DRUG STUDY 1.

Generic Name: Methylergonovine maleate Brand Name: Methergine Classification: Oxytocic Therapeutic Actions: A partial agonist or antagonist at alpha receptors; as a result, it increases the strength, duration, and frequency of uterine contractions. Indications: Routine management after delivery of the placenta. Treatment of postpartum atony and hemorrhage; subinvolution of the uterus. Uterine stimulation during the second stage of labor following the delivery of the anterior shoulder, under strict medical supervision. Contraindications Contraindicated with allergy to methylergonovine, hypertension, toxemia, lactation, pregnancy. Adverse Effects: CNS: Dizziness, headache, tinnitus, diaphoresis CV: Transient hypertension, palpitations, chest pains, dyspnea GI: Nausea and vomiting Nursing Considerations: Assess history of allergy to the drug. Administer by IM injection or orally unless emergency requires IV use. Complications are more frequent with IV use. Monitor postpartum women for BP changes and amount and character of vaginal bleeding. Avoid prolonged use of the drug. Teach client to report difficulty breathing, headache, numb or cold extremities, severe abdominal cramping Generic Name:Oxytocin Brand Name: Pitocin Classification: Oxytocic; hormone Therapeutic Actions: Synthetic form of an endogenous hormone produced in the hypothalamus and stored in the posterior pituitary; stimulates the uterus, especially the

gravid uterus just before parturition, and causes myoepithelium of the lacteal glands to contract, which results in milk ejection in lactating women. Indications: Antepartum: to initiate or improve uterine contractions to achieve early vaginal delivery; stimulation or reinforcement of labor in selected cases of uterine inertia; management of inevitable or incomplete abortion; 2nd trimester abortion Postpartum: to produce uterine contractions during the third stage of labor to control postpartum bleeding or hemorrhage Lactation defieciency Contraindications: Significant cephalopelvic disproportion, unfavorable fetal positions or presentations, obstetric emergencies that favor surgical intervention, prolonged use in severe toxemia, uterine inertia, hypertonic uterine patterns, induction or augmentation of labor when vaginal delivery is contraindicated, previous cesarian section. Adverse Effects: CV: cardiac arrhythmias, PVCs, hypertension, subarachnoid hemorrhage Fetal effects: fetal bradycardia, neonatal jaundice, low Apgar scores GI: nauseas, vomiting GU: postpartum hemorrhage, uterine rupture, pelvic hematoma, uterine hypertonicity, spasm Nursing Considerations: Ensure fetal position and size and absence of complications that are contraindicated with oxytocin therapy Ensure continuous observation for induction of labor; fetal monitoring is preferred. Regulate rate of oxytocin delivery; monitor rate and strength of contractions Monitor BP during administration 4. Generic Name:Lidocaine hydrochloride Brand Name: Dilocaine Classification: Local anesthetic Therapeutic Actions:

 Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity Indications: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia Contraindications: Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF cardiogenic shock, 2nd or 3rd degree AV blocks Adverse Effects CNS: headache, backache, septic meningitis, persistent sensory CV: hypotension Dermatologic: urticaria, pruritus, erythema, edema GU: urinary retention, urinary or fecal incontinence Nursing Considerations: Check drug concentrations carefully Establish safety precautions if CNS changes occur Teach client to report difficulty speaking, thick tongue, numbness, tingling, difficulty breathing, pain or numbness at site, swelling or pain at site 5. Generic Name:Terbutaline Sulfate Brand Name: Brethine Classification: Tocolytic Therapeutic Actions: - In low doses, acts relatively selectively at beta 2-adrenergic receptors to cause bronchodilation and relax the pregnant uterus; at higher doses, beta 1 selectivity is lost and the drug acts at beta 2 receptors to cause typical sympathomimetic cardiac effects Indications: - Tocolytic to prevent preterm labor Contraindications: - Contraindicated with hypersensitivity to terbutaline, tachyarrythmias, tachycardia, hypertension, lactation. Adverse Effects:

CNS: restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesias, insomnia, tremors CV: cardiac arrhythmias, palpitations, angina pain, changes in BP and ECG GI: Nausea, vomiting, heartburn, unusual or bad taste Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm Nursing Considerations: - Use minimal doses for minimal periods of time; drug tolerance can occur - Maintain a beta-adrenergic blocker on standby in case cardiac arrhythmias occur - Teach client to report chest pain, dizziness, insomnia, weakness, tremor 6. Generic Name:Carboprost tromethamine Brand Name: Hemabate Classification: Prostaglandin; Abortifacient Therapeutic Actions: Stimulates the myometrium of the pregnant uterus to contract; similar to the contractions of the uterus during labor, thus evacuating the contents of the uterus. Indications: - Termination of pregnancy 13-20 wk from the first day of the LMP - Evacuation of the uterus in instance of missed abortion or intrauterine fetal death in the 2nd trimester - Postpartum hemorrhage due to uterine atony unresponsive to conventional methods Contraindications: - Contraindicated with allergy to prostaglandin preparations, acute PID; active cardiac,hepatic, pulmonary, renal disease Adverse Effects: CNS: headache, paersthesias, flushing, anxiety, weakness, syncope, dizziness CV: hypotension, arrhythmias, chest pain GI: vomiting, diarrhes, nausea Nursing Considerations: - Assess allergy to the drug - Monitor uterine tone and vaginal discharge during procedure and several days after to assess drug effects and recovery - Ensure adequate hydration Generic Name:Magnesium sulfate Brand Name: Epsom salt Classification: electrolyte; anticonvulsant; laxarive Therapeutic Actions: - Cofactor of many enzyme systems involved in neuromuscular transmission

and muscular excitability Indications: - Preeclampsia/eclampsia - Inhibition of premature labor Contraindications: - Contraindicated with allergy to magnesium product; heart block, myocardial damage, abdominal pain, N/V, acute surgical abdomen, fecal impaction, hepatitis. DO NOT GIVE 2 HR PRECEEDING DELIVERY BECAUSE OF RISK OF MAGNESIUM TOXICITY IN THE NEONATE. Adverse Effects: CNS: weakness, dizziness, fainting, sweating CV: palpitations GI: excessive bowel activity, perianal irritation Metabolic: Magnesium intoxication, hypocalcemia with tetany Nursing Considerations: - Assess history of allergy to the drug and other contraindications - Reserve IV use in eclampsia for immediate life- threatening situations - Monitor magnesium levels during parenteral therapy - Monitor knee-jerk reflex before repeated parenteral administration, if happens, do not administer because respiratory failure may occur Generic Name:Hyoscine-N-butylbromide Brand Name: Buscopan Classification:Antispasmodic; Anticholinergic Therapeutic Actions: - acts by interfering with the transmission of nerve impulses by acetylcholine in the parasympathetic nervous system. Indications: - Buscopan Tablets are indicated for the relief of spasm of the genitourinary tract or gastro- intestinal tract and for the symptomatic relief of Irritable Bowel Syndrome Contraindications: - Buscopan Tablets should not be administered to patients with myasthenia gravis, megacolon and narrow angle glaucoma. In addition, they should not be given to patients with a known hypersensitivity to hyoscine-N-butylbromide or any other component of the product.

Adverse Effects: CNS: dizziness, anaphylactic reactions, anaphylactic shock, increased ICP, disorientation, restlessness, irritability, dizziness, drowsiness, headache, confusion, hallucination, delirium, impaired memory CV: hypotension, tachycardia, palpitations, flushing GI: Dry mouth, constipation, nausea, epigastric distress DERM: flushing, dyshidrosis GU: Urinary retention, urinary hesitancy Resp: dyspnea, bronchial plugging, depressed respiration EENT: mydriasis, dilated pupils, blurred vision, photopobia, increased intraocular pressure, difficulty of swallowing. Nursing Considerations: - Drug compatibility should be monitored closely in patients requiring adjunctive therapy - Avoid driving & operating machinery after parenteral administration. - Avoid strict heat