Rx: Syntocinon
Oxytocin, Parenteral
Dosage and route
- IV infusion (Drip method)
Induction or stimulation of labor
Initial: 0.5-2 milliunits/min.
Increase dose gradually in
increments of no more than 1-2
milliunits/min at 30-60 min
intervals until a contraction
pattern has been established
that is similar to normal labor.
Rates exceeding 9-10
milliunits/min are rarely required.
Control of pastpartum
bleeding add 10-40u (maximum
of 40 u) to 1000ml of a
nonhydrating diluents and run at
a rate needed to control uterine
atony.
Treatment of incomplete or
inevitable abortion. Infuse 10u of
oxytocin with 500ml
physiological saline solution or
D5W in physiological saline
infused at a rate of 10-20
milliunits ( 20-40 drops/min). do
not exceed 30 u in a 12 hr due to
the risk of water intoxication.
- IM
Control of postpartum bleeding,
give 10u after delivery of the
placenta.
Classifications and Action
Classifications:
Oxytoxic drug
Action:
Acts on smooth muscle of the uterus to
stimulate contractions; response
depends on the uterine threshold of
excitability. Is selective for the uterus,
especially toward the end of pregnancy,
during labor, and immediately ff. delivery.
Oxytocin stimulate rhythmic contractions
of the uterus, increase the frequency of
existing contractions, and raises the tone
of uterine musculature,
Onset IV: immediate; duration: within 1
hr after infusion stopped.
IM: 3-5 min; duration:2-3hrs; t1/2; 1-
6min. Plasma clearance occurs mainly
by the kidney and liver; only small
amounts excreted unchanged in the
urine.
Indications
Antepartum: Induction or stimulation of
labor at term. TO overcome true primary or
secondary uterine inertia. Induction of labor
with oxytocin is indicated only under certain
specific condition and is not usual because
serious toxic effects can occur.
Oxytocin is stimulated:
1.) for uterine inertia
2.) for induction of labor increases of
erythroblastosis fetalis, maternal
diabetes mellitus, eclampsia and
reeclampsia.
3.) For induction of labor after
premature rupture of membranes
in last moth of pregnancy when
labor fails to develop
spontaneously within 12 hr.
4.) To hasten uterine involution
5.) To complete inevitable abortion
after the 20th week of pregnancy
Postpartum: produces uterine contractions
during the third stage of labor and to control
postpartum bleeding or hemorrhage.
Contraindication
Hypersensitivity to drug. Significant
cephalopelvic disproportion; unfavorable
fetal postion or presentations that are
undeliverable without conversion prior to
delivery. In obstetric emergencies where the
benefit-to-risk ratio for either the mother or
fetus favors surgical intervention. Fetal
distress where delivery is not imminent,
prolonged use in uterine inertia or severe
toxemia, hypertonic or hyperactive uterine
patterns, when adequate uterine activity does
not achieve satisfactory progress. Induction of
augmentation of labor where vaginal delivery
is contraindicated, including invasive cervical
cancer, cord presentation or prolapsed, total
placenta previa and vasa previa, active
herpes genitalis.
Special concern:
Oxytocin is indicated for the medical rather
than elective induction of labor. Data and
information are not available to define the
benefit-to-risk consideration for using oxytoxin
for elective induction.
Nursing consideration
Don’t confuse Pitocin (oxytocin) with
Pitressin ( vasopressin). Don’t confuse
oxytocin with oxycontin.
1.) To reconstitute add 1ml to
1000ml of 0.9% aqueous Nacl
or Ringer’s lactate. Solutions
contain’s 10 milliunits/ml
2.) Use Y-Tubing system, with one
bottle containing IV solution
and oxytocin, and the other
containing only the IV solution.
This is allows for the drug while
maintaining the patency of the
vein when it is decided to
change to the drug-free
infusion bottle. Use constant
infusion pump to control the
rate of infusion accurately.
3.) Oxytocin is rapidly broken
down by sodium bisulfate.
Have Mg sulfate immediately
available to relax the uterus in
case of tetanic uterine
contractions.
4.) Have the provider immediately
available during
administration.
Rx: Methergine
Methylerogonovine Maleate
Dosage and route
-IM; IV (Emergencies only)
0.2 mg q 2-4 hr following
delivery of placenta, of the
anterior shoulder, or during the
puerperium.
-tablets
0.2 mg 3-4 times per
day in the puerperium
Classifications and Action
Classifications:
Oxytoxic drug
Action:
Synthetic drug related to ergonovine.
Acts directly on the uterine smooth
muscle to stimulate the rate, tone,
and amplitude of uterine contractions.
It induces a rapid, sustained tetanic
uterotonic effect that shortens the
third stages of labor and reduces
blood loss. The uterus becomes more
sensitive to the drug towars the end
of pregnancy. Decreases the
boiavialability after Po use probably
due to first-pass metabolism in the
liver. Onset (uterine contraction), Po:
5-10 min; IM 2-5 min; IV immediate
t 1/2, IV 2-3 min (initial) and 20-30
min (final) duration, Po,IM; 3hr, IV:
45 min. t 1/2 elimination : 3.4 hr
Indications
1.) Management anf prevention of
postpartum and postabortal hemorrhage
by producing firm uterine contractions
and decreasing uterine bleeding.
2.) During the second stages of labor
following delivery of the anterior shoulder,
but only under full obstetric supervision.
Investigational: Ergonovine has been
used to diagnose Prinzmetal's angina
(variant angina).
Contraindication Nursing consideration
Pregnancy, toxemia, hypertension 1.) Store tablets below 25ºC(77ºF) in
Ergot hypersensitivity. To induce tight, light-resistant containers.
labor or threatened spontaneous
abortions. Administration before 2.) Administer slowly over 1 min;
delivery of the placenta. Use with check V.S for evidence of shock or
CYP3A4 Inhibitors (e.g. protease hypertension after IV administration.
inhibitors, macrolide antibiotics,
azole antifungal drugs). 3.) Give only if solution is clear and
colorless; discard ampules if discolored
Special precaution:
Use with the caution in sepsis, 4.) Store ampule from 2-8ºC(36-46ºF)
obliterative vascular didease, protect from light.
impaired renal or hepatic function,
during the second stage of labor, and
during lactation. Don't routinely use
IV due to possible induction of
sudden hypertension and CVA.
Rx: carbazochrome Na
Sulfonate 1mg
Vitamin k 10 mg
Vitamin k
Dosage and route
- 1 tablet daily
It is recommended that 2 tablet
daily be given for 1 week before
and 1 week after operation. 2
tablet may be given 3-5 days
before and 3-5 days after tooth
extraction and operation.
IM:
The recommended route of
administration is intramuscular,
being given at birth, and that this
should be as a single IM
injection:
• Term babies 0.5-1mg
IM soon after birth
• Preterm 0.5mg IM soon
after birth
Classifications and Action Indications Contraindication Nursing consideration
Prevention of hemorrhage before and after Patient’s with a tendency to thrombophlebitis 1.) Explain to patient family the
Classifications: minor operation; purpuras, epistaxis, or phlepothrombosis. the indications for therapy and expected
gingival bleeding, hemoptysis, GIT result.
Hemostatic drug
bleeding, uterine bleeding and hemorrhage Special concerns:
due to hypoprothrombinemia. -G6PD deficiency 2.) stress the need for periodic lab test
Action: -Pregnancy to monitor coagulation levels
Cardiovascular and hematopoietic
system. 3.) teach patient necessary foods high in
Vitamin K to be included in diet
4.) caution patient not to use OTC meds
or take other supplements unless
directed by physician.
5.) instruct patient to report symptoms of
bleeding
6.) stress the need to carry emergency.
Rx: Hyoscine hydrobromide
Scopolamine Hydrobromide
Dosage and route
- Opthalmic solution
Cycloplegia/ mydriasis
Adults 1-2 gtt of the 0.25%
solution in the conjunctiva 1hr
prior to refraction.
Children 1 gtt of the 0.25%
solution twice a day for 2 days
prior to refraction uveitis.
Adults and children 1gtt of the
0.25% solution in the conjunctiva
1-4 times per day, depending in
the severity of the condition.
-Tablets, soluble
Prevent motion sickness. GIT
motility and hyper tonus 0.4-
0.8mg
-Transdermal system
Antiemetic, antivertigo
Adults: 1 Transdermal system
placed on the poatauricular skin
to deliver 1mg over 3 days.
(apply at least 4hrs before
antiemetic effect is required) the
canadian product should be
applied about 12hr before the
antiemetic effect is desired.
Classifications and Action
Classifications:
Cholinergic blockin drug, antiemetic
Rx: Isopthyoscine pothalmic, scopace
Action:
Anticholinergic with CNS depressants
effects; produces amnesia when given
with morphine and mepenidine. Inhibits
excessive motility and hyper tonus of the
GIT.
In the presence of pain, delirium maybe
produced. Causes pupillary dilation and
paralyzes the muscle required to
accommodate for dose vision.
Indications Contraindication Nursing consideration
Opthalmic Use of transdermal system in children or 1.) give drops into the conjunctival sac
1.) For cycloplegia and Mydriasis in lactating women. followed by digital pressure for 2-3 min
diagnostic procedures. Ophthalmic use in glaucoma or infants less after instillation.
2.) Preoperatively and postoperatively than 3 moths of age. Use of prophylaxis of 2.)not give alone for pain because it may
intreatment of iriclaycutis. excess secretion in children, infants, geriatric cause delirium; use an analgesic or
3.) Dilate the pupil in treatment of clients, diabetes, hypo or hyper thyroidism, sedative as needed
uveitis or posterior synehiae. narrow anterior chamber angle. 3.) Protect the solution from light.
Oral
1.) Prevention of motion sickness
2.) Inhibits excessive motility and
hyper tonus of the GIT, including
conditions such as arritable bowel
syndrome, mild dysentery,
diverticulitis, pylorospasm,and
cardiospasm.
Parenteral
1.) Preanesthetic sedation and
obstetric amnesia in conjunction
with analgesic
2.) Calming delirium
Transdermal: in adults for
prevention of NSV associated with
motion sickness or recovery from
anesthesia and surgery.
Rx: ADCO-MEFENAMIC
ACID
Mefenamic
Dosage and route Classifications and Action Indications Contraindication Nursing consideration
Adult dose: Classification: 1.) give drops into the conjunctival sac
500 mg of mefenamic acid three Anti-pyretic or Anti-pyretic and Anti- Mefenamic acid is used for the relief of Mefenamic acid is contra-indicated in followed by digital pressure for 2-3 min
times daily with food. The inflammatory analgesics mild to moderate pain in acute and chronic patients with known sensitivity and in after instillation.
conditions including: pain of traumatic, patients who respond to aspirin and aspirin- 2.)not give alone for pain because it may
dosage may be reduced to 1 cause delirium; use an analgesic or
capsule (250 mg) three times arthritic or muscular origin; like medicines with sensitivity reactions like
sedative as needed
daily Action: dysmenorrhoea; headache and dental pain. bronchoconstriction, skin rashes and 4.) Protect the solution from light.
Mefenamic acid has analgesic, anti- Mefenamic acid reduces blood loss in urticaria. Mefenamic acid is contra-indicated
Children: inflammatory and anti-pyretic properties. menorrhagia where menorrhagia is due to in patients with peptic ulceration or having a
It inhibits the synthesis of ovulatory dysfunctional bleeding. Uterine history of gastro-intestinal bleeding and or
6 months to 5 mL three and other pathology should first be inflammatory bowel disease.
prostaglandins. Mefenamic acid shows
1 year: times per day excluded before prescribing Mefenamic Safety in pregnancy and lactation has not
central and peripheral action and it owes
2 - 4 years: 10 mL three these properties to its capacity to inhibit acid for this indication. It is also indicated been established. Do not use in epileptic
times per day cyclooxygenase. as an anti-pyretic in febrile conditions. patients or in patients with impaired hepatic
5 - 8 years: 10 mL four Mefenamic acid is used for the treatment of function.
times per day post traumatic conditions such as pain,
swelling and inflammation, for a maximum
9 - 12 years: 15 mL four
period of five days.
times per day

Mefenamic acid should not be

used for longer than seven days
at a time.