Antepartum Meds

Generic & Trade Names: Insulin: lispro, aspart, humalog, admelog, and detemir
Usual Dose Range:weight based dosing: 0.7-1.0 units/kg
Action: lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat and
inhibiting hepatic glucose production
Side Effects: hypoglycemia, hypokalemia, lipodystrophy, pruritus, erythema, swelling,
anaphylaxis
Nursing Implications: assess for symptoms of hypoglycemia, monitor body weight periodically,
monitor blood glucose every 6 hours during therapy, more frequent in ketoacidosis or high
stress, administer lispro 15 minutes before meals, rotate injection sites,
Patient Teaching: instruct pt on proper technique for administration, emphasize the importance
selection/rotation of injection sites, and compliance of regime. instruct pt on s/s of hypoglycemia
and what to do if they occur, carry candy or sugar and identification bracelet with their disease
and treatment.

Generic & Trade Names: Ondansetron aka Zofran

Usual Dose Range: 4-8 mg Q8hrs if IV 8mg over 15 minutes every 12 hours
Action: may block 5-HT3 in the CNS in the chemoreceptor trigger zone and in the peripheral
nervous system on nerve terminals of the vagus nerve
Side Effects: dizziness, fatigue, headache, malaise, sedation, extrapyramidal syndrome, fever,
agitation, anxiety, pain, arrhythmias, chest pain. Constipation, diarrhea, gynecologic disorders,
urine retention, hypoxia, pruritus, rash, chills.
Nursing Implications: can cause prolonged QT interval and torsades de pointes (fatal heart
rhythm) monitor ECG, correct electrolyte abnormalities (hypokalemia/hypomagnesemia),
monitor LFT results don’t exceed 8 mg in pts with hepatic impairment, monitor pt for s/s of
serotonin syndrome.
Patient Teaching: call dr if s/s of abnormal HR/rhythm (palpitations, dyspnea or dizziness),
ECG may be necessary to monitor heart rate, immediately report difficulty breathing after drug
administration, don't push through foil blister peel off back and taking with liquid is not
necessary, place ODT on tongue, allow to dissolve, then swallow with saliva.

Generic & Trade Names: Ferrous sulfate aka feosol, Fer-In-Sol, Ferosul
Usual Dose Range: 300 mg twice daily up to 300 mg 4 times/day or 250 mg (extended
release) 1-2 times/day
Action: provides elemental iron, an essential component in the formation of Hb
Side Effects: nausea, constipation, black stools, diarrhea, GI discomfort, temporarily stain teeth
from liquid forms
Nursing Implications: keep out of reach from children, Gi upset may be related to dose,
enteric-coated products reduce GI upset but also reduce amount of iron absorbed, may turn
stools black, although harmless may mask melena, monitor Hb level hematocrit, and
reticulocyte count during therapy
Patient Teaching: take tablet between meals with juice (OJ) or water no dairy products, may
take if GI upset occurs, do not crush or chew extended release form, report constipation and
change in stool color and consistency, tooth discoloration is not serious or permanent,

Generic & Trade Names: Indomethacin aka Indocin, tivorbex

Usual Dose Range:
Action: May inhibit prostaglandin synthesis, to produce anti-inflammatory, analgesic, and
antipyretic effects
Side Effects: HA, dizziness, depression, fatigue, somnolence, syncope, vertigo, edema,
hearing loss, tinnitus, pancreatitis, abdominal pain, constipation, diarrhea, decreased appetite,
dyspepsia, GI bleeding, N/V, peptic ulcers, pruritus, rash, hypersensitivity reactions, hematuria,
interstitial nephritis, proteinuria
Nursing Implications: drug should not be taken with routine analgesic or antipyretic, watch for
signs of heart attack or stroke, if ductus arteriosus reopens a second course of one to three
doses may be given if ineffective surgery may be needed, watch for bleeding in patients
receiving anticoagulants or patients with coagulation defects and neonates, can cause decrease
renal blood flow and lead to reversible renal impairment, can cause sodium retention watch for
weight gain and increased blood pressure in patients with HTN, monitor pt for rash and
respiratory distress, may mask symptoms of infection. BLACK BOX WARNINGS: cause
increased risk of serious GI adverse events like bleeding, ulceration and perforation of the
stomach, intestines, which may be fatal, serious risk of thrombotic events, MI, Stroke. Use of
NSAIDs at 20 weeks or later in pregnancy may cause fetal renal dysfunction leading to
oligohydramnios and potential neonatal renal impairment; use at 30 weeks or later in pregnancy
may increase risk of premature closure of the ductus arteriosus. Avoid use in pregnant women
starting at 20 weeks gestation. If potential benefit justifies risk to fetus use lowest effective dose
for shortest duration, consider ultrasound monitoring of amniotic fluid id NSAID therapy is longer
than 48 hours
Patient Teaching: warn pregnant patients not to take NSAID at 20 weeks gestation or later
unless instructed by dr due to potential risk to fetus, discuss OTC medication with pharmacist or
Dr. during pregnancy, take with food, milk, or antacid to prevent GI upset, seek medical
attention immediately if experience chest pain, SOB, trouble breathing, weakness one side of
body or slurred speech, Teach pt s/s of GI bleeding and notify dr f symptoms occur, avoid
hazardous activities that require mental alertness until CNS effects are known, notify dr if
changes in hearing or vision or unexplained weight gain or edema occur

Generic & Trade Names: Celecoxib aka Celebrex

Usual Dose Range: Initial: 400 mg, followed by an additional 200 mg approximately 12 hours
later, if needed, on day 1; maintenance dose: 200 mg twice daily as needed; maximum daily
maintenance dose: 400 mg/day. Begin at menses onset or 1 to 2 days prior to onset of menses
for severe symptoms; usual duration: 1 to 5 days
Action: Thought to inhibit prostaglandin synthesis, impeding cyclooxygenase-2, to produce anti-
inflammatory, analgesic, and antipyretic effects.
Side Effects: erythema multiforme, exfoliative dermatitis, SJS, toxic epidermal necrolysis, rash,
HA, dizziness, insomnia, HTN, peripheral edema, pharyngitis, rhinitis, sinusitis, abd pain,
diarrhea, dyspepsia, GI reflux, flatulence, nausea, hyperchloremia, back pain, dyspnea, URI
Nursing Implications: Use of NSAIDs at 20 weeks or later in pregnancy may cause fetal renal
dysfunction leading to oligohydramnios and potential neonatal renal impairment; use at 30
weeks or later in pregnancy may increase risk of premature closure of the ductus arteriosus.
Avoid use in pregnant women starting at 20 weeks' gestation. If potential benefit justifies risk to
the fetus, use the lowest effective dose for the shortest duration. Consider ultrasound monitoring
of amniotic fluid if NSAID therapy is longer than 48 hours., watch for signs of stroke or heart
attack, monitor pt for fluid retention, watch for s/s of hepatotoxicity, monitor pt renal function,
watch for s/s of overt and occult bleeding and rash BLACK BOX WARNING: may cause GI
bleeding ulceration and perforation of stomach or intestine which could be fatal, watch for stroke
and MI.
Patient Teaching: Use of NSAIDs at 20 weeks or later in pregnancy may cause fetal renal
dysfunction leading to oligohydramnios and potential neonatal renal impairment; use at 30
weeks or later in pregnancy may increase risk of premature closure of the ductus arteriosus.
Avoid use in pregnant women starting at 20 weeks' gestation. If potential benefit justifies risk to
the fetus, use the lowest effective dose for the shortest duration. Consider ultrasound monitoring
of amniotic fluid if NSAID therapy is longer than 48 hours. Report history of allergic reactions to
sulfonamides or aspirin, report GI bleeding, rash, weight gain, swelling, chest pain. SOB, or
stroke symptoms, may harm the liver and stop taking if any s/s of hepatoxicity.

Generic & Trade Names:

Usual Dose Range: IV: 2.5 to 5 mcg/minute; increased gradually every 20 to 30 minutes by 2.5
to 5 mcg/minute up to a maximum of 25 mcg/minute; decrease to the lowest effective dose once
contractions are controlled SubQ: 0.25 mg every 20 minutes to 3 hours; hold for pulse >120
beats per minute.
Action: beta-2 adrenergic agonist, relaxes bronchial smooth muscle but can be used to
postpone delivery in premature births
Side Effects: nervousness, restlessness, decreased serum potassium, increased serum
glucose, tremor, HTN, tachycardia, dizziness, HA, insomnia, diaphoresis, N/V, muscle cramps
Nursing Implications: monitor glucose and potassium levels, pulmonary function, and CV
effects (HR, BP, OTc-interval prolongation), Injectable form is contraindicated in pregnant
women for prevention or prolonged treatment (beyond 48 to 72 hours) of preterm labor in either
the hospital or outpatient setting because of the potential for serious maternal heart problems
and death. Oral terbutaline is contraindicated for prevention or for any treatment of preterm
labor. Use only if potential benefit justifies potential risk to the fetus.
Patient Teaching: report changes in HR/ rhythm, wheezing, chest tightness, bad cough, blue
skin color, or difficulty breathing

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Labor and Delivery Meds

Generic & Trade Names: Ephedrine brand name Akovaz
Usual Dose Range: 5 to mg bolus - max 50mg.
Action: Vasopressor. Alpha & beta agonist. Triggers release of stored norepinephrine.
Side Effects: HTN, Chest pain, anxiety, dizziness, arrhythmia, palpitations, nausea, vomiting
Nursing Implications: Monitor CV status, specifically BP. Drug becomes less effective with
subsequent doses (tachyphylaxis). Don't confused with epi.
Patient Teaching: Report new symptoms immediately

Generic & Trade Names: Hespan aka Hetastarch

Usual Dose Range: 500mL - 1000mL or 20mL/kg per dose. Max 50mL/kg/day.
Action: Increases plasma volume. Colloid fluid. Increases plasma osmotic pressure, fluid shifts
into plasma, increasing plasma volume.
Side Effects: Anaphylaxis, myalgia, hypervolemia, heart failure, dyspnea, chest pain, renal
failure, decreased clotting
Nursing Implications: Monitor CV status, coags, potential for allergic reaction. Doesn’t add
volume but shifts where volume is.
Patient Teaching: Report any new symptoms
Generic & Trade Names: Fentanyl
Usual Dose Range: Bolus starting 1-2mcg/kg IV. Subsequent doses ½ initial bolus.
Action: Analgesic. Binds to opioid receptors, blocking pain.
Side Effects: Confusion, euphoria, sedation, arrhythmia, chest pain, hypotension, apnea,
respiratory depression, constipation
Nursing Implications: Monitor respiratory status, mental status. Possibility for dependence.
Possibility for interaction with other meds, IV incompatibility with other drips.
Patient Teaching: Risks for addiction, advise if new symptoms, store away from children, use
of narcan if home med.

Generic & Trade Names: Betamethasone aka Diprolene

Usual Dose Range: 12mg IM every 24 hours for two doses.
Action: Antenatal fetal maturation. Stimulates synthesis/release of surfactant to stimulate lung
growth in preterm infants.
Side Effects: Allergic reaction, hypokalemia, HTN, adrenal suppression, bradycardia,
muscle/bone pain, nausea/vomiting/diarrhea.
Nursing Implications: Monitor for reactions, immune suppression, hyperglycemia
Patient Teaching: Need to have both shots 24 hours apart, monitor for new s/s.

Generic & Trade Names: Dexamethasone aka Decadron

Usual Dose Range: 6mg Q12 for 4 doses
Action: Same Betamethasone - fetal lung maturation
Side Effects: Allergic reaction, hypokalemia, HTN, adrenal suppression, bradycardia,
muscle/bone pain, nausea/vomiting/diarrhea.
Nursing Implications: Monitor for reactions, immune suppression, hyperglycemia
Patient Teaching: Need to have both shots 24 hours apart, monitor for new s/s.

Generic & Trade Names: Magnesium Sulfate aka Mag

Usual Dose Range:
Pre/Eclampsia: 4-6g loading dose, 1-2g/hour infusion 24 hours post delivery.
Neuroprotection: 4g loading dose, 1g/hour infusion until delivery
Slowing labor: 4-6g loading dose, 1-3g/hour infusion until delivery
Action: Smooth muscle relaxant, delays labor. Slows SA node impulse, delays conduction.
Side Effects: Flushing, lethargy, nausea, vomiting, dizziness, weakness
Nursing Implications: Monitor mag levels, s/s hypermagnesemia, lower apgar’s at birth. IV
calcium antidote. Monitor I/Os, renal function.
Patient Teaching: Immediately report new signs and symptoms

Generic & Trade Names: Calcium Gluconate

Usual Dose Range: 1.5-3g IVBP
Action: Hypermagnesemia reversal?
Side Effects: Hypercalcemia, arrhythmia, bradycardia, hypotension, syncope, anxiety, flushed
Nursing Implications: Pregnancy Category C
Patient Teaching: Report new signs and symptoms

Generic & Trade Names: Oxytocin

Usual Dose Range: 0.5-2 milliunits/min until desired contraction interval.
Action: Stimulate uterine contraction, postpartum hemorrhage
Side Effects: HTN, arrhythmia, tachycardia, PVCs, nausea, vomiting, hemorrhage
Nursing Implications: Monitor CV status, increased risk of postpartum hemorrhage, interacts
with other meds, including ephedrine.
Patient Teaching: Use of medication, report contractions

Generic & Trade Names: Methergine

Usual Dose Range: Oral 0.2mg 3-4 x daily or IV 0.2mg Q2-4 PRN.
Action: Increases tone, rate and amplitude of contractions of uterine smooth muscle, shortens
labor and reduces blood loss.
Side Effects: HTN, CVA, nausea, vomiting, headache, seizure
Nursing Implications: High risk med used only in emergencies. Increased risk of CVA.
Frequent neuro exams.
Patient Teaching: Indication for use, immediately report symptoms.

Generic & Trade Names: Prostaglandin EI - misoprostol aka cytotec

Usual Dose Range: 25mcg Q2
Action: Induces labor, triggers uterine contraction. Also used for abortion.
Side Effects: Diarrhea, abdominal pain, headache, N/V/D
Nursing Implications: Monitor for contractions,
Patient Teaching: Use of medication, report side effects, report contractions

Generic & Trade Names: Prostaglandin E2 aka Dinoprostone

Usual Dose Range: 0.5mg intravaginally up to 3x. Or 20mg intravaginally for abortion.
Action: Induces uterine contraction, cervical softening
Side Effects: Uterine hyperstimulation, fever, HA, dizziness, anxiety, weakness, CP, N/V/D,
fetal depression
Nursing Implications: Monitor vaginal discharge, don’t treat fever with medications
Patient Teaching: Use of medication, immediately report symptoms of dizziness, syncope,
bleeding, N/V or abdominal pain, report contractions

Generic & Trade Names: Hemabate aka Carboprost

Usual Dose Range: IM 250mcg repeat every 15-90 minutes up to 2mg.
Action: Increases myometrial contraction, reduces atony
Side Effects: Fever, HA, parestesia, CP, N/V/D, uterine rupture, vaginal pain, chills, blurred
vision.
Nursing Implications: Given IM, often pretreat with antiemetics. Close monitoring of patients.
Patient Teaching: Use of drug, report adverse reactions
Generic & Trade Names: Bicitra aka Sodium Citrate/Citric Acid
Usual Dose Range: Oral 10-30mL 4x daily?
Action: Treats acidosis?
Side Effects: N/V/D, abdominal pain
Nursing Implications: Pregnancy category C
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Generic & Trade Names: Famotidine aka Pepcid

Usual Dose Range: 10-40mg
Action: H2 blocker, reduces stomach acid
Side Effects: HA, dizziness, constipation, diarrhea
Nursing Implications: Avoid long term, can prolong QT, abdominal assessment, can be
combined
Patient Teaching: Avoid long term, monitor pain, can take with snack, can combine with tums

Generic & Trade Names: Reglan aka metoclopramide

Usual Dose Range: 5-10mg
Action: Anti-nausea/emetic. Increases UGI motility, blocks dopamine receptors
Side Effects: Anxiety, drowsiness, SI, confusion, tardive dyskinesia, fever, SVT, hypotension,
diarrhea, nausea, urinary frequency
Nursing Implications: Monitor bowel sounds, avoid long term, monitor for EPS, fever,
arrhythmia, BP.
Patient Teaching: PRN dosing, 30 minutes before food, ODT admin, possibility of sedation, no
booze.

Generic & Trade Names: Phenergan aka promethazine

Usual Dose Range: 12.5 - 25mg
Action: Antinausea, blocks dopamine receptors, binds to H1.
Side Effects: Confusion, anxiety, hallucinations, mood alteration, seizure, nausea, diarrhea,
EPS, tachycardia, HTN, urinary retention, respiratory depression
Nursing Implications: High risk of complications for extravasation, monitor neuro status
Patient Teaching: Take with food, avoid alcohol, immediately report pain in PIV if if, report s/s
especially if NMS.

Postpartum Meds

Generic & Trade Names: Colace

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Generic & Trade Names: Simethicone

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Generic & Trade Names: Rh Immune Globulin

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Generic & Trade Names: Rubella Vaccine

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Generic & Trade Names: TDap

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Generic & Trade Names: Acetaminophen

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Generic & Trade Names: Ibuprofen

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Generic & Trade Names: Ketorolac

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Generic & Trade Names: Tylenol with codeine

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Generic & Trade Names: Oxycodone

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Generic & Trade Names: Dilaudid

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Generic & Trade Names: Morphine

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Generic & Trade Names: Diphenhydramine aka Benadryl

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Generic & Trade Names: Nubain

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Generic & Trade Names: Methergine (PO + IM)

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Generic & Trade Names: Lanolin

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Generic & Trade Names: Americaine Spray

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Generic & Trade Names: Epi Foam

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Generic & Trade Names: Witch Hazel Pads/Tucks

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Newborn Meds

Generic & Trade Names: Tylenol, Acetaminophen

Usual Dose Range: neonates > 10 days: 10-15mg/kg/dose q4-6h. Don’t exceed 5 doses in
24hrs. Max dose: 75mg/kg/day
Action: Reduces pain + fever but doesn’t affect inflammation or platelet function. Inhibits
prostaglandin synthesis to reduce pain and acts on hypothalamus to reduce heat
Side Effects: Hepatotoxicity, Nausea, upper stomach pain, itchin, loss of appetite, dark urine,
and jaundice
Nursing Implications: Not to be given to a pt. with active liver disease. To minimize GI
irritation, avoid alcohol when taking medication
Patient Teaching: Don’t take with other NSAIDs because it might cause GI bleeds, monitor for
SEs, don’t consume with alcoholic beverage, monitor for anaphylactic reaction, monitor for liver
problems: dark urine, emesis, upset stomach, light-colored stools, or yellow skin/ eyes. Stevens-
Johnson Syndrome may happen.

Generic & Trade Names: Aquamephyton, Vitamin K

Usual Dose Range:oral: 8-10 mcg/kg/day (preterm neonates) and 2 mcg/day (term neonates).
IV: 10 mcg/kg/day (preterm neonates) and 200 mcg/day (term neonates). IM administered
within 1 hr of birth. Birth weight <1,000g: 0.3-0.5 mg/kg once. Birthweight > 1,000 g: 0.5-1.0 mg
once.
Action: Promotes liver synthesis of clotting factors (II, VII, IX, X). The exact mechanism of the
stimulation is unknown. Treats hemorrhagic disease.
Side Effects: cardio: CP, flushing, hypotension, tachycardia, weak pulse, dizziness. Derm:
diaphoresis, erythema, erythematous rash. GI: dysgeusia (dysfunction in sense of taste).
Hepatic: hyperbilirubinemia. Hypersensitivity reaction. Respiratory: cyanosis, dyspnea.
Scleroderma-like lesions.
Nursing Implications: Perform frequent physical assessment. Monitor PT/INR. Protect drugs
from light because it decomposes and loses potency after exposure to light. Ensure male infants
have vitamin K before circumcision.
Patient Teaching: Monitor for anaphylaxis

Generic & Trade Names: Ilotycin Opthalmic or Erythromycin ophthalmic

Usual Dose Range: Instill 1 cm ribbon into each conjunctival sac once
Action: Protects newborns after birth from getting bacterial eye infection that is acquired during
birth. If untreated these infections can lead to blindness. Mechanistically, it inhibits RNA-
dependent protein synthesis at the chain elongation step. It binds to the 50S ribosomal subunit
resulting in blockage of transpeptidation.
Side Effects: hypersensitivity, minor ocular irritation, and redness.
Nursing Implications: Cleanse the infant’s eyes as needed before application. Hold the tube
horizontally rather than vertically to avoid eye injury from sudden movement. Administer from
the inner canthus to the outer canthus. Don’t touch the tip of the tupe to any part of the eye to
avoid further spread of infections. Don’t rinse. Observe for irritation. Use a new tube for each
infant to minimize spreading infection.
Patient Teaching: Monitor SEs. Wash hands before and after use. Don’t touch the tip of the
tube with your hands or to your child’s eye, lid or other skin. Keys eyes closed for 1-2 mins.

Generic & Trade Names: Narcan, Naloxone Hydrochloride

Usual Dose Range: IV (preferred): 0.1 mg/kg/dose; repeat every 2 to 3 minutes if needed. IM:
0.4 mg or 2 mg as a single dose; may repeat every 2 to 3 minutes if needed until emergency
medical assistance becomes available. Intranasal: 4 mg as a single dose; may repeat every 2 to
3 minutes in alternating nostrils if needed until medical assistance becomes available.
Action: Opioid antagonist. Competes and displaces opioids at opioid receptor sites
Side Effects: Cardiac: Flushing, hypertension, hypotension, tachycardia, ventricular fibrillation,
ventricular tachycardia. CNS: Agitation, coma, confusion , disorientation , dizziness, excessive
crying, hallucination. GI: Abdominal cramps, constipation (nasal), diarrhea, nausea, toothache
(nasal), vomiting. Neuromuscular & skeletal: Muscle spasm (nasal), musculoskeletal pain
(nasal), tremor, weakness. Respiratory: Dry nose (nasal), dyspnea, hypoxia (parenteral), nasal
congestion (nasal), nasal discomfort (pain; nasal), nasal mucosa swelling (nasal), pulmonary
edema, respiratory depression (parenteral), rhinitis (nasal), rhinorrhea, sneezing
Nursing Implications: ASSESS: SEs, VS q3-5min, ABGs including PO2, PCO2, Cardiac
status: tachycardia, hypertension, monitor ECG, Respiratory dysfunction: respiratory
depression, character, rate, rhythm, NeuroL monitor LOC
Patient Teaching: MONITOR SEs closely.

Generic & Trade Names: Hepatitis B Vaccine, Engerix-B; Recombivax HB

Usual Dose Range: 0.5 mL per dose for a total of 3 or 4 doses
Action: Provides immunity against the Hepatitis B virus by allowing the body to build
antibodies against the hepatitis B virus
Side Effects: Hypersensitivity, fever, erythema, swelling, and pain at injection site.
Nursing Implications: obtain and verify consent from caregiver, follow proper procedure for
administration of intramuscular (IM) injection , give IM in the vastus lateralis (remember to
aspirate), teach parent the vaccine scheduling (next @ 2 months and last @ 6 months), and
observe newborn for any anaphylactic reaction.
Patient Teaching: Monitor SEs, changes in LOC, fever