lOMoARcPSD|7393617

OB med list - Lecture notes 2

Maternal-Child Nursing ( Chamberlain University)

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Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

DRUG NAME OB OB CONTRAINDICATIONS DOSAGE ROUTE FREQUENCY MISC.

(brand/generic) INDICATIONS INFORMATION
Betamethasone Releases Hypersensitivity to 12mg injection, 2x, IM 2 injection Pulmonary edema
(Celestone) enzymes that betamethasone 12-24 hours apart Ventral dose when given in
Pd 586 produce and Systemic infections- fungal gluteal or 12-24 hours conjunction with
release lung or tb vastus apart beta-adrenergic
surfactant to lateralis Administer drugs
STERIOD stimulate lung muscles 24-34 Hyperglycemia- with
maturity in a gestation pregestational or
fetus gestational diabetes
Hypertension
Fetal decreased
breathing and body
movements
Magnesium Preterm labor Avoid using for more then Severe deficiency 8- IM/IV varies SA/E
Sulfate Prevent and 5-7 days for preterm; avoid 12g/day in divided Limit IV CNS: Drowsiness
treat seizures continuous use during does; mild fluids to Resp: Decrease RR
Parenternal active labor or within 2 hr deficiency 1 g q 6 125ml/hr CV: Arrhythmias,
VITAMIN magnesium is of delivery due to potential hrs or 250 mg/kg Have bradycardia,
used for clients for magnesium toxicity in over 4 hours calcium hypotension
who have ATI: Loading dose gluconate GI: Diarrhea
newborn.
severe 4-6 g intermittent available MS: Muscle
Passes through the
hypomagnesemi IV bolus over 15-30 Weakness
a placenta, assess status of mins ATI: Burning at IV
IV magnesium fetus Administer site, warmth,
sulfate is used maintenance dose flushing, diaphoresis
to stop preterm ATI: by continuous Nausea and vomiting
labor and Myasthenia gravis infusion at 2g/hr Drowsiness,
anticonvulsant Kidney failure Monitor headache, blurred
during labor and Hypocalcemia therapeutic levels vision, dizziness, loss
delivery (4-7mEq/L) of deep tendon

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

Place patient on left reflexes,

side Maternal
hypotension,
bradycardia,
bradypnea
Altered LOC,
Decreased urine
output
Magnesium toxicity
Pulmonary edema
Reduced variability of
fetal HR

Calcium Should be Pregnancy Class C: Animal PO 0.5- 2 g daily PO 2-4 SA/E

Gluconate available to studies have shown an IV 2-15g/day divided doses CNS: HA, tingling
reverse adverse effect and there IV continuous CV: Syncope,
magnesium are no adequate and well infusion or in CARDIAC ARREST,
THINK VITAMIN toxicity and controlled studies in divided doses arrhytymias,
prevent pregnant women bradycardia,
respiratory GI: Constipation, NV
arrest if serum
levels become
high
Procardia Calcium channel Oral loading dose: PO Hypertension Maternal flushing,
(Nifedipine) blocker used for Contraindicated in women 10-20mg = BID or TID dizziness,
hypertension. with hypotension, heart Continued oral Preterm headache, nausea
HEART Can be used to failure or disorders that therapy: 10-20mg q Labor= every Transient maternal
relax uterine affect muscle strength 3-6 hr until 20 min until tachycardia
contractions for Avoid concurrent with contractions are contractions Mild hypotension
preterm labor magnesium sulfate rare followed by are under Modest increase in
blood glucose

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Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

(suppressing terbutaline long acting control levels

preterm labor) formulations of 30-
Vasodilator 60mg q 8-12 hours
until antepartum
steroids have been
administered
Labetalol SA/E
Orthostatic
Pregnancy class C: Animal hypotension
HEART studies have shown risk to Initially: 100 mg 2x/ Tingling sensation in
the fetus, there are no day skin
Hypertension controlled studies in PO/ iv 2x/day Nausea
women, or studies in Maintenance: 200- Dizziness
women and animals are 400 mg/day Nasal congestion
not available Fatigue
Hydralazine Eclampsia Caution is essential when 20mg/mL ?? IM 5mg q15-20 Hypotension
Apresoline Vasodilator that antihypertensive IV mins no
increases medications are given to PO response,
HEART cardiac output women receiving after 20mg
and blood flow magnesium sulfate use dif.
to the placenta because hypotension may therapy
result reducing placental
perfusion
Cervidil Prostaglandin Cesarean birth, fetal CERVIDIL Vaginal Vaginal CERVIDIL Uterine tachysystole
(Dinoprostone) used to distress, vaginal bleeding Insert (10 mg) Insert should be (hyperstimulation of
promote Use with caution with removed uterine contractions)
cervical ripening maternal history of upon onset of
UTERUS and to stimulate hypotension, hypertension active labor,
uterine and asthma 12 hours or
contractions membrane
rupture

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

Cytotec Used in clients Women who have already 1 quarter of Po/ Single dose Hyperstimulation of
(Misoprostol) taking long-term had cesarean birth(s) or 100mcg tablet Vaginally for cervical uterus is major
NSAID to uterine surgery (0.25mcg) ripening, adverse effect, used
prevent gastric Labor induction: (oral for in setting with fetal
UTERUS ulcers repeat 0.25mcg q 3- gastric 3-6 hrs for monitoring and
Used in 6 hours ulcers) induction of emergency care are
pregnancy only Higher dose is labor readily available.
to induce labor more likely to cause
by causing excessive
cervical ripening contraction which
(Not FDA may or may not be
approved) accompanied by
non reassuring fetal
HR pattern

Pitocin Inducing labor, Contraindicated with Common mixtures: IV 0.5-6 Hypersensitivity to

(Oxytocin) control placenta previa, vasa 15 units of oxy plus IM milliunits/min drug, hypertonic
Read pg 309 postpartum previa, nonreassuring fetal 250 ml of solution Increases to uterine activity
bleeding heart rate pattern, 30 units + 500ml 1-2 milliunits/ (tachysystole),
UTERUS Management of abnormal fetal solution mins impaired uterine
inevitable or presentation, prolapsed 60 units + 1000ml increments q blood flow, uterine
incomplete umbilical cord, active of solution 15-40 mins rupture, abruptio
abortion genital herpes, pelvic placenta.
structural deformities, Lower
invasive cervical carcinoma concentrations.
10-20 units
+1000ml solution
Terbutaline Beta2 Cardiac disease, 2.5-7.5mg tablet PO PO q6h S/E: pulmonary
(Brethine) adrenergic hypertension or To delay preterm IV edema, dyspnea,
agonists used preeclampsia, labor cough, tachypnea
to stop preterm hyperthyroidism, Tachycardia,

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

UTERUS labor, smooth uncontrolled DM, recent myocardial ischemia,

muscle (w/n 14 days) use of chest pain,
relaxation MAIOs, angle-closure palpitations,
glaucoma hypotension
Hypersensitivity Hypokalemia
Use caution with chronic Hyperglycemia
hepatic disease, renal
disease
O2

Methergine
(methylergonovi Contracts the IM: repeat SA/Es
ne) uterus and is every 2-4 Monitor vitals
used for serious hours PRN Monitor for
Postpartum Hypertension, 0.2 mg IM following IV: routine IV manifestations for
hemorrhage, preeclampsia, asthma, delivery of the IM is not rec. hypertensive crisis
UTERUS associated with cardiac disease placenta IV PO:3-4x daily (headache, nausea,
uterine atony or 0.2 mg IV slowly PO —do not vomiting, increased
subinvolution Use with caution with over 60 seconds exceed one blood pressure
after delivery of maternal history of severe 0.2 mg PO week (HTN))
the placenta renal or hepatic disease,
diabetes mellitus, sepsis Serious SA/E
Uterine and epilepsy MI
hemorrhage, Use only after delivery and Seizure
during the not during labor
second stage of
labor after
delivery of the
anterior
shoulder

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

Hemabate Stimulates Contraindicated for Postpartum: 250mg IM (deep) Additional Excessive dose may
(carboprost contractions of women with intramuscularly doses can be cause tetanic
tromethamine) the uterus hypersensitivity to admin in contraction and
Used for the carboprost or other intervals of laceration or uterine
treatment of prostaglandins 15-90 min; no rupture. May cause
UTERUS post partum Acute pelvic inflammatory more than hypersensitivity if
hemorrhage disease 2mg (8doses) used with oxytocin.
caused by Cardiac, pulmonary, renal, Nausea, vomiting,
uterine atony and hepatic disease diarrhea, fever, chills,
Used for Use with caution with facial flushing,
abortions patients who have a headache,
history of asthma, hyper/hypotension,
hypotension, tachycardia,
hypertension, anemia, pulmonary edema
jaundice, diabetes,
epilepsy or previous
uterine surgery
Tucks Relieved Discontinue use if bleeding 1 wipe/pad up to 6 Topical Up to 6 times Do not exceed
burning, itching occurs, condition worsens/ times daily or after daily recommended usage,
GI irritation related does not improve within 7 each bowel do not insert
to hemorrhoids days movement (external use only)
Simethicone To relieve No formally assigned Dosage varies (125 Oral As needed No known side
pressure, pregnancy category mg ; 60 mg ; 95 after meals or effects
GI bloating and/or mg ; 40 mg/0.6 mL ; before
gas 180 mg ) bedtime; do
not make up
for missed
dosages
Bicitra The liquid form of PO 4 Times a day muscle twitching or
(sodium citrate) It neutralizes You should not use this this medication cramps, swelling or
the acid in the medication if you have must be mixed with weight gain,

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

at least 4 ounces weakness, mood

GI stomach. kidney failure, severe heart (120 milliliters) of changes, rapid and
Pregnant damage (such as from a water or juice shallow breathing,
women tend to prior heart attack), before taking. fast heart rate,
have a little bit Addison's disease (an restless feeling, black
more acid in adrenal gland disorder), or bloody stools,
their stomach high levels of potassium severe diarrhea, or
than. If she does seizure.
feel nauseous or
sick during
surgery.

Indocin Used to inhibit Used only for preterm 50 mg loading dose PO Maintenance nausea, vomiting,
(Indomethacin) prostaglandin labor before 32 weeks 25 mg maintenance dose Q6hr for heartburn,
synthesis, dose 48 hrs increase BP,
stopping uterine Women who are sensitive Constriction of
UTERUS contractions to aspirin may experience Do not use ductus arteriosus in
episodes of asthma longer than fetus is used more
48-72 hrs than 48-72 hrs, renal
impairment of fetus
in those who are
over 32 weeks

Promethazine Prevent and Pregnancy category C 12.5-25mg IV Q4-6h Dilution and slow
Phenergan relieve nausea Contraindicated in Dilute in 10-20ml of infusion into a large
often associated pediatric patients 0.9% normal saline vein reduces risk of
with opioids or 50 ml normal tissue necrosis
GI saline Duration of action is
Administer over 10- longer than most

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

20 minutes narcotic; may

enhance respiratory
depressant effects of
narcotics
Reglan Anti-nausea Pregnancy Category B 10mg q6-8hr PO q2-4h Restlessness, anxiety,
(metoclopramid Works by Should be avoid in the first IM irritability,
e) speeding up and third trimester if IV hyper/hypotension
gastric emptying possible
GI
Loperamide Pregnancy class B: No risk
in other studies: Animal 4 mg PO Followed by 2 SA/Es
(Imodium) Diarrhea reproduction studies have mg after each Hyperglycemia
failed to demonstrate a loose stool up Abdomnial pain
risk to the fetus and there to a N, V
GI are no adequate and well- maximum of Xerostomia
controlled studies in 16 mg/day Dizziness
pregnant women OR Somnolence
Animal studies have shown fatigue
an adverse effect, but
adequate and well-
controlled studies in
pregnant women have
failed to demonstrate a
risk to the fetus in any
trimester.
Nubain Pain during Delivery within 1-4 hours 10mg/mL/20mg/mL IM q3-6 hours Cat C
(nalbuphine) labor of administration 10mg; SUB-Q Dizziness, HA,
Moderate to If opioid is given too soon, max:20mg/dose or IV sedation, dry mouth,
severe pain it can delay the 160mg/day nausea and vomiting,
PAIN progression of labor; if too neonatal depression,
late, can depress neonatal clammy feeling,

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Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

respirations diaphoretic, sedation

Toridol Ketorolac or Administration of NSAIDs PO: 20 mg once PO Q6hr Upset stomach,
ketorolac during the latter part of after IV or IM IM nausea, vomiting,
PAIN tromethamine is pregnancy may cause therapy, THEN 10 IV constipation,
a non-steroidal premature closure of the mg q4-6hr; not to diarrhea, gas,
Mild anti- fetal ductus arteriosus, exceed 40 mg/day dizziness, or
inflammatory fetal renal impairment, drowsiness may
drug in the inhibition of platelet occur
family of aggregation, and delay
heterocyclic labor and delivery
acetic acid
derivatives,
used as an
analgesic
Stadol Opioid analgesic Opioid-dependent women, 1 mg; range 0.5-2 IV, PCA, Every 3-4 hrs Respiratory
Butorphanol given for pain respiratory disease, If mg; may be diluted oral depression, apnea,
relief during woman is on other PCA- prn dizziness, fainting,
PAIN labor medications that could Assess nausea, vomiting,
Post episiotomy produce narcotic respiratory altered HR and BP
pain antagonist effects status do not drowsiness, lethargy,
Moderate to administer if confusion, flushing,
severe pain <12/minute, dry mouth, delirium,
report euphoria, excitement
significant
finding in
blood
pressure or
barnyards,
observe
newborn for
signs if

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

respiratory
depression,
IV
administratio
n slowly, IM
rotate sites

Hepatitis B Vaccine Immunization with a live- 3 shots IM First shot Sore limb, redness at
preventing vaccine is contraindicated within 12 hrs site, fever, fatigue,
SHOTS infection of in pregnant women, of birth, head ache
Hepatitis B second dose
infection to Hypersensitivity to yeast 1-2 months,
exposed and 3rd 6-18
unexposed months
infants
Measles, The MMR Immunization with rubella, IM 2 shots First Dose: Sore arm from the
Mumps, Rubella vaccine it is measles-rubella (MR) or 12-15 months shot
effective at MMR vaccine whilst of age Fever
SHOTS preventing pregnant or shortly before Second Mild rash
measles, becoming pregnant has no Dose: 4-6 Temporary pain and
mumps, and known risk. MMR vaccine years of age stiffness in the joints,
rubella. is not recommended in (may be given mostly in teenage or
pregnancy as matter of earlier, if at adult women who
caution. least 28 days did not already have
after the 1st immunity to the
dose) rubella component of
the vaccine
TDAP Immunity Rx to DTaP, progressive 0.5mL (single dose) IM Single dose Fatigue, HA, GI
against tetanus, neurological disease or should be symptoms, and pain
SHOTS diphtheria, and recent (7days) CNS given as soon at injection site.
acellular pathology as feasible to

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Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

pertussis all pregnant

woman
(preferred
27-36 wks
gestation)
Vitamin K Preventing 0.5-1mg (0.25- Erythema, pain at
Phytonadione bleeding Protect drug from light 0.5ml of solution IM 0.5-1mg injection site, edema
problems in until just befoe containing 1mg-0.5 within 1 hr of at injection site,
VITAMIN newborns with administration to prevent ml) given 1 birth. If mom anaphylaxis;
low levels of decomposition and loss of intramuscularly was on hemolysis or
vitamin K potency. Observe all within 1 hours of anticoagulant hyperbilirubinemia
(hemorrhagic infants for signs of Vit K birth s, addtl dose especially in a
disease). Can deficiency (ecchymosis or may be preterm infant or
prevent bleeding from any site) ordered and when a large dose is
bleeding Check that the infant has given 6-8hrs used.
problems in had vit k before a after the 1st
newborns. circumcision is performed injection
Ilotycin Antibiotic Contraindicated in Ribbon 1cm in Ophthalmi As directed May cause blurred
ERYTHOMYCIN prevent hypersensitivity to length in the c vision in the infant
ophthalmia medication conjunctival sac
ANTIBIOTIC neonatorum in Pregnancy category B
case the mother
is infected with
gonorrhea
Colace Laxative/stool Prevention of constipation 100mg PO BID PO/ Once daily Abdominal pain,
Docusate softner (in patients who should Rectum nausea, vomiting
sodium avoid straining)

GI
Ibuprofen Reduce fever, Not recommended during Varies on indication Oral As directed Take with food or
prevent pain last trimester; pregnancy ( 100 mg/5 mL ; 800 milk to lessen

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

PAIN and/or category C mg ; 300 mg ; 600 stomach upset; side

inflammation mg ; 400 mg ; 200 effects include upset
mg) stomach, mild
Mild indigestion, bloating,
constipation, gas,
dizziness, headache

Percocet Moderate to Avoid chronic use; PO(adults >50kg) 5- PO As directed SA/E

severe pain prolonged use of extended 10 mg q 3-4 CNS: Confusion,
PAIN release during pregnancy initially, as needed. sedation,
Moderate can result in neonatal PO(adults<50kg) RESP: Respirator
opioid withdraw syndrome 0.2mg/kg 3-4 hr Depression
initially, as needed GI: Constipation
GU: Urinary
retention
Morphine Moderate to Be cautious can cause Intermittent Epidural II: if no relief Cat C
severe pain resp. depression in injection(II):5 after 60 min, Confusion, sedation,
PAIN newborn. mg/day; 1-2 mg resp depression,
severe increase can hypotension,
Continuous be made (no constipation (given
infusion(CI): 2-4mg/ more than after babies cord is
24hr; 10mg/day) clamped)
CI: can
increase 1-
2mg/day (no
more than
30mg/day)
Duramorph DURAMORPH High risk for addiction and The initial dose of Epidural If adequate Monitor for 24hrs
(morphine dependence. Can cause morphine should pain relief is could have sever resp
Morphine injection) is a respiratory distress and be 2 mg to 10 not achieved depression
systemic death when taken in high mg/70 kg of body within one

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

PAIN narcotic doses weight. No hour, careful

analgesic for information is administratio
administration available regarding n of
by the the use of incremental
intravenous, DURAMORPH in doses of 1 to
epidural or patients under the 2 mg at
intrathecal age of 18. intervals
routes. It is used sufficient to
for the assess
management of effectiveness
pain not may be given.
responsive to No more than
non-narcotic 10 mg/24 hr
analgesics. should be
administered.
RhoGAM Administered to Women who are Rh+, Standard dose is IM Given to the Pain at site, fever,
Rh-neg women Previously sensitized to 300mcg IM mother the
SHOT who have been Rh(D), hypersensitivity to 1. At 28 first 72 hours
exposed to Rh- immune globulins weeks after delivery
positive blood pregnancy of an Rh-
by delivering an and within infant
Rh-pos infant, 72 hours of
aborting an Rh- delivery of
pos fetus, an Rh-pos
undergoing infant
chorionic villus 2. Within 72
sampling, hours after
amniocentesis termination
or of
intraabdominal pregnancy
trauma while of 13 weeks

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 lOMoARcPSD|7393617

Chamberlain College of Nursing

NR 327 Maternal Child Nursing
January 2017
CLINICALS: IMPORTANT MEDICATIONS

carrying an Rh- or more

pos fetus, gestation
receiving One microdose of
inadvertent 50mcg within 72
transfusion of hours after the
Rh-pos blood termination of a
pregnancy of less
than 13 weeks
gestation
Prenatal Vitamin Studies have
Prenatal Recommended that shown that
VITAMINS vitamins contain any woman who taking a
many vitamins could get pregnant larger dose
and minerals. take 400 (up to 4,000
They are: folic No contraindications micrograms (mcg) PO micrograms) No side effects
acid, iron, of folic acid daily, at least one
iodine, and starting before month before
calcium are conception and and during
especially continuing for the the first
important. first 12 weeks of trimester
pregnancy may be
beneficial for
those women
Iron Supplemental No contraindications safe 300-325mg Take one to S/E: Nausea ,
Ferrous Sulfate iron to treat for pregnancy po three times a constipation,
anemia day vomiting, GI upset

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