HOLY FAMILY COLLEGE OF NURSING

DRUGS USED
IN

OBSTETRICS AND GYNAECOLOGY

SUBMITTED TO SUMBITTED BY

MADAM SMITHA MS. ANURADHA

ASSISSTANT PROFESSOR MSc. NURSING 1ST YEAR

HFCON HFCON
 DRUGS USED IN OBSTETRICS

Trade Name Dinoprostone

Generic Name Prostin E, Prepidil, Cervidil
Dosage Intravaginal administration
 Cervidil = Intracervical gel
 Prostin E2 = Intravaginal suppository
The dosage of dinoprostone in the vaginal insert is 10 mg
designed to be released at approximately 0.3 mg/hour over a 12
hour period. Cervidil should be removed upon onset of active
labor or 12 hours after insertion.
Classification Uterine Stimulants, Abortifacient, Prostaglandin
Action  Prostaglandin E2
 Uterine and gastrointestinal smooth muscle stimulation
 Cervical softening and dilation
 Increases frequency and strength of uterine contraction.
Indication Cervidil Vaginal Insert (dinoprostone, 10 mg) is indicated for the
initiation and/or continuation of cervical ripening in patients at or
near term in whom there is a medical or obstetrical indication for
the induction of labor.
Contraindication Endocervically administered dinoprostone gel is not recommended
for the following:
 Patients in whom oxytocic drugs are generally
contraindicated or where prolonged contractions of the
uterus are considered inappropriate, such as:
o Cases with a history of cesarean section or major
uterine surgery.
o Cases in which cephalopelvic disproportion is present.
 o Cases in which there is a history of difficult labor
and/or traumatic delivery.
o Grand multiparae with 6 or more previous term
pregnancies cases with non-vertex presentation.
o Cases with hyperactive or hypertonic uterine patterns.
o Cases of fetal distress where delivery is not imminent.
o In obstetric emergencies where the benefit-to-risk ratio
for either the fetus or the mother favors surgical
intervention.
 Patients with hypersensitivity to prostaglandins or
constituents of the gel.
 Patients with placenta previa or unexplained vaginal
bleeding during this pregnancy.
 Patients for whom vaginal delivery is not indicated, such
as vasa previa or active herpes genitalia.
 Vaginal Suppository
 Hypersensitivity to dinoprostone.
 Acute pelvic inflammatory disease.
 Patients with active cardiac, pulmonary, renal, or hepatic
disease.
Adverse Reaction  Nausea and vomiting; diarrhea
 Fever
 Orthostatic hypotension
 Arrhythmia
Nursing Responsibilities  Store suppositories in freezer and bring to room
temperature before insertion.
 Store cervical gel in freezer and bring to room temperature
in room temperature, just prior to use. Do not force
warming with external sources (ie, water bath, microwave)
 Ensure adequate hydration throughout the procedure.
 Monitor uterine tone and vaginal discharge throughout the
procedure and several days after procedure.
 Be prepared to support patient through labor (cervical
ripening). Give oxytocin 6-12 hours after dinoprostone.
 Trade Name Methergine, Methylergobasine, Methylergobrevin,
Methylergonovine
Generic Name Methylergonovine maleate
Dosage PO = 0.2 mg q 6-8 H (max 1 week); IM = 0.2 mg q 2 – 4 H (max 5
doses)
Classification Uterine Stimulants
Action  Directly stimulate uterine contractions
o Small doses = with normal resting muscle tone
o Intermediate doses = more forceful and prolonged
contractions with elevated resting muscle tone
o Large doses = severe, prolonged contractions
 Not for induction of labor (intense uterine activity)
Indication Prevention and treatment of postpartum and postabortion
hemorrhage caused by uterine atony or subinvolution
Contraindication  contraindicated in patients hypersensitive to
methylergonovine or any component of the formulation.
 ergot alkaloids are contraindicated with potent inhibitors of
CYP3A4 (includes protease inhibitors, azole antifungals,
and some macrolide antibiotics);
 hypertension; toxemia of pregnancy (PIH)
Adverse Reaction  Nausea, vomiting, abdominal cramping
 Hypertension
Nursing Responsibilities  Be alert for adverse reactions and drug interactions.
 This drug should be used extremely carefully because of
its potent vasoconstrictor action. I.V. use may induce
sudden hypertension and cerebrovascular accidents. As a
last resort, give I.V. slowly over several minutes and
monitor blood pressure closely.
 Monitor Uterine Contractions
 Trade Name Pitocin, Syntocinon
Generic Name Oxytocin
Dosage  For stimulation of labor: 10 units (1ml) of drug
infused in 1L D5LRS before deliver
 For Reduction of Postpartum bleeding: 1 amp after
delivery of placenta
Classification Uterine Stimulants
Action  Stimulates the smooth muscles of uterus, blood vessels
and mammary glands
 Third trimester = active labor
Indication Induction of labor at term; control of postpartum bleeding;
adjunctive therapy in management of abortion
Contraindication  Contraindicated in patients hypersensitive to the drug or
any of its component.
 Also contraindicated in cephalopelvic disproportion or
delivery that requires conversion, as in tranverse lie; in
fetal distress when delivery isn’t imminent; in
prematurity and in severe toxemia, hypertonic uterine
patterns, total placenta previa or vasa previa.
 Also contraindicated in fetal distress.
Adverse Reaction  Cardiovascular: hypertension; increased heart rate,
systemic venous return, and cardiac output, and
arrhytmias
 CNS: seizures, coma from water intoxication
 Gastrointestinal: Nausea, vomiting,
 GU: titanic uterine contractions, abruption placentae,
impaired uterine blood flow, pelvic hematoma
 Hematologic: afibrinogenemia
 Respiratory: anoxia, asphyxia
Nursing Responsibilities  Monitor and record uterine contractions, heart rate, BP,
intrauterine pressure, fetal heart rate, and blood loss
q15.
 Be alert for adverse reaction
 Monitor I/O. Antidiuretic effect may lead to fluid
overload, seizures, and coma
 Never give oxytocin simultaneously by more than one
route.
 Have 20% solution magnesium sulfate available for
relaxation of the myometrium.
 If contractions are less than 2 minutes apart, if they’re
above 50mm Hg ,or if they last 90sec. or longer, stop
infusion, and turn patient on her side, and notify
physician or midwife.
 Trade Name Apresoline
Generic Name Hydralazine
Dosage 5 mg/dose then 5-10 mg every 20-30 minutes as needed. (TIV)
Classification
Action Hydralazine
↓
Directly relaxes arteriolar smooth muscle
↓
Vasodilaion
↓
Lowers Blood Pressure
Indication Pre-eclampsia /eclampsia
Contraindication  Contraindicated to pt.s hypersensitive to the drug and
any of its component and in those with coronary artery
disease or mitral valvular rheumatic heart disease.
 Use cautiously in patients with suspected cardiac
disease, CVA, or severe renal impairment, and in those
taking other antihytensives.
Adverse Reaction  CNS: peripheral neuritis, headache, dizziness
 CV: orthostatic hypotension, tachycardia, arrythmias,
angina, palpitations.
 GI: n/v, diarrhea, anorexia
 Hematologic: neutropenia, leukopenia,
agranulocytopenia
 Metabolic: weight gain, sodium retention
 Skin: rash
Nursing Responsibilities  Assess blood pressure before starting therapy and
regularly thereafter.
 Instruct client to take oral form with meals.
 Inform client that orthostatic hypotension can be
minimized by rising slowly and not changing position
suddenly.
 Tell pt. not to abruptly stop taking drug, but to call the
one who prescribed it if adverse reaction occurs.
 Tell client to limit sodium intake.
 Trade Name Ferrous Sulfate
Generic Name Ferrous Sulfate (FeSO4)
Dosage 200mg/day PO
Classification Antianemic, Iron
Action Males: 12-20mg
Females: 8-15mg
Iron is absorbed from the duodenum and upper jejunum by an
active mechanism through the mucosal cells where it combines
with the protein transferrin.
Indication  Prophylaxis and treatment of iron deficiency and iron-
deficiency anemias.
 Dietary supplement for iron. Optimum therapeutic
responses are usually noted within 2-4 weeks.
Contraindication Hemosiderosis, hemochromatosis, peptic ulcer, regional
enteritis, and ulcerative colitis. Hemolytic anemia, pyridoxine-
responsive anemia, and cirrhosis of the liver. Use in those with
normal iron balance.
Adverse Reaction Constipation, gastric irritation, nausea, abdominal cramps,
anorexia, diarrhea, dark colored stools.
Nursing Responsibilities  Substitution of one iron salt for another without proper
adjustment may result in serious over or under dosing.
 Eggs, milk, coffee, or tea consumed with a meal or 1 hr
after may significantly inhibit absorption of dietary iron.
 Ingestion of calcium and iron supplements with food
can decrease iron absorption by one-third; iron
absorption is not decreased if calcium carbonate is used
and taken between meals.
 Do not crush or chew sustained-release products.
 Trade Name Magnesium sulfate
Generic Name Magnesium sulfate
Dosage  Anticonvulsant:
o IM = loading dose (10 g of 50% solution [20 mL]
divided into 2 doses); maintenance dose (4 – 5 g of
50% solution [10 mL] q4H deep IM; alternate
buttocks
o IV = loading does (4 g MgSO4 in 250 mL of D5W
infuse at 10 mL per minute; maintenance dose (1 – 2
g per hour by continuous infusion)
 Preterm labor: IV = loading dose (4 g of MgSO4 over 15
– 30 minutes; maintenance dose (1 – 3 g per hour by
continuous infusion)
Classification CNS depressant
Action  CNS depressants = potentiate CNS depressant effects of
MgSO4 (barbiturates, analgesics, general anesthetics,
tranquilizers, and alcohol
 Neuromuscular blocking agents = concurrent use with
MgSO4 will further depress muscular activity.
Indication Seizures of eclampsia (toxemia of pregnancy)
Contraindication  Conditions:Kidney Disease, Serious Kidney Problems,
High Amount of Magnesium in the Blood, Low Amount
of Calcium in the Blood
 Allergies:Magnesium Magnesium Sulfate
Adverse Reaction  Deep tendon reflexes = absent
 Decreased urine output
 Decreases respiratory rate, blood pressure, fetal heart rate
(fetal distress)
 Confusion
 Neonates = hypotension, hyporeflexia, respiratory
depression
Nursing Responsibilities Pregnancy safety: Magnesium sulfate is administered to treat
toxemia of pregnancy. It is recommended that the drug not be
administered in the 2 hours before delivery, if possible. IV
calcium gluconate or calcium chloride should be available as an
antagonist to magnesium if needed. Convulsions may occur up to
48 hr after delivery, necessitating continued therapy. The "cure"
for toxemia is delivery of the baby. Magnesium must be used
with caution in patients with renal failure, since it is cleared by
the kidneys and can reach toxic levels easily in those patients.
Prophylactic administration of magnesium sulfate for patients
with
acute mvocardial infarction should be considered.
 Trade Name Phenergan
Generic Name promethazine HCI
Dosage 25-50 mg (sedation); 10-25mg q 4hr as needed (anti-emetic)
(1amp)
Classification anti-emetics, antihistamines, sedative/hypnotics
Action Selectively blocks H1 receptors, diminishing the effects of
histamine on cells of the upper respiratory tract and eyes and
decreasing the sneezing, mucus production, itching and tearing
that accompany allergic reactions. blocks cholinergic receptors
in the vomiting center that are believed to mediate the nausea
and vomitting caused by gastric irritation.
Indication Preoperative sedation, treatment and prevention of nausea and
vomiting, adjunct to anesthesia and analgesia.
Contraindication Hypersensitivity, comatose patient, prostatic hypertrophy,
bladder neck obstruction, narrow angle glaucoma
Adverse Reaction  CNS: neuroleptic malignant syndrome, confusion,
disorientation, sedation, dizziness, extrapyramidal
reaction, fatigue, insomnia, nervousness;
 EENT: blurred vision, diplopia, tinnitus;
 CV: bradycardia, hypertension, hypotension, tachycardia;
 GI: constipation, drug-induced hepatitis, dry mouth;
Derm: photosensitivity, rashes;
 Hema: blood dyscrasias
Nursing Responsibilities  Monitor BP, pulse and respiratory rate frequently.
 Assess level of sedation after administration.
 Assess patient for nausea and vomiting before and after
administration.
 Administer each 25mg slowly over at least 1 hr.
 Do not give rectal supp or tabs to children younger than 2
years old because of risk of fetal respiratory depressions
 Give IM injections deep into muscle
 Do not administer SQ, tissue necrosis may occur
 Arteriospasms and gangrene of artery may occur when
administered intra-arterially.
 Reduce dosage of barbiturates given concurrently within
promethazine by least half.
 Trade Name Xylocaine
Generic Name Lidocaine
Dosage  For normal vaginal delivery: 50mg/ml of a 5%
hyperbaric solution or 9mg-15mg (0.6ml-1ml) of a
1.5% solution.
 For Cesarean Section: Up to 75 mg (1.5ml) of a 5%
hyperbaric solution.
Classification Infiltration and Nerve Blocker
Action Lidocaine
↓
Stabilizes the neuronal membrane
↓
Inhibits sodium ion movemnts
↓
Conduction of impulses are inhibited
↓
Local loss of pain sensation
Indication  Injected prior to normal spontaneous delivery to
anesthetize the area of the perineum to be used for
episiotomy.
 Used as a local anesthesia for Cesarean section
Contraindication  Hypovolemia
 Heartblock
 Other Conduction Disturbances
Adverse Reaction  Dizziness
 Paresthesia
 Drowsiness
 Confusion
 Respiratory Depression
 Convulsions
Nursing Responsibilities Observe for untoward reactions such as drowsiness, depressed
respiration, or seizures.
 Trade Name Fumide , Furomide , Lasix, Luramide
Generic Name FUROSEMIDE
(fur-oh'se-mide)
Dosage  Edema
Adult: PO 20–80 mg in 1 or more divided doses up to
600 mg/d if needed IV/IM 20–40 mg in 1 or more
divided doses up to 600 mg/d
 Hypertension
Adult: PO 10–40 mg b.i.d. (max: 480 mg/d)
Classification Electrolytic and water balance agent; loop diuretic
Action Rapid-acting potent sulfonamide "loop" diuretic and
antihypertensive with pharmacologic effects and uses almost
identical to those of ethacrynic acid. Exact mode of action not
clearly defined; decreases renal vascular resistance and may
increase renal blood flow
Indication Treatment of edema associated with CHF, cirrhosis of liver, and
kidney disease, including nephrotic syndrome. May be used for
management of hypertension, alone or in combination with other
antihypertensive agents, and for treatment of hypercalcemia. Has
been used concomitantly with mannitol for treatment of severe
cerebral edema, particularly in meningitis.
Contraindication History of hypersensitivity to furosemide or sulfonamides;
increasing oliguria, anuria, fluid and electrolyte depletion states;
hepatic coma; pregnancy (category C), lactation.
Adverse Reaction  CV: Postural hypotension, dizziness with excessive
diuresis, acute hypotensive episodes, circulatory collapse.
 Metabolic: Hypovolemia, dehydration, hyponatremia
hypokalemia, hypochloremia metabolic alkalosis,
hypomagnesemia, hypocalcemia (tetany), hyperglycemia,
glycosuria, elevated BUN, hyperuricemia.
 GI: Nausea, vomiting, oral and gastric burning, anorexia,
diarrhea, constipation, abdominal cramping, acute
pancreatitis, jaundice.
 Urogenital: Allergic interstitial nephritis, irreversible
renal failure, urinary frequency.
  Hematologic: Anemia, leukopenia, thrombocytopenic
purpura; aplastic anemia, agranulocytosis (rare).
 Special Senses: Tinnitus, vertigo, feeling of fullness in
ears, hearing loss (rarely permanent), blurred vision.
 Skin: Pruritus, urticaria, exfoliative dermatitis, purpura,
photosensitivity, porphyria cutanea tarde, necrotizing
angiitis (vasculitis).
 Body as a Whole: Increased perspiration; paresthesias;
activation of SLE, muscle spasms, weakness;
thrombophlebitis, pain at IM injection site.
Nursing Responsibilities Assessment & Drug Effects
 Observe patients receiving parenteral drug carefully;
closely monitor BP and vital signs. Sudden death from
cardiac arrest has been reported.
 Monitor BP during periods of diuresis and through period
of dosage adjustment.
 Observe older adults closely during period of brisk
diuresis. Sudden alteration in fluid and electrolyte
balance may precipitate significant adverse reactions.
Report symptoms to physician.
 Lab tests: Obtain frequent blood count, serum and urine
electrolytes, CO2, BUN, blood sugar, and uric acid
values during first few months of therapy and
periodically thereafter.
 Monitor for S&S of hypokalemia.
 Monitor I&O ratio and pattern. Report decrease or
unusual increase in output. Excessive diuresis can result
in dehydration and hypovolemia, circulatory collapse,
and hypotension. Weigh patient daily under standard
conditions.
 Monitor urine and blood glucose & HbA1C closely in
diabetics and patients with decompensated hepatic
cirrhosis. Drug may cause hyperglycemia.
 Trade Name Buscopan
Generic Name Hyoscine Butylbromide
Dosage Given via IV, 1mg/ml to promote cervical effacement.
Classification
Action Hyoscine Butylbromide
↓
Inhibits muscarinic actions of acetylcholine in the ANS
↓
Affecting neural pathway
↓
Relieves spasticity, nausea and vomitting; reduces secretions;
and blocks cardiac vagal reflexes.
↓
Promotes cervical effacement
Indication To reduce secretions perioperatively.
Contraindication Contraindicated in patients with angle-closure glaucoma,
obstructive uropathy, asthma, COPD, myasthenia gravis,
paralytic ileus, intestinal atony, & unstable CV.
Adverse Reaction  CNS: dizziness, headache, restlessness, disorientation,
irritability, fever
 GI: constipation, dry mouth, nausea, vomiting
 CV: palpitations, tachycardia, flushing
 EENT: dilated pupils, blurred vision, photophobia,
dysphagia
 GU: urinary hesitancy, urinary retention
 Skin: rash, dryness
Nursing Responsibilities  Be alert for adverse reactions and drug interactions.
 Encourage pt. to void
 Monitor BP for possible hypotension.
 Monitor cervical effacement and dilatation.
 Trade Name VITAMIN B9, PTEROYLGLUTAMIC ACID)
(fol'ic)

Generic Name Folic acid

Dosage 5 mg
Classification Vitamin B complex group, water soluble vitamin.
Action Vitamin B complex essential for nucleoprotein synthesis and
maintenance of normal erythropoiesis. Acts against folic acid
deficiency that impairs thymidylate synthesis and results in
production of defective DNA that leads to megaloblast
formation and arrest of bone marrow maturation.
Megaloblastic or macrocytic anemia caused by folic acid
deficeiency; hepatic caused by folic acid deficiency; hepatic
disease, alcoholism, hemolysis
Indication Folate deficiency, macrocytic anemia, and megaloblastic
anemias associated with malabsorption syndromes, alcoholism,
primary liver disease, inadequate dietary intake, pregnancy,
infancy, and childhood.
Contraindication Folic acidalone for pernicious anemia or other vitamin B12
deficiency states; normocytic, refractory, aplastic, or
undiagnosed anemia.
Adverse Reaction  Reportedly nontoxic. Slight flushing and feeling of
warmth following IV administration.
Nursing Responsibilities  Obtain a careful history of dietary intake and drug and
alcohol usage prior to start of therapy. Drugs reported to
cause folate deficiency include oral contraceptives,
alcohol, barbiturates, methotrexate, phenytoin,
primidone, and trimethoprim. Folate deficiency may
also result from renal dialysis.
 Keep physician informed of patient's response to
therapy.
 Monitor patients on phenytoin for subtherapeutic
plasma levels.