Maternal Medications – Uterotonic (Induction/Augmentation of Labor and/or

Prevention/Treatment of Hemorrhage)

1. Oxytocin (Pitocin)
● Route of administration: IV & IM
● Therapeutic uses: to induce or stimulate labor, to reduce postpartum bleeding after expulsion of placenta, or
incomplete or inevitable abortion.
● Adverse Effects: arrhythmias, abruptio placentae, postpartum hemorrhage, infant brain damage, bradycardia,
low apgar scores at 5 minutes, death.
● Client education: instruct pt to report adverse effects (site irritation, nausea, bleeding, blurred vision)
● Medication/ Food Interactions: cyclopropane anesthetics, drugs that prolong QT interval, misoprostol, and
vasoconstrictors.
● Nursing Interventions: All patients receiving oxytocin IV must be under continuous observation.
Discontinue infusion immediately if uterine hyperactivity or fetal distress occurs.
● Nursing Administration:
○ IV
■ never give simultaneously by more than one route
■ to induce labor, dilute drug by adding 10 units to 1 L of NSS, lactate ringers, or D5W.
■ To produce intense uterine contractions and reduce postpartum bleeding, dilute drug by
adding 10 units to 1,000 ml of NSS, lactate ringers, or D5W.
■ Don't give bolus injection, use an infusion pump only by piggyback.
○ IM
■ Drug isn't recommended for routine IM, but 10 units may be given IM after delivery of
placenta to control postpartum uterine bleeding.
● Evaluation of Medication effectiveness: Pt is in labor

2. Misoprostol (Cytotec)
● Route of administration: PO
● Therapeutic uses: to prevent NSAID induced gastric ulcer in patients at high risk.
● Adverse Effects: abdominal pain, diarrhea, miscarriage
● Client Education: Drug can cause abortion, premature birth, birth defects, and uterine rupture and is
contraindicated during pregnancy. Take the full course. May have diarrhea. Notify doctor if it last longer than
1 week; avoid food at alcohol that cause GI irritation
● Medication/Food Interactions: increased risk of diarrhea with magnesium containing antacids
● Nursing Interventions: monitor uterine cramping and bleeding during therapy; assess dilation of cervix
periodically during therapy
● Nursing Administration: administer with meals and at bedtime to reduce severity of diarrhea
● Evaluation of Medication Effectiveness: prevention of gastric ulcers in patients on chronic NSAID therapy;
termination of pregnancy; cervical ripening and induction of labor
3. Methylergonovine (Methergine)
● Route of administration: IM, IV, PO
● Therapeutic uses to prevent and treat postpartum hemorrhage caused by uterine atony or subinvolution;
uterine contraction
● Adverse Effects: HTN, N/V, cramps, stroke, dyspnea, tinnitus
● Client Education:
○ Take as directed to not skip or double doses; notify if infection occurs; notify of all OTC medications
taking
● Medication/Food Interactions:
○ Cigarette smoking and increase vasoconstriction
○ Grapefruit juice may increase levels; use with caution
○ May decrease the antianginal effects of nitrates
● Nursing Interventions: excessive vasoconstriction may result when used with heavy cig smoking or other
vasopressors (ie. dopamine)
● Nursing Administration: Admin at a rate of 0.2mg over at least 1 min
○ Monitor BP, HR and uterine response frequently during medication administration. Notify is uterine
relaxation becomes prolonged or character of vaginal bleeding changes
○ Assess for ergotism (cold, numb fingers and toes, chest pain, nausea, vomiting, headache, muscle
pain, weakness)
● Evaluation of Medication Effectiveness: contractions that maintain uterine tone and prevent postpartum
hemorrhage

4. Carboprost tromethamine (Hemabate)

● Route of administration: IM
● Therapeutic uses (focus on the indication listed below): to terminate pregnancy weeks 13-20 of gestation;
refractory postpartum hemorrhage that has not responded to conventional therapy
● Adverse Effects: diarrhea, N/V, uterine rupture, fever, angioedema, anaphylaxis
● Client Education: strictly adhere to recommended dosages and only use in a hospital that can provide
immediate intensive and acute surgical care; instruct patient to notify health professional immediately if
fever, chills, foul-smelling discharge, lower abd pain, or increased bleeding occurs
● Medication/Food Interactions: augments the effects of other oxytocic drugs
● Nursing Interventions:
○ Use with caution in pts with a hx of asthma, hypo- or HTN, cardiovascular, renal, or hepatic disease,
anemia, jaundice, diabetes, epilepsy, or pts with compromised (scarred) uterus.
○ Monitor BP, pulse, watch for hemorrhage. Examine for cervical trauma.
○ Possible teratogenic effects on fetus; 20% of abortions may be incomplete.
○ Do not use in pts with acute PID, active cardiac, pulmonary, renal or hepatic disease.
○ May result in excessive uterine tone, causing decreased uterine blood flow and fetal distress.
● Nursing Administration: avoid skin contact; store in refrigerator; rotate injection sites (doses repeated every
1.5-3.5 hours)
 ● Evaluation of Medication Effectiveness: complete abortion; control of postpartum or post-abortal
hemorrhage

5. Prostaglandin E2 (PGE2, Cervidil insert, Prepidil gel)

● Route of administration: suppository, gel
● Therapeutic uses (focus on the indication listed below): to terminate second-trimester pregnancy; to
evacuate uterine contents in missed abortion, intrauterine fetal death up to 28 weeks gestation, or benign
hydatidiform mole.
● Adverse Effects: amniotic fluid embolism (gel); uterine rupture, headache, diarrhea, N/V
● Client Education: explain purpose of medication; notify medical professional if fever, chills, and foul
smelling vaginal discharge, lower abdominal pain, or increased bleeding occurs; inform patient that she may
experience a warming sensation in her vagina during administration
● Medication/Food Interactions: augments the effects of other oxytocics
● Nursing Interventions: strictly adhere to recommended doses
● Nursing Administration: insert 20 mg suppository high into posterior vaginal fornix, repeat every 3-5 hours
until abortion is complete. Or Apply 0.5 mg gel intravaginaly, if cervix is unfavorable after 6 hours, repeat
dose.
● Evaluation of Medication Effectiveness: abortion is successful

Maternal Medications –Uterine Tocolytics and Antenatal Glucocorticoid Therapy (Preterm

Labor)

1. Terbutaline (Brethine)
● Route of administration: PO, Subcutaneous
● Therapeutic uses (focus on the indication listed below): Bronchospasm in patients with reversible obstructive
airway disease.
● Adverse Effects: arrhythmias, paradoxical bronchospasm with prolonged use.
● Client Education: instruct pt to report changes in HR or rhythm, which patient may experience as feeling
anxious, palpitations, or a racing heart.
● Medication/Food Interactions: Cardiac glycosides, cyclopropane,CNS stimulants, MAO inhibitors,
propranolol, sympathomimetics.
● Nursing Interventions: drug may reduce the sensitivity of spirometry for the diagnosis of bronchospasm.
Monitor pulmonary function and CV effects.
● Nursing Administration:
○ PO
■ Give without regard for food
 ○ Subcutaneous
■ Protect drug from light. Don't use if discolored.
● Evaluation of Medication Effectiveness: relaxes bronchial smooth muscle.

2. Indomethacin (Indocin)
● Route of administration: PO, IV, Rectal
● Therapeutic uses (focus on the indication listed below): moderate to severe RA or osteoarthritis, ankylosing
spondylitis. Acute gouty arthritis. Acute painful shoulders. Mild to moderate acute pain. To close a
hemodynamically significant patent ductus arteriosus in premature neonates.
● Adverse Effects: pancreatitis, GI bleeding
● Client Education: alert pt that using oral forms with other NSAIDs may increase risk of adverse GI reactions.
Teach pt signs and symptoms of GI bleeding, including blood in vomit, urine, or stool. Warn patients to avoid
hazardous activities that require mental alertness until CNS effects are known.
● Medication/Food Interactions: ACE inhibitors, aminoglycosides, anticoagulants, antihypertensives,diuretics,
corticosteroids, garlic, senna, white willow.
● Nursing Interventions: watch for immediately evaluate signs and symptoms of heart attack. NSAIDs cause
an increased risk of serious GI adverse events.Monitor patient on long term oral therapy for toxicity by
conducting regular eye exams, hearing tests,CBC, and kidney function test.
● Nursing Administration:
○ PO
■ Give drug with food, milk, or antacid
○ IV
■ Use only preservative free sterile saline solution or sterile water to prepare. If anuria or
marked oliguria is evident. Withhold administration of second or third scheduled IV dose and
notify prescriber. Watch carefully for bleeding and for reduced urine output.
○ Rectal
■ If suppository is too soft, place in refrigerator for 15 mins or run under cold water in wrapper.
● Evaluation of Medication Effectiveness: Pain relief

3. Nifedipine (Adalat, Procardia)

● Route of administration: PO
● Therapeutic uses (focus on the indication listed below):Vasospastic angina, hypertension, or ureteral calculi.
● Adverse Effects: lightheadedness,nervousness,peripheral edema, nasal congestion, nausea, muscle cramps,
and dyspnea.
● Client Education: tell pt that chest pain may worsen briefly as therapy starts or dosage increases. Advise
patient to avoid taking drug with grapefruit juice.
● Medication/Food Interactions: ACE inhibitor, Alpha 1 blocker, digoxin, diuretics, phenytoin, warfarin,
ginkgo, ginseng, st.john's wort, melatonin, grapefruit juice.
● Nursing Interventions: Monitor BP and HR regularly, watch for symptoms of HF, the most common adverse
effect is peripheral edema which occurs within 2-3 weeks of therapy. immediate-release drug is considered
 high risk for elderly patients because of the potential for hypotension. Use extended release form cautiously
because of an increased risk of serious GI obstruction in patients both with and without risk factors.
● Nursing Administration:
○ PO
■ Don’t use capsules SL to rapidly reduce severe high BP because the result may be fatal
■ Don't give immediate-release capsules within 1 week of acute MI or in acute coronary
syndrome.
● Evaluation of Medication Effectiveness: contractility and oxygen demand are decreased. As well as dilated
coronary arteries.

4. Betamethasone
● Route of administration: Topical
● Therapeutic uses (focus on the indication listed below): inflammation and pruritus from corticosteroid-
responsive dermatoses, inflammation and pruritus from corticosteroid-responsive dermatoses of scalp.
● Adverse Effects: HPA axis suppression, glycosuria, hyperglycemia, burning,dryness.
● Client Education: teach patient how to apply drug. Emphasize that drug is for external use only. Tell patient
to wash hands after application.
● Medication/Food Interactions: nothing significant
● Nursing Interventions: avoid using plastic pants or tight fitting diapers on treated areas in young
children.drug is not for ophthalmic use.
● Nursing Administration:
○ Topical
■ Apply sparingly to affected areas. Decrease dosing frequency to once daily if clinical
improvement. Don’t dispense foam directly into warm hands because foams will begin to
melt on contact.
● Evaluation of Medication Effectiveness: decreased inflammation
 Maternal Medications – Preeclampsia/Eclampsia
1. Magnesium sulfate
● Route of administration: IV
● Therapeutic uses: Seizures in preeclampsia or eclampsia
● Adverse Effects: Absent deep tendon reflexes, drowsiness, weak slow pulse, arrhythmias, diarrhea,
hypocalcemia, respiratory paralysis, diaphoresis, hypothermia
● Client Education: Explain use and administration of the drug, tell them to report adverse effects
● Medication/Food Interactions: Alendronate, fluoroquinolones, tetracyclines, cardiac glycosides, CNS
depressants, neuromuscular blockers, nifedipine
● Nursing Interventions: Keep IV calcium in hand to reverse effects, test knee jerk and patellar reactions
before next dose, check mag levels, monitor fluid intake/ output, monitor renal function, may contain
aluminum
● Nursing Administration: Administer bolus at a rate of 150 mg/ min or less or use an infusion pump
● Evaluation of Medication Effectiveness: Pt remains seizure free

2. Calcium gluconate
● Route of administration: IV
● Therapeutic uses: Treatment of magnesium intoxication
● Adverse Effects: Syncope, tingling sensation, bradycardia, arrhythmias, cardiac arrest,vasodilation, chalky
taste, cardiac arrest, hemorrhage, N/V, thirst abdominal pain, renal calculi, hypercalcemia, local reactions,
burning, necrosis, cellulitis, soft tissue calcification
● Client Education: Tell them to report anorexia, nausea, vomiting, tell prescriber if taking iron, don’t eat
rhubarb, whole grains, spinach bc it can interfere with calcium absorption
● Medication/Food Interactions: Bis Phosphorus, cardiac glycosides, fluoroquinolones, phenytoin,
tetracyclines, thiazide diuretics, verapamil
● Nursing Interventions: use cautiously in patients with sarcoidosis, renal or cardiac disease, double check that
you are giving the right med, monitor calcium levels frequently, watch for hypercalcemia (stupor, confusion,
delirium, coma)
● Nursing Administration: Verify that you have the right med, only give IV route, monitor ECG, extravasation
may cause necrosis and tissue sloughing, don’t exceed 200 mg/ minute
● Evaluation of Medication Effectiveness: Electrolyte levels are normal

3. Hydralazine (Apresoline)
● Route of administration: Injection/ Oral
● Therapeutic uses: Hypertension
● Adverse Effects: Headache, dizziness, chest pain, palpitations, orthostatic hypotension, nasal congestion,
conjunctivitis, N/V, constipation, neutropenia, dyspnea, rash
 ● Client Education:
● Medication/Food Interactions: Diazoxide, MAO inhibitors, diuretics, indomethacin, metoprolol, food
increases drug absorption
● Nursing Interventions: Monitor vitals closely, drug may be given with diuretics and beta blockers, elderly
are more sensitive to hypotensive effects, monitor closely for signs and symptoms of lupus like syndrome-
sore throat, fever, muscle and joint ache, rash
● Nursing Administration: Only give drug IV if it can’t be taken orally, don’t add to infusion solutions, drug
may be discolored if it comes into contact with metal, use immediately after vial is opened,
● Evaluation of Medication Effectiveness: Vitals are WNL

4. Labetalol- Trandate
● Route of administration: Injection/ Oral
● Therapeutic uses: Hypertension
● Adverse Effects: Fatigue, paresthesia, scalp tingling, syncope, vertigo, asthenia, orthostatic hypotension,
ventricular arrhythmias, nasal congestion, dyspepsia, urine retention, sexual dysfunction, bronchospasm, rash
● Client Education: Dont stop drug as it can cause a heart attack, dizziness is the most common effect, avoid
sudden position changes, some harmless scalp tingling may occurs at the beginning of therapy
● Medication/Food Interactions: Beta-agonists, cimetidine, CV drugs, diuretics, halothane, nitroglycerin,
NSAIDs TCAs, Ma huang
● Nursing Interventions: Monitor BP closely, monitor glucose levels, dont’ routinely withdraw long term beta
blockers therapy before surgery, some hepatic injury has been reported
● Nursing Administration: Give at bedtime or in small doses. When switching from IV to PO begin PO
regimen at 200mg after BP begins to rise, repeat with 200-400 mg in 6-12 hours, adjust according to BP
response
● Evaluation of Medication Effectiveness: decrease in BP

Maternal Medications – Labor Pain Relief

1. Opioid Agonist Analgesic (focus on class) Eg. fentanyl (Sublimaze)

● Route of administration: injection/transdermal patch/intranasal
● Therapeutic uses: used to relieve pain and induce sedation
● Adverse Effects: bradycardia, hypotension, sedation, arrhythmias, DVT, PE, constipation, N/V, urine
retention, respiratory depression,
 ● Client Education: drug appears in breastmilk, don’t take drug with benzodiazepines, CNS depressants, or
alcohol, instruct patient to ask for before pain becomes too intense, avoid hazardous activities until the
effects of drug subside
● Medication/Food Interactions: CNS depressants, antipsychotics, anxiolytics, barbiturates, and muscle
relaxants
● Nursing Interventions: Monitor for signs and symptoms of serotonin syndrome(if patient taking serotonergic
drugs), adrenal insufficiency, and decreased sex hormone levels. Monitor circulatory and respiratory status
and urinary function.
● Nursing Administration: for more analgesic effect give drug before patient has intense pain, keep opioid
antagonist(naloxone) and resuscitation equipment available , inject slowly over 1-2 minutes
● Evaluation of Medication Effectiveness: decreased pain level, appropriate level of sedation

2. Opioid Agonist-Antagonist Analgesic (focus on class) Eg. Nalbuphine (Nubain) and butorphanol (Stadol)
● Route of administration: injection
● Therapeutic uses: pain relief during labor and delivery; moderate to severe pain
● Adverse Effects: dizziness, headache, sedation, bradycardia, dry mouth, respiratory depression, diaphoresis
● Client Education: Monitor for signs of serotonin syndrome, adrenal insufficiency, and decreased sex
hormone levels. Caution ambulatory patient about getting out of bed or walking
● Medication/Food Interactions: CNS depressants, general anesthetics, hypnotics, MAO inhibitors, sedatives,
tranquilizers, serotonergic drugs, alcohol use, St. John’s wort.
● Nursing Interventions: reassess patient’s level of pain at least 15 and 30 minutes after parenteral
administration. Before starting use assess client’s risk of opioid abuse, misuse, or addiction.
● Nursing Administration: Inject slowly over at least 2-3 minutes into a vein or into an I.V. line containing a
compatible free-flowing I.V. solution such as D5W, NSS, or lactated ringer solution. Keep opioid
antagonist(naloxone) and resuscitation equipment available
● Evaluation of Medication Effectiveness: Decreased pain level, appropriate level of sedation

3. Naloxone (Narcan)
● Route of administration IV /IM SUbQ
● Therapeutic uses : reversal of mild respiratory depression that follows use of opioids, in some cases it may
need to be administered to the infant
● Adverse Effects: seizure, ventricular tachycardia, fibrillation, hypo/hypertension, cardiac arrest, sinus
tachycardia, pulmonary edema, dyspnea
● Client Education: Expected results
● Medication/Food Interactions: tramadol overdose increases seizures
● Nursing Interventions: Assess for withdrawal; assess for respiratory dysfunction; assess pain
● Nursing Administration: An initial 0.4-2.0mg can be administered Iv to the laboring mother, if the woman is
unresponsive it can be readministered every 2 to 3 minutes. Nurse should be prepared to provide basic airway
managgement
 ● Evaluation of Medication Effectiveness: should have a reverse of respiratory depression and increased LOC

4. Metoclopramide hydrochloride (Reglan) – pre-operative use

● Route of administration:Injection/Oral
● Therapeutic uses (focus on the indication listed below): to reduce or prevent postoperative nausea
● Adverse Effects: seizures, suicidal ideation, bradycardia, supraventricular tachycardia, neutropenia, prolactin
secretion, gynecomastia
● Client Education: DO not drink alcohol while taking drug, urge patient to report persistent or serious
adverse effects
● Medication/Food Interactions: Anticholinergics, opioid analgesics,Levodopa, MAO inhibitors, CNS
depressants
● Nursing Interventions: Monitor bowel sounds, monitor patient for involuntary movements of face, tongue,
and extremities which could indicate tardive dyskinesia. Monitor for CNS symptoms, irregular pulse or
abnormal BP
● Nursing Administration: NSS is preferred diluent (drug is most stable in this solution) GIve doses of 10mg or
less by direct injection over 1-2 minutes. Dilute doses larger than 10mg in 50mL of compatible diluent, and
infuse over 15 min, monitor BP closely. Drug does not need to be protected from light if infusion mixture is
given within 24hours.
● Evaluation of Medication Effectiveness: Client is not experiencing nausea

5. Epidural anesthesia
● Description of procedure: consists of a local anesthetic, bupivacaine, along with an analgesic, morphine or
fentanyl, injected into the epidural space at the level of the fourth or fifth vertebrae. This eliminates all
sensation from the level of the umbilicus to the thighs, relieving the discomfort of uterine contractions, fetal
descent, and pressure and stretching of the perineum.
● Indications: it is administered when the client is in active labor and dilated to at least 4 cm. Continuous
infusion or intermittent injections can be administered through an indwelling epidural catheter.
● Nursing Interventions: administer a bolus of IV fluids to help offset maternal hypotension as prescribed.
Help position and steady the client into a sitting or lying side-lying modified sims position with her back
curved to widen the intervertebral space for insertion. Encourage the client to remain in the side lying
position after insertion to avoid supine hypotension syndrome with compression of the vena cava. Coach the
client in pushing efforts, and request an evaluation of epidural pain management. Monitor b/p and pulse.
Maintain IV line, and have oxygen and suction available.
● Outcomes/Evaluations: pain is rapidly decreased and patient is still able to bear down.
● Potential complications: maternal hypotension, fetal bradycardia, inability to feel the urge to void, loss of the
bearing down reflex.
● Client Education: Provide client education regarding controlled analgesia, if used.
6. Spinal anesthesia
● Description of procedure: consists of using analgesics such as fentanyl and sufentanil, which are short-
acting opioids that are administered as a motor block into the epidural or intrathecal space without
anesthesia. These opioids produce regional analgesia, providing rapid pain relief while still allowing the
client to sense contractions and maintain the ability to bear down.
● Indications: via request from the patient giving birth
● Nursing Interventions: institute safety precautions, such as putting side rails up on the client's bed. The
client can experience dizziness and sedation, which increases maternal risk for injury. Access for nausea and
emesis, and administer antiemetics as prescribed. Monitor maternal vital signs per facility protocol. Monitor
for allergic reaction. Continue FHR pattern monitoring.
● Outcomes/Evaluations: pain is rapidly decreased and patient is still able to bear down.
● Potential complications: Decreased gastric emptying resulting in nausea and vomiting. Inhibition of bowel
and bladder elimination sensations. Bradycardia or tachycardia. Hypotension. Respiratory depression.
Allergic reaction and pruritus. Elevated temperature.
● Client Education: Provide the client with ongoing education related to expectations for the procedure.

Maternal Medications – Postpartum Care

1. Ibuprofen
● Route of administration:IV, PO
● Therapeutic uses (focus on the indication listed below): Mild to moderate pain, fever, dysmenorrhea.
● Adverse Effects: GI bleed, hepatitis, headache, allergic reactions, N/V
● Client Education: tell patient to take with meals or milk to reduce adverse GI reactions. Advise patient to
wear sunscreen to avoid hypersensitivity to sunlight.
● Medication/Food Interactions: anticoagulants, antihypertensives, aspirin, SSRI, ginger, ginkgo, white
willow.
● Nursing Interventions: NSAID can increase risk of heart attack or stroke in patients with or without heart
disease or risk factors for heart disease.
● Nursing Administration:Use caution: enters breast milk in small amounts. Do not use in pts with
hypersensitivity to ibuprofen, aspirin, or other NSAIDs. May increase risk of GI bleeding, irritation,
ulceration, and perforation. Not recommended for pregnant patients; has been associated with persistent
pulmonary HTN in infants.
● Evaluation of Medication Effectiveness: Pain is at tolerable rate

2. Tylenol
● Route of administration: PO, IV, Rectal
● Therapeutic uses (focus on the indication listed below): Mild- moderate pain, HA, fever
● Adverse Effects: hepatic and renal failure, rash, urticaria
● Client Education: advise patient or caregiver
● Medication/Food Interactions:
 ● Nursing Interventions: Delayed absorption if given with food. Don’t use with alcohol, teach S/ S of
hepatotoxicity, consult healthcare provider if temp is greater than 103 for more than 3 days
● Nursing Administration:
● Evaluation of Medication Effectiveness:

3. Tylenol with codeine #3

● Route of administration : oral
● Therapeutic uses: mild to moderate pain; antitussive in small doses
● Adverse Effects: possible allergic reactions; respiratory depression, constipation, decreased focus and
cognitive function; blurred vision; hypotension; sedation; confusion
● Client Education
○ Do not take more than 4g of acetaminophen per day due to hepatotoxicity
○ Avoid alcohol when taking Tylenol 3

● Medication/Food Interactions:
○ Tylenol: warfarin (INR should not exceed 4); concurrent use of rifampin, phenytoin, isoniazid; other
NSAIDS; propranolol
○ Codeine: do not take with MAOI’s, alcohol; taking with kava-kava, valerian, chamomile and increase
CNS depression
● Nursing Interventions:
○ Assess for rash development during therapy
○ Reassess pain 30 minutes after administration
○ Acetylcysteine antidote of Tylenol if overdose occurs
○ Assess level of sedation if respirations are less than 10/min
○ Narcan if suspected overdose
● Nursing Administration
○ Dosing based on weight under 50kg
○ Administer with full glass of water and can be taken with food or on an empty stomach
○ May be administered with food or milk to minimize GI irritation
● Evaluation of Medication Effectiveness: relief of mild to moderate pain without significant alteration in
level of consciousness

4. Acetaminophen and oxycodone (Percocet)

● Route of administration: Oral
● Therapeutic uses: Moderate to severe pain
● Adverse Effects: Fatigue, headache, hypotension, shock, dry mouth, constipation, N/V, dysuria, anemia,
respiratory arrest, rash, anaphylactic reaction
● Client Education: caution taking drugs with other CNS depressants, look for acetaminophen on labels of all
prescription and only take one product with acetaminophen, report problems breathing, may be habit
forming, swallow pill whole
● Medication/Food Interactions:
 ● Nursing Interventions: Monitor circulatory and respiratory status within the 24 hours, start out with the
lowest amount possible, assess clients risk for dependency, watch for signs of serotonin syndrome, monitor
for low sex hormones
● Nursing Administration: Store at room temperature
● Evaluation of Medication Effectiveness: Patients pain is at a tolerable level

5. Hydrocodone bitartrate/acetaminophen (Norco)

● Route of administration: Oral
● Therapeutic uses: Moderate to Severe pain
● Adverse Effects: mental clouding, dizziness, anxiety, stupor, coma, bradycardia, cardiac arrest, hearing loss/
impairment, gastric upset, urine retention, low blood counts, hypoglycemia, respiratory depression, rash,
clammy skin, allergic reaction
● Client Education: Dont take with an opioid, take drug before pain becomes severe, explain assessment and
monitoring process, only take meds as prescribed, caution that addiction with this med, avoid alcohol
● Medication/Food Interactions: anticholinergics, antidepressants, antihistamines, MAO inhibitors,
barbiturates, phenothiazines, kava, valerian, st john’s wort, alcohol
● Nursing Interventions: watch for skin reactions, CNS depression, and trouble breathing
● Nursing Administration: Give with food/ milk
● Evaluation of Medication Effectiveness: Client is at a tolerable pain level

6. Morphine sulphate
● Use: Moderate to severe pain
● Adverse Reactions: Seizures, bradycardia, cardiac arrest, shock, apnea, respiratory depression
● Drug Interactions: Benzodiazepines, CNS depressants, cimetidine, general anesthetics
● Food interactions: Alcohol, st john's wort
● Nursing Considerations: Assess for risks for addiction, monitor for respiratory depression
● Patient teaching: Tell patients not to take meds with CNS depressants or alcohol, report all meds being
taken, watch for signs of serotonin syndrome, caution ambulatory patients when getting out of bed
● Evaluation: Client’s pain level is at an acceptable level

7. Ketorolac tromethamine (Toradol)

● Route of administration: PO, IV, IM
● Therapeutic uses: Short term management of moderately severe, acute pain
● Adverse Effects: headache, dizziness, arrhythmias, dyspepsia, GI pain/ upset, peptic ulceration, renal failure,
decreased platelet aggregation, prolonged bleeding time, purpura, diaphoresis, rash, pain at injection site
 ● Client Education: Don’t take with other NSAIDS, seek medical attention for shortness of breath and chest
pain, maintain an adequate fluid intake, report edema/ weight gain, watch for signs of hepatotoxicity, notify
prescriber if pregnant, watch for signs of GI bleeding, don’t take for more than five days in a row
● Medication/Food Interactions: ACE inhibitors, anticoagulants, anticonvulsants, antihypertensives,
disulfiram, lithium, methotrexate, pentoxifylline, dong quai, feverfew, garlic, ginger, horse chestnut, red
clover, white willow, alcohol
● Nursing Interventions: Correct hypovolemia before giving meds, don’t use epidural or intrathecal, dont give
with NSAIDS
● Nursing Administration: IV: dilute with NSS, D5W, lactated ringers, give injection over 15 seconds, protect
from light, IM: put pressure on injection site
● Evaluation of Medication Effectiveness: Client’s pain level is at a tolerable level

8. Hydrocortisone acetate (Tucks)...Witch Hazel? Pg 1690 no info

● Route of administration: topical
● Therapeutic uses: local anesthesia, decrease pain and pruritus
● Adverse Effects: burning, edema, irritation, stinging, tenderness
● Client Education: instruct proper application technique and inform of potential overuse; avoid contact with
eyes; discontinue use of skin becomes more irritated
● Medication/Food Interactions
○ Use cautiously in pediatrics due to increase risk of systemic toxicity
○ Should not be used in patients <2yrs. Old
○ Action may be increased with concurrent use of cholinesterase inhibitors (Aricept)
● Nursing Interventions
○ Asses pain and discomfort prior to administration
○ Assess skin integrity of site
● Nursing Administration:
○ Avoid overuse or liberal application (can cause methemoglobinemia)
● Evaluation of Medication Effectiveness: temporary relief of discomfort associated with minor irritations of
skin of mucous membranes

9. Docusate sodium (Colace)

● Route: oral, rectal
● Dosage/Range: 50-500 mg PO divided qid
 ● Onset/Peak/Duration:
○ Oral: 12-72hrs./ unk/unk
○ Rectal: 2-15min./unk/unk
● Therapeutic Uses: Constipation; adjunct to painful anorectal conditions (hemorrhoids)
● Contraindications: Don’t use with mineral oil; intestinal obstruction, acute abdominal pain, N/V
● Implementation: give with full class of water or juice; may be diluted in milk or infant formula
● Nursing Considerations: Take with full glass of water; no laxative action; do not use > 1 week
● Client Education: does not stimulate peristalsis and may need stimulant laxative for constipation
● Adverse Effects: throat irritation, mild cramps, rash

10. Simethicone (Mylicon)

● Dosage/Range: PO40-125mg QID
● Onset /Peak/ Duration: immediate/ N/A/ 3 hrs
● Therapeutic Use: decrease GI gas formation
● Indication: Relief of pain caused by gas in the GI tract
● Contraindications: not recommended for infant with colic
● Interactions: none significant
● Education:
○ Explain the importance of diet and exercise to prevent gas
● Nursing Considerations: assess abd pain, bowel sounds, and distention during therapy. Assess frequent
belching and passage of flatus
● Implementation: administer after meals and at bedtime for best results; shake liquid preparations well;
chewable tablets should be chewed thoroughly for best results; can be mixed in fluid if needed
● AE: no significant side effects
● Evaluation: decrease in abdominal distention and discomfort

11. Rubella vaccination

● Route: IM injection
● Dosage/Range: 0.5 mL Subcutaneous
● Onset /Peak/ Duration: 2-4 weeks/ unk/unk
● Indication: prevents infection by the Rubella virus by stimulating the body to produce antibodies
● Contraindications: do not become pregnant for three months following immunization
● Nursing Considerations: assess pts for signs of allergic reaction following administration

12. Tdap (tetanus, diphtheria, and pertussis) vaccination

● Route of administration: IM injection
● Therapeutic uses: reduce the possibility of contracting tetanus, diphtheria, and pertussis
● Adverse Effects: redness and irritation at site; fever, fussiness, poor appetite, vomiting can sometimes occur
1-3 days after injection
● Client Education: the child should not receive the booster if there was an allergic reaction to the first
injection
 ● Medication/Food Interactions:
○ Blood thinners, corticosteroids, chemotherapy, immunosuppression agents
● Nursing Interventions:
● Nursing Administration:
○ 0.5mL IM at 2, 4, 6, 15-18 mo and 4-6 yrs (first dose may be given as early as 6 weeks and 4th dose may
be given as early as 12 mos)
● Evaluation of Medication Effectiveness: patient does not contract infection and does not experience allergic
reaction

13. Flu vaccination

● Route of administration: nasal, IM
● Route/Dosage:
○ Intranasal (adults and children 9-49yrs.): one dose per season
○ Intranasal (2-8yrs.): previously immunized with FluMist - one dose (0.2 mL per season); not
previously immunized (0.2 mL 30 days apart for initial season)
● Therapeutic uses: decreased influenzal illness, with fewer days lost from school or work if contracted
● Adverse Effects: headache, rhinitis, nasal congestion, fever
● Client Education: explain purpose to parent for vaccination; avoid contact with immunocompromised for at
least 21 days
● Medication/Food Interactions
○ Concurrent antiviral therapy
○ Concurrent use of aspirin or salicylates in children and adolescents may increase risk of Reye’s
syndrome
● Nursing Interventions: assess for asthma or reactive airway disease
● Nursing Administration:
○ Do not administer antivirals within 48hrs before or 2 weeks after
○ Do not administer FluMist concurrently with other vaccines, or in patients who have received a live
virus within 1 mo or an inactivated vaccine within 2 weeks of vaccination.
● Evaluation of Medication Effectiveness: prevention of infleunza

14. Rho(D) immune globulin (RhoGAM)

● Route: IM, IV (management of immune thrombocytopenic purpura
● Use: prevention of antibody response and hemolytic disease of the newborn; decreased bleeding in patients
with ITP
● Dosage/Range: Rh Immune Globulin for IM only: 1 vial standard dose (300 mcg) w/in 72 hrs of delivery Rh
Immune Globulin IV (for IM or IV use)WinRho – 600 IU (120mcg) OR Rhophylac – 1500 IU (300 mcg) w/in 72
hr of delivery
● Adverse Reactions: dizziness, headache, rash, intravascular hemolysis, fever, pain at the injection site
● Onset /Peak/ Duration IM: rapid/ 5-10 days/ unk; IV: unk/2 hr /unk Indication: Admin to Rh- pts who have
been exposed to Rh+ blood
 ● Patient Education: explain to the patient that the purpose of this medication is to protect from RH0-positive
infants
● Contraindications: prior allergic rxn to human immunoglobulin
● Nursing Considerations: Do not confuse IM and IV formulations. Rh Immune Globulin (microdose and
standard dose) is for IM use only and cannot be given IV. Rh Immune Globulin IV may be given IM. Admin at
room temp IM into deltoid – should be given within 3 hrs but may be given up to 72 hr after delivery IV admin
over 3-5 min
● Evaluation: prevention of erythroblastosis fetalis in RH positive infants; prevention of RH sensitization
following incompatible transfusion; decreased bleeding episodes in patients with ITP

15. Lanolin ointment

● Route: topical
● Indication: Sore, cracked nipples
● Contraindications/Nursing Considerations: area may burn, sting or become red
● Duration: 6-8 hours topically
● Adverse Effects: burning, stinging, redness and irritation
● Interactions: none known
● Nursing Considerations: avoid eye contact and cleanse area before application
● Evaluation: decreased nipple irritation

Newborn Medications
1. Vitamin K: Phytonadione (Aquamephyton)
● Dosage/Range: 0.5-1 mg IM, within 1 hr of birth, may repeat in 6-8 hrs if needed.
● Onset /Peak/ Duration: 1- 2 hours/ Normal PT achieved 12 to 14 hours.
● Therapeutic Use: prevention of bleeding due to hypoprothrombinemia
● Indication: Prevention of hemorrhagic disease of the newborn.
● Interactions: warfarin, mineral oil
● Contraindications: Use cautiously with impaired liver function.
● Nursing Considerations: Monitor for frank and occult bleeding (guaiac stools, Hematest urine, and emesis).
Monitor pulse and blood pressure frequently; Apply pressure to all venipuncture sites for at least 5 min; avoid
unnecessary IM injections.
● AE: pain at site, hyperbilirubinemia if dose is too large, kernicterus, rash, unusual taste
● Education: take as directed; use soft toothbrush and do not floss

2. Erythromycin ophthalmic ointment 0.5%

● Dosage/Range: 0.5 to 1 cm strip along lower conjunctival surface of each eye, inner canthus to outer canthus.
● Onset /Peak/ Duration: Onset/Duration: unlisted for topical medications. It is safe to wipe away excess
medication after 1 hour. Indication: Prevention of infection with neonatal conjunctivitis and ophthalmic
neonatorum, which may be passed to infant from mother during birth
 ● Indications: may be used in pregnancy to treat chlamydial infections or syphilis
● Interactions: may increase warfarin levels and risk of bleeding; increase serum digoxin levels
● Contraindications/Nursing Considerations:
○ Wash hands before applying.
○ Observe for hypersensitivity. Possible side effects include sensitivity reaction, inability to focus
(temporarily), edema, inflammation.
○ Apply before 1 hour after birth.
● AE: rash, allergic rxn, ototoxicity, resolution of signs and symptoms of infection
● Evaluation: prevention of infection following birth; decreases transmission of STD from mother to newborn

3. Hepatitis B vaccination (Recombivax HB, Energix-B)

● Dosage/Range: Children and Adolescents 0 to 19 yr of age. IM 5 mcg at 0, 1, and 6 mo.
● Onset /Peak/ Duration: Duration: prolonged immunity (years).
● Indication: Results in endogenous production of antibodies to protect against HBV for those who are now or
may be
at risk of contracting HBV in the future.
● Contraindications: hypersensitivity to previous hepatitis vaccine, to preservatives, or other additives (may
contain
thimerisol, neomycin, and/or egg protein).
● Nursing Considerations: Assess for fever >39.5, dyspnea, hives, urticaria, severe lethargy or weakness,
convulsions, or swelling of eyes, face, or inside of nose.
● AE: allergic rxn

4. Hepatitis B immune globulin

● Dosage/Range: Newborns of HBsAg-Positive Mothers IM 0.5 mL.
● Onset /Peak/ Duration: Onset of immunity is rapid. Duration is up to 3 months.
● Indication: Provides passive immunization to hepatitis B following exposure
● Contraindications: hypersensitivity to previous hepatitis immune globulin, to preservatives, or other
additives (may contain thimerosal, neomycin, and/or egg protein).
● Interactions: may interfere with the immune response to live-vaccines

● Nursing Considerations:
○ Assess for fever >39.5, dyspnea, hives, urticaria, severe lethargy or weakness, convulsions, or swelling
of eyes, face, or inside of nose
○ For passive immunity, determine the date of exposure to infection. Hepatitis B immune globulin
should be administered within 24 hours but no later than 7 days after exposure.
● Implementation: solution should be clear, slightly amber, and viscous; keep in refrigerator
● AE: allergic rxn, pain/redness at injection site
 ● Education: report signs of anaphylaxis immediately
● Evaluation: prevention of hepatitis B infection by providing passive immunity

5. Oral sucrose
● Route of administration: oral
● Therapeutic uses: minor procedures known to cause pain in infants and young children
● Adverse Effects:
● Client Education:
○ Ensure parents know the reason behind this chosen intervention.
● Medication/Food Interactions
● Nursing Interventions:
● Nursing Administration:
○ Premature infants at risk
○ Neonates with hypo- or hyperglycemia should be cautioned to use
○ No analgesic effect if medication if given via NG tube
○ Administration may be easier if parents holds child
● Evaluation of Medication Effectiveness: analgesia

6. Acetaminophen
● Route of administration: Oral
● Therapeutic uses: mild pain or fever
● Adverse Effects: headache, pyrexia, N/V, hypokalemia, muscle spasms, hypoxia, pulmonary edema
● Client Education: Drug is only for short term use, do not use for marked fever(temp higher than 103.1
degrees), contact patient about signs and symptoms of liver damage. Drug appears in breastmilk in low levels.
● Medication/Food Interactions: alcohol
● Nursing Interventions: use caution when prescribing, and preparing, and administering IV acetaminophen
to avoid dosing errors
● Nursing Administration: Many OTC drugs contain acetaminophen. Take that into consideration when
calculating total daily dose.
● Evaluation of Medication Effectiveness: Decreased pain level

7. Naloxone hydrochloride (narcan)

● Dosage/Range: 0.4 mg IV, IM, SC (or 10 mcg/kg), may repeat a 2-3 mins.
● Onset/Peak/Duration: IV: 1-2 mins/unk/45 mins
● Indication: opioid overdose
● Adverse Effects: ventricular arrhythmias, hypertension, hypotension, nausea, vomiting
● Interactions: precipitate withdrawal in patients who are dependent on opiates
● Contraindications: Hypersensitivity
● Nursing Considerations: monitor RR, rhythm and depth, HR, ECG, BP and LOC for 3-4 after dose given; pt
may be extremely sensitive to narcan
● Implementation:
○ Resuscitative equipment should be available.
○ Administer a single spray into 1 nostril. If patient does not respond or relapses into respiratory
depression, additional doses may be given every 2-3 minutes in alternating nostrils.