Name /bks_53161_deglins_md_disk/oxytocin 03/14/2014 07:53AM Plate # 0-Composite pg 1 # 1

1 High Alert ternal— hypotension; fetal, arrhythmias. F and E: maternal— hypochloremia,

hyponatremia, water intoxication. Misc: maternal—q uterine motility, painful
PDF Page #1
oxytocin (ox-i-toe-sin) contractions, abruptio placentae,puterine blood flow, hypersensitivity.
Pitocin Interactions
Classification Drug-Drug: Severe hypertension may occur if oxytocin follows administration of
Therapeutic: hormones vasopressors.
Pharmacologic: oxytocics
Pregnancy Category X Route/Dosage
Induction/Stimulation of Labor
Indications IV (Adults): 0.5– 1 milliunits/min;qby 1– 2 milliunits/min q 30– 60 min until de-
IV: Induction of labor at term. IV: Facilitation of threatened abortion. IV, IM: Post- sired contraction pattern established; dose may bepafter desired frequency of con-
partum control of bleeding after expulsion of the placenta. tractions is reached and labor has progressed to 5-6 cm dilation.
Action Postpartum Hemorrhage
Stimulates uterine smooth muscle, producing uterine contractions similar to those in IV (Adults): 10 units infused at 20– 40 milliunits/min.
spontaneous labor. Has vasopressor and antidiuretic effects. Therapeutic Ef- IM (Adults): 10 units after delivery of placenta.
fects: Induction of labor. Control of postpartum bleeding.
Pharmacokinetics Incomplete/Inevitable Abortion
Absorption: IV administration results in 100% bioavailability. IV (Adults): 10 units at a rate of 20– 40 milliunits/min.
Distribution: Widely distributed in extracellular fluid. Small amounts reach fetal NURSING IMPLICATIONS
circulation.
Metabolism and Excretion: Rapidly metabolized by liver and kidneys. Assessment
● Fetal maturity, presentation, and pelvic adequacy should be assessed prior to ad-
Half-life: 3– 9 min.
ministration of oxytocin for induction of labor.
TIME/ACTION PROFILE (reduction in uterine contractions) ● Assess character, frequency, and duration of uterine contractions; resting uterine
ROUTE ONSET PEAK DURATION tone; and fetal heart rate frequently throughout administration. If contractions oc-
IV immediate unknown 1 hr cur ⬍2 min apart and are ⬎50– 65 mm Hg on monitor, if they last 60– 90 sec or
IM 3–5 min unknown 30–60 min longer, or if a significant change in fetal heart rate develops, stop infusion and turn
patient on her left side to prevent fetal anoxia. Notify health care professional im-
Contraindications/Precautions mediately.
Contraindicated in: Hypersensitivity; Anticipated nonvaginal delivery. ● Monitor maternal BP and pulse frequently and fetal heart rate continuously
Use Cautiously in: OB: First and second stages of labor; slow infusion over 24 hr throughout administration.
has caused water intoxication with seizure and coma or maternal death due to oxy- ● This drug occasionally causes water intoxication. Monitor patient for signs and
tocin’s antidiuretic effect. symptoms (drowsiness, listlessness, confusion, headache, anuria) and notify phy-
Adverse Reactions/Side Effects sician or other health care professional if they occur.
Maternal adverse reactions are noted for IV use only CNS: maternal— COMA, SEI- ● Lab Test Considerations: Monitor maternal electrolytes. Water retention may
ZURES; fetal, INTRACRANIAL HEMORRHAGE. Resp: fetal— ASPHYXIA, hypoxia. CV: ma- result in hypochloremia or hyponatremia.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/oxytocin 03/14/2014 07:53AM
2 setron, heparin, hydrocortisone sodium succinate, hydromorphone, imipenem/
Potential Nursing Diagnoses
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Implementation
● Do not administer oxytocin simultaneously by more than one route.
IV Administration
● Continuous Infusion: Rotate infusion container to ensure thorough mixing.
Store solution in refrigerator, but do not freeze.
● Infuse via infusion pump for accurate dose. Oxytocin should be connected via Y-
site injection to an IV of 0.9% NaCl for use during adverse reactions.
● Magnesium sulfate should be available if needed for relaxation of myometrium.
● Induction of Labor: Diluent: Dilute 1 mL (10 units) in 1 L of compatible in-
fusion fluid (0.9% NaCl, D5W, or LR). Concentration: 10 milliunits/mL. Rate:
Begin infusion at 0.5– 2 milliunits/min (0.05– 0.2 mL); increase in increments of
1– 2 milliunits/min at 15– 30-min intervals until contractions simulate normal la-
bor.
● Postpartum Bleeding: Diluent: For control of postpartum bleeding, dilute 1–
4 mL (10– 40 units) in 1 L of compatible infusion fluid. Concentration: 10–
40 milliunits/mL. Rate: Begin infusion at a rate of 20– 40 milliunits/min to con-
trol uterine atony. Adjust rate as indicated.
● Incomplete or Inevitable Abortion: Diluent: For incomplete or inevitable
abortion, dilute 1 mL (10 units) in 500 mL of 0.9% NaCl or D5W. Concentra-
tion: 20 milliunits/mL. Rate: Infuse at a rate of 20– 40 milliunits/min.
● Y-Site Compatibility: acyclovir, alfentanil, allopurinol, amikacin, aminocaproic
acid, aminophylline, amphotericin B liposome, anidulafungin, argatroban, ascor-
bic acid, atropine, azathioprine, azithromycin, aztreonam, benztropine, bivaliru-
din, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium glu-
conate, capreomycin, caspofungin, cefazolin, cefepime, cefoperazone,
cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloram-
phenicol, ciprofloxacin, cisatracurium, clindamycin, cyanocobalamin, cyclospor-
ine, daptomycin, dexamethasone, dexmedetomidine, digoxin, digoxin, diphen-
hydramine, dobutamine, dolasetron, dopamine, doxycycline, droperidol,
enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, ertapenem, eryth-
romycin, esmolol, famotidine, fenoldopam, fentanyl, fluconazole, folic acid, fos-
carnet, fosphenytoin, furosemide, ganciclovir, gentamicin, glycopyrrolate, grani-
Plate # 0-Composite pg 2 # 2
cilastatin, isoproterenol, ketamine, ketorolac, labetalol, leucovorin calcium, lev-
ofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, meperi- PDF Page #2
dine, meropenem, metaraminol, methyldopate, methylprednisolone, metoclopra-
mide, metoprolol, metronidazole, midazolam, milrinone, morphine,
moxifloxacin, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, ne-
siritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, ondansetron,
oxacillin, palonosetron, pamidronate, papaverine, penicillin G , pentamdine, pen-
tazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytona-
dione, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium
phosphates, procainamide, prochlorperazine, promethazine, propranolol, prot-
amine, pyridoxime, quinupristin/dalfopristin, ranitidine, sodium acetate, sodium
bicarbonate, sodium phosphates, streptokinase, succinylcholine, sufentanil, tac-
rolimus, theophylline, thiamine, ticarcillin/clavulanate, tigecycline, tirofiban, to-
bramycin, tolazoline, vancomycin, vasopressin, verapamil, vitamin B complex
with C, voriconazole, warfarin, zidovudine, zoledronic acid.
● Y-Site Incompatibility: dantrolene, diazepam, diazoxide, indomethacin,
methohexital, phenytoin, remifentanil, trimethoprim/sulfamethoxazole.
● Solution Compatibility: dextrose/Ringer’s or lactated Ringer’s combinations,
dextrose/saline combinations, Ringer’s or lactated Ringer’s injection, D5W,
D10W, 0.45% NaCl, 0.9% NaCl.
Patient/Family Teaching
● Advise patient to expect contractions similar to menstrual cramps after adminis-
tration has started.
Evaluation/Desired Outcomes
● Onset of effective contractions.
● Increase in uterine tone.
● Reduction in postpartum bleeding.
Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company