
asthma via divided doses. appetite, and inability to function. Monitor
decongestant & urinate. for dry mouth.
bronchodilator actions. Parenteral:
Initial dose: 25 to 50 Serious side effects
mg IM, or include stroke, heart Do not use
Ephedrine reduces
subcutaneously attack, and abuse. While ephedrine if:
swelling & constricts
every 3 to 4 hours. likely safe in pregnancy allergic to this
blood vessels in the
or its use in this population medication.
nasal passages. Thus
widening the lung 5 to 25 mg slow IV is poorly studied. Use
airways, allowing you to push (over at least during breastfeeding is do not have a
breathe more easily. 15 minutes). May not recommended. diagnosis of
repeat in 5 to 10 asthma
minutes, if
necessary. you have a
Maximum dose: diagnosis of
150 mg per day in asthma but use
divided doses prescription
asthma
medications
 if you have ever
been hospitalized
for asthma

you are taking a

monoamine
oxidase (MAO)
inhibitor (eg,
phenelzine) now
or have taken an
MAO inhibitor in
the last 14 days.

you have high

blood pressure,
heart disease, an
irregular
heartbeat, thyroid
disease, diabetes,
or difficulty in
urination due to
enlargement of the
prostate gland or
other severe heart
problems

Dura-morph/epidural Depresses pain impulse Injection: 5 mg Adverse: seizures, Assess pain:

morphine sulfate transmission at the initially, max of bradycardia, cardiac location, type,
spinal cord level by 10mg/24hr shock, cardiac arrest, character, give
interacting with opioid tachycardia, dose before pain
receptors Continuous epidural thrombocytopenia, becomes severe.
infusion: 24mg/24hr respiratory depression, Assess bowel
respiratory arrest, status:
apnea. constipation
common, use
Side effects: drowsiness, stimulant laxative
dizziness, confusion, if needed. Assess
headache, sedation, I&O ratio; check
euphoria, insomnia, for decreasing
palpitations, change in output; may
BP, chest pain, indicate urinary
hypo/hypertension, retention; monitor
edema, blurred vision, serum sodium.
miosis, diplopia, Assess B/P, pulse,
gynecomastia, nausea, respirations
vomiting, anorexia, (character, depth,
constipation, cramps, rate), Assess CNS
biliary tract pressure, changes:
urinary retention, dizziness,
impotence, gonadal drowsiness,
suppression, hallucinations,
rash,urticaria, bruising, euphroia, LOC,
flushing, diaphoresis, pupil reaction.
pruritus. Abrupt
discontinuation:
gradually taper to
prevent withdrawal
symptoms;
 decrease by 50%
q1-2days; avoid
use of narcotic
antagonists.
Assess for allergic
reactions: rash,
urticaria.
Accidental
exposure: if
Duramorph gets
on skin, remove
contaminated
clothing, rinse
affected area with
water. Assess for
respiratory
dysfunction:
depressioin,
character, rate,
rhythm; notify
prescriber if
respirations are
<12/min;
accidental
overdose has
occurred with
high-potency oral
sols. Gradual
withdrawal after
long-term use.
Preeclampsia

magnesium sulfate depresses the CNS and Mild: 1-2g IV Drowsiness, impaired Monitor Mg, urine
blocks peripheral cardiac function, output if renal
neuromuscular Moderate: 2-4g IV flushing, pulmonary impairment,
transmission edema, diaphoresis patellar reflexes,
Severe:4-8g IV serum
creatinie/BUN
calcium gluconate Acute hypocalcemia IV (Calcium Frequent: PO: Chalky Assess B/ P, EKG
(e.g., neonatal Gluconate): taste. Parenteral: Pain, and cardiac
hypocalcemic tetany, ADULTS, rash, redness, burning at rhythm, renal
alkalosis), electrolyte ELDERLY: 1 2 g injection site; flushing, function, serum
depletion, cardiac arrest over 2 hrs. May nausea, vomiting, magnesium,
(strengthens myocardial repeat q60 min until diaphoresis, phosphate,
contractions), level resolved. hypotension. potassium.
hyperkalemia (reverses CHILDREN: 200 Occasional: Monitor serum
cardiac depression), 500 mg/ kg/ day in 4 PO: Mild constipation, BMP, calcium,
hypermagnesemia (aids divided doses. fecal impaction, ionized calcium,
in reversing CNS NEONATES: 200 peripheral edema, magnesium,
depression). 800 mg/ kg/ day in 4 metabolic alkalosis. phosphate; B/ P,
divided doses. cardiac rhythm,
renal function.
Monitor for signs
of hypercalcemia.
Normodyne/labetalol Produces decreases in Hypertension: PO Dizziness, fatigue, Assess:
hydrochloride B/P without reflex 100 mg BID; max orthostatic hypotension, Hypertension: B/P
tachycardia or significant 2400mg/day bradycardia, tinnitus, during beginning
reduction in heart rate nausea, vomiting, treatment,
through mixture of alpha Hypertensive crisis: diarrhea periodically
blocking and beta IV intermittent 20mg Life threatening: thereafter; note
blocking effects; over 2 min; may CHF, ventricular pulse, rate,
elevated plasma renins repeat 20-80mg dysrhythmias, rhythm, quality;
are reduced over 2 min q 10 min, hepatotoxicity, apical/radial pulse
200mg agranulocytosis, before
thrombocytopenia, administration;
purpura, and notify prescriber of
bronchospasm any significant
changes
CHF: I&O, daily
weight, fluid
overload: weight
gain, jugular
venous distention,
edema, crackles in
lungs
*Abrupt
discontinuation:
product should be
tapered to prevent
adverse reactions
Baseline/ hepatic
studies before
therapy begins
Lasix/furosemide Inhibits loop of Henle PO: 4-120mg/day *Black Box Warning* Monitor BUN/cr,
and proximal and distal fluid and electrolyte serum CO2,
convoluted tubule depletion. Urinary electrolytes, blood
sodium and chloride frequency, dizziness, glucose,
resorption IM/IV: start 20-40 weakness, muscle audiometry
mg IM/IVx1 cramps, blurred vision,
tinnitus, hypokalemia
Apresoline/hydralazi Vasodilates arteriolar Hypertension-Adult Headache, tremors, Assess: cardiac
ne hydrochloride smooth muscle by direct PO 10mg qid 2-4 dizziness, anxiety, status,
relaxation; reduction in days, then 25mg for palpitations, reflex electrolytes, blood
BP with reflex increases rest of 1st wk, then tachycardia, angina, studies, weight
in HR, SV, CO 50mg qid shock, N/V, anorexia, daily, I&O, edema,
individualized to diarrhea, hepatotoxicity, crackles, dyspnea,
desired response, leukopenia, orthopnea, IV site
max 300mg/day agranulocytosis, for extravasation,
Hypertensive crisis- thrombocytopenia, rate, mental status
adult IV BOL 10- lupuslike symptoms
20mg q4-6hr, IM 10-
50mg q4-6hr
CHF-adult PO 10-
25mg tid, max
100mg tid
Preterm labor

Brethine/terbutaline Relaxes bronchial Child 6-11 yr: PO Tremors, anxiety, Assess:

smooth muscle by direct 0.05 mg/kg q8hr, insomnia, headache, respiratory
action on B2- may increase slowly. dizziness, stimulation, function, tolerance
adrenergenicreceptors, Adolescent: 12-5 tachycardia, in patients
bronchodilation, diuresis, yrs: 2.5 mg tid, max hypertension, receiving long-
 CNS, cardiac stimulation 75 mg/day. Adult: dysrhythmias, nausea, term therapy,
occur; relaxes uterine PO 2.5-5 mg q8hr: vomiting, hypokalemia, paradoxical
smooth muscle subcu 0.25 mg q 15- hyperglycemia, bronchospasms.
30 min, max 0.5 mg paradoxical Evaluate: absence
in 4 hr. bronchospasm, of dyspnea,
dyspnea. Life wheezing. Teach:
threatening: cardiac not to use OTC
arrest, QT prolongation meds, about all
aspects of
product(avoid
smoking, smoke-
filled rooms),
increase fluids,
take on time.
Celestone/betamethas Decreases inflammation Adult: PO 0.6-7.2 Depression, flushing, Monitor:
one sodium by suppression of mg daily; IM/IV 0.6- sweating, hypertension, potassium, B/P,
migration of 7.2 mg daily in joint diarrhea, nausea, I&O ratio, edema
phosphate polymorphonuclear or soft tissue abdominal distention, Assess for:
leukocytes, fibroblasts, (sodium phosphate) acne, poor wound adrenal
reversal of increased Child: PO 17.5-250 healing, bruising, insufficiency crisis,
capillary permeability mcg/kg/day in 3 Adverse effects: symptoms of
and lysosomal divided doses; IM circulatory collapse, GI infection,
stabilization 17.5-250 hemorrhage, symptoms of
mcg/kg/day in 3 thrombocytopenia, CHF, potassium
divided doses every thromboembolism, depletion,
3rd day or 5.8-8.75 pancreatitis systemic
mcg/kg/day as a absorption, and
single dose (adrenal mental status
insufficiency) Check: temp,
plasma cortisol
levels
Antibiotics

ampicillin works by killing sensitive 250 milligram (mg) Eosinophilia Assess patient for
bacteria by interfering and 500 mg tablets, Skin rash previous
with formation of the syrup of 125 mg/5ml Nausea sensitivity
bacteria's cell wall or 250 mg/5ml Vomiting reactions to
Diarrhea penicillin. Assess
for signs and
symptoms of
infection. Assess
for allergic
reactions: rash,
urticaria, pruritis,
chills, and fever.
Cleocin/clindamycin Binds to 50S subunit of PO 150-450 mg Nausea, vomiting, Assess patients
bacterial ribosomes; q6hr, max 1.8 g/day abdominal pain, with compromised
supresses protein IM/IV 1.2-2.7 g/day diarrhea, renal system;
synthesis (Absence of in 2-4 divided doses pseudomembranous product is
infection) q6-12-hr, max colitis, vaginitis, excreted slowly in
2700mg/day Stevens-Johnson poor renal system
syndrome, exfoliative function; toxicity
dermatitis may occur rapidly
Assess patients
for signs and
symptoms of
infection including

Ancef/cephalzolin Bactericidal; inhibits cell
wall
**discontinued in the mucopeptidesynthesis
US, alternative is
cefazolin**
Pre-op meds
Reglan/metocloprami increases muscle
de contractions in the upper
digestive tract
Zantac/ranitidine Inhibits histamine at H2
receptor site in parietal
cells; which inhibits
gastric acid secretion
characteristics of
wound
Assess for allergic
reactions; rash,
urticaria, chills,
pruritus
Identify urine
output; if
decreasing, notify
prescribers, look
for increased BUN
and creatinine
Monitor blood
studies
Monitor
electrolytes:
potassium,
sodium, chloride
monthly if patient
on long term
therapy
Assess bowel
pattern daily; if
severe diarrhea
occurs, product
should
discontinued
Adult: mild infection Diarrhea, rash, vomiting, Assess sensitivity
250-500 mg IM/IV nausea, abdominal pain, to penicillin and
q8h anorexia, alt, ast other
Peds: neonates elvated, urticaria, cephalosporins,
40mg/kg/day im/iv thrombophlebitis monitor for
q12h max 6g/day nephrotoxicity:
Infants: 25-100 increased BUN,
mg/kg/day im/iv q6- creatinine; urine
8h output; if
decreasing, notify
prescriber. I&O
daily, monitor
electrolytes.
Monitor for
anaphylaxis.
Monitor for
bleeding of gums,
stool guaiac
10 mg to 15 mg Drowsiness, dizziness, Assess GI
orally up to q.i.d. 30 tiredness, trouble complaints.
minutes before each sleeping, agitation, Assess mental
meal and at bedtime headache, and diarrhea status:
depression,
anxiety, irritability
during treatment.
Adult PO 150mg bid Hepatotoxicity, acute Assess:GI
or 300 mg/day after interstitial nephritis(rare), complaints, I&O
PM meal or at pneumonia, anaphylaxis ratio, BUN,
bedtime; (rare) creatinine,LFT's
 maintenance 150 serum, stool
mg at bedtime guaiac before
Bicitra/sodium citrate temporary neutralizing 120 ml/day PO Abd. pain, diarrhea, Monitor serum
buffer- acts by hypernatremia,hypertens creatinine/BUN &
generating sodium ion, nausea, tremor, serum electrolytes
bicarbonate, tetany, vomiting
thus raising the blood
and urine pH

Bleeding

Methergine/methyler Acts directly on the Adult IM- 1 mL, 0.2 Abdominal pain, Monitor fundal
gonovine maleate smooth muscle of the mg dizziness, hypertension, height and
uterus and increases the hypotension, N/V, consistency and
tone, rate, and amplitude IV-1 mL, 0.2 mg, anaphylaxis, the amount and
of rhythmic contractions. administered slowly vasoconstriction, character of the
Thus, it induces a rapid over a period of no vasospasm, coronary lochia.
and sustained tetanic less than 60 arterial spasm,
uterotonic effect which seconds bradycardia, Assess the blood
shortens the third stage tachycardia, dyspnea, pressure before
of labor and reduces PO-0.2 mg, 3 or 4 hematuria,thrombophlebi and routinely
blood loss. times daily in the tis, water intoxication, throughout drug
puerperium for a hallucinations, leg administration.
maximum of 1 week. cramps,
dizziness,tinnitus, nasal Observe for
congestion, diarrhea, adverse effects or
diaphoresis, palpitation, symptoms of ergot
rash, and foul taste toxicity(ergotism)
such as nausea
and
vomiting,headach
e,muscle pain,cold
or numb fingers
and toes,chest
pain and general
weakness
Hemabate/prostaglan Synthetic analog of Adult: IM Initial: 250 Fever, flushing, chills, Monitor uterine
din F naturally occurring mcg (1 mL) cough, headache, pain contractions and
prostaglandin F2 alpha repeated at 1 3 (muscles, joints, lower observe and
with longer duration of -h intervals if abdomen, eyes), report excessive
biologic activity. indicated by uterine hiccups, breast vaginal bleeding
Stimulates myometrial response. Dosage tenderness, Nausea, and cramping
contractions of gravid may be increased to diarrhea, vomiting pain. Save all clots
uterus; contractions are 500 mcg (2 mL) if and tissue for
qualitatively similar to uterine contractility physician
those occurring at term is inadequate after inspection and
labor. several doses of 250 laboratory
mcg (1 mL), not to analysis.
Effectively stimulates exceed total dose of
uterine contraction and 12 mg or continuous Check vital signs
is used to induce administration for at regular
abortion over a wide more than 2 d. intervals.
range of gestational age. Carboprost-
Useful in treatment of induced febrile
postpartum hemorrhage reaction occurs in
due to uterine atony more than 10% of
patients and must
 unresponsive to usual be differentiated
measures. from endometritis,
which occurs
around third day
after abortion.

Newborn meds

Narcan/naloxone Opioid antagonist; Intranasal: 1 spray Serious: VFib, Cardiac Caution in patients
hydrochloride reverses the effects of (4mg) into each Arrest, Seizure with renal
opioids by competing for nostril. Common: Tachycardia impairment,
the same receptor sites, ETT: 0.8-5mg ETT HTN,Hypotension, N/V, hepatic
including respiratory q2-3 min tremor, withdrawl impairment, cardio
depression, sedation, SC/IM/IV: 0.4-2mg q sx,diaphoresis,pulmonar disorders, opiod
and hypotension. It can 2-3 min prn y edema. addiction.
also reverse the Alternate: 0.005 Monitor respiratory
psychotomimetic and mg/kg IV x 1, then status and neuro
dysphoric effects of 0.0025-0.16 mg/kg. checks
agonist-antagonists (eg, May repeat if
pentazocine). symptoms recur
Ilotycin/erythromycin Macrolide antibiotic Moderate to Severe GI: Nausea, vomiting, Report onset of GI
ophthalmic ointment produced by a strain of Infections abdominal cramping, symptoms after
Streptomyces erythreus. Adult: PO 250500 diarrhea, heartburn, PO administration
0.5% Bacteriostatic or mg q6h; 333 mg q8h anorexia. Body as a to physician.
bactericidal, depending Child: PO 3050 Whole: Fever, These are dose
on nature of organism mg/kg/d divided q6h eosinophilia, urticaria, related; if
and drug concentration Topical Apply skin eruptions, fixed symptoms persist
used. ointment to infected drug eruption, after dosage
eye 1 or more anaphylaxis. reduction,
times/d Superinfections by physician may
Neonate: PO 7 d, nonsusceptible bacteria, prescribe drug to
10 mg/kg q12h; >7 yeasts, or fungi. Special be given with
d, 10 mg/kg q812h Senses: Ototoxicity: meals in spite of
Topical 0.51 cm in reversible bilateral impaired
conjunctival sac hearing loss, tinnitus, absorption.
once vertigo.Digestive: Monitor for
(Estolate) Cholestatic adverse GI
Chlamydia hepatitis syndrome. effects.
trachomatis Skin: (topical use) Pseudomembrano
Infections Erythema, us enterocolitis
Adult: PO 500 mg desquamation, burning, (see Appendix F),
q.i.d. or 666 mg q8h tenderness, dryness or a potentially life-
Child: Topical Apply oiliness, pruritus threatening
0.51 cm ribbon in condition, may
lower conjunctival occur during or
sacs shortly after after antibiotic
birth therapy.
Observe for S&S
of superinfection
by overgrowth of
nonsusceptible
bacteria or fungi.
Emergence of
resistant
staphylococcal
strains is highly
predictable during
prolonged therapy.
 Lab tests: Periodic
liver function tests
during prolonged
therapy.
Monitor for S&S of
hepatotoxicity.
Premonitory S&S
include:
Abdominal pain,
nausea, vomiting,
fever,
leukocytosis, and
eosinophilia;
jaundice may or
may not be
present.
Symptoms may
appear a few days
after initiation of
drug but usually
occur after 12 wk
of continuous
therapy.
Symptoms are
reversible with
prompt
discontinuation of
erythromycin.
Monitor for
ototoxicity that
appears to
develop most
frequently in
patients receiving
4 g/d or more,
older adults,
female patients,
and patients with
kidney or liver
dysfunction. It is
reversible with
prompt
discontinuation of
drug.

Aqua Fat-soluble Anticoagulant Body as a Whole: Monitor patient

mephyton/vitamin K naphthoquinone Overdose Hypersensitivity or constantly. Severe
derivative chemically Adult: PO/SC/IM anaphylaxis-like reactions,
identical to and with 2.510 mg; rarely up reaction: facial flushing, including fatalities,
similar activity as to 50 mg/d, may cramp-like pains, have occurred
naturally occurring repeat parenteral convulsive movements, during and
vitamin K. Vitamin K is dose after 68 h if chills, fever, diaphoresis, immediately after
essential for hepatic needed or PO dose weakness, dizziness, IV injection (see
biosynthesis of blood after 1224 h IV shock, cardiac arrest. ADVERSE
clotting Factors II, VII, Emergency only: CNS: Headache (after EFFECTS).
IX, and X. 1015 mg at a rate oral dose), brain Lab tests:
of 1 mg/min, may damage, death. GI: Baseline and
be repeated in 4 h if Gastric upset. frequent PT/INR.
Hematologic: Paradoxic
 bleeding continues hypoprothrombinemia Frequency, dose,
(patients with severe and therapy
Hemorrhagic liver disease), severe duration are
Disease of hemolytic anemia. guided by PT/INR
Newborns Metabolic: clinical response.
Infant: IM/SC 0.51 Hyperbilirubinemia, Monitor therpeutic
mg immediately kernicterus. effectiveness
after delivery, may Respiratory: which is indicated
repeat in 68 h if Bronchospasm, by shortened PT,
necessary dyspnea, sensation of INR, bleeding, and
chest constriction, clotting times, as
Other Prothrombin respiratory arrest. Skin: well as decreased
Deficiencies Pain at injection site, hemorrhagic
Adult: IM/SC 225 hematoma, and nodule tendencies.
mg formation, erythematous Be aware that
Child: IM/SC 510 skin eruptions (with patients on large
mg repeated doses may
Infant: IM/SC 1 mg injections).Special develop temporary
Senses: Peculiar taste resistance to
sensation coumarin-type
anticoagulants. If
oral anticoagulant
is reinstituted,
larger than former
doses may be
needed. Some
patients may
require change to
heparin.

Recombivax HB, Suspension of Hepatitis B Body as a Whole: Mild Note: The ACIP
Energix- inactivated and purified Prophylaxis local tenderness at recommends
hepatitis B surface Adult: IM injection site, local serologic
B/recombinant antigen (HBsAg) derived Recombivax 1 mL inflammatory reaction confirmation of
hepatitis B vaccine from human plasma of (10 mcg) at 0, 1, and (swelling, heat, redness, postvaccination
screened asymptomatic 6 mo; Engerix-B 1 induration, pain); fever, immunity in
HBsAg-positive carriers mL (20 mcg) at 0, 1, malaise, patients
of hepatitis B virus. and 6 mo or 0, 1, 2, fatigue,headache, undergoing
Hepatitis B vaccine and 12 mo dizziness, faintness, leg dialysis and in
recombinant is the first Child: IM cramps, myalgia, immunodeficient
vaccine produced by Recombivax 0.5 mL arthralgia. GI: Nausea, patients.
gene splicing. No human (5 mcg) at 0, 1, and vomiting, diarrhea. Skin: Monitor
plasma is used in its 6 mo; Engerix-B 0.5 Rash, urticaria, pruritus. temperature.
production. mL (10 mcg) at 0, 1, Some patients
and 6 mo or 0, 1, 2, develop a
and 12 mo temperature
elevation of 38.3
Dialysis and C (101 F)
Immunodeficient following
Patients vaccination that
Adult: IM may last 1 or 2 d.
Recombivax 2 mL
(20 mcg) at 0, 1, and
6 mo Engerix-B 2
mL (40 mcg) at 0, 1,
and 6 mo or 0, 1, 2,
and 12 mo
HBIG/hepatitis B Provides passive IM 0.5 mL within 12 Headaches, dizziness, Assess for skin
Immune Globulin immunity to hepatitis hrs of birth. nausea, vomiting, reactions.
immunity. soreness at injection Assess for
site. sneezing,
dysphagia,
vomiting,
angiodema.
Assess for
anaphylaxis.

Bacitracin Interferes with bacterial Apply enough Rash,urticaria, scaling, Assess for allergic
ointment/triple protein synthesis. medication to cover redness. reaction: burning,
lesions completely stinging, swelling,
antibiotic ointment after cleansing with redness.
soap and water. Assess for signs
of nephroxicity or
ototoxicity.
Postpartum meds

Colace/docusate Increases water, fat Adult: PO 50-300 Bitter taste, throat Assess for
sodium penetration in intestine; mg/day. irritation, nausea, cramping, rectal
allows for easier anorexia, cramps, bleeding, nausea,
passage of stool. diarrhea, rash. vomiting. If
symptoms occur
then discontiune.
Identify cause of
constipation;
identify fluids,
bulk, or exercise is
missing from
lifestyle.
Meruvax II, Prevention of measles, Subcut 1 vial; 2 vials Redness or pain at Contraindications:
MMR/rubella mumps, and rubella seperated by 1 mo, injection site; hypersensitivity,
in person born after noncontagious rash; blood dyscrasias,
virus vaccine, live 1957 joint pain anemia, active
Child>15 mo and infection,immunos
adult: Subcut. 0.5ml Life threatening: uppression;
Allergic reaction febrile egg/chicken
seizures, allergy;
encephalopathy, mild pregnancy, febrile
meningitis illness, neomycin
allergy, neoplasms

Motrin/ibuprofen Inhibits prostaglandin Fever Nausea, vomiting, Assess onset,

synthesis PO:ADULTS 200 dyspepsia, dizziness, type, location,
400 mg q4 6h prn. rash. Diarrhea or duration of pain,
Maximum: 1,200 constipation, flatulence, inflammation.
mg/ day. CHILDREN abdominal cramps or Inspect
6 MOS 11 YRS: 5 pain, pruritus, increased appearance of
10 mg/ kg/ dose q6 B/P. affected joints for
8h prn. Maximum: immobility,
40 mg/ kg/ day. IV: deformities, skin
ELDERLY: 400 condition. Assess
mg q4 6h or 100 temperature.
200 mg q4h prn.
Maximum: 3.2 g/ Monitor for
day. evidence of
Pain
 PO:ADULTS, nausea,
ELDERLY, dyspepsia.
CHILDREN 12 YRS Monitor CBC,
AND OLDER: renal function,
200 400 mg q4 6h LFT. Assess skin
prn. for rash. Observe
for bleeding,
bruising, occult
blood loss.
Evaluate for
therapeutic
response: relief of
pain, stiffness,
swelling;
increased joint
mobility; reduced
joint tenderness;
improved grip
strength. Monitor
for fever.

Percocet/oxycodone Moderate to severe pain. 2.5-10 mg Respiratory depression Monitor Cr levels,

Opioid analgesic; PO q6h or arrest, seizures, periodic LFT if
semisynthetic pure hepatotoxicity, patient using long
opioid agonist whose lightheadedness, term. Monitor
principal therapeutic N/V,rash, dysphoria patient mental
action is analgesia. status and
Effects are mediated by respiratory rate
receptors (eg, and and effort, ensure
kappa) in the CNS for adequate
endogenous opioid-like oxygenation.
compounds (eg,
endorphins,
enkephalins).
Lortab/hydrocodone Moderate to severe pain 2.5-10mg Respiratory depression Monitor Cr levels,
uses. PO q6h prn or arrest, seizures, periodic LFT if
Opioid analgesic and hepatotoxicity, patient using long
antitussive; has not been lightheadedness, term. Monitor
established. Action N/V,rash, dysphoria patient mental
believed to be related to status and
the existence of opiate respiratory rate
receptors in the CNS. and effort, ensure
adequate
oxygenation.
Tylenol/acetaminoph Inhibits synthesis of PO: 325650 mg q 6 anxiety, headache, Pain: Assess
en prostaglandins that may hr or 1 g 34 times fatigue, insomnia, type, location, and
serve as mediators of daily or 1300 mg q 8 atelectasis, intensity prior to
pain and fever, primarily hr dyspnea, and 3060 min
in the CNS. IV: 15 mg/kg q 6 hr hypertension, following
or 12.5 mg/kg q 4 hr hypotension administration.
Mild to moderate pain, RECT: 325650 mg HEPATOTOXICITY ( Fever: Assess
moderate to severe pain q 46 hr as needed DOSES), nausea, fever; note
with opioid analgesics, or 1 g 34 times/day vomiting, hypokalemia, presence of
fever. renal failure, associated signs
neutropenia, (diaphoresis,
pancytopenia, muscle tachycardia, and
spasms, trismus malaise).
Derm: ACUTE Assess overall
GENERALIZED health status and
 EXANTHEMATOS alcohol usage
PUSTULOSIS, before
STEVENS- administering
JOHNSON acetaminophen.
SYNDROME, Assess for rash
TOXIC periodically during
EPIDERMAL therapy
NECROLYSIS, Assess amount,
rash, urticaria frequency, and
type of drugs
taken in patients
self-medicating,
especially with
OTC drugs.

Iron sulfate Ferrous sulfate: Iron Deficiency GI: Nausea, heartburn, Lab tests: Monitor
Standard iron Adult: PO Sulfate anorexia, constipation, Hgb and
preparation against (30% elemental diarrhea, epigastric pain, reticulocyte values
which other oral iron iron) 7501500 abdominal distress, during therapy.
preparations are usually mg/d in 13 divided black stools. Special Investigate the
measured. Corrects doses; Fumarate Senses: Yellow-brown absence of
erythropoietic (33% elemental discoloration of eyes and satisfactory
abnormalities induced by iron) 200 mg t.i.d. or teeth (liquid forms.) response after 3
iron deficiency but does q.i.d.; Gluconate Large Chronic Doses wk of drug
not stimulate (12% elemental in Infants Rickets (due treatment.
erythropoiesis. May iron) 325600 mg to interference with Continue iron
reverse gastric, q.i.d., may be phosphorus absorption). therapy for 23
esophageal, and other gradually increased Massive Overdosage mo after the
tissue changes caused to 650 mg q.i.d. as Lethargy, drowsiness, hemoglobin level
by lack of iron. Ferrous needed and nausea, vomiting, has returned to
gluconate:Claimed to tolerated abdominal pain, normal (roughly
cause less gastric Child: PO Sulfate diarrhea, local corrosion twice the period
irritation and be better (30% elemental of stomach and small required to
tolerated than ferrous iron) <6 y, 75225 intestines, pallor or normalize
sulfate. mg/d in divided cyanosis, metabolic hemoglobin
doses; 612 y, 600 acidosis, shock, concentration).
mg/d in divided cardiovascular collapse, Monitor bowel
doses; Fumarate convulsions, liver movements as
(33% elemental necrosis, coma, renal constipation is a
iron) 3 mg/kg t.i.d.; failure, death. common adverse
Gluconate (12% effect.
elemental iron) <6
y, 100300 mg/d in
divided doses; 612
y, 100300 mg t.i.d.

Iron Supplement
Adult: PO Sulfate
Pregnancy, 300600
mg/d in divided
doses; Fumarate
200 mg once/d;
Gluconate 325600
mg once/d
Child: PO Fumarate
3 mg/kg once/d;
Gluconate <6 y,
100300 mg/d in
 divided doses; 612
y, 100300 mg
once/d
Infant: PO
Fumarate Low birth
weight, 2 mg/kg/d up
to 15 mg/d; 3 y, 1
mg/kg/d (max: 15
mg/d)
Dermaplast Inhibits conduction of Can be used Rash, irritation, Assess:
nerve impulses from topically and sensitization Pain: location,
sensory nerves rectally; TOP- apply duration,
four times a day characteristics
RECT- insert three before and after
times a day and administration
after each BM For infection:
redness, drainage,
inflammation; this
product should not
be used until
infection is treated
Tucks Relieves using witch- Pre-medicated Rash, hives, itching, Do not place
hazel to relieve topical pads difficulty breathing, directly in rectum.
discomfort following tightness in the chest, Stop use/contact
childbirth, rectal/vaginal swelling of the mouth, provider if rectal
surgery, and decreases face, lips, or tongue. bleeding occurs or
pain from hemorrhoids Bleeding from rectum; condition does not
increase irritation, pain, approve in 7 days.
redness, swelling, or
other symptoms.
Lansinoh/lanolin Prevent rough, dry, scaly Medicated cream Rash, itching, hives, Hypoallergenic
cream skin. Relief of nipple OTC burning, stinging and safe for both
pain during redness mother and baby.
breastfeeding Additive, pesticide,
and preservative
free.
Other

Versed/midazolam Depresses subcortical Preoperative Nausea, vomitting, Asses:

levels in CNS; may act sedation for adult Life threatening: cardiac B/P, pulse,
on limbic system, and child >12: IM arrest, apnea, respirations during
reticular formation; may 0.07-0.08 mg/kg bronchospasm, IV; emergency
potentiate GABA by hour to 1 hour laryngospasm, equipment should
binding to specific before general respiratory depression be nearby
benzodiazepine anesthesia Inj site for
receptors Induction of general redness, pain, and
anesthesia for adult swelling
<55 years old: IV Anterograde
200-350 mcg/kg amnesia
over 20-30 seconds Vital signs for
recovery period in
obese patients;
half-life may be
extended
Assistance with
ambulation until
drowsy period
ends
 - Respiratory
depression
insufficiency in
geriatric patients
RhoGAM Prevents production of Before delivery: Dizziness, headache, ITP
anti-Rh antibodies in Rh- Adults 1 vial hypertension, (Immunoglobulin
negative patients who standard does (300 hypotension, rash, thrombocytopeni
were exposed to Rh- mcg)at 26-28 wk. diarrhea/nausea/vomitin a): Monitor
positive blood. Increase Following delivery: g, acute renal failure, patient for signs
platelet counts in pts w Adults 1 vial anemia, arthralgia (joint and symptoms of
ITP. standard dose (300 pain), myalgia (muscle intravascular
mcg) within 72 hours pain), pain at injection hemolysis (IVH)
of delivery. site, fever. (back pain,
shaking chills,
fever,
hemoglobinuria),
anemia, and
renal
insufficiency. If
transfusions are
required, use
Rh(D)-negative
packed red blood
cells to prevent
exacerbation of
IVH.
IV: Assess vital
signs periodically
during therapy.
Lab Test
Considerations:
Pregnancy-Type
and crossmatch of
mother and
newborn's cord
blood must be