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OB pharmacology

STUDY
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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 ???
What is the use of Naropin (ropivacaine)?
used in labor for pain relief
Dosage of Naropin for C-Section
20-30 ml of 0.5% sol
Dosage of Naropin for Labor pain.
10-20 ml 0.2% sol then 6-14 ml/1 hr
What are the general adverse effects to Naropin?
difficulty breathing or swallowing, resp depression or arrest, convulsions, anaphylactoid reaction, burning contact dermatitis
What are the s/e to Naropin?
Urinary retention, Status asthmaticus, respiratory arrest, anaphylaxis, Anxiety, restlessness, seizures, loss of consciousness, drowsiness, disorientation, tremors, shivering, paresthesia, Nausea, vomiting, cardiac arrest, dysrhythmias, bradycardia, hypo/hypertension, fetal bradycardia
The nurse will assess what when given Naropin
• B/P, pulse, respirations during treatment
• Fetal heart tones during labor
• Allergic reactions: rash, urticaria, itching
• Cardiac status: ECG for dysrhythmias, pulse, B/P during anesthesia
What is Xylocaine (Lidocaine) used for?
Used as a nerve block for spinal and epidural anesthesia
What is Xylocaine dosage ?
Do not exceed 75 mg b/c major neurological toxicity
(IV IM SC)
What are the adverse effects to Xylocaine?
Malignant hyperthermia: tachypnea, tachycardia, changes in B/P, increased temp
CNS excitement: irritability/confusion, SERIOUS: convulsions, resp depression, cardiac arrest
Treatment for Xylocaine overdose:
O2, artificial ventilation, ECG; administer DOPamine for circulatory depression, diazepam or thiopental for seizures; decrease product if needed
What is Narcan used for?
reverse opiod initiated CNS and resp depression within minutes
What is the initial dose of Narcan?
0.4-2mg IV (nonresponsive give every 2-3 minutes)
What are the adverse effects to Narcan?
increase blood pressure, tremors, hyperventiliation, drowsiness
What is the treatment of overdose in Narcan?
oxygen, IV fluids, vasopressor, supportive measure
What is the use of Zantac (Ranitidine)?
heartburn when accompained by GERD
What is the dose for Zantac (Ranitidine)
100-150 mg BID
What are the administration alerts to Zantac (Ranitidine)?
administer after meals and monitor liver and renal function
What are the Adverse effects to Zantac?
musculoskeletal pain, tachycardia, blood dyscrasia, blurred vision
What are the side effects to Zantac?
headache, bradycardia, nausea, constipation, dry mouth, dizziness, fatigue, irritability, confusion, rash
Sodium Bicarbonate is used for?
antacid
What is the dosage for Sodium Bicarbonate?
PO 300 mg to 2 g chewed, taken with water daily-qid
What are the s/e for Sodium Bicarbonate?
Irritability, headache, confusion, stimulation, tremors, twitching, hyperreflexia,weakness, seizures of alkalosis, Irregular pulse, cardiac arrest, water retention, edema, weight gain
Flatulence, belching, distention, Metabolic alkalosis, Muscular twitching, tetany, irritability
What teaching will be needed for Sodium Bicarbonate
Not to take antacid with milk because milk-alkali syndrome may result; not to use antacid for >2 wk
To notify prescriber if indigestion accompanied by chest pain; trouble breathing; diarrhea; dark, tarry stools; vomit that looks like coffee grounds; swelling of feet/ankles
About sodium-restricted diet; to avoid use of baking soda for indigestion
What is the action of Atropine?
Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, heart rate by blocking vagal stimulation in heart; dries secretions by blocking vagus
What is the Atropine dose for bradycardia?
IV BOL 0.5-1 mg given q3-5min, max 3 mg
What are the adverse effects to Atropine?
dry mouth, constipation, urinary retention increase hr, blurry vision, anorexia
Administration Alerts for Atropine:
never administer IM; monitor blood pressure, pulse, respirations 1 hour after SQ
Demerol is used for
labor pain
What is the usual dosage (IV and IM/SQ) for Demerol?
IV 2.5-15 mg q 4 hours
IM/SQ 5-20mg q 4 hrs
What are the common s/e for Demerol?
pruritus, dizziness, sedation, nausea, constipation
What are the contraindications to Demerol?
Hypersensitivity, convulsive disorder, breast feeding, undiagnosed acute abdomen pain
What is the life threatening s/e for Demerol?
resp depression, convulsions, cardiovascular collapse, cardiac arrest, newborn resp depression, bronchoconstriction
What is the treatment for overdose in Demerol?
Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids, vasopressors
Ritodrine is no longer used in the US. But was used for?
premature labor
What is the use and action for Nalbuphine (Nubain)?
synthetic opioid analgesic with agonist properties ( labor pain)
What is the dosage, route, and frequency of Nubain?
10-20mg q 3-6 hours prn (SQ/IM/IV)
What are the common maternal s/e of Nubain?
sedation, depression, nausea, sweaty clammy skin, ab pain, cramps, dizziness, faintness, blurred vision. diplopia, pruritis, urinary urgency, dyspnea, flushing, nervousness, restlessness, nightmares, headache, bradycardia, tachycardia, HTN or Hypotension
What is the life threatening s/e of Nubain?
resp depression
What are the contraindications to Nubain?
Hypersensitivity, resp depression, acute asthma, bradycardia, inflammatory bowel disease, substance abuse
What are allergic reaction may occur especially in clients with ____ sensitivity.
sulfite
Nubain toxicity is treated with ?
Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids, vasopressors
What is the use of stadol?
reducing pain and intensity in laboring women; opioid analgesic
What is the usual dose of Stadol in IM and IV cases?
IM 1-2 mg q 4 hours
IV 0.5- 2 mg 2 4 hours
What are the common side effectt to Stadol?
sedation, dizziness, hypotension, HTN, fainting
What is the life threatening s/e to stadol?
resp depression
Stadol contraindications
narcotic dependency, breastfeeding, chronic HTN, preeclampsia
What is the reversal agent for Stadol?
Naloxone HCl (Narcan) 0.2-0.8 mg IV, O2, IV fluids, vasopressors
What is the use of Digoxin ?
peripartum cardiomyopathy, slows hr, increase force of myocardial systolic contractions
What is the lab values to watch in Digoxin use?
potassium, calcium, mg, hepatic and renal functions, hyrdation, digoxin levels take 6-8hrs after dose
What is a toxic level of digoxin?
above 2ng/ml
Doses are lowered in renal dysfunction if creat is under:
10mL/min
What are the adverse effects of Digoxin?
dysrhythmias=hypokalemia, n/v, fatigue, anorexia, visual disturbances (yellow green tinge halos), blurring
Digoxin and diurects cause:
hypokalemia
Digoxin and ACE Inhibitors and Spironolactone cause:
hyperkalemia
Digoxin and Betablockers cause
addictive bradycardia
What is Depo Provera (medproxyprogesterone) used for?
contraceptive; suppresses ovulation
What is the route, dose, and frequency of Depo Provera?
150mg IM q 3 months or 104 mg SQ q 10-13 weeks (SQ is used instead to prevent loss of bone density
What are some side effects to Depo Provera?
menstural irregularities, headache, weight gain, breast tenderness, depression, long term loss of bone density, angioedema
What should the nurse assess in Depo Provera?
Pelvic exam, Pap smear before treatment, periodically
Severe allergic reaction, angioedema; have EPINEPHrine and rescusitative equipment available
• Weight daily; notify prescriber of weekly weight gain >5 lb; bone mineral density
• B/P at beginning of treatment and periodically
• I&O ratio; be alert for decreasing urinary output, increasing edema
• Hepatic studies: ALT, AST, bilirubin periodically during long-term therapy
• Edema, hypertension, cardiac symptoms, jaundice
• Mental status: affect, mood, behavioral changes, depression
When does ferility return after dcing Depo Provera?
6-12 months
What is flagyl (Metronidazole) used for?
bacterial anaerobic infections, Urethritis, PID, endocarditis Protozoan Infections such as trichomoniasis
What are the adverse effects of flagyl?
Rare serious adverse effects
May cause a metallic taste in mouth and urine may turn reddish brown during treatment
Flagyl interacts with anticoagulant causing
bleeding
Flagyl is contradicted in the ______ trimester of pregnancy
first
Penicillin G Procaine is used for:
Treatment of moderately-severe infections due to Treponema pallidum and other penicillin G-sensitive microorganisms that are susceptible to low, but prolonged serum penicillin concentrations; anthrax due to Bacillus anthracis (postexposure) to reduce the incidence or progression of disease following exposure to aerolized Bacillus anthracis
Penicillin G Procaine Adverse Affects
Cardiovascular: Conduction disturbances, myocardial depression, vasodilation
Central nervous system: CNS stimulation, confusion, drowsiness, myoclonus, seizure
Hematologic: Hemolytic anemia, neutropenia, positive Coombs' reaction
Local: Pain at injection site, sterile abscess at injection site, thrombophlebitis
Renal: Interstitial nephritis
Hypersensitivity reactions, Jarisch-Herxheimer reaction, pseudoanaphylactic reactions, serum sickness