OB Meds
Oringinal Teresa Wells MSN RN
Edited by SusaNNE Benisch-Tolley MS
Pitocin – Oxytocin – hormone
• Pitocin –is a synthetic form of the hormone.
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• Purpose:
• Labor induction & augmentation
• Post partum= to prevent hemorrhage
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• Pitocin Induction or Augmentation Calculation Rules
• Convert Units to Miliunits
• Solve Problem
• Multiply by 60.
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Magnesium Sulfate
• Magnesium – an electrolyte & mineral
• Action: Relaxes smooth muscles by competing with calcium in cells
• Purpose: Used in Labor & Delivery for two reasons.
• Prevention or control of convulsions in a client with Pregnancy
Induced Hypertension
• Prevention of pre-term labor contractions in a client who is going into
early labor.
• Magnesium Rules
• 1. Identity what the question is asking.
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Loading dose
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Maintenance Dose
• 2. Solve the problem
Terbutaline (Brethine)
• Terbutaline (Brethine) relaxes smooth
muscle, inhibiting uterine contractions
and causing bronchodilation.
• Purpose: Used in Labor & Delivery
• Side effects and major nursing
implications
• Prevention of pre-term labor
• Mom
contractions in a client who is going into
• Tachycardia
early labor.
• Myocardial ischemia
• Route: subcutaneous
• Dose 0.25 mg
• Transient hyperglycemia
• **What could this drug be used for other • Tremors
than preventing pre-term labor?
• Restlessness
• Fetal/Newborn
• Increase in HR and blood sugar levels
CalCium Channel Blocker
• Nifedipine (Adalat, Procardia) relaxes smooth muscles by blocking
calcium entry.
• Purpose: Used in Labor & Delivery
• Prevention of pre-term labor contractions in a client who is going into
early labor.
• Route/Dose – initial dose10-20 mg oral (ideal dose has not been
established)
• **What could this drug be used for other than preventing pre-term
labor?
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Prostaglandin Synthetase Inhibitor (NSAIDS)
• Indomethacin (Indocin) relaxes uterine smooth muscle by inhibiting
protaglandins
• Purpose Used in Labor & Delivery.
• Prevention of pre-term labor contractions in a client who is going into
early labor.
• Route/Dose – loading dose 50 mg oral then 25-50mg every 6 hour for
48 hours;
• ** What could this drug be used for other than preventing pre-term
labor?
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Prostaglandin E1
Prostaglandin E2
• Prostaglandin E1 Misoprostol (Cytotec)
• Prostaglandin E2 Dinoprostone (Cervidil Insert, Prepidil Gel
• Purpose: Used in Labor & Delivery
• Pre-induction cervical ripening – before Oxytocin induction of labor
• Cytotec – tablet form – administered orally or inserted vaginally.
• Cervidil insert –
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• Prepidil gel – pre-filled syringe – medication inserted vaginally.
• **Cytotec is also used to for prevention of gastric ulcers.
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Opioid Agonist Analgesic
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Fentanyl Citrate (Sublimaze)
Sufentanil Citrate (Sufenta)
Purpose: Used to decrease the pain of labor and post-op pain.
Route: via Epidural
Short duration of action when given IV
Meperidine (Demerol)
Hydromorphone hydrochloride (Dilaudid)
Medications used to treat labor and post-op pain.
Both may be administered IM or IV.
**Which route IV or IM would provide the fastest pain relief?
**What client assessment would you perform before administering Demerol
or Dilaudid to a client in labor?
Opioid Agonist-Antagonist Analgesics
• Butorphanol Tartrate (Stadol)
• Nalbuphine Hydrochloride (Nubain)
• Both are mixed agonist-antagonist analgesics.
• Purpose: Used to decrease the pain of labor and post-op pain.
• Stadol – 1mg IV or 2mg IM every 3-4 hr PRN
• Nubain – 10mg IV or 10 mg IM every 3-4 hr PRN
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• **Before administering Stadol or Nubain remember to carefully
assess your client**
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Opioid Antagonist
• Naloxone Hydrochloride (Narcan)
• Opioid antagoist block opioid receptors from the effects of opioid
agonist.
• Purpose Use to reduce opioid-induced respiratory depression in
women or newborns; may be used to reverse pruritis from epidural
opioids.
• ** Narcan should not be given to women or a newborn of client who
is opioid dependent.
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• After administering Narcan would the client complain of an increase
or decrease in their pain and why?
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Spinal, Epidural or General Anesthesia
• Before administering a spinal anesthetic the client usually receives
500-1000mL IV fluid to prevent hypotension.
• Spinal used for cesarean birth, not suitable for vaginal birth.
• Epidural most commonly used pain relief method used in Labor &
Delivery for vaginal or cesarean delivery
• General is rarely used, may be used for an emergency delivery
• The following medications are used prior to the administration of an
epidual or general anesthetic. All 3 help to reduce stomach acid.
• Sodium Citrate (Bictra)
• H2 receptor (Tagamet)
• Metoclopramide (Reglan)
Corticosteroids
• Purpose: Used in Antepartum to stimulate fetal lung maturity in
fetuses between 24 to 34 weeks gestations
• Betamethasone (Celestone) 12 mg IM for 2 doses 24 hours apart.
• Dexamethasone 6 mg IM for 4 doses 12 hours apart
• What effect would steroids on the glucose level?
• **Steroids have a wide variety of medical uses.
Rhogam
• Rhogam –Used to suppress the immune response in non-sensitized
Rh-negative women who receive Rh-positive blood cell because of
feto-maternal hemorrhage, transfusion or accident.
• Post-partum – Within 72 hour after delivery Rhogam is given to all
Rh-negative women who give birth to an Rh-positive infant
• Antepartum – administered at 20 to 30 weeks of gestation to women
with Rh-negative blood. Given after
• Miscarriage or termination of pregnancy
• Abdominal trauma
• Ectopic pregnancy
• Amniocentensis
• Version
• Chorionic Villi Sampling
Drugs to manage PP hemorrhage
• Drugs to Mange Postpartum Hemorrhage
• Oxytocin – IV 125 mg or greater depending on physicians order
• Methergine – 0.2mg IM every 2-4 h up to 5 doses (may be given
intrauterine or orally)
• Hemabate – 0,25 mg IM or intrauterine every 15-90 minutes up to 8
doses.
• Dinoprostone (Prostin E2) 20 mg vaginal or rectal suppository every 2
hour.
• Misoprostol (Cytotec) 800 to 1000 mcg rectally once.
• Algorithm used for treating PP hemorrhage **These meds may be
used immediately after delivery if bleeding is not being controlled.**
Page 724-725
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Rubella
• Rubella vaccine is given to women in PP who:
• Have not had a rubella vaccine
• Are non-immune (titer 1:8)
• Purpose: to prevent the possibility of contracting rubella in the future
• 1.) Informed consent required.
• 2. Pregnancy is contraindicated for this vaccine
• 3) Check for allergies to duck eggs
• 4) Pregnancy should be avoided for 1 month after being vaccinated.
• Because it is a live vaccine
Vitamin K
• Vitamin K is used in the newborn nursery for prevention and
treatment of hemorrhagic disease.
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• Neonate dose/route – 0.5-1mg IM within 2 hours of birth may be
repeated if newborn shows bleeding tendencies.
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• What medication is vitamin K the antidote for?
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Erythromycin Ophthalmic ointment
• Erythromycin ophthalmic ointment is used in the newborn nursery as
a precautionary measure against Ophthalmia Neonatorum which is
an inflammation of the eyes resulting from gonorrhea or chlamydia
infection.
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• Neonate dose/route – apply 1-2 cm ribbon of ointment to the lower
conjuctival sac of each eye.
Hepatitis B vaccine
• Hepatitis B vaccine is given in the newborn nursery for immunization
against infection caused by the hepatitis B virus.
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• Neonate dose/route 5 or 10mg IM
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• Which muscle is used to administer IM injections in newborn infants?
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Let’s Review
• What is the purpose of using Pitocin in Labor & Delivery?
• What is the purpose of using Magnesium Sulfate in Labor & Delivery?
• Name 2 drugs other than Mag Sulfate used to stop pre-term labor?
• What medication is given to the Rh-negative mother after a
miscarriage?
• What factors determine if a client in PP will receive a rubella vaccine?
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• References
• Lowdermilk, D., Perry, S., Cashion, K. (2020). Maternity & Women’s
Health Care. (12th ed.). St Louis, Mosby