DRUG STUDY
1. Generic Name : Meth Methyl yler erg gonov onovin ine e malea leate 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; hemorrhage; subinvolution of the uterus. Uterine stimulation during the second stage of labor following the delivery of the anterior shoulder, under strict medical supervision. supervision. Contraindications Contraindicated Contraindicated with allergy to methylergonovine, methylergonovine, hypertension, toxemia, lactation, pregnancy. Adverse Effects: CNS: Dizziness, headache, tinnitus, diaphoresis 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 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. •
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2. Generic Name: Dinoprostone Dinoprostone (prostaglandin (prostaglandin E2) Brand Name: Cervidil Classification: Prostaglandin; 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 12-20 wks from the first day of the LMP. Evacuation of the uterus in the management of missed abortion or intrauterine fetal death up to 28 wk gestational stage Initiation of cervical ripening before induction of labor Contraindications: Contraindicated Contraindicated with allergy to prostaglandins; acute PID; active cardiac hepatic; pulmonary, renal disease; women in whom prolonged uterine contractions are inappropriate. inappropriate. Adverse Effects: CNS: Headache, paresthesias, anxiety, weakness, syncope, dizziness CV: Hypotension, arrthymias, chest pain Fetal: Abnormal heart rates GI: vomiting, diarrhea, nausea Respiratory: Respiratory: Coughing, dyspnea Nursing Considerations: Monitor uterine tone and vaginal discharge throughout the procedure and several days after the procedure. Ensure adequate hydration throughout the procedure. •
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Be prepared to support patient through labor. Give oxytocin infusion 612 hr after dinoprostone. Teach client to report severe pain, difficulty breathing, palpitations, eye pain, rash. •
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3. 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 initiate or improve uterine contractions contractions to achieve early vaginal delivery; stimulation or reinforcement reinforcement of labor in selected cases of uterine inertia; management of inevitable or incomplete abortion; 2 nd trimester abortion Postpartum: to produce uterine contractions contractions during the third stage of labor to control postpartum bleeding or hemorrhage Lactation defieciency Contraindications: Significant cephalopelvic disproportion, disproportion, unfavorable fetal positions or presentations, 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, arrhythmias, PVCs, hypertension, subarachnoid hemorrhage Fetal effects: fetal bradycardia, 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 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 •
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4. Generic Name: Lidocaine hydrochloride 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 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 Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF cardiogenic shock, 2 nd or 3rd degree AV blocks Adverse Effects: •
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CNS: headache, backache, septic meningitis, persistent sensory CV: hypotension Dermatologic: Dermatologic: urticaria, pruritus, erythema, edema GU: urinary retention, urinary or fecal incontinence Nursing Considerations: Check drug concentrations 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 low doses, doses, acts relatively relatively selectivel selectively y at beta 2-adrener 2-adrenergic gic recept receptors ors to cause bronchodilation 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 sympathomimetic cardiac effects Indications: - Toco Tocoly lyti tic c to to pre preve vent nt pret preter erm m lab labor or Contraindications: - Contrain Contraindica dicated ted with with hypersen hypersensiti sitivity vity to terbu terbutali taline, ne, tachy tachyarryt arrythmia hmias, s, tachycardia, hypertension, lactation. Adverse Effects: CNS: restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesias, insomnia, tremors CV: cardiac arrhythmias, palpitations, palpitations, angina pain, changes in BP and ECG GI: Nausea, vomiting, heartburn, unusual or bad taste Respiratory: Respiratory: Respiratory Respiratory difficulties, pulmonary edema, coughing, bronchospasm bronchospasm Nursing Considerations: - Use minim minimal al doses doses for minim minimal al perio periods ds of time; drug drug toleranc tolerance e can occur occur - Maintain Maintain a beta-ad beta-adrener renergic gic blocker blocker on standby standby in in case case cardia cardiac c arrhyth arrhythmias mias occur - Teach Teach client client to report report chest chest pain, pain, dizzi dizziness ness,, insomni insomnia, a, weakne weakness, ss, tremor tremor
6. Generic Name: Carboprost tromethamine Brand Name: Hemabate Classification: Prostaglandin; 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: - Termi Terminat nation ion of of pregna pregnancy ncy 13-2 13-20 0 wk from from the the first first day day of the the LMP - Evacuatio Evacuation n of the the uterus uterus in instance instance of missed missed abortion abortion or or intraut intrauterin erine e fetal fetal death in the 2nd trimester - Postpart Postpartum um hemor hemorrhag rhage e due due to uteri uterine ne atony atony unrespons unresponsive ive to conventio conventional nal methods Contraindications: - Contrain Contraindica dicated ted with with allergy allergy to prosta prostagland glandin in prepar preparation ations, s, acute acute PID; PID; active active cardiac,hepatic, cardiac,hepatic, pulmonary, pulmonary, renal disease Adverse Effects: CNS: headache, paersthesias, flushing, anxiety, weakness, syncope, dizziness CV: hypotension, arrhythmias, chest pain GI: vomiting, diarrhes, nausea Nursing Considerations: - As Asse sess ss alle allerg rgy y to to the the dru drug g - Monitor Monitor uteri uterine ne tone tone and and vaginal vaginal discharg discharge e during during procedur procedure e and several several days after to assess drug effects and recovery - Ensu Ensure re adeq adequa uate te hydr hydrat atio ion n •
7. Generic Name: Nalbuphine hydrochloride hydrochloride Brand Name: Nubain Classification: Narcotic agonisy-antagonist analgesic Therapeutic Actions: - Nalbuphi Nalbuphine ne acts acts as an agonis agonistt at specific specific opioid opioid recept receptors ors in the the Cns to produce analgesia, sedation but also acts to cause hallucinations and is an antagonist at mu receptors Indications: - Reli Relief ef of mode modera rate te to seve severe re pain pain - For obstet obstetric ric analge analgesi sia a duri during ng labo laborr and and deliv delivery ery Contraindications: - Contrain Contraindica dicated ted with with hyper hypersens sensitivi itivity ty to nalbuphin nalbuphine, e, sulfite sulfites; s; lactat lactation ion Adverse Effects: CNS: sedation, clamminess, clamminess, sweating, headache, nervousness, restlessness, depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations, euphoria, blurred vision CV: hypotension, hypertension, bradycardia, bradycardia, tachycardia Dermatologic: Dermatologic: itching, burning, urticaria GI: N/V, cramps, dyspepsia, bitter taste, dry mouth GU: Urinary urgency Respiratory: Respiratory: Respiratory Respiratory depression, dyspnea, asthma Nursing Considerations: - As Asse sess ss h hyp yper erse sens nsit itiv ivit ity y to to the the dru drug g - Provide Provide narcot narcotic ic antagon antagonist, ist, facilitat facilitates es for assisted assisted or contro controlled lled respir respiratio ation n on standby in case of respiratory depression depression - Reassur Reassure e patient patient about about addic addiction tion liabi liability; lity; most most patie patients nts who who receive receive opiat opiates es for medical reasons do not develop dependence syndrome - Inform Inform client clients s about about these these side effects: effects: dizzin dizziness, ess, sedation, sedation, drowsine drowsiness, ss, impaired visual acuity, nausea, loss of appetite
8. Generic Name: Magnesium sulfate Brand Name: Epsom salt Classification: electrolyte; anticonvulsant; laxarive Therapeutic Actions: - Cofactor Cofactor of many many enzyme enzyme systems systems involved involved in neuro neuromusc muscular ular transmis transmission sion and muscular excitability Indications: - Pree Preecl clam amps psia ia/e /ecl clam amps psia ia - Inhi Inhibi biti tion on of of prem premat atur ure e labo laborr Contraindications: - Contrain Contraindica dicated ted with with allergy allergy to magnesi magnesium um produ product; ct; heart heart block block,, myocard myocardial ial damage, abdominal pain, N/V, acute surgical abdomen, fecal impaction, hepatitis. DO NOT GIVE 2 HR PRECEEDING DELIVERY BECAUSE 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: - Ass Assess ess histo history ry of of allerg allergy y to the drug and other other contr contraindi aindicati cations ons - Reserve Reserve IV IV use use in eclamps eclampsia ia for for immedi immediate ate lifelife- threateni threatening ng situat situations ions - Monito Monitorr magn magnesi esium um leve levels ls d duri uring ng pare parente nteral ral thera therapy py - Monitor Monitor knee-j knee-jerk erk reflex reflex befor before e repeate repeated d parente parenteral ral administ administrati ration, on, if happens, do not administer because respiratory failure may occur
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Do not not giv give e oral orally ly wit with h abdo abdomi mina nall pain pain,, N/V N/V Mon Monito itor urine ine outp utput
9. Generic Name : Butorphanol tartrate Brand Name: stadol Classification: Narcotic agonist- antagonist analgesic Therapeutic Actions: - Acts as an an agonis agonistt at opioid opioid recept receptors ors in the the CNS CNS to produce produce analgesia analgesia,, sedation, but also acts to produce hallucinations; has low abuse potential Indications: - Reli Relief ef of mode modera rate te to seve severe re pain pain - To suppl supplemen ementt balanc balances es anesth anesthesia esia and to reliev relieve e prepar prepartum tum pain Contraindications: - Contraindicated with hypersensitivity to butorphanol, physical dependence on a narcotic analgesic, pregnancy lactation Adverse Effects: CNS: sedation, clamminess, sweating, headache, vertigo, dizziness, lethargy, confusion, unusual dreams, agitation, euphoria, hallucinations CV: Palpitations, increase or decrease in blood pressure Dermatologic: Dermatologic: Ras, hives, pruritus, flushing, warmth, sensitivity to cold EENT: diplopia, blurred vision GI: N/V Respiratory: Respiratory: slow, shallow respiration Nursing Considerations: - Ass Assess ess histo history ry of allergy allergy to to butorp butorphano hanoll , depre depressio ssion n DM, lactatio lactation, n, and and dependence - Monitor Monitor diet diet for for presenc presence e of caffei caffeinene- contain containing ing foods foods that may contr contribut ibute e to overdose - Inform Inform patien patients ts that that these these side side effects effects may may occur: occur: diure diuresis, sis, restless restlessness ness,, insomnia, muscular tremors, light- headedness, nausea, abdominal pain - Remind Remind patien patientt to report report abnor abnormal mal heart heart rate, dizziness dizziness,, palpita palpitation tions s
Generic Name: Misoprostol Brand Name: Cytotec Classification: Prostaglandin Therapeutic Actions: - A syntheti synthetic c prosta prostagland glandin in E1 E1 analog; analog; inhibits inhibits gastric gastric acid acid secre secretion tion and increases bicarbonate bicarbonate and mucus production, protecting the lining of the stomach Indications: - With With mif mifep epri rist ston one e as an an abor aborti tifa faci cien entt - Cerv Cervic ical al rip ripen enin ing g and and labo laborr indu induct ctio ion n Contraindications: - Histor History y of allerg allergy y to prosta prostagla glandi ndins; ns; preg pregnan nancy; cy; lacta lactatio tion n Adverse Effects: GI: nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, constipation constipation GU: Miscarriage, excessive bleeding, spotting, cramping, menstrual disorders Nursing Considerations: - As Asse sess ss h his isto tory ry of of all aller ergy gy to to the the drug drug - Report Report severe severe diarrhea diarrhea,, spotting spotting,, or menstrua menstruall pain, pain, severe severe menstrua menstruall bleeding 10.
Generic Name: Midazolam hydrochloride Brand Name: Versed Classification: Benzodiazepine (short-acting); CNS depressant Therapeutic actions:
Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation; potentiates the effects of GABA, an inhibitory neurotransmitter; anxiolytic anxiolytic and amnesia effects occur at doses below those needed to cause sedation, ataxia; has little effect on cortical function. Indications - IV or IM: Sedation, anxiolysis, and amnesia prior to diagnostic, therapeutic, or endoscopic procedures or surgery - Indu Induct ctio ion n of of gene genera rall anest anesthe hesi sia a - Continuous sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in the critical care setting - Unlabeled Unlabeled uses: Treatment Treatment of epile epileptic ptic seizure seizure or refrac refractory tory status status epilepticus -
Contraindications Contraindications and cautions - Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis have been reported when used in first trimester; neonatal withdrawal syndrome reported in infants); neonates. - Use cautio cautiously usly in elderl elderly y or debilitat debilitated ed patient patients; s; with with impair impaired ed liver liver or kidney function, lactation. Adverse effects CNS: Transient, mild drowsiness (initially); sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions (during first 2 wk of treatment), visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitations, edema Dermatologic: Urticaria, pruritus, skin rash, dermatitis GI: Constipation, diarrhea, dry mouth, salivation, s alivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, elevations of blood enzymes: LDH, alkaline phosphatase, AST, ALT, hepatic dysfunction, jaundice GU: Incontinence, urinary retention, changes in libido, menstrual irregularities Hematologic: Decreased Hct, blood dyscrasias Other: Phlebitis and thrombosis at IV injection sites, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain, burning, and redness after IM injection Dependence: Drug dependence with withdrawal syndrome when drug is discontinued (more common with abrupt discontinuation of higher dosage used for longer than 4 mo) Nursing considerations considerations -
History: Hypersensitivity Hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs; elderly or debilitated patients; impaired liver or kidney function; pregnancy, lactation
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Physical: Weight; skin color, lesions; orientation, affect, reflexes, sensory nerve function, ophthalmologic examination; P, BP; respiratory rate, adventitious sounds; bowel sounds, normal output, liver evaluation; normal output; LFTs, renal function tests, CBC Do not administer intra-arterially, which may produce arteriospasm or gangrene. Do not not use smal smalll veins veins ((dor dorsum sum of of hand or or wrist wrist)) for IV IV inject injection ion.. Admini Administe sterr IM IM inject injection ions s deep deep into into musc muscle. le. Arrange to reduce dose of midazolam if patient is also being given opioid analgesics; reduce dosage by at least 50% and monitor patient closely. Monitor level of consciousness before, during, and for at least 2–6 hr after administration of midazolam. Carefu Carefully lly moni monitor tor P, P, BP, and and respi respirat ration ions s carefu carefully lly duri during ng administration. Keep resuscitative facilities readily available; have flumazenil available as antidote if overdose should occur. Keep Keep patient patients s in bed bed for 3 hr; hr; do not not permi permitt ambula ambulator tory y patien patients ts to operate a vehicle following an injection. Establ Establish ish safet safety y precau precautio tions ns if CNS chan changes ges occur occur (use (use side side rails, rails, accompany ambulating patient). Client may experience these side effects: Drowsiness, dizziness (these may become less pronounced after a few days; avoid driving a car or engaging in other dangerous activities if these occur); GI upset; dreams, difficulty concentrating, fatigue, nervousness, crying (it may help to know that these are effects of the drug; consult your health care provider if these become bothersome). Report Report severe severe dizziness, dizziness, weakness, weakness, drowsines drowsiness s that that persist persists, s, rash rash or or skin lesions, visual or hearing disturbances, difficulty voiding.
Generic Name: Fresofol Brand Name: Propofol Classification: sedative hypnotic; anesthetic agent Therapeutic Actions: - Propof Propofol ol is a shortshort-act acting ing hypno hypnotic tic.. Its mecha mechanis nism m of action action has has not been well-defined. Indications: - induct induction ion of gener general al anesth anesthesi esia a in adults adults and in in pediatr pediatric ic patien patients ts greater than 3 years of age - mainte maintenanc nance e of anesth anesthesi esia a utilizi utilizing ng balance balanced d techniq techniques ues with with other other appropriate agents such as opioids and inhalation anesthetics a nesthetics in adults and pediatric patients greater than 2 months of age - produc produce e sedati sedation on or amne amnesia sia as a supp supplem lement ent to to local local or regi regional onal anesthetics Contraindications: - Contraindi Contraindicated cated in pediatric pediatric patients patients for monitore monitored d anesthe anesthesia sia care (MAC) sedation or for sedation in intensive care; epileptics; use cautiously in lactation Adverse Effects: CV: Arterial hypotension; decreased systemic vascular resistance, myocardial blood flow, and oxygen consumption, palpitations, tachycardia Respiratory: apnea, hyperventilation, bradypnea, dyspnea, wheezing, swelling of throat
CNS: increased ICP, lethargy, drowsiness, euphoria, hallucinations, blurred vision, anxiety, tension, seizure, lightheadedness, fainting DERM: skin rash, flushing, urticaria Nursing Considerations: Considerations: - Ass Assess ess his histor tory y of aller allergy gy to the comp compone onents nts of of the drug. drug. - Use safety safety precaut precaution ions s afte afterr admini administr strati ation. on. - Advise Advise pati patient ent that that ment mental al alert alertnes ness, s, coordi coordinati nation, on, and phys physica icall dexterity may be impaired for some time after administration. - For IV, IV, do not not mix mix with with other other therap therapeut eutic ic agent agents s prior prior to to administration. Avoid mixing blood or plasma in same IV catheter. - Minimi Minimize ze pain pain associat associated ed with with admini administr strati ation on by infusi infusing ng into into larger larger veins. - Should Should be be admin administ istere ered d only only by pers personn onnel el who who are are train trained ed in in administration of general anesthesia and familiar with drug. - Shake Shake well well before before use. use. Do Do not use use if ther there e is evide evidence nce of of separa separatio tion n of phases of emulsion.
Generic Name: Hyoscine-N-butylbromide Brand Name: Buscopan Classification: Antispasmodic; Anticholinergic Therapeutic Actions: - acts acts by inter interfer fering ing with with the the trans transmi missi ssion on of nerve nerve impu impulse lses s by acetylcholine in the parasympathetic nervous system. Indications: - Buscop Buscopan an Tablet Tablets s are indic indicate ated d for the reli relief ef of spasm spasm of the the genito genito-urinary tract or gastro- intestinal tract and for the symptomatic relief of Irritable Bowel Syndrome Contraindications: - Buscop Buscopan an Tablet Tablets s should should not not be admi adminis nister tered ed to pati patient ents s with with myasthenia gravis, megacolon and narrow angle glaucoma. In addition, they should not be given to patients with a known k nown hypersensitivity to hyoscine-N-butylbromide 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: Considerations: - Drug compatibi compatibility lity should be monitored monitored closely closely in patient patients s requiri requiring ng adjunctive therapy - Avoid Avoid drivin driving g & operating operating machinery machinery after parenteral parenteral administra administration. tion. - Avoid st strict he heat
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Raise Raise side side rails rails as as a precau precautio tion n becaus because e some some patien patients ts becom become e temporarily excited or disoriented and some develop amnesia or become drowsy. Reori Reorient ent pati patient ent,, as need needed, ed, Tolera Tolerance nce may devel develop op when when therap therapy y is prolonged Atropi Atropine-l ne-like ike toxic toxicity ity may may cause cause dose dose relate related d adverse adverse reac reactio tions. ns. Individual tolerance varies greatly Overdose Overdose may cause curare-li curare-like ke effect effects, s, such such as as respir respiratory atory paralysis. paralysis. Keep emergency equipment available.
