ob drugs 2263

3.

MEDICATION NAME

GENERIC/TRADECLASSIFICATION

(PHARM) AND PREGNANCY CATEGORY

Indication/ ActionDOSE, ROUTE, TIMES

DOSGERANGE

(include therapeutic dose calculation)

Food/Drug INTERACTI

ONS

SIDE EFFECTSEFFECTS

PREGANCY FETUS AND/OR NEONATE

NURSING CONSIDERATIONS

MAGNESIUM SULFATE (IV, Parenteral)

Mineral electrolyte replacement

Preg Cat B

Davis Drug Guide for Nsg Page 768-770

Treatment of pre eclampsia, decrease blood pressure, eclampsia, or nephritis, pre term labor

Essential for the activity of many enzymes, plays an important role in neurotransmission and muscular excitability, replacement in deficiency states,

IM, IV Preterm labor –Loading dose 4-6 g magnesium sulfate administered over a 20 minute period Maintain dose 1-4g/h by infusion pump.Antidote - calcium Pre eclampsia –Loading dose 4-6 g magnesium sulfate administered over a 15-20 minute period

See Davis Drug Guidepage 769See Olds pg 500

Therapeutic sermon blood level 4-8mg/dL. Diagnosed maternal myasthenia gravis is he only absolute contraindication to the administration of magnesium sulfate (ACOG, 2003b) Myocardial damage or heart block is a relative contraindication use of the drug because of the effects on nerve transmission and muscle contractility. Extreme care is necessary in administration to women with impaired renal function because the kidneys eliminate the drug, and toxic magnesium levels may develop quickly.

Cross the placenta, may cause fetal heart rate decrease, dose not pose risk to fetus, ill effects in the newborn may actually be related to fetal growth retardation, prematurely, or perinatal asphyxia

Monitor pulse, BP, Respiration and ECG frequently throughout administration of parenteral magnesium. Monitor maternal serum magnesium levels as ordered (usually 9-13 mg/dL), respiratory depression level of 14mg/dL or less than 12/minute, magnesium toxicity may occur at; cardiac arrest occurs at levels above 30mg/dL. If respiratory rate falls below 12/minute protocols require stopping medication. Assess hypo-magnesemia/anticonvulsant, knee jerk (patellar tendon reflex) for evidence of diminished or absent reflexes. Loss of reflexes is often the first sign of developing toxicity. Marked lethargy or decreased level of consciousness and hypotension. Determine urinary output , less that 30mL/hour may result in the accumulation of toxic levels of magnesium. Respiratory, urine output specified levels and diminished/absent reflexes indicate no further magnesium should be administrated until these factors return to normal. Antagonist magnesium sulfate is calcium and ampule of calcium gluconate should be available at bedside, 1 dose IV over period of about 3 minutes. Monitor fetal heart tones with IV administration. Continue magnesium sulfate infusion for approximately 24 hours after birth for prophylaxis against postpartum seizures of given for pre eclampsia. Baby should be monitored for signs of magnesium toxicity for 24-48 hours.

UZ2/Zip 9/RSNG 2263 Packet

Note: Any up-dates are to be completed in different color ink. The student is expected to document all meds the client is currently receiving. MEDICATION NAME



INDICATION/ ACTIONDOSE, ROUTE, TIMES

DOSGERANGE


FOOD/DRUG INTERACTIONS

SIDE EFFECTSEFFECTS PREGANCY

FETUS AND/OR NEONATE


Oxytocin(Pitocin)

Oxytoxic

Preg. Cat.C

OLDs Page 600-609

Parmacology for Nsg Care Page 747

Mosby’s Nsg Drug Card 211

Oxytocic effect due to increase sodium ion permeability in uterine smooth muscle cells, which increase number of contracting myofibrils, enable uterus to contract, uterine sensitivity to oxytocin gradually increase during pregnancy, reaching peak before parturition.

Injection (IM/IV)Adult 10unit/ml

Ante partum – Start with infusion rate 1-2mU/m, slowly increase until contractions reach desired rate, intensity. Postpartum – IV 10-40unit 1000ml, infused at sufficient rate to control uterine atony.--IM 3-10 units after delivery of placenta

Use with Adrenergics, vasopressors can produce severe hypertension. Hypersensitivity, cephalopelvic disproportion, unfavorable fetal position, obstetric emergencies that favor surgical intervention, fetal distress when delivery not imminent, prolonged use in uterine patterns when vaginal delivery is contraindicated. Induction &/or stimulation of labor must be given by IV route. Use should be limited to medical and not elective induction of labor.

Cardiac arrhythmia, hypertensive episodes, postpartum hemorrhage, fetal bradycardia, GI N/V, GU pelvic hematoma, uterine hypertoniciy, spasms, tetnic contractions, rupture.

Induces labor, postpartum hemorrhage, fetal bradycardia, pelvic hematoma, uterine hypertonicity, spasms, tetanic contractions, rupture

Assess fetal maturity, position, and hx of hypersensitivity, pain. Administer IV use infusion pump, do not give IV push, patient in left lateral position and do not leave unattended, have emergency support equipment available, avoid over stimulation of uterus. Monitor BP, pulse q 15m, fetal heart rate, intrauterine pressure, signs of uterine rupture, fetal distress, uterine contractions, stop if very frequent (< q2m) or prolonged. Assess hydration status (continuous infusion, PO fluids can lead to H2O intoxication). Maintain Hemodynamics, relaxation techniques, comfort measures. Explain occurrence of contractions.

UZ2/Zip 9/RSNG 2263 Packet2





DOSGERANGE






PRENATAL VITAMINS A, B, C, D, E, and KPO/IM - B 12

Fat-Soluble supplements A, D, E, K

Vitamin E (Tocopherol)

Vitamin K (Memadione)

Water-soluble supplements C, B.

Vitamin B1 (Thiamine)B2 (Ribofavin)

B 12 (coalamin).Folic acid, pantothenic acid,NiacinVitamin B6 (pyridoxine)Vitamin C (Ascorbic acid)

Preg. Cat. A, B, C

Olds page 428-430

Organic substances necessary for life and growth, vitamins A, D, E, and K (fat-soluble) are stored in the liver available should the dietary intake become inadequate (not excreted in the urine). Vitamin A for growth of epithelial cells for lining entire gastrointestinal tract and compose the skin. Vitamin A (retinol) prevents night blindness.Vitamin D plays a role in absorption and utilization of calcium and phosphorus in skeletal developmentVitamin E involves enzymatic, metabolic reactions, antioxidant, and affects health of all cells in body protecting cell membrane. Synthesis or nucleic acids required

forming red blood cells. Vitamin K is an essential factor for synthesis of thrombin, normal blood clottingVitamin C is to aid the formation and development of connective tissue and vascular system. Ascorbic acid essential to the formation of collagen, which binds cells together.

(PO)RDAVitamin A is 770 mcg per day for pregnant women age 19 and older. Inadequate dietary supplementation is 5000 international units (e.g. strictly vegetarian, deficiency of vitamin A is endemic in recent emigrants). Vitamin D 5mcg/day Vitamin E 15mg per dayVitamin K 90mcg per dayVitamin C is increase in pregnancy from 75 to 85 mg per day Vitamin B1 pre-pregnant level 1.1 mg/day to 1.4 mg/dayVitamin B6 , 0.3 mg/day to 1.9 mg/day pregnant women 19 & olderNiacin 4mg/day to 18mg/dayFolic acid 400mcg/day pantothenic acid 5mg/day B 12 , 2.6 mcg/day to an increase of 0.2mcg/day during pregnancy

Vitamin A sources include deep green, yellow and orange vegetables and some fruits, animal sources include liver, egg yolk, cream, butter, fortified margarine, and milk.Vitamin D sources include fortified milk, liver, egg yolk, cream, butter, ultra-violet light rays of sunlight.Vitamin Esources include whole grains, greens, vegetable fats/oils, and egg.Vitamin KSources include liver, green leafy vegetableVitamin C Sources include citrus fruit, tomatoes, cantaloupe, strawberries, potatoes, broccoli, and other leafy green vegetables, but air, heat and water during storage and cooking destroy ascorbic acid.Vitamin B2

Sources include milk, liver, eggs, enriched breads, cereals

Fat-soluble vitamins toxicity includes nausea, gastrointestinal upset, dryness and cracking of the skin, and loss of hair. A & D can lead to toxicity. Overdose of Vitamin D during pregnancy can cause hypercalcemia or high blood calcium levels because of calcium from the skeletal tissue. Toxicity symptoms include excessive thirst, loss of appetite, vomiting weight loss, irritability and high blood calcium levels.Vitamin E is beneficial in treating certain types of muscular pain and intermittent claudiction, surface healing of wounds, burns, protecting lung tissue from damaging effects of smog.Vitamin K Need for Vitamin K dose not increase during pregnancy, adequate in well-balanced prenatal diet. Water-soluble vitamins are excreted in urine small amounts are stored there is little protection from dietary inadequacies.Adequate amounts must be ingested daily. Water-soluble vitamins concentrations in maternal serum falls, where as high concentration are found in

Vitamins A,D,C, and B6 have a negative effect on the fetus. Excessive intake of one vitamin may interfere with the body’s use of vitamin B12 (mega doses are best avoided) .. Inadequate maternal intake of vitamin A associated with preterm birth, intrauterine growth restriction, decreased birth weight.

Vitamin D is needed for developing fetus and in pregnant women the need for calcium absorption.

Vitamin E massaged as oil prevents permanent stretch marks. Excessive intake) may cause abnormal coagulation in newborns.Deficiency symptoms of Vitamin E relate to long-term inability to absorb fats (mal-absorption exits in cases of cystic fibrosis, liver cirrhosis, obstructive jaundice).Vitamin K synthesis by destroying intestinal E-coli in the intestine.

Water-soluble vitamins concentrations in maternal serum falls,

Folic acid and iron are the only nutritional supplements generally recommended during pregnancy. An increase need for other vitamins and mineral can usually be met with an adequate diet. To avoid possible deficiencies, many healthcare professionals still recommend a daily vitamin supplement.

Monitor dietary intake and food sources. Check for vitamin deficiencies. Dietary education on maintaining a good healthy diet from the four food groups.

OTC vitamins and minerals, food supplements may potentially be harmful if used in excess.

Notify physician before taking OTC medications, herbs or other vitamin supplements.



B 12 (Niacin).Folic acid, pantothenic acid,Vitamin B6 vital coenzyme factors in many reactions-cell respiration, glucose oxidation, and energy metabolism.

Vitamin K is an essential factor for synthesis of thrombin, normal blood clottingVitamin C is to aid the formation and development of connective tissue and vascular system. Ascorbic acid essential to the formation of collagen, which binds cells together.


B 12 (Niacin).Folic acid, pantothenic acid,Vitamin B6 vital coenzyme factors in many reactions-cell respiration, glucose oxidation, and energy metabolism.

Vitamin B6

Sources include wheat germ, yeast. Fish, liver, pork, lentils, potatoesVitamin B 12 Sources include fresh leafy vegetables, liver, peanuts, whole-grain breads (folic acid can inactive by oxidation), store covered to protect from light, cook with small amount of water, do not over cook.

the fetus.Vitamin B1 (Thiamine), B2

(Ribofavin) , B 12 (Niacin), Folic acid, antothenic acid Vitamin B6 are needed as caloric intake increases to meet metabolic & growth needs of pregnant women. B2 manifest cheilosis (fissures and cracks lips & corners of mouth)

where as high concentration are found in the fetus. Folic acid for normal growth, reproduction, and lactation and prevents macrocytic, megaloblastic anemia of pregnancy, neural tube defects (NTDs) (spinal bifida, anencephaly).






DOSGERANGE




FETUS AND/OR NEONATE NURSING CONSIDERATIONS

Magnesium citrate/ Magnesium Hydroxide

Mineral and electrolyte replacement/supplements, laxatives

Milk of Magnesia(saline)

Preg. Cat. B

OLDs Page 428Mosby’s Nsg Drug Card 353Davis Drug Guide for Nsg Page 766

Cathartic Saline -Hyperosmotic activity produces H2O retention, resulting in an H2O stool bowel evacuation, resulting in diarrhea and complete cleansing of intestines before diagnostic procedure. Used for treating constipation and with anthelmintics for removal of drug and parasite. Also used before diagnostic or intestinal surgical procedures.

M. Citrate adult 200ml single dose, Adult /children >12 y/o 30-60 ml/day, Children 100ml single doseChildren 2-5 y/o 15ml/day, 6-11 y/o, 5-30 ml/day

Dietary aids such warm beverages (non caffeinated), prune juice and moderate exercise will assist in natural action of the body to produce defecation Severe or pre-exiting constipation may need a mild laxative such as Milk of Magnesia recommended by caregiver.

Diarrhea, fatigue fluid volume, risk for deficient, risk or impaired tissue integrity. Rectal irritation.

Safe use in pregnancy.Magnesium is essential for cellular metabolism and structural growth. (RDA for pregnancy is 320mg /day) Advantage/disadvantage to fetus non-specific. Caution use in immature systems.

Use caution if pregnant or breastfeeding and increased illness-related restrictions. Assess hx of hypersensitivity, health, nutritional status Medication hx , bowel sounds, GI function, duration of constipation, medication contributing to constipation. Caution –abdominal pain, acute pain, impaired physical mobility. Administer on empty stomach at hs unless otherwise directed or appropriate times for diagnostic study. Provide appropriate toileting facilities, establish defecation schedule. Encourage increase of fluids, bulk-containing foods, prunes, and increase activity. Monitor for dehydration, electrolyte imbalance. Avoid chronic use, promote regular bowel habits, followed by high-fiber diet. Notify physician of acute undiagnosed abdominal pain (Fecal impaction, obstruction of intestinal tract).






DOSGERANGE




FETUS AND/OR NEONATE NURSING CONSIDERATIONS

Hydrocodone(Vicodin)

Analgesic p-aminophenol, nonsalicylate analgesic

Preg. Cat. C

OLDs Page 394-395 and Mosby’s Nsg Drug Card 2

Increase pain threshold affects hypothelamic heat-regulating center, resulting in analgesia/antipyresis about equal to aspirin exerts no anti-inflammatory or uricosuric activity. Analgesic for mild to moderate pain as sole agent or in combination with other analgesics or narcotics. Antipyretic for fertile states. Decrease pain and fever associated with DPT inoculation

POHydrocodone/acetaminophen Rx C-III 5/500mg , ES 7.5/750mg (caplet, capsule, chewable tablet, elixir, gel caps, liquid , suspension, suppository, tablet.

Erythematous medications, PO anticoagulants can e displaced from protein storage sites, excessive use can enhance bleeding tendencies. Use with phenothiazines may produce hypothermia . Use with alcohol, anticonvulsants, INH can increase liver toxicity.

Anemia, leukoenia, neutropenia, pancytopenia, hemolytic anemia, methemoglobinema, (rare) jaundice , erythematous rxs, urticaria. OTC blood glucose testing kits can produce false-negative results.

Use of medications during pregnancy, including prescription, over-the-counter drugs, and herbal remedies, is of great concern because maternal drug exposure is through to account for at lest 10% of birth defects. OTC drugs by pregnant women for therapeutic purposes such as infection, allergies, and other pathologic processes pose extreme complexity due to fetal organs are developing during the first trimester and potential gross abnormalities in the fetus occurs during the first trimester.

Monitor hepatic, renal status during long-term therapy, bleeding (GI, GU, skin/mucous membranes) with long-term, high-dose therapy, signs of OD, (sweating, gastric irritation chills, cyanosis, oliguria, jaundice, come, convulsions, death from respiratory failure). Assess hx of hypersensitivity, Shake suspensions well before administration and give with food if GI irritation occurs. Store suppositories in refrigerator. Maintain patient comfort, bleeding precautions with long-term regimen. Remove of drug by emesis or gastric lavage followed by acetycysteine to decrease liver toxicity.






DOSGERANGE



SIDE EFFECTSEFFECTS PREGANCY FETUS

AND/OR NEONATE NURSING CONSIDERATIONS

Ibuprofen(Motrin, Motrin IB, Advil)

Antipyretic, nonopioid analgesic

Preg Cat NA

OLDs Page 394-395Mosby’s Nsg Drug Card 139

Anti inflammatory, analgesic, antipyretic activity appears related to inhibition of prostaglandin synthesis. Use to treat rheumatoid arthritis/osteoarthritis, relief of pain (mild/moderate) primary dysmenorrheal, antipyretic. Treatment of pauciarticular/poly arthritic cause of juvenile RA for >2y/o, OA/RA, Treatment of perioperative pain or coronary artery bypass graft (CABG).

PO Fever children 6mo-12y/o 5mg/kg if <102.5 o

F. Do not exceed max dose 40mg/kg/day Arthritis 30-40mg/kg/day in divided doses. Adult arthritis 400-800mg 3-4 times /day, Do not exceed 3.2g/day Pain 200-400mg q4-6hDysmenorrheal 200-400mg q4-6hFever 200-400mg q4-6h

Use with ulcerogenic drugs produces additive effects, anticoagulants may increase their activity and aspirin will decrease ibuprofen plasma levels.

Dizziness, headache, drowsiness, edema, palpitations, tinnitus, decrease hearing, blurred vision, abdominal pain, N/V, constipation, steatites, glomerular nephritis, hematuria, interstitial nephritis, nephrotic syndrome, agranulocytosis, aplastic anemia, hemolytic anemia, rash, alopecia, pruius, purpura, uricaia, thirst, eosinophilic pneumonia.

Use of medications during pregnancy, including prescriptions, over the counter drugs, and herbal remedies, is a great concern because maternal drug exposure is thought to account for at least 10% of birth defects. Statistics indicate that the use of prescription and over the counter medications by pregnant women is more widespread than might be expected. Many pregnant women need medication for therapeutic purposes, such as tx of infections, allergies other pathologic processes. They can have taken potentially teratogenic medication before their pregnancy was diagnosed.

Assess hx of NSAID, salicylate hypersensitivity, and asthma, bleeding disorders, avoid use. Administer with food/milk, best on empty stomach (1h ac/2h h pc), encourage upright position for 15-30m, and avoid exposure to moisture/light in storage. Monitor hematologic, hepatic renal status with prolonged use. PO anticoagulants may potentiate bleeding, I&O, daily weight with prolonged use, extremities for edema, presence of visual disturbances, skin rash, D/C drug and notify physician.






DOSGERANGE






Acetaminophen(Tylenol)


Preg. Cat. B

Mosby’s Drug Nsg Card 2

Used as analgesic for mild to moderate pain as sole agent or in combination with other analgesics or narcotics, antipyretic for febrile states, decrease pain and fever associated with DPT inoculations. Increase Pain threshold affects hypothalamic heat-regulating center, resulting in analgesia/antipyresis about equal to aspirin, exerts no anti-inflammatory or uricosuric activity.

PO Adults & Children >12yr (30/300mg) 325-650mg (not to exceed 4g/d or 2.6g/d with long term).

Children/Pediatric 0-3mo 40mg, 4-11mo 80mg, 1-ylo 120mg, 2-3yr/o 160mg4-5y/o 20mg6-y/o 320mg9-10y/o 400mg11-12y/o 480mg

PO anticoagulants can be displaced from protein storage sites, excessive use can enhance bleeding tendencies, use with phenothiazines may produce hypothermia, use with alcohol, anticonvulsants, INH, can increase liver toxicity.

Armenia, leukopenia, neutropenia, pancytopenia, hemolytic anemia, methemoglobinemia (rare), jaundice, erthemaous rxs, urticaria...


Assess hx of hypersensitivity, Pain, acute/chronic, body temperature, risk of imbalanced. Shake suspensions well before administering, administer with food if GI irritation occurs, and store suppositories in refrigerator.

Monitor hepatic, renal status during long-term therapy, bleeding (GI,GU, skin/mucous membrane)with long-term therapy, Signs of OD, sweating , gastric irritation, chills, cyanosis, oliguria, jaundice, coma, convulsions, and death from respiratory failure.

Maintain patient comfort, bleeding precautions with long-term therapy. Overdose management to remove drug by emesis or gastric lavage followed by acetylcysteine to decrease liver toxicity






DOSGERANGE


FOOD/DRUG INTERACTIONS SIDE EFFECTSEFFECTS

PREGANCY FETUS

AND/OR NEONATE


Morphine sulfate(Duramrph)

Narcotic – opium alkaloid (DURAMORPH is a systemic narcotic analgesic for administration by the intravenous, epidural or intrathecal routes. It is used for the management of pain not responsive to non-narcotic analgesics)

Preg. Cat. C


Morphine is the most important alkaloid of opium and is a phenanthrene derivative. It is available as the sulfate salt, having the following structural formula is a sterile, nonpyrogenic, isobaric solution of morphine sulfate, free of antioxidants, preservatives or other potentially neurotoxic additives and is intended for Dosette ampul of Duramorph.Morphine is the most important alkaloid of opium and is a phenanthrene derivative. Used for relief of pain, Sedation, hypnosis when painis present , Preop/ postop sedation/analgesia. Narcotic produce analgesa, euphoria, sedation, morphine sulfate has high misuse potential, addition liability. Pprovides pain relief for extended periods without attendant loss of motor, sensory or sympathetic function.

Morphine sulfate injection (Preservative Free, SINGLE USE ONLY)intravenous, epidural or intrathecal administration as a narcotic analgesic. Each milliliter contains morphine sulfate 0.5 mg or 1 mg and sodium chloride 9 mg in Water for Injection. pH range is 2.5-6.5. Each 10 mLDiscard any unused portion. DO NOT HEAT-STERILIZE(Pediatric SC Neonates 0.02-0.05mg/kg q –4hInfants 0.1-0.2mg/kg dose q 2-4h (do not exceed single dose 15mg. Adults PO 10-30mgq 4hr, IM 5-10mgq 4hr, Rectal 10-20mgq4hr)

. Additive compatibilities alteplase, atracurium, baclofen, bupivacaine, doutamine, fluconazole, furosemide, meropenem, meoclopramide, ondanseron, succinylcholine, veapamil.Y-site compatibilities allopurinol, amiostine, amikacin, aminphyline, amiodarone, ampicillin, ampicillin/sulbactam, amsacrine, atenolol, atracurium, aztreonam, bumetanide, calcium chloride, cefamandole, cefazolin, cefmetazole, cefoperazone, clindamycin dopamine, Syringe Compatibilities atropine, benzuinamide, bupivacaine, butorphanol, cimeidine, dimenhydrinate, diphnhydramine, and droperidol.

Respiratory depression, sedation, tremors, lightheadedness, euphoria, dysphoria, disorientation, decrease convulsive threshold, hypotension, palpitations, flushing of face, phlebitis of IV site, miosis, dry mouth, constipation, biliary tract spasm, urine retention, pruritus. Depressant effect, signs of OD (coma, pin point pupils, respiratory depression)

Injection -Lumbar epidural block has become fairly common during labor and birth. Complete pain relief is achieved for 85% of women, 12% experience partial relief, and only 3% of women report to no relief at all.

Avoid breastfeeding

Assess hx of opioid hypersensitivity, quality, intensity ,location of pain, Respirations ,12/m do not administer Avoid administration in pts with suspected head injury, Pain, acute/chronic and key document use accurately, check compatibility for mixing with other drugs in solution.

IV –dilute slowly (3-5m), keep supine for hr Have narcotic antagonist (naloxone), support measures available, before patient experiences intense pain Avoid abrupt withdrawal with long-term use, Around clock to pts with severe chronic pain.

Po liquid –dilute with juice to mask disagreeable.

IM inject deep into muscle, rotate sites.


http://www.rxlist.com/script/main/art.asp?articlekey=10933










DOSGERANGE






Ergonovine maleate/ etylergonovine maleate(Methergine)

Oxytoxic

Preg. Cat. NA/C


Treatment/prevention of postpartum/postabortal hemorrhage due to uterine atony, with full supervision may be given in second stage of labor following delivery of anterior shoulder (methylergonovine). Oxytoxic effect due to direct stimulation of uterine smooth muscle, resulting in intense contractions followed by periods of relaxation, accordingly, increase uterine tone, decrease postpartum uterine bleeding, drug can occasionally produce severe hypertensive episodes, esp in toxemic patients.

PO/MI/IVErgonovine-Adults IM 0-2mg; may be repeated for severe hemorrhage IV adults Route should be restricted to lifesaving situations because of higher rate of side effects.

Methylrgonoine -Adult PO 0-2mg; 3-4 times/day in puerperium for a maximum of 1 wk.Adult IM 0.2mg after delivery of anterior shoulder, placenta, or during puerperium prn q2-hAdult IV –Route limited to lifesaving situations because of increase rate of adverse effects

Concurrent/sequential use with vasoconstrictors /regional anesthesia may affect BP. Additive Compatibilities-amikacin, cephapirin, sodium bicarbonate.

Headache, hypertension, particularly when administered IV, GI N/V, possible symptoms of ergot poisoning.

Uterine contraction (decrease hemorrhage)

Assess hx of hypersensitivity, BP, serum calcium, IV calcium gluconate if hypo-calcemic. Do not administer discolored/precipitated solution, IV infuse slowly, use infusion control device, Have emergency support equipment available. PO avoid excessive moisture in storage, Injection store in cold place (46oF) do not exceed 60days at room temperature. Monitor BP, pulse, serum calcium, signs of ergotism (N/V, dizziness, cramps, anuria, convulsions). During Postpartum monitor fundal height/tone, assess amount/character of lochia. Maintain emotional support. Explain process to patient, procedure and rationale.






DOSGERANGE






Docusate sodium(Colace)

Laxative

Preg. Cat. C

OLDs Page 1206 and Mosby’s Nsg Drug Card 353

Cathartic- Fecal stool softeners lower the surface tension of intestinal fluids , resulting in H2O & lipid passage into fecal mass. Used for constipation to soften fecal impacts, to facilitate easy defecation with painful anorectal conditions . Bowel evacuant. Diverse group of drugs that promote defecation (BM) with mechanism of action are available primarily as OTC preparation. Laxatives that produce a rapid, forceful BM with a loose stool are called cathartics (pergatives) this term is obsolete because the intensity of BM is primarily a dose-related, cause-an-effect relationship

PODocusate CaAdult/ Children >12 y/o 100-240mg/day

Docusate K50-240mg/day Adult/Children >12 y/o 50-360mg/day Children 2-11y/o 50-150mg/dayChildren <2 y/o 25mg/day

Dietary aids such warm beverages (non caffeinated), prune juice and moderate exercise will assist in natural action of the body to produce defecation Severe or pre-exiting constipation may need a mild laxative such as Colace recommended by caregiver.

Diarrhea, fatigue fluid volume, risk for deficient, risk or impaired tissue integrity. Rectal irritation.

Caution if pregnant, immature systems, do not breastfeed.Advantage/disadvantage to fetus non-specific.

Use caution if pregnant or breastfeeding and increased illness-related restrictions. Assess hx of hypersensitivity, health, nutritional status Medication hx , bowel sounds, GI function, duration of constipation, medication contributing to constipation. Caution –abdominal pain, acute pain, impaired physical mobility. Administer on empty stomach at hs unless otherwise directed or appropriate times for diagnostic study. Provide appropriate toileting facilities, establish defecation schedule. Encourage increase of fluids, bulk-containing foods, prunes, and increase activity. Monitor for dehydration, electrolyte imbalance. Avoid chronic use, promote regular bowel habits, followed by high-fiber diet. Notify physician of acute undiagnosed abdominal pain (Fecal impaction, obstruction of intestinal tract).






DOSGERANGE






Acetaminophen(Tylenol #3)


Preg. Cat. B


Used as analgesic for mild to moderate pain as sole agent or in combination with other analgesics or narcotics, antipyretic for febrile states, decrease pain and fever associated with DPT inoculations. Increase Pain threshold affects hypothalamic heat-regulating center, resulting in analgesia/antipyresis about equal to aspirin, exerts no anti-inflammatory or uricosuric activity.

PO Adults & Children >12yr (30/300mg) 325-650mg (not to exceed 4g/d or 2.6g/d with long term).

Children/Pediatric 0-3mo 40mg, 4-11mo 80mg, 1-ylo 120mg, 2-3yr/o 160mg4-5y/o 20mg6-y/o 320mg9-10y/o 400mg11-12y/o 480mg

PO anticoagulants can be displaced from protein storage sites, excessive use can enhance bleeding tendencies, use with phenothiazines may produce hypothermia, use with alcohol, anticonvulsants, INH, can increase liver toxicity.

Amenia, leckopenia, neutropenia, pancytopenia, hemolytic anemia, methemoglobinemia (rare), jaundice, erthemaous rxs, urticaria...


Assess hx of hypersensitivity, Pain, acute/chronic, body temperature, risk of imbalanced. Shake suspensions well before administering, administer with food if GI irritation occurs, store suppositories in refrigerator.

Monitor hepatic, renal status during long-term therapy, bleeding (GI,GU, skin/mucous membrane)with long-term therapy, Signs of OD, sweating , gastric irritation, chills, cyanosis, oliguria, jaundice, coma, convulsions, death from respiratory failure.

Maintain patient comfort, bleeding precautions with long-term therapy. Overdose management to remove drug by emesis or gastric lavage followed by acetylcysteine to decrease liver toxicity






DOSGERANGE



SIDE EFFECTSEFFECTS



Diphenhydraamine hcl(Benadryl)

Antihistamines (H1 blockers)

Preg. Cat. C


Chemically diverse group of drugs that competitively antagonize (block) physiologic effects of histamine, an endogenous agonist at histamine receptor sites. These agents can antagonize most effects of histamine and are subdivided according to type of histamine receptor they block. Histamine receptors are currently divided into peripheral H1and parietal H2 receptors. H1 blockers (H1 receptor antagonist ) are original and largest group of antihistamines. Term antihistamine usually associated with H1 blockers. Medication use is commonly for allergic condition, motion sickness, parkinsonism , sleep, vertigo.

PO Adults 20-50mg 3-4 times/day

Use with anitcholinergics or CNS depressants produces additive sedation affects MAO-1 can increase anticholinergic effects of antihistamines.Ethanolamines moderate acting (6-8h) with moderate anticholinergic and low sedation activity.

Activity intolerance , sensory perception, disturbed (visual, skin integrity, impaired (PO mucous membrane) urinary elimination impaired.Drowsiness, dizziness, euphoria, parestheias,. Hypotension, palpitation, extrasystole, tachycardia, blurred vision nasal stuffiness, N/V, anorexia ,agranulocytosis, hemolytic anemia, thrombocytopenia, wheezing, thickening of bronchial secretions, anticholinergic effects.

Use extreme caution when used if pregnant and lactation. Potential ability o cross blood-brain barrier to produce sedation.Classic antihistamines, H1 antihistamines can be classified according to their chemical derivation , duration of activity, anticholinergic activity,

Assess hx of hypersensitivity, allergy symptoms, lung sounds, caution if pregnant and lactation, GI, cardiac, hepatic impairment.Administer PO forms with meals, Monitor VS, BP, Monitor activity status Monitor children for paradoxic rxs (CNS stimulation) Institute safety precautions. Advise patient to avoid CNS depressants alcohol and potentially hazardous activity (drowsiness, dizziness), increase fluid intake, Use sugarless bum/hard candy to diminish dry mouth,






DOSGERANGE



SIDE EFFECTSEFFECTS



Meperidine(Demerol)

Opioid analgesis NarcoticsOpioid agonists (schedule II)

Preg. Cat C

Davis Drug Guide for NSG Page 784-787

Mosby’s Nsg Drug Card 305

Moderate or severe pain (alone or with non- opioid agents) Anesthesia adjunct. Analgesic during labor. Preoperative sedation (Rigors- unlabeled use).Binds to opioid receptors in the CNS, alters the perception of and response to painful stimuli, while producing generalized CNS depression. Decrease in severity of pain.

IV, IM, SUBCU, POAdults-IM or subcut Analgesia during labor and when contractions become regular, may repeat q 1-3 hrPreoperative sedation 1-2mg/kg 30-90 min before anesthesia (not to exceed adult dose)IV adults 15-35mg/hr as a continuous infusion, PGA 10mg initially with range of 1-5mg/incremental dose, recommended lockout interval is 6-10 min (minimum 5min) IV children Continuous infusion 0.5-1 mg/kg loading dose followed y 0.3mg/kg/hr, titrate to effect up to 0.5-0.7mg/kg/hr.

Do not use in patients receiving MAO inhibitors or procarbazine (may cause fatal reaction –contraindicated within 4-21 days of MAO inhibitor therapy). Increase CNS depression with alcohol, antihistamines and sedative/ hypnotics. Administration of agonist/antagonist opioid analgesics may precipitate opioid withdrawal in physically dependent patients. Nalbuphine or pentazocin may decrease analgesia. Protease inhibitor anti retrovirals may increase effects an adverse reaction (concurrent use should e avoided). Pheytoin increase metabolism and may decrease effects. Chlorpromazine and thioridazine may increase risk of adverse reactions.

Seizures, confusion, sedation, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams, blurred vision, diplopia, miosis, respiratory depression hypotension, bradycardia, constipation, nausea, vomiting, flushing, urinary retention, sweating, physical dependence, psychological dependence, tolerance.

Widely distributed crossing placenta, enters breast milk. Neonates 52% protein binding occurs, Infants 3-18 months 85% protein binding occurs.

Assess type, location, and intensity of pain prior to and 1hr following PO, subcut and IM doses and 5 min (peak) following IV administration. When titrating opioid doses, increases of 25-50% should be administered until there either a 50% reduction in the patient’s pain rating on a numerical or visual analogue scale or the patient repots satisfactory pain relief. Repeat dose can be safely administered at the time of the peak if previous dose is ineffective and side effects are minimal. An equianalgesic chart should be used when changing routes or when changing form on opioid to another. Assess BP, pulse, and respiration before and periodically during administration. If respiratory rate is ,10/min, assess level of sedation. Dose may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use. Neonates and infants are more susceptible to respiratory depression. Assess respiratory rate frequently.






DOSGERANGE



SIDE EFFECTSEFFECTS



Aminoglycosides(Gentamyacim)

Ani-infectives

Preg. Cat. C

Davis Drug Guide for NSG Page 140-145Mosby’s Drug Nsg Card 356

Treatment of entrococcal infections, syergy with penicillin required, Tx for serious gram-negative bacillary infections and infections caused by staphylococci when penicillin or other less toxic dugs are contraindicated. Gentamicin IV prevention of in effective endcarditis. Steptomycin with gentamicin as combination with other agents in the management of serious enterococcal infections.Inhibits protein synthesis in bacteria a level of 30S ribonsome. Most aminoglycosides notable for activity against Staphylococcus, P. aeruginosa, Klebsiella pnuemoniae, E.coli, Proteus, Serratia, acineobarter,

IM, IV Adults and Children 5mg/kg q 8hr or 7.5 mg/kg q 12 hr (not to exceed 1.5g/day)IM, IV Adults Renal impairment - Loading dose 10mg/kg further dosing based on blood level monitoring and renal function assessment.M.avium complex 7.5-15mg/kg/day divided q12-24hr. IM, IV Neonates loading dose 10mg/kg Maintenance dose 7.5mg/kg q 12hr.

Inactived by penicillins and cephalosporins when coadministered to patient with renal insufficiency. Possible respiratory paralysis after inhalation anesthetics or neuromuscular blocking agents. Increase incidence of ototoxicity with loop diuretics, nephrotoxicity with other nephrotoxic drugs. Neomycin may increase anticoagulant effects of warfarin or decrease absorption of digoxin and methotrexate.

Burning, inflammation, itching lacrimation, redness, irritation after application, development of ocular hypersensitivity and other local adverse rxs. Possible growth of non-susceptible organisms, viral infection. Ataxia, vertigo, ototoxicity, (vestibular and cochler), Nephrotoxicity. Neomycin-diarrhea, nausea, vomiting, Hypomagnesemia, muscle paralysis (high parenteral doses). Increased neuromuscular blockade. Apnea and hypersensitivity reaction.

AminoglycosidesCan cross the placenta and may be toxic to the fetus. Infection, risk for.

Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, WBC) beginning of and throughout therapy. Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results. Assess patient for signs of super infection (fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea) Evaluate eighth cranial nerve function by andiometry before and throughout therapy. Hearing loss is usually in the high –frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Also monitor for vestibular dysfunction (vertigo, ataxia, nausea, vomiting) Eighth cranial nerve dysfunction is associated with persistently elevated peak aminoglycosides if tinnitus or subjective hearing loss occurs. Monitor intake & output and daily weight to assess hydration status and renal function.






DOSGERANGE



SIDE EFFECTSEFFECTS

PREGANCY FETUS AND/OR

NEONATE


Anti-infectivesaminopnicillins( Ampicillin)

Preg. Cat. B

Davis Drug Guide for NSG 4-169Mosby’s Drug Nsg Card 361

Prevention of infection in certain high-risk patients undergoing cesarean section. Treatment of the following infections-Skin and skin structure infections, Soft-tissue infections, Genitourinary infections, Otitis media, Sinusitis, Respiratory infections, Meningitis, Septicemia. Endocarditis prophylaxis. Unlabeled Binds to bacterial cell wall, resulting in cell death. Bactericidal action , spectrum is broader than penicillin. Active against Streptococci, nonpenicillin-producing staphylococci, Listeia Pheumococci, Escherichia coli, Enterococci, Haemophilus influenze, Eserichia coli, Enterobacter, Klebsiella, Proteus mirabilis, Neisseria meningitides, N.gonorrboeae, Shigella, Salmonella.

N. GonorrhoeaePO Adults 3g with 1g probenecid.IM, IV Adult and children > 40 kg 500mg q 6hrIM, IV Children <40 kg 100-200mg/kg day divided doses q 6-8hrBacteria Meningitis-H. Influenza, Streptococcus pneumoniae, Group B streptococcus or N. Meningitidis or SepticemiaIM, IV Adults 500mgto 3g q 6hr hr (not to exceed 14g/day) IM, IV children. 1 month 200mg/kg in divided doses q 6 hr (not to exceed 12g/day)IM, IV Neonates <7 days old 200mg/kg/day divided q 8hrIM, IV Neonates >7 days old 300mg/kg/day divided q 6hr

Probenecid decrease renal excretion and increases blood levels of ampicillin –therapy may be combined for this purpose. Large doses may increase the risk of bleeding with warfarin. Incidence of rash increases with concurrent allopurinol therapy. May decrease the effectiveness of oral hormonal contraceptives.

Seizures, (high doses) , Pseudo membranous Colitis, diarrhea, nausea, vomiting rashes, urticaria, blood dyscasias, allergic reactions including anaphylaxis and serum sickness, super infection. May cause increased AST and ALT. May cause false-positive direct Coombs’ test result. May cause a false-positive urinary glucose.

May cause transient decreases in estradiol total conjugated estriol in pregnant women.

. Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBC) at beginning of and throughout therapy. Obtain a history before initiating therapy to determine previous use and reactions to penicillins or cephalosporins. Obtain specimens for culture and sensitivity before therapy. First dose may be given before receiving results. Observe patient for signs and symptoms of anaphylaxis. Do not confuse with omnipen with imipernem. (rash, pruritus, laryngeal edema, wheezing) Discontinue the drug and notify he physician or other health care professional immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Assess skin for “ampicillin rash”, a non allergic, dull red, macular or maculopapular, mild pruritic rash. Administer around the clock on an empty stomach. Reserve IN or IV route for moderately severe or severe infections or patient unable to take oral medication. Change to PO as soon as possible.


CLINI





DOSGERANGE






Promethazine hcl(Phenergan)

Preg. Cat. C


Pharmacology for Nsg Care Page 92

Sedation for obstetrics, surgery, Adjunct with epinephrine in anaphylactic rxs, with narcotics for postop pain Symptomatic treatment of allergic disorders medicated y histamine. Treatment of N/V, motion sickness.H1 antihistaminic activity due to competitive inhibition of histamine at H1

histamine receptors on peripheral cells, drug exhibits good anticholinergic, antiemetic, antipruritic, sedative properties.

MI Obstetric Adult Early labor, 50mg Labor, 25-75mg PO/MI/Rectal Sedative Adult 25-50 mg at bedtime Pediatric 12.5mg at bedtimePO/MI/Rectal Preop Adult 25-50mg, Pediatric 0.5mg/lb PO allergyAdult 12.5-25mg tid or 25mg at bedtime.PO/MI/Rectal N/V Adult 25mg q 4-6hr prnPediatric rectal 0.5mg/lb.

Incompatible with strong alkaline drugs. Compatibilities: amikacin, ascorbic acid, chloroquine, hydromorphone, netilmicin, vitamin B/C, Syringe-atropine, butorphanol, chlorpromazine, cimetidine, dephenhydramine, drperido, fentanly, mepridine Unreliable results with human chorionic gonadotropin/antihuman chorionic gonadotropin pregnancy test, possible increase in blood glucose. Use with anti-cholinergics, CNS depressants, TCAs produces additive effects MAO-I can increase anticholinergic effects of antihistamines.

Drowsiness, dizziness, fatigue, euphoria, blurred vision, hyotension, palpitations, tachycardia, extrasystole, agranulocytosis, thrombocytopenia, cholestatic, jaundice, drug rash, photosensitivity, anicholinergic effects, thickening of bronchial secretions.

Neonate may experience heightened drug sensitivity, due largely to immature state of five pharmacokinetic process; Drug absorption, protein binding of drugs, exclusion of drugs form he central nervous system(CNS) by the blood-brain barrier , hepatic drug metabolism, renal drug excretion.

Assess hx or hypersensitivity, hx of peptic ulcer, open-angle glaucoma, bladder obstruction, prostatic hypertrophy, use caution. Administer IM preferred parenteral route, Inject deeply into large muscle mass, IV avoid concentration . 25mg/ml and inject slowly (,25mg/m) avoid perivascular extravasations, intra-arterial injection, protect from light with foil covering, do not use discolored/precipitated solutions, avoid subcutaneous administration. Have support equipment available for anaphylaxis. Avoid exposure to moisture/light in storage.


CLINICAL NURSING – RNSG 2263MEDICATION SHEETS





DOSGERANGE






Antiarrhythmic-local anesthetic(Lidocaine)

Preg. Cat. B


Available in a wide array of preparation intend for local anesthesia. Treatment of acute ventricular arrhythmias occurring during MI/cardiac surgical procedures, Local anesthetic. Anti arrhythmic effect due to depression of ventricular automaticity, depolarization, drug has no effect on atrial arrhythmias, local anesthetic effect due to reversible blocking of nerve conduction by undetermined mechanism..

MI Adult 4.3mg/kg may be repeated after 60-90m IV Initial bolus dose 50-100mg May be repeated in 5m. Do not exceed 200-300mg over 1 hr. Usual maintenance infusion rate 1-4/mIV Pediatric Suggested bolus dose 0.-1mg.kg Usual maintenance infusion rate 10-50mcg/kg/m

Solution compatibilities D5W, D5/09,NaCL,

D5/0.45% NaCL, D5/LR, LR, 0.9%, NaCI, 0.45% NaCIUse with succinylcholine, other surgical muscle relaxants may increase neuromuscular blockage. Use with other antiarrhythmics increase effects. Use with B blockers, cimetidine increase lidocaine serum levels.

Twitching convulsions, respiratory depression/arrest, drowsiness, dizziness, sensation of heat/cold, numbness, disorientation, hypotension, bradycardia, (can induce cardiac arrest/CV collapse) blurred vision, tinnitus, vomiting

Hypersensitivity to amidetype local anesthetics, Stokes-Adams syndrome, Wolf-Parkinson-White syndrome, severe SA/AV intra-ventricular block. Use requires constant ECG monitoring . Use with caution in presence of CHF, decrease cardiac output, elderly patients digitalis toxicity with AV lockage, decrease dosage or D/C withExacerbation of arrhythmias.

Hx of amide-type local anesthetic/tocainide hypersensitivity,. Cardiac output, decreased. Pain, acute, Tissue perfusion, ineffective. Administer IM injection into deltoid muscle , IV dilute according to mfg directions, bolus dose (over 60), followed by infusion drip, use infusion –control device, cardiac monitoring do not give with epinephrine, preservative, do not administer discolored/ precipitated solutions, do not use solution with preservatives for spinal anesthesia, do not add to blood product infusions, discard solutions without preservatives after use, Have emergency support equipment available. Topical (PO) have pt swish in mouth, abstain form food for 60m. Monitor VS, BP, Respiratory status, auscultate lungs, signs of neurotoxic effects (confusion, hallucinations, behavioral changes) Notify physician D/C. Serum levels of toxicity, therapeutic blood levels 1.505mg/ml. Maintain safety precautions (convulsions, respiratory depression,


hypotension , anesthesia) .

CLINICAL NURSING– RNSG 2263MEDICATION SHEETS





DOSGERANGE






Nalbuphine hcl(Nubain)

Analgesic-opioid agonist-antagonist

Preg. Cat. B


Relief of moderate/severe pain, Preop sedation, obstetric analgesia, adjunct to surgical anesthesia. Analgesic mechanism not determined , possible site of activity may be in sub cortical areas of brain, narcotic agonist activity equivalent to morphine (mg/mg), narcotic antagonist activity ¼ that of allophone, 10 time pentazocine.

IM/IV/SC10mg/70kg may repeat q 3-6hr Do not exceed single dose 20mg , daily total 160 mg in non tolerant patientsSupplemental Balance anesthesia IV 03.3mg/kg given over 10-15 min. Maintenance dose of 0.25-0.5mg/kg as a single if required.

Drug is physically incompatible with ketorolac & nafcillin

Use with CNS depressants produces additive effects Use in narcotic-dependent patients can produce withdrawal symptoms.

CNS sedation , dizziness, vertigo, dreams, headache, depression, hypertension, hypotension, bradycardia, tachycardia, blurred vision, bitter taste, cramps, dyspepsia, dry mouth urinary urgency urticaia, rash, autonomic responses (sweating/clammy sensation , flushing, warmth).

Widely disturbuted and crossing placenta, enters breast milk. Neonates 52% protein binding occurs, Infants 3-18 months 85% protein binding occurs (Caution with Breastfeeding mothers due to small amount of drug in the mild..)

Hx of opioid hypersensitivity, respiration, do not administer if <12m, quality/intensity/location of pain, avoid administration in patients with suspected head injury. Administer- check compatibility chart for mixing preop IM preparation, IM- inject deep into muscle, rotate sites,. IV dilute, slow push, Have narcotic anagonist, support measures available, before patient has intense pain, avoid light/freezing in storage, avoid abrupt withdrawal. Monitor respirations, circulatory status, bowel function, abdominal distention, renal status, urinary retention, signs of dependence with prolonged use (increase drug request) Potential of CNS depressant effect Signs of OD (coma, pinpoint pupils, respiratory depression. Maintain positive power of suggestion, safety precautions (orthostasis). Diet (increase fluid, bulk-containing foods).


CLINICAL NURSING - RNSG 2263MEDICATION SHEETS





DOSGERANGE






Climdamycin(Cleocin)

Anti-infectious

Preg. Cat. B


Treatment of Gynecologic infections, skin and skin structure infections, respiratory tract infections, septicemia, Intra-abdominal infections, Osteomyelitis, Endocarditis prophylaxis Topical –bacterial vaginosis, severe acne, Has good activity against those anaerobic bacteria that cause bacterial vaginosis, including bacteroides fragillis, gardnerela aginalis, mobiluncus spp, mycoplasma bominis, and corynebacteriumm also active against P. carinii and toxoplasma gondii. Unlabeled uses –PO/IM/IV treatment of Bactericidal or bacteriostatic, depending on susceptibility and concentration. Spectrum is active against most gram-positive aerobic cocci, including; staphylococci, streptococcus pneumoniae,. Inhibits protein synthesis in susceptible bacteria a the level of 50S ribosome.

IM/IV/SCMost infection 300-600mg/q 6-8mg or 900 q 8hr (up to 4.8g/day IV have been used, single IM doses of 600mg are not recommended ) P.carinii pneumonia 2400-2700 mg/day in divided doses with primaquine (unlabeled) Toxoplasmosis 1200-4800 mg/day in divided doses with pyrimethamine. Bacterial endocarditis prophylaxis – 600mg min before procedure.Administer Intermittent infusion diluents vials must e diluted before use. Dilute a dose of 300mg or 600mg in 50ml and a dose of 900mg or 1200mgin 100ml. Compatible diluents include D5W, 0.9% NaCI, D5/09%,NaCL,

D5/0.45% NaCL,OR lrI

Kaolin/pectin may decrease GI absorption. May enhance the neuromuscular absorption. May enhance the neuromuscular blocking action of other neuromuscular blocking agents.Topical usage concurrent use with irritants , abrasives, or desquamating agents may result in additive irritation.

CNS dizziness, vertigo, arrhythmias, hypotension, headache, rash, depression, pseudomembranous colitis, diarrhea, better taste (IV only), Phlebitis at IV site, Nausea, vomiting,

Safety not established for systemic and topical. Vaginal approved for use in 3rd trimester of pregnancy , lactation has been used safely but des appear in breast milk and exposes infant t drug and its side effects.

Assess for infection (vital signs, appearance of wound, sputum, urine and stool, WBC) beginning of and during therapy. Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results. Monitor bowel elimination. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. This may begin up to several weeks following the cessation of therapy. Assess patient for hypersensitivity, (skin rash, urticaria). Monitor CBC, May cause transient decrease in leukocytes, eosinophils and platelets. May cause increase alkaline phosphatase, bilirubin, CPK, AST, and ALT concentrations.


CLINICAL– RNSG 2263MEDICATION SHEETS




INDICATION/ ACTIONDOSE, ROUTE, TIMES DOSGE

RANGE(include therapeutic dose

calculation)


SIDE EFFECTS

EFFECTS PREGANCY



Penicillin (penicillin G,-Pfizerpen/ pencillin V- Apo-pen VK, Cystapen, Novo-pen-VK, Nu-Pen-VK, Penccilline V/ Procaine penicillin G- Wycillin, benzathine penicillin G- Bicillin L-A, Permapen)

Anti-infectiousPenicillins

Preg. Cat. B


Treatment of a wide variety of infection including Streptococcus pharyngitis, Syphillis, Gonorrhea strains. Tx of enterococcal infections ( requires the addition of an aminoglycoside). Prevention of rheumatic fever. (unlabeled uses- tx of Lyme disease. Prevention of recurrent Streptococcal pneumoniae septicemia in children with sickle-cell disease. Inhibits protein synthesis in susceptible bacteria a level of 50S ribosome. Binds to bacterial cell wall, resulting in cell death. Spectrum active on most gram-positive organisms, including may streptococci, ( Streptococcus pneumoniae, group A beta-hemolytic strepto-inducing strains) and Bacillus anthracis. Some gram-negative organisms, such as Neisseria meningiitdis and Neissera gonorrbaeae (only penicillin susceptible strains)

IM/IV/SCPencillin GIM, IV Adult –most Infectious 1-5million units q 4-6 hr. IM, IV Children 8,333-16,6671 units/kg q 4hr. 12,500-25,000 units/kg q hr up to 250,000 units/kg/day in divided doses, some infections may require up to 300,000units/kg/day. IV Infants>7days 25,000units/kg/q 8hr meningitis 50,000-75,000 units/kg q 6hr Infants <7days 25,000units/kg/q 12hr Streptococcus B meningities 100,000-150,000 units/kg in divided doses.Pencillin VPO Adults and Children >12yr Most Infections/ erysipeloid 125-500mg q 6-8 hr. Rheumatic fever prevention 125-250mg q 12 hr----Children <12yr Lyme disease 12.5mg/kgq 6hr (unlabeled), prevention of Streptococcus pneumoniae sepsis in children with sickle cell disease- 1mg twice daily

Penicillin may decrease effectiveness of oral contraceptive agents. Probenecid decrease renal excretion and increase blood levels of penicillin (therapy may be combined for his purpose). Neomycin may decrease absorption of penicillin V decrease elimination of methotrexate and increase risk of serious toxicity. May cause positive direct Coombs’ test results, Hyperkalemia may develop after large doses of penicillin G potassium.

Seizures, diarrhea, epligastric distress, nausea, vomiting, pseudomembranous colitis. Interstitial nephritis. Rashes, urticaria, eosinophilia, hemolytic anemia, leukopenia, Pain at IM site, phlebitis at IV site. Allergic reactions including anaphylaxis and serum sickness, super-infection.

Safety not established for systemic and topical. vaginal approved for use in 3rd trimester of pregnancy , lactation has been used safely but does appear in breast milk and exposes infant t drug and its side effects.

Assess for infection (vital signs, appearance of wound, sputum, urine and stool, WBC) beginning of and during therapy. Obtain history to determine previous use of and reactions to penicillins, cephalosporins, or other bet-lactam antibiotics. Persons with a negative hx of penicillin sensitivity may still have an allergic response. Observe patient of signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). D/C drug and health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction. Do not confuse penicillin with penicillamine. Do not confuse penicillin G aqueous (potassium or sodium salt) with penicillin G procaine. Monitor serum sodium concentrations in patient with hypertension or CHF. Hypermatremia may develop after large doses of penicillin sodium. May cause increase ST, ALT, LDH and serum alkaline phosphatase concentrations.







DOSGERANGE


FOOD/DRUG INTERACTIONS SIDE EFFECTSEFFECTS PREGANCY



Metoclopramide hcl(Reglan)

GI stimulant peristaltic stimulant , dopamine receptor antagonist

Preg. Cat. B


Tx of symptomatic gastro-esophageal reflux not responsive to conventional therapy, Tx of symptoms associated with acute/recurrent diabetic gastroparesis, antiemetic for cancer chemotherapy, facilitation of small bowel intubation, facilitation of barium removal after radiologic exam. Suppresses emesis (by blocking receptors for dopamin and serotonin in the CTZ) and increases upper GI Motility (by enhancing the actions of acetylcholine).Persistaltic stimulation appears related to upper gut sensitizing of acetylcholine, increase gastric tone, amplitude contraction, relaxation of pyloric sphincter, resulting in accelerated emptying drug causes release of prolactin.

Antiemetic- AdultChemotherapy IV 1-mg/kgPostop IM 10-20mg Intubation IV10mg Barium removal IV 10mgDiabetic gastropaesisIV severe symptoms 10mgPO 10mg 30m ac, at bedtime for 8 wksReflux PO 10-15mg 30m ac, at bedtime Single 20mg dose before provoking conditionPediatric IntubationIV <6y/o 0.1mg/kg 6-14y/o 2.5-5mg

Use with anticholinergics/narcotics can antagonize stimulant effect, Use with CNS depressants produces additive depression, Insulin adjustment may be required for diabetics, Use with acetaminophen, aspirin, sysloserine, diazepamethanol, levodopa, lithium tetracycline can increase their absorption in the small intestines.

CNS drowsiness, restlessness, lassitude, dizziness, headache, insomnia, akathisia, extra pyramidal rxs (rare), visual disturbances, galactorrhea, amenorrhea, gynecomastis, impotence, nausea, bowel disturbances (diarrhea) rash, Bronchospasm, porphyria.

GI hemorrhage, obstruction, perforation, hypersensitivity, pheochromcytoma, epilepsy with drugs that induce extrapyramidal symptoms. Use can result in rare cases of depression, extrapyramidal symptoms, tardive dyskinesia. Like high-dose therapy, sedation and diarrhea are common. Life other dopamine antagonists, metoclopramide may cause extrapyramidal reactions especially in children.

Hx of hypersensitivity, renal function may require decrease dosage if impaired, Pain, acute/chronic. Administer PO 30m ac, at bedtime.IV dilute according tomfg directions via slow direct injection (1-2m, infusion>15m) discard unused portions, avoid exposure to heat/light in storage, cover IV bags with aluminum foil, Na content 0.14mEg/ml.(IV) calculate in Na restricted diets. Monitor VS, daily weight, I&O, presence of extrapyramidal symptoms (muscle spasms, tremors, shuffling gait), notify physician. Serum electrolytes (decrease K+, increase Na), blood glucose, potentiation of CNS depressant effect. Maintain safety precautions (drowsiness).







DOSGERANGE






Ondansetron hcl(Zofran)

Antimatics

Preg. Cat. B



Prevention of N/V with emetogenic antineoplastic therapy including high-dose cisplatin, Tx, Prevention/tx of postop nausea. Originally developed to suppress nausea and vomiting caused by anticancer drugs. By blocking 5-HT, receptors, the drug could in theory, prevent alcohol form activating the brains’ reward system making drug conducive to administration to alcoholics. Antiemetic activity due to selective antagonism of 5-hydroxytryptamine receptors (5-HT 3 receptors) Receptors are located on peripheral nerve terminals and in the chemoreceptor trigger zone in the CN. Drugs block access of 5 hydroxytryptamine (serotonin) to 5 HT 3 receptors, resulting in an antiemetic effect. The main site of antagonism appears related to peripheral receptors on vagal nerve terminals.

IV Adult nausea – 12.5mg 15m before end of anesthesia Children 1-16y/o –0.35mg/kg before end of anesthesia to a maximum of 12.5mgIV Adult Postop nausea – 100mg w/in 2h before surgery.Children 1-16y/o –1.2mg/kg to a maximum of 100mg w/in 1h before surgeryIV Adult & Children 2-16y/o Chemotherapy – 1.8mg/kg 30m before treatmentPO Adult Chemotherapy-100mg 1h before treatmentChildren 2-16y/o –1.8mg/kg to a maximum of 100mg w/in 1h before treatment

None currently reported

CNS –dizziness, headache, sleep disorder. EKG changes, bradycardia, rare edema. Abdominal pain, constipation/diarrhea, dyspepsia, taste disorder. Arthalgia, myalgia. Increase AST/ALT, abnormal vision, chills, fatigue, fever, rash, tinnitus.

Caution in patients with hypersensitivity. Avoid use in patient <2 yrs. Alcohol during pregnancy can result in FASD (including FAS) stillbirth, and spontaneous abortion, Women who are pregnant or trying to conceive should not drink.

OB nonspecific. Hx of hypersensitivity. Caution – hepatic impairment. Adverse effects – Injury, risk for. Mobility, impaired physical. Maintain safety precautions (dizziness). Maintain hydration. Monitor VS, F/E balance, hepatic status, activity status (safety precautions).


Note: Any up-dates are to be completed in different color ink. The student is expected to document all meds the client is currently receiving. MEDICATION

NAMEGENERIC/TRADECLASSIFICATION



DOSGERANGE






Bronchodilator(Terbutaline)

Bronchodilators B-2 Adrenergics

Preg. Cat. C


Mosby’s Drug Nsg Card 334-334a

Use widely to delay/suppress preterm labor, although it is not approved by the FDA for this use. Drugs are as effective as magnesium sulfate, but pose a greater risk to the mother and considered second-line agents.

Short acting B-2 adrenergic.Treatment/prevention of asthma and reversible bronchospasm in patients >12y/o associated with bronchitis and emphysema.

A selective group of B-2 Adrenergics ( beta-selective adrenergic antagonist). Sympathomimetics used in the management of obstructive respiratory conditions. Treatment/ management/ prophylaxis of abstractive respiratory diseases as sole agents r in combination with other bronchodilators/anti-asthmatic drugs.Sympathomimetic agonist activity at B-2 adrenergic receptors in bronchial smooth muscle produces bronchodilation

Drug is given IV or sub-Q for p to 48 hs. SC Injection Adult – 0.25mg repeat with no improvement w/in 15-30m. do not exceed 0.5mg/4hrPO Adult (tablet) 0.25mg 3 times a day. Do not exceed 0.5mg/4h.Children 12-15y/o –5mg 2.5 times/day. Do not exceed 7.5mg/day

Avoid use with MAOIs, beta blockers will antagonize. Use with B-2 Adrenergics will produce additive effects. Loop thiazide, TEAs require caution. Avoid caffeine.

CNS – dizziness, drowsiness, headache, insomnia, nervousness. CV- angina, arrhythmias associated with palpitations, hypo/hypertension. GI-N/V, diarrhea, dry mouth, gastric distress. Respiratory- asthma, bronchitis, cough, nasopharyngitis,

Pose a greater risk to the mother and considered second-line agents.Use caution with cardiac disorders, diabetes, hypertension, hyperthyroidism, hx of seizures and nursing mothers.

Assess hx catecholamine hypersensitivity, adequate renal function, lung sounds, airway clearance, ineffective, breathing pattern, ineffective, risk for injury, sleep pattern disturbance, tissue perfusion, ineffective.Caution- diabetes. Check preparation, dosage calculations with another nurse.Maintain IV access site, cardiac monitoring , hydration with special consideration to decrease dosage (increase sensitivity). Avoid breastfeeding. Observe for therapeutic increased air exchange.






DOSGERANGE



SIDE EFFECTSEFFECTS



Butorphanol tartrate(Stadol)

Preg. Cat. C



Relief of moderate/severe pain. Peak analgesic activity in 30-60m (IM/IV) & 1-2hr (spray). Preop medication and as a supplement to balanced anesthesia. Analgesic mechanism not determined, possible site of activity of 2mg approximately equivalent to 10-15mg morphine, narcotic antagonist activity equivalent to 1/40 that of naloxone. Analgesic mechanism not determined, possible site of activity may be subcortical areas of brain. Action similar to those of pentazocine. Antagonist at kappa receptors and an antagonist at mu receptors. Analgesic effects are less than those of morphine. Butophanol increases cardiac work and should not be given to patients with myocardial infarction.

IV/IM Adult Preop-2mg IM 60-90m before surgery.Adult Pain- 2MG IM q 3-4h or 1mg IV q 3-4h. For severe pain 4mg IM or 2mg IV may be required. Adult Balanced anesthesia- Usual incremental dose 0.5-1mg IVAdult nasal spray- 1mg (1 spray) in one nostril. Repeat in 60-90m

Use in narcotic-dependent patients can produce withdrawal symptoms. Use with CNS depressant produces additive effects. This drug has low potential for abuse and toxicity can be reversed by naloxone.

CNS- sedation, euphoria, hallucinations, dizziness, vertigo, headache. CV-palpitations, BP changes, blurred vision. GI-vomiting, dry mouth, rash, hives,. Respiratory depression. Autonomic responses (clammy sweating, flushing/warmth, sensitivity to cold).

Widely disturbuted and crossing placenta, enters breast milk. Neonates 52% protein binding occurs, Infants 3-18 months 85% protein binding occurs (Caution with Breastfeeding mothers due to small amount of drug in the mild.)

Hx opioid hypersensitivity. Respirations-do not administer if <12/m. Administer IM and check compatibility chart for mixing preop IM preparations. IM inject deep into muscle, rotate sites. IV dilute and administer slowly. Do not administer SC. Have narcotic antagonist/support measures available. Administer before patient is in intense pain. Avoid administration in patients with suspected head injury. Avoid abrupt withdrawal. Avoid light/freezing in storage. Monitor respirations, circulatory status, bowel movement, abdominal distention, renal status, urinary retention. Maintain positive power of suggestion, safety precautions (orthostasis, sedation, dizziness). Keep bedside rails up when non ambulatory. Turn, cough, deep breathe after surgery. Constipation may occur, increase fluid, bulk-containing foods.







calculation)





Naloxone(Narcan)

Preg. Cat. B



Reversal of postoperative opioid effects, opioid-induced neonatal respiratory depression, over dose with pure opioid agonist. IV, IM, subQFor initial treatment, administer IV, one opioid-induced CNS depression and respiratory depression have been reversed, IM or subQ administration may be employed. Narcotic antagonism primarily due to competition with narcotics for CNS receptor sites.

IV, IM, subQNeonate 0.01mg/kg. Repeat at 2-3m intervals to desired degree of reversal. Overdose- Pediatric0.01mg/kg IV subsequent dose 0.1mg/kg may be given IV prnTitrate dosage carefully. In opioid addicts, excessive doses can precipitate withdrawal. In postoperative patients, excessive doses can unmask pain by reversing opioid-medicated analgesia. IM/SC ONSET 2-5m, iv 1-2m-half-life 60-90m in adults, longer in infants-excreted via urine primarily as metabolites.Postop- adult 0.1-0.2mg/kg IV. Repeat 2-3m intervals to desired degree of reversalOverdose-adult 0.4-2mg IV Repeat at 2-3m intervals to desired degree of reversal.Postop–Pediatric 0.005-0.01mg/kg IV. Repeat at 2-3m intervals to desired degree of reversal.

Use with caution, esp with newborns of known or suspected opioid dependent mothers. Not intended for non-opioid respiratory depression.

GI- N/V (rare) with high doses postop. Withdrawal symptoms in narcotic dependent patients. Respiratory depression.

NEONATE require relatively low doses because the blood-brain barrier is poorly developed. All opioids are contraindicated for premature infants (both during and after delivery).

Monitor respirations in all patients. D/C if respirations <12/m. Notify physician Monitor VS, esp respirations, decrease after treatment, action of narcotic may be longer than naloxone. Signs of narcotic withdrawal (restlessness muscle spasms, Increase VS, lacrimation). Signs of increase PTT. ABGs. Maintain patent airway, safety precautions, comfort measures. Assess hx of hypersensitivity. Respiratory function (rate/depth, pulse oximetry, ABGs) Medication recently take/given. Administer mix with sterile H2O for injection prn. Do not leave patient unattended. Have emergency support equipment available. Store inoriginal container. Avoid exposure to light.







calculation)





Fentanyl citrate (Fentanyl)

Preg. Cat. C

Pharmacology for Nsg Care Page 265-267


Relief of moderate/severe pain. Preop sedation, operative, preop analgesia. Relief of chronic pain requiring opioids (transdermal). Management of breakthrough cancer pain in patients already receiving or intolerant folioed therapy for persistent pain (Actiq). Narcotics produce analgesia, euphoria, sedation- 0.1-mg dose approximately equivalent to 10mg morphine, 75g meperidine.

IV, IMPreop Adjunct to general anesthesia - adult 0.05-0.1mg IV before surgery Induction low dose. 0.002mg/kg moderate dose 0.002-0.02mg kg high dose 0.02-0.05mg/kgMaintenance- low dose0.002mg/kg, moderate dose 0.002-0.02mg/kg high dose 0.02-0.5mg/kgAdjunct to regional anesthesia - adult0.05-0.1mg. May be repeated Postop Adjunct to general anesthesia - adult.0.05-0.01mg. May be repeated in 1-2h prnAdult Transdermal Start with 25mg/h & adjust Pediatric (2-12y/o – IM/IV Indications, maintenance 1.7-303mcg/kg

Actiq. Adult/children > 16y/o PO Start with 200mcg that is sucked & adjust to patient pain

Use with alcohol, antihistamines, barbiturates, bezodiazepines, methorimepraine, penothiazines, other CNS depressants produces additive CNS depression, decrease dosage may be required. Use with TCAs may produce addictive respiratory depressionUse with caution, esp with newborns of known or suspected opioid dependent mothers. Not intended for non-opioid respiratory depression.

CNS- sedation, lightheadedness, euphoria, dysphoria, tremor, disorientation, decrease convulsive threshold, CV-hypotension, palpitations, flushing of face, phlebitis of IV site. Miosis. N/V, dry mouth, constipation, biliary tract spasm.GU-urinary retention. INT-pruritus, urticaria. Resp-Respiratory depression.

NEONATES require relatively low doses because the blood-brain barrier is poorly developed. All opioids are contraindicated for premature infants (both during and after delivery).

Assess hx of hypersensitivity. Respiratory. D/C if respirations in all patients <12/m. Notify physician. Monitor (rate/depth, pulse oximetry, ABGs) Medication recently take/given. Store under double lock and key, document use accurately. Check compatibility for mixing with other drugs in solution IM inject deep into muscle. IV dilute and administer slowly (1-2m) Have emergency support equipment available. Store in original container. Avoid exposure to light. Monitor VS, esp respirations, decrease after treatment, action of narcotic may be longer than naloxone. Signs of narcotic withdrawal (restlessness muscle spasms, Increase VS, lacrimation). Signs of increase PTT. ABGs. Maintain patent airway, safety precautions and comfort measures.






RANGE(include therapeutic

dose calculation)




Warfarin sodium(Coumadin)

Coumarin anticoagulant

Preg. Cat. X

Pharmacology for Nsg Care Page 594-595


Adjunct in coronary occlusion. Treatment of thromboembolic complications associated with atrial fibrillation, cardiac valve replacement. Prophylaxis, treatment of venous thrombosis, pulmonary embolism. Coumarin anticoagulants inhibit synthesis of prothrombin (factor III), proconertin (factor VII), Christmas factor (factor (IX), Stuart-Prower factor (X) in liver by interering with action of vitamin K.

PO Adult PT determines maintenance dose, usually 2-10mg/day

List of drug interactions extremely long, main interactions that increase anticoagulant activity include enzyme decrease of biotransformation, displacement for inactive protein storage sites, decrease intestinal absorption of vitamin K, alteration of intestinal bacterial flora, alteration of platelet count/activity PO contraceptives and estrogens drugs that decrease coumadin activity. Main inter-action that decrease anti-coagulant activity is enzyme induction of biotransformation. Drugs that increase activity incl anabolic steroids, broad-spectrum antibiotics, clofibrate, disulfiram, dextrothyroxine, oxyphenutazone, phynylbutazone, salicylates. Drugs that decrease activity incl arbiturates, cholestyramine, gulutethimide,.

GI/GU- Hemorrhage, agranulocytosis, leucopenia, amenia. HEP- hepatitis, jaundice, dermatitis, urticaria, alopecia, fever.

Hypersensitivity, subacute bacterial endocarditis, any bleeding .potential bleeding condition, pregnancy. Use can result in major/fatal hemorrhage.

Assess hx of coumarin anticoagulant hypersensitivity Tissue perfusion, ineffective. Trauma, risk for. Administer PO as single daily dose with food. Avoid abrupt withdrawal. Avoid exposure to moisture in storage. Regulate dosage according to PT. Have vitamin K available (antidote)

Monitor Hepatic, renal status, PT-maintain at 1.5-2.5 times control value. Serum for increase ALT, AST, LDH. Patient for signs of hemorrhage, incl. abdominal/lumbar pain. Treat with vitamin K/whole blood.

Maintain Bleeding precautions.Notify physician immediately of unusual bleeding/bruising, blood detected in urine/stool.







calculation)


SIDE EFFECTSEFFECTS


NEONATE


Iron Supplement – Ferrous Sulfate (30% elemental Iron)

Apo-ferrous Sulfate, ED-IN-SOL, Fe50, Feosol, Feratab, Fergen, Fergen-sol, Fer-in-Sil, Fer-Iron, Fero-Grad, Novoferrosulfa,PMS Ferrous Sulfate,, Slow FE

Preg. Cat. A

Davis Drug Guide for Ns. Page700-705

Pharmacology for nursing Care page 625

Prevention/Tx of iron-deficiency anemia. IM, IV Iron dextran –Tx of iron-deficiency anemia in patients who cannot tolerate or receive oral Iron. Sodium ferric gluconate complex- Tx of iron deficiency in patients undergoing chronic hemodialysis or perrneal dialysis who are concurrently receiving erythropoietin. Tx of iron-deficiency anemia in patients with chronic kidney disease including patients who are not on dialysis (with or without erythropoietin) and patients dependent on dialysis (with erythropoietin).Essential mineral found in hemoglobin, myoglobin, and many enzymes. Enters the bloodstream and is transported to organs of he reticuloendothelial system (liver, spleen, bone marrow), where it is separated out and becomes part of iron stores.

Oral Iron Dosage for Iron Deficiency (expressed as mg elemental iron, note individual salt forms, multiple ones exist-see approximate equivalent doses below or dose conversions)Approximate Equivalent Doses (mg of iron salt: Fer fumarate 197, Ferrous gluconate 560, Ferrous sulfate exsiccated 217)PO Adults deficiency 120-240mg/day (2-3 mg/kg /day) in 2-4 divided doses. Prophylaxis. PO Children-Severe deficiency 4-6mg/day in 3 divided doses. Mild to moderate deficiency – 3mg/kg/day in 1-2 divide doses. Prophylaxis-1-2mg/kg/day in 1-2 divided does (max. -15mg/day).PO Neonate, Premature – 2-4mg/kg/day in 1-2 divided doses. does (max.-15mg/day).

Oral iron supplements decrease absorption (tetracycline’s, bisphosphonates, fluoroquinolones, levothyroxine, mycophenolate mofetil, and penicillamine (simultaneous administration should be avoided). Increase absorption of and my decrease effects of levodopa and methydopa. Concurrent administration of H2

antagonists, proton pump inhibition and choestyramine may decrease absorption of iron. Doses of ascorbic acid > 200mg may increase absorption of iron up to > 30%

CNS- IM,IV –seizures, dizziness, headache, syncope, CV- IM,IV hypotension, hypertension, tachycardia. GI-nausea, PO- constipation , dark stools, diarrhea, epigastric pain. GI-bleeding. IM,IV –taste disorder, vomiting. Derm- IM, IV flushing, urticarta.Resp- IV-cough, dyspnea. Local- pain at IM site (iron dextran) phlebitis at IV site, skin staining at IM site site (iron dextran). MS-IM,IV arthralgia, myalgia. Misc- PO staining of teeth (liquid preparations)-IM, IV-allergic reactions including anaphylaxis.

During pregnancy, requirements for iron increase dramatically, owing to (1. expansion of maternal blood volume and production of RBCs (red blood cells) by the fetus. In most cases, the iron needs of pregnant women are too great to be met by diet alone. Consequently, iron supplements (abut 30mg/day) are recommended during pregnancy and for 2-3 months after parturition.

Assess nutritional status and dietary history to determine possible cause of anemia and need for patient teaching. Assess bowel function for constipation or diarrhea. Notify physician care professional and use appropriate nursing measures should this occur. Monitor hemoglobin, hematocrit, and reticulocyte values prior to and every 3 k during the first 2 mo of therapy and periodically thereafter. Serum ferrin, total iron-binding capacity, and plasma iron concentrations periodically during therapy. Serum ferritin levels peak in 7-9 days and return to normal in 3 wk. Serum iron determinations may be inaccurate for 1-2 wk after therapy with large doses, therefore hemoglobin and hematocrit are used to gauge initial response, May impart a brownish hue to blood drawn within 4 hr of administration. May cause false increase in serum bilirubin and false decrease in serum calcium values. Prolonged PTT may be


calculated when blood sample is anticoagulated with citrate dextrose solution use sodium citrate instead. May cause increase liver enzyme.




INDICATION/ ACTIONDOSE, ROUTE,

TIMES DOSGE/RANGE





Nifedpine(Procardia, Procardia XL, Adalat, adalt CC, Adalal PA, Adala XL, Afeditab CR, Apo-Nifed, Nifedical XL, Novo-Nifedin, Nu-Nifed).

Antianginals, anti-hypertiensives

Preg. Cat. C

Davis Drug Guide for Ns. Page 884-886


Management of hypertension, (extended-release only, Angina pectoris, vasopastic, prinzmetal’s angina. Unlabeled uses- Prevention of migraine headache. Management of CHF or cardiomyopathy. Inhibits calcium transport into myocardial and vascular smooth muscle, cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Systemic vasodilatation, resulting in decrease blood pressure. Coronary vasodilation, resulting in decreased frequency and severity of attacks of angina.

PO Adult-10-30mg 3 times daily (not to exceed 180mg/day), or 10-20mg twice daily as PA form, or 30-90mg once daily as sustained-release (CC<XL) fom (not to exceed 90-120mg/day).

Additive hypotension may occur when used concurrenly with fentanyl, other antihypertensives, nirates, acute ingestion of alcohol, or quinidine. Antihypertensive effects may decrease by concurrent use of NSAIDs. May increase serum levels and risk of toxicity form digoxin, disopyramide, or phenytoin may result in bradycardia, conduction defects or CHF. Cimetidine and propranolol may decrease metabolismand increase risk of toxicity. May decrease metabolism of and increase risk of toxity form cyclosporine, prazosin, quinidine, or carbamazepine. Grapefruit and grapefruit juice increase serum levels and effect. Sublingual use is not recommended due to serious adverse dug

Gynecomastia, hyperglycemia, anemia, leukopenia, thrombocytopenia, weight gain, joint stiffness, muscle cramps, paresthesia, tremor, Steven-Johsonson Syndrome, gingival hyperplasia. Headache, abnormal dreams anxiety, confusion, dizziness, drowsiness, jitteriness, nervousness, psychiatric disturbances, weakness, blurred vision, disturbed equilibrium, epistaxis, and tinnitus. Cough, dyspnea, shortness ofr breath, arrhythmias, CHF, peripheral edema, bradycardia, chest pain, abnormal liver function studies, anorexia, dyspepsia, nausea, vomiting, dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency, flushing, dermatitis, erythema mulifome, increase sweating, photosensitivity, pruritus/urticaria, rash.

Contraindicated for pregnancy, lactation, children (safety not established).Patients with history of serious ventricular arrhythmias, caution in use for severe hepatic impairment (decrease dose recommended), hypersensitivity and sick sinus syndrome.

Monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy. Monitor ECG periodically prolonged therapy. Monitor intake and output ratios and daily weight. Assess for signs of CHF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention). Assess fall risk and institute fall prevention strategies. Patients receiving digoxin concurrently with Nifedipine should have routine tests of serum digoxin levels and be monitored for signs and symptoms of digoxin toxicity. Assess location, duration, intensity, and precipitating factors of patient’s anginal pain. Total serum calcium concentrations ar no affected by calcium channel blockers. Monitor renal and hepatic functions periodically during long-term therapy. Several days of therapy may cause increase in heptic enzymes, which return tonormal upon discontinuation of therapy. Administer without regard to meals and with meals if GI irritation becomes a problem.


reactions.





DOSGE/RANGE(include therapeutic dose

calculation)





Phytonadione Vitamin K, Aguamephyton, Mephyton.

Classification antidote, vitamins

Preg. Cat. UK



Prevention and treatment of hypoprothrombinemia, which may be associated with excessive doses of oral anticoagulants, Salicylates, Certain anti-infective agents, Nutritional deficiencies, Prolonged total parenteral nutrition. Prevention of hemorrhagic disease of the newborn.

Required for hepatic synthesis of blood coagulation factor II (prothrombin(, VII, IX, and X. Prevention of bleeding due to hypoprothrombinemia.

IM (Neonates) 0.5-1mg within 1 hour of birth, may repeat in 6-8 hrs if needed. May be repeated in 2-3 wk if mother received previous anticonvulsant/ anticoagulant/ anti-infective/ anti-tubercular therapy. 1-5mg may be given IM to mother 12-24 hr before delivery. Treatment of Hemorrhagic Disease of Newborn- IM, SUBCUT (Neonates) 1-2gm/day

Large doses will counteract the effect of warfarin. Large doses of salyiclates or broad-spectrum anti-infectives may increase vitamin K requirements. Bile acid sequestrants, mineral oil, and sucralfate may decrease vitamin K absorption for the GI tract.

GI-gastric upset, unusual taste. Derm- flushing, rash, urticaria. Hemat- Hemolytic anemia. Local – erythemia, pain at injection site, swelling Misc- allergic reactions, hyperbilirubinemia, (large doses in very premature infants), Kernicterus.

Prevent excess bleeding by simulation of clotting factors

Monitor for side effects and adverse reactions. Neonates, especially premature neonates may be more sensitive than older children. Monitor prothrombin time (PT) prior to and throughout vitamin K therapy to determine response to and need for further therapy. Children may be especially sensitive to the effects and side effects of vitamin K Monitor for frank and occult bleeding (guaiac stools, Hematest urine, and emesis). Monitor pulse and blood pressure frequently, notify physician immediately if symptoms of internal bleeding or hypovolemic shock develop. Inform all personnel of patient’s bleeding tendency to prevent further trauma. Apply pressure to al l venipuncture sites for at least 5 min, avoid unnecessary IM injections.


Terbutaline





DOSGE/RANGE(include therapeutic dose

calculation)

FOOD/DRUG INTERACTIONS SIDE EFFECTSEFFECTS


NEONATE


HeparinCalcilean, Calciparine, Hepalean, Hapain Leo-Lock, Hep-Lock U/P

Classification Preg. Cat. C


Prophylaxis nd treatment of various thromboembolic disorders including; venous thromboembolic, Pulmonary embolic, Atrial fibrillation, with embolization, Acute and chronic consumptive coagulopathies, Peripheral arterial thromboembolism. Used in very low doses (10-100 units) to maintain patency of IV catheters (heparin flush). Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin. In low does, prevents the conversion of prothrombin to thrombin by its effects on factor Xa. Higher doses neutralize thrombin, preventing the conversion of fibrinogen to fibrin. Prevention of thrombus formation. Prevention of extension of existing thrombi (full dose.

IV (Neonates and Infants < 1yr) - Hemorrhagic Disease of Newborn Continuous infusion –Loading dose 75 units/kg, followed by 28 units/kg/hr, adjust to maintain aPTT of 60-85 seconds. Treatment of Arterial Line Patency 1A (Neonates) 0.5-2 units/mlCardiovascular surgery (Neonates, Infants and Children) 100-150 units/kg via an artery prior to cardiac catheterization.

Heparin is frequently used concurrently or sequentially with other agents affectin coagulation. The risk of potentially serious interaction is greatest with full anticoagulation. Risk of bleeding may be increase by concurrent use of drugs that affect platelet function, including aspirin, NSAIDs, clopidogrel, dipyridamole, some penicillins, ticlopidine, abcxibab, epifibitide, tirofiban, and dextran. Risk for bleeding may be increase by concurrent use of drugs that cause, hypoprothrombinemia, including quinidine, cefoperazone, cefotetan, and alproic acid. Concurrent use of thrombolytics increase risk of bleeding. Heparins affect the prothrombin time used in assessing the response to warfarin.

Drug induced hepatitis, alopecia (long-term use) rashes, uticaria, bleeding, anemia, thrombocytopenia (can occur up t o several weeks after discontinuation of therapy) pain at injection site osteoporosis (long-term use) fever hypersensitivity

Prevent excess bleeding, Pulmonary embolic and prevents the conversion of prothrombin to thrombin.

Assess signs of bleeding and hemorrhage (fall in hematocrit or blood pressure, unusual bruising, hematuria, bleeding gums, nosebleed, black tarry stools, gualac-positive stools). Notify physician if these occur. Monitor activity partial thromboplasin time (aPTT) and hematocrit prior to and periodically throughout therapy. Monitor platelet count every 2-3 days throughout therapy. Mild thrombocytopenia, which appears on 4th

day and resolves despite continued heparin therapy. High alert- Unintended concomitant us of two heparin products (unfractional heparin and LMW heparins) has resulted in serious harm or death. Review patient’s recent (emergency department, operating room) and current medication administration records before administering any heparin or LMW heparin product. Dose calculation and infusion pump programming errors have also occurred. Have second practitioner independently check original order, see calculation and infusion pump settings, Do not confuse heparin with Hespa ( hetastarch in sodium chloride) Do not confuse vials of heparin wih vials of


insulin.





TIMES DOSGE/RANGE






Hepatitis B

Vaccine .

Classification Vaccine

Preg. Cat. UK

Olds’s Maternal and Newborn Nursing Page 883-884

Recombinant hepatiis B is used as a prophylactic treatment against all subtypes of the hepatitis B virus. It proides passive immunization for newborns of HbsAg-negative and positive HbsAg-positive mothers. Hepatitis B can be transmitted across the placenta, but most newborns are infected during birth.

The vaccine is produced form bakers’ yeast and plasmid containing the HbsAg gene. Hepatitis B (thimerosal free) vaccine contains more ha 95% HbsAg protein and is an inactivated (noninfective) product. Universal immunization is recommended. Infants with HbsAg-positive mothers should concurrently receive 0.5 ml of Hepatitis B immunoglobulin (HBIG) prophylaxis at separate injection sites

Infants born HbsAg-negative mothers receive their 1st dose of vaccine at birth, the 2nd dose at 1 to 2 months, and the third dose at6 to 18 months. Infants whose mother’s HBsAg-status is unknown should receive the same doses of vaccine as infants born to HbsAg-positive mothers.

IM (Neonates) 0.5ml (10mcg) into the anterolateral thigh within 12 hours of birth for infants born to of HbsAg-positive mothers. The 2nd

dose of vaccineis given at 1 month of age and followed by a final dose at 6 months of age.

Unknown The only common side effect is soreness at the injection site. Occasionally, there is erythema, swelling, warmth, and indurations at injection site, irritability or low-grade fever.

Recommended for Newborn/Infants birth to 2 months for first dose of hepatitis B. Second dose should be 1 month after first dose, Third dose should be given 4 months after first dose or at least 2 months after second dose.

Delay administration during active infection, the vaccine will not prevent infection during its incubation period.

The vaccine should be used as supplied, do not dilute, shake well. Do not inject intravenously or interdermally.

Monitor for adverse reactions, temperature closely. Have epinephrine available to treat possible allergic reactions. Responsiveness to the vaccine is age dependent. Preterm infants weighing less than 1000g have lower serconversion rates. Consider delaying the first dose until the infant is term post conceptual age or use a 4-dose schedule.






TIMES DOSGE/RANG

E(include

therapeutic dose

calculation)


SIDE EFFECTSEFFECTS


NEONATE


Acyclovir

Avarix, Zovirax.

Classification: antiviral/purine analogue; inhibits viral replication

Preg. Cat. B C-Topical Davis Drug Guide for Nsg Page 883-884

Recurrent genital herpes infections. Localized cutaneous herpes zoster infections (shingles) and chickenpox (varicella – IV severe initial episodes of genital herpes in nonimmunosuppressed patients. Mucosal or cutaneous herpes simplex infections or herpes zoster infections (shingles) in immunosuppressed patients. Herpes simplex encephalitis. Topical-Recurrent herpes labialis (cold sores). Ointment –treatment of limited non-life threatening herpes simplex infections in immunocompromised patients( systemic treatment is preferred) Interferes with viral DNA synthesis. Inhibition of viral replication , decreased viral shedding, and reduced time for healing of lesions.

IV Herpes Simplex Encephalitis ( Neonates, Premature) 10mg/kg q 12 hr for 14-21 days.

Probenecid increases blood levels of acyclovir. Increase blood levels and risk of toxicity for theophylline, dose adjustment may be necessary. Decrease blood levels and may increase effectiveness of alproic acid or hydantoins Concurrent use of other nephrotoxic drugs increase risk of adverse renal effects. Zidovudine and IT methotrexate may increase risk of CNS side effects.

Thrombolic, thrombocytopenic purpurvhemoclytic uremic syndrome (high doses in immunosuppressed patients), seizures, dizziness, headache, hallucinations, trmbling , diarrhea, nausea, vomiting , elevate liver enzyme, hyperbilirubinemia, abdominal pain, anorexia, renal failure, crystalluria, hematuria, acne hives, skin rashes, unusual sweating, Stevens-Johnson syndrome changes in menstrual cycle. Local-pain, phlebitis, local irritation, joint pain.

Acyclovir -widely distributed CSF concentrations are 50% if plasma, Crosses placenta enters breast milk.

IV administration- Intermittent Infusion – diluent –reconstitute 500mg 0r 1-g vial with 10 ml or 20ml respectively, of sterile water for injection, do not reconstitute with bacteriostatic water benzyl alcohol or parabens. Shake well to dissolve completely. Further dilute in at least 100,l of D5W, 0.9% NaCL, dextrose/saline combinations or LR. Concentrations- 7mg/ml. Rate-administer via infusion pump over 1 hr to minimize renal tubular damage. Use reconstituted solution within 12 hr . Once diluted for infusion, the solution should be used within 24 hr. Refrigeration results in precipitation, which dissolves at room temperature.

Assess lesions before and daily during therapy. Monitor neurologic status in patients with herpes encephalitis. Monitor BUN, serum creatinine, and CCr before and during therapy. Increase BUN and serum creatinine levels or decrease CCr may indicate renal failure. Treatment should be started as soon as possible after herpes simplex symptoms appear and within 24 r of a herpes zoster outbreak. IV maintain adequate hydration (2000-3000ml/day, especially during first 2 hr after IV infusion, to prevent cystalluria. Observe infusion site for phlebitis.

Acyclovir inject able should not be administered topically, IM, subcut, PO or in the eye.






TIMES DOSGE/RANGE



SIDE EFFECTSEFFECTS PREGANCY FETUS

AND/OR NEONATE NURSING CONSIDERATIONS

Infant Vitamins

Classification Vitamin Supplement

Olds’s Maternal and Newborn Nursing Infant Page 895Pregnancy 428-430Preg. Cat. A, B, C

PRENATAL VITAMINS A, B, C, D, E, and KPO/IM - B 12

Vitamin E (Tocopherol)Vitamin K (Memadione)Water-soluble supplements C, B. Vitamin B1

(Thiamine)B2 (Ribofavin)

B 12 (coalamin).Folic acid, pantothenic acid,NiacinVitamin B6 (pyridoxine)Vitamin C (Ascorbic acid)

Water soluble vitamins B and C Fat-soluble vitamins A,D, E, and KCan result in toxicity in high dosesUse to treat vitamin deficiency or associated problems such as anemiaMinerals – primary minerals are sodium, phosphorus necessary for bone formation. Calcium, Chlorine, phosphorus, potassium need for nerve function and fluid balance. Iodine is used for thyroid functionMagnesium and manganese and zinc are for enzymes process Organic substances necessary for life and growth, vitamins A, D, E, and K (fat-soluble) are stored in the liver available should the dietary intake become inadequate (not excreted in the urine). Vitamin A for growth of epithelial cells for lining entire gastrointestinal tract and compose the skin. Vitamin A (retinol) prevents night blindness.Vitamin D plays a role in absorption and utilization of calcium and phosphorus in skeletal developmentVitamin E involves enzymatic, metabolic reactions, antioxidant, and affects health of all cells in body protecting cell membrane. Synthesis or nucleic acids

required forming red blood cells. Vitamin K is an essential factor for synthesis of thrombin, normal blood clottingVitamin C is to aid the formation and development of connective tissue and vascular system. Ascorbic

PO or IM Infants 1ml solution/ daily in with feeding

PO or IM PreganancyRDAVitamin A is 770 mcg per day for pregnant women age 19 and older. Inadequate dietary supplementation is 5000 international units (e.g. strictly vegetarian, deficiency of vitamin A is endemic in recent emigrants). Vitamin D 5mcg/day Vitamin E 15mg per dayVitamin K 90mcg per dayVitamin C is increase in pregnancy.

Should be taken with mealsVitamin A sources include deep green, yellow and orange vegetables and some fruits, animal sources include liver, egg yolk, cream, , and milk.Vitamin D sources include fortified milk, liver, , cream, butter, ultra-violet light rays of sunlight.Vitamin Esources include whole grains, greens, vegetable fats/oils, and egg.Vitamin KSources include liver, green leafy vegetableVitamin C Sources include citrus fruit, tomatoes, cantaloupe, strawberries, potatoes, broccoli, and, but air, heat and water during storage and cooking destroy ascorbic acid

Urine discoloration, body aches, skin color changes, joint pain

Fat-soluble vitamins toxicity includes nausea, gastrointestinal upset, dryness and cracking of the skin, and loss of hair. A & D can lead to toxicity. Overdose of Vitamin D during pregnancy can cause hypercalcemia or high blood calcium levels because of calcium from the skeletal tissue. Toxicity symptoms include excessive thirst, loss of appetite, vomiting weight loss, irritability and high blood calcium levels.Vitamin E is beneficial in treating certain types of muscular pain and intermittent claudiction, surface healing of wounds, burns, protecting lung tissue from damaging effects of smog.Vitamin K Need for Vitamin K dose

Vitamins A,D,C, and B6 have a negative effect on the fetus. Excessive intake of one vitamin may interfere with the body’s use of vitamin B12 (mega doses are best avoided) .. Inadequate maternal intake of vitamin A associated with preterm birth, intrauterine growth restriction, decreased birth weight. Vitamin D is needed for developing fetus and in pregnant women the need for calcium absorption. Vitamin E massaged as oil prevents permanent stretch marks. Excessive intake) may cause abnormal coagulation in newborns.Deficiency symptoms of Vitamin E relate to long-term inability to absorb fats (mal-absorption exits in cases of cystic fibrosis,liver cirrhosis, obstructive jaundice).Vitamin K synthesis by destroying intestinal E-coli in the intestine. Water-soluble vitamins concentrations in maternal serum falls, where as high concentration are found in the fetus. Folic acid for normal growth, reproduction, and lactation and prevents macrocytic, megaloblastic anemia of pregnancy, neural tube defects (NTDs) (spinal bifida, anencephaly).

Monitor blood serum levels. Taken as directed. Folic acid and iron are the only nutritional supplements generally recommended during pregnancy. An increase need for other vitamins and mineral can usually be met with an adequate diet. To avoid possible deficiencies, many healthcare professionals still recommend a daily vitamin supplement.

Monitor dietary intake and food sources. Check for vitamin deficiencies. Dietary education on maintaining a good healthy diet from the four food groups.

OTC vitamins and minerals, food supplements may potentially be harmful if used in excess.

Notify physician before taking OTC medications, herbs or other vitamin supplements.

MEDICATION NAME DOSE, ROUTE, TIMES EFFECTS PREGANCY




INDICATION/ ACTION DOSGE/RANGE(include therapeutic dose

calculation)

FOOD/DRUG INTERACTIONS SIDE EFFECTS FETUS AND/OR NEONATE


Bupivacaine--1.5-5 hr (after epidural use); ropivacaine--4.2 hr (after epidural use).

RopivacaineSurgical Anesthesia/ analgesia

Olds Pg. 695

Bupivacaine-/Ropivacaine

Olds Pg. 695

Local or regional anesthesia or analgesia for surgical, obstetric, or diagnostic procedures. Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission. Epidural administration allows action to take place at the level of the spinal nerve roots immediately adjacent to the site of administration. The catheter is placed as close as possible to the dermatomes (skin surface areas innervated by a single spinal nerve or group of spinal nerves) that, when blocked, will produce the most effective spread of analgesia for the site of injury. Therapeutic Effects: Decreased pain or induction of anesthesia; low doses have minimal effect on sensory or motor function; higher doses may produce complete motor blockade.

Epidural 10-30 min unknown 2-8 hr. Solutions containing preservatives should not be used for caudal or epidural blocks. BupivacaineSolution for injection (preservative-free): 0.25%, 0.5%, 0.75%.In combination with: epinephrine 1:200,000.Bupivacaine Epidural (Adults): Lumbar epidural-15-30 ml of 0.5% solution or 15-25 ml of 0.75% solution or 15-20 ml of 1% solution; Lumbar epidural for cesarean section-20-30 ml of 0.5% solution or 15-20 ml of 0.75% solution; Thoracic epidural-5-15 ml of 0.5-0.75% solution. Labor PainEpidural (Adults): Lumbar epidural-10-20 ml of 0.2% solution initially, then continuous infusion of 6-14 ml/hr of 0.2% solution with incremental injection of 10-15 ml/hr of 0.2% solution. Postoperative PainEpidural (Adults): Lumbar or thoracic epidural-Continuous infusion of 6-14 ml/hr of 0.2% solution. RopivacaineSolution for injection (preservative-free): 0.2%, 0.5%, 0.75%, 1%.

Additive toxicity may occur with concurrent use of other amide localanesthetics (includinglidocaine, mepivacaine, and prilocaine). Use of bupivacaine solution containing epinephrine with MAO inhibitors may cause hypertension. Fluvoxamine, amiodarone, ciprofloxacin, and propofol may ↑ effects of ropivacaine. Hypersensitivity; cross-sensitivity with other amide local anesthetics may occur (lidocaine, mepivacaine, prilocaine) Bupivacaine contains bisulfites and should be avoided in patients with known intolerance OB: Use Cautiously in: Concurrent use of other local anesthetics Liver disease Concurrent use of anticoagulants (including low-dose heparin and low-molecular-weight heparins/heparinoids); the risk of spinal/epidural hematomas Pedi: Children (safety not established

CNS: SEIZURES, anxiety, dizziness, headache, irritability. EENT: blurred vision, tinnitus. CV: CARDIOVASCULAR COLLAPSE, arrhythmias, bradycardia, hypotension, tachycardia. GI: nausea, vomiting. GU: urinary retention. Derm: pruritus. F and E: metabolic acidosis. Neuro: circumoral tingling/numbness, tremor. Misc: allergic reactions, fever.

Obstetrical paracervical block anesthesia (bupivacaine only).Ready cross placenta and can be measured in the fetal circulation.Affects fetal for a prolong period.Ropivacainehve long acting action with fewer effects, produce analgesia for labor. Only opioids are used epidurally for better pain control.

AssessmentSystemic Toxicity: Assess for systemic toxicity (circumoral tingling and numbness, ringing in ears, metallic taste, dizziness, blurred vision, tremors, slow speech, irritability, twitching, seizures, cardiac dysrhythmias) each shift. Report to physician or other health care professional. Orthostatic Hypotension: Monitor blood pressure, heart rate, and respiratory rate continuously while patient is receiving this medication. Mild hypotension is common because of the effect of local anesthetic block of nerve fibers on the sympathetic nervous system, causing vasodilation. Significant hypotension and bradycardia may occur, especially when rising from a prone position or following large dose increases or boluses. Treatment of unresolved hypotension may include hydration, decreasing the epidural infusion rate, and/or removal of local anesthetic from analgesic solution. Unwanted Motor and Sensory Deficit: The goal of adding low-dose local anesthetics to epidural opioids for pain management is to provide analgesia, not to produce anesthesia. Patients should be able to ambulate if their condition allows, and epidural analgesic should not hamper this important recovery activity. However, many factors, including location of the epidural catheter, local anesthetic dose, and variability in patient response, can result in patients experiencing unwanted motor and sensory deficits. Pain is the first sensation lost, followed by temperature, touch, proprioception, and skeletal


muscle tone. Assess for sensory deficit every shift. Ask patient to point to numb and tingling skin areas (numbness and tingling at the incision site is common and usually normal). Notify physician or other health care professional of unwanted motor and sensory deficits. Unwanted motor and sensory deficits often can be corrected with simple treatment. For example, a change in position may relieve temporary sensory loss in an extremity. Decreasing the epidural infusion rate and keeping the patient in bed until the weakness resolves often treat minor extremity muscle weakness. Sometimes removing the local anesthetic from the analgesic solution is necessary, such as when signs of local anesthetic toxicity are detected or when simple treatment of motor and sensory deficits has been unsuccessful.

MEDICATION NAME

GENERIC/TRADECLASSIFICATION (PHARM) AND

PREGNANCY CATEGORY


DOSGE/RANGE(include therapeutic

dose calculation)


SIDE EFFECTSEFFECTS



Causes uterine PO Adult Increased risk of Headache, abdominal pain, Termination of Assess patient routinely for


MistaprostalCytotec

Antiulcer agents, cytoprotective agents

Preg. Cat X

Half-life 20-40 min

Davis Drug Guide for Nsg page 832

contractions. Prevention of gastric ulceration form NSAIDs. With mifeprestone for termination of pregnancy less than 49 days. Prevention of gastric mucosal injury from NSAIDs, including aspirin, in high-risk patients (geriatric patients, debilitated patients or those with history of ulcers). With. Unlabeled uses treatment of duodenal ulcers.Acts as a prostaglandin analogue, decreasing gastric acid secretion (antiscecretory effect ) and increasing the production of protective mucus (cytoprotective effect).

Termination of Pregnancy 400mcg single dose two days after mifepristone if abortion has not occurred. Antiulcer 200mcg 4 times daily with or after meals and at bedtime, or 0 mcg twice daily, with the last dose at bedtime. If intolerance occurs, dosage may be decreased to 100mcg twice daily, with the last dose at bedtime.

diarrhea with magnesium-containing antacids

diarrhea, constipation, dyspepsia, flatulence, nausea, vomiting, miscarriage, menstrual disorders.

Pregnancy 400mcg single dose two days after mifepristone if abortion has not occurred.

epigastric or abdominal pain and for frank or occult blood in the stool, emesis, or gastric aspirate. Women of childbearing age for pregnancy. Misoprostol is usually begun on 2nd or 3rd day of menstrual period following a negative pregnancy test result

MEDICATION NAME


PREGNANCY CATEGORY



dose calculation)


SIDE EFFECTSEFFECTS



Carboprost trometamine (hemabate) is used to

Immediate postpartum

The drug is contraindicated in

The most common side effects are nausea and

Not to be given to pregnant

The injection should be given in a large muscle


Carboprost Thromethamine Hemabate

Preg. Cat D

Olds page 675

reduce blood loss secondary to uterine atony. It stimulates myometial contractions to control postpartum hemorrhaging that is unresponsive to usual techniques. Carboprost trometamine can also be used to induce labor in women desiring an elective termination of a pregnancy. The drug is also used to induce labor in cases of intrauterine fetal death and hydatidiform mole.

hemorrhage, usually intramuscular dose is 250mcg (1mL) which can be repeated every 1 ½ to 3 ½ ors if uterine atony persist, The dosge can be increased to 500 mcg (2mL) if uterine contractility is inadequate after several doses of 250mcg. The total dosage should not exceed 12 mg. The maximum duration of use is 48 hours

women with active cardiac, pulmonary or renal disease. It should not be administered during pregnancy or in women with act pelvic inflammatory disease. It should be used with caution in women with asthma, adrenal disease, hypertension, hypotension, diabetes mellitus, epilepsy, fibroids, cervical stenosis, or previous uterine surgery.

diarrhea. Fever, chills and flushing can occur. Headache, muscle, joint abdominal or eye pain can also occur.

women. aspiration should be performed to avoid injection into a blood vessel which can result in broncho spasm, titanic contractions, and shock.After administration, monitor uterine status and bleeding carefully Report excess bleeding to physician/CNMCheck vital signs routinely, observing for an increase in temperature, elevated pulse, and decreased blood pressureBreastfeeding should be delayed for 24 hours after administration.

MEDICATION NAME


PREGNANCY CATEGORY



dose calculation)


SIDE EFFECTSEFFECTS



ErythromycinOphthalmic

Topical ophthalmic neonate prophylaxsis treatment of ophthalmic infections due to susceptible organisms,

Ophthalmicointment 0.5% (5mg/ml)

Neonatorum - use new tube for each

Current use with pimozide increase risk of serious arrhythmias (concurrent use contraindicated)-similar

Local ophthalmic irritation. Sensitivity reactions may interfere with ability to focus and may cause edema and

Use as prophylactic treatment of ophthalmia neonatorum

Wash hands immediately before instillation to prevent t introduction of bacteria. Do not irritate the eyes after instillation. Use new tube or


ointment

Preg. Cat B

Olds Materal –newborn Nsg. Page 871 Mosby’s Nsg Drug Card 112-112a

gonococcal/ chlamydial.. Bacteriostatic activity due to inhibition of ribosomal protein synthesis in susceptible microorganisms, topical ophthalmic application has limited tissue penetration may fail to protect against gonococcal pencillinae-producing strains of neisseria gonorrhoeae.

infant apply ribbon (0.5-1cm) of ointment in each conjunctive sac not later than1 hour after delivery/birth.

effects may occur with ditiazem, verapamil, ketoconazole, itraconazole, nefazodone, and protease inhibitors, avoid concurrent use. Increase blood levels and effects of silfenafil, tadalafil and vardenafil, use lower deses. Concurent rifabutin or rifampin may decrease effect of erythromycin and increase risk of adverse GI reactions. Increase levels of risk of toxicity from alfentanil, alprazolam, buspirone, clozapine, bromocriptine.

inflammation Side effects usually disappear in 24 h

which is caused by the bacteria Neisseria gonorrhoeae. Preventive treatment of gonorrhea in the newborn is required by law. Erthromycin is also effective against ophthalmic chlamydial infections. It is either bacterostatic or bactericidal, depending on the organisms involved and the concentration of the drug.

single use container for ophthalmic ointment administration shortly after birth. May wipe away excess after 1 minute. Observe for hypersensitivity teach parents out need for eye prophylaxis. Educate them regarding side effects and signs that need to be reported to the healthcare provider.


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