Drug of the patient Drug class Action Side effects Nursing consideration

Anticonvulsant/Antiarrhythmic This medicine is thought  Muscle  May reduce

. to affect the action of weakness. risks of
Magnesium calcium in the body, and  Lack of energy. cerebral palsy
sulfate calcium must be present  Low blood in the
for the muscles of the pressure (rare). premature
uterus to contract. newborn if
 Headache.
 Nausea and preterm labor
CNS depressant, progresses on
anticonvulsant, vomiting.
 Stuffy nose. to preterm
antiarrhyhmic.
 Chest pain. delivery during
treatment.4
 Buildup of
fluid in the  Affects a
lungs mother's
(pulmonary central nervous
edema) and system. Part of
slowed or normal care
difficult when
breathing. intravenous
magnesium
 Blurry vision.
sulfate is given
 Slurred speech.
includes
 Flushing. checking the
mother's
reflexes,
usually every 2
to 4 hours,
while she is on
this medicine.
 Affects the
fetus's central
nervous
system. If a
mother is given
 large doses of
magnesium
sulfate, the
newborn may
have trouble
breathing
immediately
after birth. But
this problem is
easily treated
with medicine.
Some studies
show that
magnesium
sulfate may
increase the
risk of death
for the baby.1
 Can lower a
mother's blood
pressure and
increase her
heart rate. Her
blood pressure
and pulse are
checked
frequently for
the first few
hours of
treatment.
 Leaves the
mother's body
through her
 urine. The
amount of
urine she
produces is
closely
watched to
ensure that the
medicine does
not build up in
her blood.

Drug of the patient Drug class Action Side effects Nursing consideration
terbutaline beta adrenergic receptor Terbutaline is derived  tremor  For IV
agonists from a hormone called  nervousness administration,
Sympathomimetic. epinephrine, which is  dizziness obtain baseline
released when a woman is  drowsiness potassium level
under stress (a response prior to
 weakness
that's commonly called administration
the "fight or flight"
 headache
 upset stomach and place patient
response). Stress causes on cardiac
many of the muscles in a  flushing
monitor to assess
woman's body to  sweating
for tachycardia
contract, so that she is  dry mouth or arrhythmias.
ready to respond quickly.  throat irritation Toxic symptoms
One type of muscle in the
have been
body (smooth muscle), irregular heartbeats, documented in
however, relaxes when a extra fluid in the lungs patients with CV
woman is under stress. (pulmonary edema), and disorders.
Since most of the uterus is chest pain.  Do not allow
made up of smooth
muscle, the uterus will patient to use
increase a woman's
relax in response to a drug
that contains substances
like epinephrine.
However, the medication
can delay labor long
enough to allow
medications to be given
that will help the
premature infant's lungs
to develop. It can also
delay labor long enough
to transport a pregnant
woman to a facility with a
neonatal intensive care
unit (NICU), a hospital unit
that specializes in caring
for newborns.
inhaler form of
short-term risk for medication more
diabetes, in addition to than 6 times/day.
raising blood sugar  Limit
levels in women who subcutaneous
already have diabetes. doses to up to
0.5 mg in 4 h.
For the Baby
Avoid Beta-blockers
Terbutaline can cause a
temporary increase in Block bronchodilator
the baby's heart rate and effect of terbutaline.
blood sugar levels.
These effects are not MAOIs
usually serious and are
easy to treat after Hypertension may
delivery, if they should occur.
occur.
Tricyclic
antidepressants
CV effects of terbutaline
may be enhanced.
 Instruct patient
on proper
technique for use
of inhalers and
evaluate return
demonstration.
 Demonstrate use
of spacer or peak
flow meter if
 prescribed.
 Caution patient
not to use inhaler
form of
medication more
than 6 times/day.
 Advise patient to
take tablets with
food to avoid GI
upset.
 Inform patient
that the drug can
stop working
over time. If this
is noted or if the
inhalation makes
breathing worse,
notify the health
care provider at
once.
 Instruct patient
to report these
symptoms to
health care
provider: chest
pain, dizziness
or headache,
persisting
symptoms of
asthma.
 Drug of the patient Drug class Action Side effects Nursing consideration
nifedipine calcium channel Nifedipine is a tocolytic  Dizziness,  A mother's blood
blockers medicine sometimes lightheadedness, pressure is
used during preterm and nervousness. checked
labor to slow uterine  Skin flushing or frequently while
contractions. Nifedipine redness. she takes this
is taken only by mouth  Headache. medicine.
(orally) as a tablet or  Nausea.  Pregnant women
capsule.  Muscle cramps with liver
or tremors. disease should
Use of nifedipine for the  Low blood not take
treatment of preterm pressure in the nifedipine.
labor is an unlabeled use mother and a  Nifedipine
of the drug. Nifedipine, possible should not be
a calcium channel decrease in the used together
blocker, is more blood supply to with magnesium
commonly used to treat the fetus. sulfate.
high blood pressure and
heart disease. - Assess for anginal
pain, including location,
How It Works intensity, duration, and
alleviating and
Smooth muscle tissue, aggravating factors.
like the uterus, needs
calcium to contract. - Assess cardiac status
Nifedipine blocks the with BP, pulse,
passage of calcium into respiration and ECG
certain tissues, relaxing
the uterine muscles and Blood pressure should
smooth muscles of be constantly
blood vessels monitored. May worsen
throughout the body. congestive heart failure.
Nifedipine should not be
administered to patients
 Relaxes smooth muscle receiving intravenous
causing arteriolar beta blockers.
vasodilation decreases
peripheral vascular
resistance.

Drug of the patient Drug class Action Side effects Nursing consideration
indomethacin non-steroidal anti- Indomethacin is a Indomethacin appears to  Indomethacin is
inflammatory drugs nonsteroidal anti- have fewer side effects used with
inflammatory drug on the mother but caution,
(NSAID) that blocks the potentially more serious particularly for
production of certain effects on the fetus than pregnant women
substances called other tocolytic with heart
prostaglandins, which medicines used to treat disease, asthma,
contribute to uterine preterm labor. But fetal a history of
contractions. side effects are very intestinal
unlikely when treatment bleeding or
lasts fewer than 7 days. ulcers, kidney
Indomethacin may disease,
cause: problems with
blood clotting, or
 A fetus's kidneys a decreased
to produce amount of
abnormally low amniotic fluid
amounts of (oligohydramnio
urine, resulting s). It is also not
in a decrease in used during the
the amount of last 2 months of
amniotic fluid pregnancy
(oligohydramnio because of
s). possible effects
 Early changes in on fetal heart
the heart that do development.
 not normally  When
occur until after indomethacin is
birth. This may used for more
cause problems than 3 to 7 days,
with fetal blood fetal monitoring
circulation. with an
echocardiogram
Maternal side effects are and regular
very rare. They include: ultrasound tests
on the mother
 Headaches. are used to check
 Dizziness. the amount of
 Nausea and/or amniotic fluid.
vomiting.
 Stomach upset
or heartburn.
 Prolonged
vaginal bleeding.

For the Mother

Indomethacin causes
indigestion in many
women. This effect may
be lessened by taking
indomethacin with food
or, if necessary, by also
taking an antacid.

For the Baby

Indomethacin has two

potentially serious side
effects for the fetus.
This drug can cause (1)
a reduction in the
amount of urine the
fetus produces and (2)
changes in the way the
blood circulates through
the fetus's body.

If the fetus makes less

urine, the amount of
amniotic fluid in the
uterus may also be
reduced, a condition
known as
oligohydramnios. The
reduction in fluid seems
to be most common
when a mother is on
indomethacin for more
than two days. During
this time, amniotic fluid
levels should be
checked regularly by
ultrasound (a machine
that uses sound waves to
produce a picture of the
inside of the body).
Fortunately, the amount
of amniotic fluid almost
always returns to
normal once
indomethacin is
discontinued.

Indomethacin can also

cause a major blood
vessel, the ductus
arteriosus, to close
prematurely. This can
cause serious problems
after the baby is born.
Fortunately, the ductus
does not close early if
indomethacin is used for
less than 48 hours. It's
also less likely to be a
problem before 32
weeks of pregnancy. If a
mother takes the
medicine for more than
2 days, it is useful to
check an ultrasound of
the baby's heart to make
sure this blood vessel
has not been affected.