OB pharmacology

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Clomid (Clominhpene) action and use is:

promotion of follicle maturation and ovulation
stimulates LH resulting in maturation of more ovarin follicles than would normally occur

Clomid (Clominhpene) adverse reactions:

headache, hot flashes, breast discomfort, abnormal uterine bleeding, distention, bloating, discomfort, n/v, blurred vision, diplopia, appetite increased, constipation, diarrhea, vaginal dryness, rash, insomnia, light headness, weight gain or loss.

Clomid (Clominhpene) dosage and max dosage:

50 mg a day for 5 days
max dosage is 100 mg once daily for 5 days (6 cycles)

Clomid (Clominhpene) Administration route:

Oral

Clomid (Clominhpene) Patient Teaching:

basal body temp, timing intercourse

Pergonal (Menotropins) action and uses:

promotion of follicle maturation and ovulation.
used when infertility result of disruption at pituitary level

Menotropins (Pergonal) regular dosage and max dosage:

150 units daily for 5 days
adjustments no more than 75-150 once q 2 days
max dose is 450 units and dosage no longer than 12 days

Menotropins (Pergonal) adverse reactions:

headache, dizziness, nausea, ab pain, malaise, flushing, breast tenderness, hot flashes, menstrual irregularities, back pain, angioedema, rash

Menotropins (Pergonal) Administration:

IM or SubQ
alternating sites on the abdomen

Menotropins (Pergonal) Client Teaching:

self injections, basal body temp, needle disposal

What is apresoline (hydralazine) used for?

antihypertensive; used for severe preeclampsia

What are the adverse effects for apresoline (hydralazine)?

headache, reflex tachycardia, palpations, flushing, n/v/d, na+ and fluid retention, RARE: lupus like syndrome

What are the contraindications for apresoline (hydralazine)?

angina, rheumatic heart disease, MI, tachycardia, pts with lupus

What is done if the patient overdoses on apresoline (hydralazine)?

vasopressor and or IV infusion of fluids because hypotension

What is erthyromycin ointment used for?

prophylactic treatment of ophthalmia neonatorum caused by neisseria gonorrhea (required by law)

Where do you place erthyromycin ointment?

inner canthus of each eye; only one drop

What are the s/e to erthyromycin ointment?

sensitivity reaction, may interfere with ability to focus, may cause edema and inflammation ( usually disappears in 24-48hours)

The use of Vitamin K ( aqua mephyton)?

prophylaxis and treatment of vit k deficiency bleeding.

Where do you give the IM injection of Vitamin K in newborns?

vastus lateralis thigh muscle

What is the dose of Vitamin K?

0.5-1 mg

What are the neonatal side effects of Vit. K?

pain and edema at injection sight, allergic reaction such as rash or urticaria

What are the nursing considerations for Vit K?

give before circumcision, observe for signs of bleeding may be seen as generalized ecchymoses or bleeding from umbilical cord, circumcision site, nose, or gi tract, observe for jaundice and kernicterus

What is RHiG (rhogam) used for?

prevention of isoimmunization in RH neg women; Rh - mother and Rh + fetus

What is the dosage, route and frequency for rhogam?

-300mcg IM RH at 28 weeks
- given with in 72 hours after birth if mothers coombs test is neg. and infants test in coombs neg.

What are the side effects of Rhogam?

ards, anaaphylaxis, pulmonary edema, DIC

What are the teachings to Rhogam?

how the pproduct works, must be given after deliveries,
report immediately shaking, fever, chills, dark urine, sweeling of the hands or feet, back pain, SOB (intravascular hemolysis)

What is Betamethasone used for?

to develop the lungs of a fetus when a mother may deliver early; prevents neonate resp distress

How long should birth be delayed when mother is given Betamethasone?

at least 24 hours after the 1st round

What is the dosage of Betamethasone given to the mother?

IM injection of 12 mg once a day for 2 days deep in the gluteal muscle

What are the maternal s/e of Betamethasone?

hyperglycemia, increase risk of pulmonary edema

What are the fetal s/e of
Betamethasone?

lowered cortisol levels at birth, but rebounds by 2hrs of age, hypoglycemia, increase risk of neonatal sepsis

What is the use of heparin in
pregnancy?

given to prolong coagulation time in women who have coagulation problems. DIC
(HEPARIN DOES NOT CROSS THE PLACENTA)

What are the side effects of Heparin?

itching, burning, bleeding, ecchymoses ( bruising)

What are the adverse effects to Heparin?

excessive bruising, petechiae, prolonged bleeding, blood in urine or stool

What is the treatment of an overdose on Heparin?

protamine sulfate

What are the nursing implications for Heparin?

it is poorly absorbed in the GI must be given IM or SQ
monitor PTT goal is 1.5-2

What is the use for Labetalol? Dosage?

Chronic HTN

100-200 mg bid

What are the maternal s/e for Labetalol?

Dizziness, sleepiness, or weakness Lack of energy.
Nausea or vomiting. Skin flushing or tingling of the scalp. Stuffy nose Trouble breathing. Hives.
Swelling of your face, lips, tongue, or throat.

What are the fetal s/e to Labetalol?

May cause a decrease in FHR; need to monitor

What is the use of Pitocin/Oxytocin?

induction of labor ; missed or incomplete abortion; postpartum bleeding by increasing the force and frequency of uterine contractions

Pitocin/Oxytocin is contraindicated in:

Hypersensitivity, preeclampsia/eeclampsia, serum toxemia, cephalopelvic disproportion, fetal distress, hypertonic uterus, prolapsed umbilical cord, active genital herpes, hx of c-section, placenta previa, presents of nonreassuring fetal status

What is the dosage for Pitocin/Oxytocin when used for postpartum hemorrhage?

IV 10-40 units in 1000 ml nonhydrating diluent infused at 20-40 mU/min

IM 3-10 units after delivery of placenta

What is the dosage for Pitocin/Oxytocin when used for inducing labor?

IV 0.5-1 mU/min, increase by 1-2 mU q15-60min until contractions occur then decrease dose (q 2-3 minutes lasting 40-60 seconds)

What are the maternal adverse effects of oxytocin?

most common: rapid, painful utterine contractions and fetal tachycardia, n/v, headache, dyspnia

serious: uterine rupture (severe ab pain, sustained uterine contraction, diminish urine outputm change in LOC), seizures, coma

What are the maternal s/e of oxytocin?

abruptio placentae, impaired uterine blood flow---> fetal hypoxia, rapid labor leading to cervical lacerations perineum uterine atony and fetal trauma, water intoxication (n/v, hypotension, tachycardia, cardia arrhythmia)

What are the fetal adverse effects ofoxytocin?

dysrhythmias, hypoxia, jaundice, intracranial pressure

What are the fetal s/e of oxytocin?

irregular or decrease FHR, Hypoxia, Hyperbilirubinemia, trauma from rapid birth, hypoxia as an effect of maternal hypotension

If woman becomes hypotensive on Oxytocin what are the nursing actions?

Keep on her side, may change to other sides, dc oxytocin, increase rate of primary IV line, monitor FHR, notify physician, assess for cause of hypotension

A nurse needs to DC oxytocin infusion if:

-nonreassuring fetal status
-contractions are more frequent than q 2 minutes
-contraction duration exceeds 90 seconds
-uterus does not relax between contractions

The fetus is bradycardic lasting more than 30seconds; what would you do with the oxytocin?

dc oxytocin, administer oxygen by face mask at 7-10 L/min, position on the left side,

What is zofran used for?

Hyperemesis gravidarum
Prevention of nausea and vomiting;

What is the dosage, route, and frequency for Zofran?

4-8 mg bid-tid

What are the s/e to zofran?

headache, fatigue, dizziness, drowsiness, diarrhea, constipation, musculoskeletal pain, shivering, fever, hypoxia, urinary retention, Bronchospasms

What are the teachings for zofran?

-report diarrhea, constipation, rash, or changes in respirations
-headache requiring analgesic is common

Phenergan (Promethazine) is used for:

nausea and vomiting; analgesic potentiators (decrease anxiety and effectiveness of analgesics)

What is the dosage, frequency, and route for Phenergan?

PO/IM/IV/RECT: 12.5-25 mg; q4-6hr prn

What are the s/e to Pheregan?

dizziness, drowsiness, constipation, urinary retention

What are the adverse effects to Pheregan?

neuroleptic malignant syndrome, agranulocytosis, hemolytic anemia

What are the client's teachings for Pheregan?

photosensitivity, avoid driving if drowsiness occurs, avoid use of alcohol or CNS depress, may reduce sweating=heat stroke, use frequent sips of water, gum to decrease dry mouth

What is the use of magnesium sulfate?

preeclampsia and eclampsia (reduces the possibility of convulsions)

What is the route dosage and frequency in preeclampsia?magnesium sulfate

Loading dose: 4-6g over 20-30 minutes
Maintenance dose: 2-3g/hr by infusion pump

What is the route dosage and
frequency in eclampsia? magnesium sulfate

Bolus 4-6 g IV over 5 minutes

What are the maternal contraindication to magnesium sulfate?

myasthenia gravis, hx of myocardial heart block, extreme care in women with renal impairment--> can lead to mg toxicity

What are the effects of fetal/newborn (magnesium sulfate)?

decrease FHR, general no risk of fetus, newborn occasionally neurological depression or resp depression, lost of reflexes and muscle weakness

What is the therapeutic levels of
magnesium sulfate?

4-8 mg/dL

What are the sign and symptoms of magnesium toxicity?

no dtr or sudden change in the DTR
resp less than 12/min
urinary output is less than 30 ml/hr or 120 ml/4hr
drop in pulse or bp
signs of fetal distress
MgSO4 level of greater than 8mEq/L

What is given to reverse magnesium toxicity>

Calcium Gluconate (1g IV over a period of 30 minutes)

What is the first sign of magnesium toxicity?

diminished or absent reflexes

What are the maternal s/e of magnesium sulfate?

COMMON: lethargy and weakness, feeling of warmth, flushing, sweating, nasal congestion due to peripheral vasodilation, N/V, constipation, visual blurring, headache, slurred speech

What is the use of fentanyl?

short acting opiate that has been used during labor to relieve pain and induce sedation (does not cross the placenta)

What is the dosage, route, and frequency for fentanyl?

50-100 mcg q 2 hours IV/IM
(IV onset is 1-2 minutes, duration 30-60 minutes)
IM onset is 7-15 minutes

What are the common side effect of fentanyl?

bradycardia, hypotension, nausea and vomiting, resp depression, prutitis

(less s/e than Demerol)

What are the the life threatening side effect of fentanyl?

muscle rigidity especially respiratory muscles

DO NOT GIVE FENTANYL TO WOMEN WITH

opioid dependency

What are the uses for morphine? pg 795

Moderate to Serve Pain (epidural opioid analgesia after birth

What are the s/e to Morphine?

Drowsiness, dizziness, confusion, headache, sedation, euphoria, insomnia, seizures, Palpitations, bradycardia, change in B/P, shock, cardiac arrest, chest pain, hypo/hypertension, edema, tachycardia, Tinnitus, blurred vision, miosis, diplopia
Nausea, vomiting, anorexia, constipation, cramps, biliary tract pressure, Urinary retention, flushing, diaphoresis, pruritus, Respiratory depression, respiratory arrest, apnea

What are the signs of toxicity? What is used for overdose of Morphine?

cardiac arrest, resp depression, convulsions

Narcan

What is use of Reglan (Metachopramide)?

antiemetic, helps eliminate gastric contents for a c-section, GERD

What are the s/e of Reglan (Metachopramide)?

sedation, fatigue, restlessness, headache, sleeplessness, drowsiness, dystonia, dizziness

What are the adverse effects of Reglan (Metachopramide)?

suicide ideation, seizures, neutropenia, agranulocytosis, leukopnenia

What is the dosage, route, and frequency for Reglan (Metachopramide)?

PO 10-15 mg qid 30 min before meals and at bedtime for gastric reflex

What is the use of Brethine (Terbutaline)?

tocolytics: inhibit uterine contractions during premature labor

What is the route, dosage, and frequency for Brethine (Terbutaline)?

IV: 2.5-10 mcg 1 minute; increase q 10-20 minutes(duration 12 hours);
PO maintence dose 2.5-10 mg q 4-6 hours

What are the common side effects for Brethine (Terbutaline)?

nervousness, tremor, drowsiness

What are the common adverse effects for Brethine (Terbutaline)?

bronchoconstriction, dysrhythmias, altered maternal and fetal HR

Monitor women recieving Brethine for:

maternal heart rate, B/P, contraction, fetal heart rate; can inhibit uterine contractions, labor; monitor for hypoglycemia

What would you teach to women taking Brethine?

•Not to use OTC medications because extra stimulation may occur
•About all aspects of product; to avoid smoking, smoke-filled rooms, persons with respiratory infections
•To increase fluids by >2 L/day; to allow 15 min between inhalation of product and inhaled product containing steroid
•To take on time; if missed, not to make up after 1 hr, to wait until next dose

What are the uses of Penicillin V?

Respiratory infections, scarlet fever, erysipelas, otitis media, pneumonia, skin and soft-tissue infections, gonorrhea; effective for gram-positive cocci

What are the s/e for Penicillin V?

Lethargy, hallucinations, anxiety, depression, twitching, coma, seizures, hyperreflexia, Nausea, vomiting, diarrhea, increased AST, ALT, abdominal pain, glossitis, colitis, pseudomembranous colitis, Oliguria, proteinuria, hematuria, vaginitis, moniliasis, glomerulonephritis, renal tubular damage, Anemia, increased bleeding time, bone marrow depression, granulocytopenia, hemolytic anemia
Meta: Hypo/hyperkalemia, alkalosis, hypernatremia, Anaphylaxis, serum sickness, Stevens-Johnson syndrome

What is the dosage of Pencillin V?

Staph/Pneumococcal: 250-500 mg q6hrs
Strep: 125-250 mg q6-8hrs

What is the use of percocet?

moderate to serve pain

What is the dosage of percocet?

PO 10-30 mg q4hr

What are the maternal side effects to percocet?

Increased urinary output, dysuria, urinary retention, Rash, urticaria, bruising, flushing, diaphoresis, pruritus, Respiratory depression, Drowsiness, dizziness, confusion, headache, sedation, euphoria, fatigue, abnormal dreams/thoughts, hallucinations, Palpitations, bradycardia, change in B/P, Tinnitus, blurred vision, miosis, diplopia, Nausea, vomiting, anorexia, constipation, cramps, gastritis, dyspepsia, biliary spasms

Percocet crosses the placenta and if given in the 3rd trimester the baby can be born with narcotic withdrawls. What s/s will the infant have?

Irritability and excessive crying
Shakiness (tremors)
Hyperactive reflexes
Fast breathing
Increased stools
Sneezing
Yawning
Vomiting
Fever.

What are lortabs used for?

mild to moderate pain

What is the dosage for lortabs?

PO 2.5-10 mg q3-6hr prn, max 60 mg/day

When giving lortabs give with:

a meal to reduce gastric upset

What are the side effects to lortabs?

Drowsiness, dizziness, light-headedness, confusion, headache, sedation, euphoria, dysphoria, weakness, hallucinations, disorientation, mood changes, dependence, seizures, Palpitations, tachycardia, bradycardia, change in B/P, circulatory depression, syncope; Tinnitus, blurred vision, miosis, diplopia, Nausea, vomiting, anorexia, constipation, cramps, dry mouth, ulcers, Increased urinary output, dysuria, urinary retention, Respiratory depression; pulmonary edema, bronchopneumonia

What are the patient teaching to Lortabs?

To report any symptoms of CNS changes, allergic reactions
That physical dependency may result when used for extended periods
That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
To avoid driving, other hazardous activities because drowsiness occurs
To avoid other CNS depressants; they will enhance sedating properties of this product
To change positions slowly to reduce orthostatic hypotension

What is Methergine (methylergonovine) used for?

Treatment of hemorrhage postpartum or postabortion, uterine contractions

What is Methergine is contraindicated in?

Pregnancy, hypertension, PID, respiratory/cardiac disease, peripheral vascular disease, angina, arteriosclerosis, CAD, dysfunctional uterine bleeding, eclampsia, MI, neonates, Raynaud's disease, sepsis, stroke

What is the dose and route for Methergine?

PO 200 mcg tid-qid × ≤7 days; IM/IV 200 mcg q2-4hr × 1-5 doses

What are 2 administration guidelines for Methergine?

Only during 4th stage of labor; not to be used to augment labor
IM in deep muscle mass; rotate inj sites for additional doses

What are the s/e to Methergine?

Headache, dizziness, seizures, Hypotension, chest pain, palpitation, hypertension, dysrhythmias, CVA (IV), Tinnitus, Nausea, vomiting, Cramping, Sweating, rash, allergic reactions, Dyspnea

What would you teach a client about Methergine?

To report increased blood loss, severe abdominal cramps, fever or foul-smelling lochia
To avoid smoking
Not to breastfeed while taking this product

What is the use for Cytotec (mifeoristone) ?

-induce a medical abortion during first 7 weeks of pregnancy

If Cytotec (mifeoristone) is given within ___ days of intercourse pregnancy is 100%

3 days

What is the Cytotec (mifeoristone) dosage.

PO: Day 1 600 mcg and Day 3 400 mcg if abortion did not occur

What are the adverse effects to Cytotec (mifeoristone)?

COMMON: N/V and diarrhea
SERIOUS: ab pain, uterine hemorrhage
Primary: cramping

What are the client teaching to Cytotec (mifeoristone)?

report increase blood loss, increase temperature, foul smelling lochia, weakness, n/v, diarrhea may be sepsis
comfort measures, must continue with a follow up, cramping and bleeding will occur

What is Cytotec (Misoprostol) used for?

ripen the cervix and induce labor

What is the Cytotec (Misoprostol) dosage?

Initial 25 mcg; do not exceed intervals more than 3-6 hours

(PO, Sublingually, buccally, vaginal, rectal)

The is the major risk factor when using Cytotec (Misoprostol).

uterine rupture

Administration alerts for Cytotec (Misoprostol)

using only in 3rd trimester for cervical ripening or labor induction
Pitocin not to be given unless 4 hours after Cytotec Dose

What are the contraindications to Cytotec (Misoprostol)?

uterine contractions more than q 2 minutes or 75 seconds, maternal asthma, placenta previa, fetal tachycardia, nonreassuring FHR, meconium passage, previous c-section, uterine scars, bleeding during pregnancy

What is the use of Prepidil (dinoprostone)?

vaginal get to ripen the cerix and stimulate the smooth muscle of the uterus to enchance contractions

What is the route, dosage, and frequency of Prepidil (dinoprostone)?

0.5 mggel placed in posterior fornix of the vagina and client is kept in supine for 2 hours

Why is the woman assessed for 2 hours after prepidil is place?

complications such as hyperstimulation and nonreassuring fetal status typically occur in the first hour after the administration and peak in 4 hours.

What are the contraindications to Prepidil?

sensitivity to prostaglandins, nonreassuring fetal status, unexplained bleeding, strong suspicion of cephalopelvic disproportion, client already receiving Pitocin, (Previous c-sec, uterine scars, uterine rupture)

Use prepidil in caution with what patients?

rupture membranes, breech presentation, presence of glaucoma, hx of asthma

What are the maternal s/e to prepidil?

uterine hyperstimulation, gastrointestinal disturbances, fever, n/v, diarrhea, ab pain

What is the fetal s/e to prepidil?

nonreassuring FHR

What are the nursing considerations for prepidil?

monitor maternal v/s, cervical dilationn, and effacement
monitor fetal status for presence of reassuring pattern

If hyperstimulation, sustain conctractions, or nonreassuring fetal status occurs with prepidil administration; What is the nursing action?

prepare to administer terbutaline

What is the action to methotrexate?

folic acid antagonist that interferes with DNA synthesis and cell multiplication (abortion and ectopic pregnancies)

What is the dosage and route for methotrexate?

IM 50 mg/m2 then intravaginal misoprostol 5-7 days later

What are some adverse effects of methotrexate?

fetal bone toxicity, n/v, anorexia, GI ulcerations, serve fetal dermatologic reactions (Steven Johnson Syndrome)

What are the contraindications to methotrexate?

alcoholism, chronic liver disease, immunosuppressed pts, or blood dycrasis

What are the drug interventions to methotrexate?

NSAIDs--> serve toxicity and aspirin may interfere with excretion

What lab test need to be monitored while taking methotrexate?

uric acid and CBC

What is the treatment for overdose on methotrexate?

Leucovorin (folinic acid) used to rescue normal cells or protect against serve bone marrow damage

What client teaching is needed for Methotrexate?

-To report any complaints, side effects to nurse or prescriber: black tarry stools, chills, fever, sore throat, bleeding, bruising, cough, SOB, dark or bloody urine, seizures
-That hair may be lost during treatment; that wig or hairpiece may make patient feel better; that new hair may be different in color, texture (alopecia rare)
-To avoid foods with citric acid, hot or rough texture if stomatitis is present
-To report stomatitis and any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily; to report symptoms to nurse; to use good oral hygiene
-To drink 10-12 glasses of fluid/day
-To avoid alcohol, salicylates, live vaccines
-To avoid use of razors, commercial mouthwash
-To use sunblock to prevent burns
-Use contraception during and at least 8 weeks after
-do not breastfeed

What is leucorvin used for?

macrocytic anemia caused by folic acid deficiency

What is the dosage for Leucorvin?

IM ≤1 mg/day until adequate response

What are the s/e for Leucorvin?

Rash, pruritus, erythema, urticaria, Wheezing

To prevent Leucorvin overdose you:

increase fluid intake

What is the teaching for Leucorvin?

-to eat folic-acid-rich foods: bran; yeast; dried beans; nuts; fresh, green leafy vegetables
-To take product exactly as prescribed
-To notify prescriber of side effects
-To report signs of hyposensitivity reaction immediately
-To avoid breastfeeding

Calcium Gluconate use:

magnesium sulfate toxicity

Calcium Gluconate dosage:

PO 0.5-2 g bid-qid; IV 0.5-2 g at 0.5 ml/min (10% solution); max IV dose 3 g

What are the s/e to calcium gluconate?

hypotension, bradycardia, cardiac arrest in IV, Vomiting, nausea, constipation
Hypercalcemia: Drowsiness, lethargy, muscle weakness, headache, constipation, coma, anorexia, nausea, vomiting, polyuria, thirst

What teachings for Calcium Gluconate?

To add foods high in vit D
To add calcium-rich foods to diet: dairy products, shellfish, dark green leafy vegetables; to decrease oxalate- and zinc-rich foods: nuts, legumes, chocolate, spinach, soy
To prevent injuries; to avoid immobilization

Ephedrine is used for :

hypotension from epidural regional block
or nasal stuffiness

Ephedrine dosage is :

5-10mg IV (BP is monitored and maternal and fetal response recorded) ---- hypotension from epidural regional block

Epinephrine is used for:

Acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis, allergic reactions, cardiac arrest, adjunct in anesthesia, shock

Epinephrine dosage is:

IM/SUBCUT 0.3-0.5 mg, may repeat q10-15min (anaphylaxis) or q20min-4 hr (asthma)

S/E of Epinephrine

Tremors, anxiety, insomnia, headache, dizziness, confusion, hallucinations, cerebral hemorrhage, weakness, drowsiness
Palpitations, tachycardia, hypertension, dysrhythmias, increased T wave, Anorexia, nausea, vomiting, Sweating, dry eyes, Dyspnea

What is the dosage of sufentanil?

Epidural: 10-15 mcg with 10 mL bupivacaine 0.125% with/without epinephrine.

What is the s/e to sufentanil?

Anaphylaxis, apnea, arrhythmia, biliary spasm, bronchospasm, cardiac arrest, chills, circulatory depression; cold, clammy skin; dizziness, dysesthesia, erythema, itching, laryngospasm, mental depression, paradoxical CNS excitation or delirium, physical and psychological dependence with prolonged use, respiratory depression (dose related), seizure, skeletal muscle rigidity, skin rash, tachycardia, urinary retention, urinary tract spasm, urticaria

Sufentanil use:

used in labor pain relief ???

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