Medication: Intrapartum
Medication Order
(Standard drug/dose/route frequency)
Generic & brand names
Oxytocin (Pitocin)
IV (adults): 0.5-1milliunits/min every 30-60 min until desired contraction pattern
established
Classification
Therapeutic: hormones
Pharmacologic: oxytocics
Stimulates uterine smooth muscle, producing uterine contractions similar to
those in spontaneous labor.
To induce labor at tern or facilitate threatened abortion.
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Maternal: coma, seizures, hypotension, hyponatremia, water intoxication, painful
contractions.
Fetal: asphyxia, hypoxia, intracranial hemorrhage, arrhythmias.
Assess fetal maturity, presentation, and pelvic adequacy before administering
oxytocin.
Assess character, frequency, and duration of contractions frequently throughout
administration.
(Vallerand & Sanoski, 2019)
Why is this med given in OB?
Why is pt receiving this med?
Nalbuphine (Nubian)
Analgesia-IM, subcut, IV (adults)10 mg every 3-6 hr, (children): 0.1-0.15mg/kg q
3-6 hr
Supplement to balanced anesthesia IV adults: initial 0.3-3 mg/kg over 10-15 min
and maintenance- 0.25-0.5 mg/kg as needed.
Therapeutic: opioid analgesics
Pharmacologic: opioid agonists/analgesics
Binds to opiate receptors in the CNS and alters the perception of and response
to painful stimuli.
To manage moderate to severe pain. To provide analgesia during labor,
sedation before surgery, supplement to balanced analgesia.
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Headache, sedation, confusion, dysphoria, respiratory depression, orthostatic
hypotension, hypertension, physical dependence.
Nursing Implications
Assess type, location, and intensity of pain before and 1 hour after IM or 30 min
after IV administration.
(Vallerand & Sanoski, 2019)
Medication Order
(Standard drug/dose/route frequency)
Generic & brand names
Classification
Physiologic Action
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
Betamethasone (Celestone)
IM adults: 12 mg daily for 2-3 days before delivery.
Therapeutic: anti-inflammatories (steroidal)
Pharmacologic: corticosteroids
Physiologic Action
Suppresses inflammation and the normal immune response.
Why is this med given in OB?
Why is pt receiving this med?
Unlabeled use: It is given to high-risk mothers before delivery to prevent
respiratory distress syndrome in the newborn.
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Depression, hypertension, muscle wasting, osteoporosis, delayed wound
healing, muscle pain.
Assess for signs of adrenal insufficiency (hypotension, weight loss, weakness,
nausea, vomiting).
Monitor intake and output ratios and daily weights.
(Vallerand & Sanoski, 2019)
Magnesium sulfate
IV, IM (adults): 4-5 g by IV infusion, concurrently with up to 5g IM in each
buttock; then 4-5g IM q 4 hr or 4g by IV infusion followed by 1-2 g/hr continuous
infusion.
Therapeutic: mineral and electrolyte replacements/ supplements
Pharmacologic: minerals/ electrolytes
Essential for the activity of many enzymes in neurotransmission and muscular
excitability.
To treat and prevent hypomagnesemia. Prevention of seizures associated with
severe eclampsia, pre-eclampsia. Unlabeled use in preterm labor.
Drowsiness, reduced respiratory rate, arrhythmias, bradycardia, hypotension,
hypothermia.
Nursing Implications
Monitor pulse, BP, respirations, and ECG frequently throughout administration.
Monitor neurologic status before and throughout therapy.
(Vallerand & Sanoski, 2019)
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
calcium gluconate (Kalcinate)
PO (adults): 0.5-2g daily in 2-4 divided doses. IV (adults): 2-15 g/day as a
continuous infusion or in divided doses.
Therapeutic: mineral and electrolyte replacements/ supplements
Physiologic Action
Replacement of calcium in deficiency states, essential for nervous, muscular,
and skeletal systems.
Prevention of hypocalcemia.
Why is this med given in OB?
Why is pt receiving this med?
Headache, syncope, arrhythmias, constipation, calculi, hypercalcemia.
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Monitor BP, pulse, and ECG frequently throughout parenteral therapy.
Observe for symptoms of hypocalcemia.
(Vallerand & Sanoski, 2019)
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Pyridoxine (Diclegis)
For treatment of deficiency. PO adults: 2.5-10 mg/day until clinical signs are
corrected, then 2-5mg/day.
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Therapeutic: vitamins
Pharmacologic: water soluble vitamins
Used in the transport of amino acids, formation of neurotransmitters, and
synthesis of heme.
Treatment and prevention of pyridoxine deficiency.
Sensory neuropathy, paresthesia, pyridoxine-dependency syndrome.
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Assess for signs of Vitamin B6 deficiency (anemia, seizures, nausea, vomiting)
before and periodically throughout therapy.
(Vallerand & Sanoski, 2019)
Ephedrine (Akovaz)
IV adults: 5-10mg initially, may repeat dose as needed based on blood pressure.
Therapeutic: vasopressors
Pharmacologic: adrenergics
Stimulates a1, b1 and b2 receptors, leading to vasoconstriction and increase in
cardiac output, both increasing blood pressure.
Treats hypotension occurring in the setting of anesthesia.
Dizziness, restlessness, bradycardia, hypertension, palpitations, tachycardia
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Monitor BP during administration.
(Vallerand & Sanoski, 2019)
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Dinoprostone (Cervidil)
Vag (adults, cervical): Endocervical gel-0.5 mg; if response is unfavorable, may
reeat in 6 hr (not to exceed 1.5 mg/24 hr).
Vaginal insert: one 10 mg insert.
Classification
Therapeutic: cervical ripening agent
Pharmacologic: oxytocics, prostaglandins
Produces contractions similar to those occurring during labor at term by
stimulating the myometrium.
To induce labor, expulsion
of fetus
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Syncope, dyspnea, wheezing, hypotension, hypertension, UTI, uterine
hyperstimulation, vaginal/uterine pain
Monitor frequency, duration, and force of contractions and uterine resting tone.
Auscultate breath sounds. Wheezing and sensation of chest tightness may
indicate hypersensitivity reaction.
(Vallerand & Sanoski, 2019)
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Cytotec (misoprostol)
Intravaginally (adults): 25 mcg; may repeat q 3-6 hr, if needed.
Therapeutic: cytoprotective agents
Pharmacologic: prostaglandins
Causes uterine contractions.
Unlabeled use: Cervical ripening and labor induction.
Abdominal pain, dyspepsia, headache, miscarriage, menstrual disorders.
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Assess dilation of cervix periodically during therapy.
(Vallerand & Sanoski, 2019)
Carboprost (Hemabate)
Test dose IM (adults): 100 mcg.
Therapeutic: abortifacients
Pharmacologic: oxytocics, prostaglandins
Causes uterine contractions by directing stimulating the myometrium.
Expulsion of fetus or induction of mid-trimester abortion.
Dizziness, wheezing, uterine rupture, abdominal pain, fever, chills, shivering.
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Monitor frequency, duration, and force of contractions and uterine resting tone.
Monitor vital signs periodically throughout course of therapy.
(Vallerand & Sanoski, 2019)
methylergonovine (Methergine)
PO: 200-400 mcg q 6-12 hr for 2-7 days.
IM, IV: 200 mcg q 2-4 hr for up to 5 doses.
Therapeutic: oxytocic
Pharmacologic: ergot alkaloids
Directly stimulates uterine and vascular smooth muscle.
To promote uterine contraction.
Stroke, tinnitus, dyspnea, hypertension, paresthesia, arrhythmias, chest pain
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Monitor BP, heart rate, and uterine response frequently during therapy.
Assess for signs of ergotism (cold, numb fingers and toes, chest pain, muscle
pain, weakness).
(Vallerand & Sanoski, 2019)
Postpartum Medications
Medication Order
(Standard drug/dose/route frequency)
Generic & brand names
Rhogam/Rho (D) immune globulin
Following delivery IM (Adults): HyperRHO S/D Full dose, RhoGAM- 1 vial
standard dose (300 mcg) within 72 hr of delivery.
Classification
Therapeutic: Vaccines/immunizing agents
Pharmacologic: immune globulins
Prevent production of anti-Rho (D) antibodies in Rho(D) negative patients who
were exposed to Rho(D) positive blood.
To prevent Rho (D) sensitization following transfusion accident.
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Hypertension, hypotension, acute renal failure, anemia, arthralgia, myalgia, ITP
Nursing Implications
Assess vital signs periodically during therapy.
Monitor signs and symptoms of intravascular hemolysis (IVH) (back pain,
shaking chills, fever, hemoglobinuria). (Vallerand & Sanoski, 2019)
Medication Order
(Standard drug/dose/route frequency)
Generic & brand names
Classification
Tdap (combined tetanus, diphtheria, and acellular pertussis) vaccine/ Adacel
IM: 0.5 mL for ages 10-64 yr. Then administered every 10 years.
IM: 15.5 mcg/2Lf/5Lf/0.5mL
Therapeutic: Vaccines/immunizing agents
Physiologic Action
To convey active immunity via stimulation of production of endogenously
produced antibodies
To reduce morbidity and mortality associated with pertussis in infants less than 2
months.
Joint pain, sore or weak muscles, swelling, fever, Malaise, headache, tiredness
Why is this med given in OB?
Why is pt receiving this med?
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Assess for signs of hypersensitivity.
Cautiously use for neurological disorder like CVA, epilepsy & encephalopathy.
(Vallerand & Sanoski, 2019)
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
Rubella virus vaccine live/ Meruvax II, GamaSTAN S/D, Hizentra
Subcutaneously: 0.5 mL.
Physiologic Action
Stimulate active immunity to diseases caused by rubella virus.
Why is this med given in OB?
Why is pt receiving this med?
It prevents mother from passing the rubella virus before the baby gets own
MMR vaccination at about 12 months.
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Therapeutic: Vaccines/immunizing agents
Fever, syncope, arthritis, arthralgia, myalgia, encephalitis, conjunctivitis,
anaphylaxis, vasculitis, thrombocytopenia
Assess for signs of hypersensitivity and infection. Renal function should be
monitored.
(Vallerand & Sanoski, 2019)
Medication: Newborn
Medication Order
(Standard drug/dose/route frequency)
Generic & brand names
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Medication Order
(Standard drug/dose/route frequency)
Generic & brand names
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Medication Order
(Standard drug/dose/route/ frequency)
Generic & brand names
Classification
Physiologic Action
Why is this med given in OB?
Why is pt receiving this med?
Side Effects/Adverse Effects (include
fetal/neonatal effects, as necessary)
Nursing Implications
Aqua Mephyton/Phytonadione/ Vitamin K
Subcut, IV (children> 1 mo):1-2 mg single dose.
PO (children> 1 mo): 2.5-5mg/day
Therapeutic: antidotes, vitamins
Pharmacologic: fat-soluble vitamins
Required for hepatic synthesis of blood coagulation factors II (prothrombin), VII,
IX, and X.
Prevention of bleeding due to hypoprothrombinemia.
Gastric upset, flushing, rash, urticaria, hemolytic anemia, erythema,
hyperbilirubinemia, kernicterus.
Monitor for side effects and adverse reactions.
(Vallerand & Sanoski, 2019)
Erythromycin (Ilotycin) Ophthalmic Ointment (0.5%)
PO (neonates): Ethyl succinate 20-50 mg/kg/day divided q6-12 hr.
Therapeutic: anti-infectives
Pharmacologic: macrolides
Suppresses protein synthesis at the level of the 50S bacterial ribosome.
To prevent neonatal conjunctivitis, syphilis or gonorrhea
Seizures, hepatitis, diarrhea, hypertrophic pyloric stenosis, superinfection,
allergic reactions
Assess for infection and obtain specimens for culture and sensitivity.
Monitor bowel function.
(Vallerand & Sanoski, 2019)
Hepatitis B immune globulin/ BayHep B, Nabi-HB
IM (neonates): 0.5 ml within 12 hr of birth.
Therapeutic: vaccines/immunizing agents
Pharmacologic: immune globulins
An immune gamma-globulin fraction containing high teiters of antibodies to the
hepatitis B surface antigen, transfers passive immunity to hepatitis B infection.
Prevention of hepatitis B infection.
Dizziness, malaise, pruritus, urticaria, joint pain, rashes.
Pain, swelling and tenderness at IM site
It should be administered preferably within 24 hr but not later than 7 days after
exposure to hepatitis B.
Assess patient for signs of anaphylaxis.
(Vallerand & Sanoski, 2019)