Generic /Trade Name Normal Dosage >12 y.o.: 325560 mg PO q 4-6 hr or 1300 mg PO q 8 hr Max dose: 4,000 mg/day Classification Analgesic FDA Pregnancy Class: B Therapeutic Effects & Indications Inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever Adverse Effects 12 mg/dose 2x 12 or 24 hours apart when used during pregnancy Betamethasone Corticosteroid FDA Pregnancy Class: C Maternity use: For minor aches and pains associated with childbirth, labor or childbirth complication Reduction in fever from minor infections or illnesses Help ease pain from circumcised infant Binds to glucocorticoid receptors and then binds to DNA to modify gene expression Causes the release of surfactant (helping with lung development) Treatment of primary or secondary andreocortical insufficiency Short term management of inflammatory and allergic disorders Management of MS exacerbations Maternity use: Single round doses are given to pregnant women to help speed up lung development in infant when at rish for delivering prematurely Teachings Hepatoxixity/hepatic failure Myocardial damage Gastrointestinal bleeding Adverse effects increase when mixed with alcohol or barbiturates. Pregnancy/Breastfeeding: Safe for women who are currently pregnant or breastfeeding Acetadote is the antidote for overdose May increase risk for bleeding with warfarin therapy Note that it could alter blood glucose levels Assure patient does not mix with any other acetaminophen containing drugs. Assure that patient knows risks if mixed with other acetaminophen containing meds and provide examples as to what common meds are Safe with breastfeeding Not recommended for use over 10 continuous days Aggravation of infection Headache Immunosuppression Increased appetite Masking of infection Vertigo Weight gain There is an interaction with live vaccines Make sure patient is wearing alert tag after administration Monitor blood glucose levels Caution should be taken when breastfeeding; excreted through breastmilk Educate on the risk of the outcome of corticosteroids that are excreted in breastmilk from medication Educate on the possibility of growth suppression Not recommended for use over 10 continuous days Antipyretic; Temporary reduces fever Temporary relief of minor aches and pains Acetaminophen Nursing Care Generic /Trade Name Normal Dosage 19-50: 1000 mg/d PO 14-18: 1300 mg/d PO Classification Antacid/electrolyte FDA Pregnancy Class: C Calcium Gluconate 12 y.o.: 50-200 mg/day Laxative, emollients FDA Pregnancy Class: C Treatment of hypocalcemia, hyperphosphatemia and magnesium intoxication disorders Management of acid reflux induced by pregnancy Increases the amount of water the stool absorbs in the large intestine Treats constipation or difficult defecation from fluctuating increase in hormone levels Pressure of the growing uterus places on the large intestine Colace Cytotec Therapeutic Effects & Indications Reacts with hydrofluoric acid to form an insoluble and non-toxic form of calcium fluoride 200 mcg 4x daily with food (to prevent ulcers) 25-100 mcg for induction of labor 200-1000 mcg for reduction of PP hemorrhage Prostaglandin, gastrointestinal agents FDA Pregnancy Class: X Lines walls of stomach and aids in the prevention of acid erosion Softens cervix to induce labor Prevent stomach ulcers caused by NSAID pain medications Used to terminate pregnancy Used to induce labor Used to treat PP hemorrhage Adverse Effects Nursing Care Teachings Anorexia Bradycardia Constipation Hypercalcemia Hypotension Do not administer other oral meds within 1-2 hours of giving antacid Monitor serum phosphate periodically Administer between meals and at bedtime Only give med if medically necessary Teach importance of not taking within 1-2 hours of other oral meds o Drug affects the absorbtion of medication Unknown if passed through breastmilk Stomach cramps Nausea Diarrhea Weakness Sweating Muscle cramps Consider giving, suggesting or getting doctor approval for use of colace if mother is experiencing three or fewer bowel movements per week Mention lifestyle changes in conjunction or instead of taking a medication if mother is wary of taking drugs while pregnant or breastfeeding Decide if colace is the correct choise and decide on proper dosage. Educate on severity of symptoms Recommend lifestyle modifications to ease constipation (i.e. increased water intake, exercise) Explain that colace is safe for baby if symptom relief is needed Mild to moderate symptoms may occur until body gets used to med No side effects passed to baby if used during breastfeeding Vaginal bleeding Nausea Diarrhea Weakness Sweating Feeling thirsty/hot Muscle/menstrual cramps Hyperstimulation of uterus Uterine rupture Start at 25 mg and increase dosage as labor progresses/closer gets to delivery Monitor mother and baby during delivery for fetal distress and extrem contractions Recognize that a c-section is indicated if a dose of 100 mg does not fully induce labor Explain possible side effects and severity of birth defects if any of the side effects occurred Clear up misconceptions that med is used to cause an abortion when used in lateterm pregnancy as induction agent If used for ulcers, explain risk of miscarriage and importance of contraception use Can cause abortion if given too early in gestation. Must have negative pregnancy test 2 weeks prior to first dose Generic /Trade Name Normal Dosage 150 mg/mL Classification Antineoplastics FDA Pregnancy Class: X Contraceptive Manages conditions related to your menstrual cycle Depo Provera Dose: IV 4-10 mg diluted over 5 min. SUBQ/IM 5-20 mg Q4 hrs PRN Duramorph Opioid Agonist/analgesic Morphine Injection Controlled schedule II FDA Pregnancy Class: C Dose: IM; initial 250 mcg (1mL) Prostaglandin FDA Pregnancy Class: C Hemabate Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors, produces CNS depression. Pain effects in 10-20 min last 2-5 hrs Use as a last resort. Epidural Respiratory depression Stimulates uterine and vascular smooth muscle, causing contraction and decrease bleeding. In pregnancy and postpartum: Preventing hemorrhage. Induction of midterm abortion. Hep B Vaccine Insulin Regular Therapeutic Effects & Indications Prevents ovulation for up to 12 weeks Thickens cervical mucus to prevent sperm from reaching the egg Varies per person SubQ 0.3-0.7 units/kg/day Insulin; antidiabetic, short-acting insulin Adverse Effects Nursing Care Teachings Unexplained vaginal bleeding Liver disease Breast cancer Osteoporosis Delay in the return to fertility Abdominal pain Bloating Weight gain Weakness Should be given no less than 5 days PP to assure that the patient is not pregnant before administration if not breastfeeding If breastfeeding, initial injection PP should be given no less than 6 weeks after delivery Respiratory depression C-section effects last for 24 hours Pruritus Constipation Nausea Sedation Drowsiness Dizziness anaphylactic reaction cardiac arrest convulsions bradycardia. Should not be given in the latent stage due to the effects on the fetus. Do not give to women with opioid dependency. Explain possible SE/AE and severity of birth defects if SE occurred Educate Pt on frequency of injection (every 12 weeks) Explain that after 89 days from last injection, if not followed by another pregnancy, to use other forms of contraception Explain the risk of heave and prolonged bleeding might occur if injections are started immediately after delivery or termination of pregnancy No breastfeeding while taking it because it can be passed through breastmilk Regulates carbohydrate, fat, and protein metabolism Nausea Give when fundus is boggy to contract uterus and provide Vomiting increased blood flow. Diarrhea Don’t exceed 12mg or continuous Numbness administration for 1mo. Headache Should not be given if patient has menstrual pain asthma. fever/chills uterine laceration rupture or hemorrhage. Hypoglycemia Hematoma Sinus tachycardia Headache Instruct patient to notify health care professional if you experience severe pelvic pain, cramping, high fever, light headedness, or increased blood pressure. Monitor and control blood glucose Safe for breastfeeding Insulin usually returns to normal levels after labor Follow up 6 weeks PP Generic /Trade Name Normal Dosage Classification FDA Pregnancy Class: B Must be individualized Intermittent IV initial 20 mg over 2 minutes. Oral: 100mg BID Antihypertensive (Beta blocker) FDA Pregnancy Class: C Labetalol Therapeutic Effects & Indications Promotes storage and inhibits breakdown of glucose Treats diabetes during pregnancy Combines selective, competitive, alpha-1 adrenergic blocking and nonselective, competitive, betaadrenergic blocking activity Treat high blood pressure 40 mg PO BID Diuretic, antihypertensive FDA Pregnancy Class: C Lasix Lovenox 40 mg deep SubQ 2 hrs before surgery repeated 24 hrs after initial does and continued daily for 7-10 days Anticoagulant FDA Pregnancy Class: B Thought to inhibit sodium and chloride reabsorption from loop of Henle. Increase K excretion and plasma volume Promote renal excretion Hypertension Acute pulmonary edema Edema caused by heart failure Hepatic cirrhosis Renal disease Inhibits thrombus and clot formation Deactivates thrombin and prevents conversion of fibrinogen to fibrin Deep vein thrombosis Preventing clots Adverse Effects Diaphoresis Dyspnea (shortness of breath) Hypertension Edema Weight gain Maternal and fetal tachycardia Palpitations Cardiac dysrhythmias Hypokalemia Hyperglycemia Chest pain Wide pulse pressure Dyspnea Tremors Restlessness Weakness Dizziness Dizziness Hypotension Tachycardia Arrhythmias Blurred vision Cramping Dyspnea Dry mouth Anorexia Dizziness Edema Confusion Urinary retention Anemia Hyperkalemia Fever Bleeding Atrial Fibrilation Hemorrhage Nursing Care Teachings First-line medication for management of acute-onset, severe hypertension Assess FHR o >160 should report Mother’s HR o >120 Respirations o >24 RR Dyspnea Systolic BP o <80-90 Avoid getting up too fast Avoid drinking alcohol Crosses the placenta Can be given direct of over 1 to 2 minutes Don’t infuse more than 4 mg/minute IV or IM given for rapid onset diuresis Watch for ototoxicity Monitor CO2 Monitor BP Monitor glucose Monitor fluid intake and output Monitor pulse Monitor symptoms of hypokalemia Be aware of Lovenox is a high alert drug Don’t expel air bubble from syringe before giving Don’t give IM or IV Use tuberculin syringe with multidose Use cautiously when breastfeeding or pregnant Take in morning with food May interact with common other drugs Avoid driving Move slowly when getting up Avoid alcohol and herbs Report irregular heartbeat, bleeding, or rash Avoid bruising Weigh themselves regularly o Report gains Inform dentist of medication use Generic /Trade Name Magnesium Sulfate Normal Dosage Dose: 4-6g in 100mL IV over 15-20 min continuing infusion 2g/hr for preeclampsia. Classification Tocolytics (anticonvulsant) FDA Pregnancy Class: D Methadone Methergine 1mL (0.2 mg) IV: administered slowly over 60 sec IM: every 2-4 hours Pharmacologic: Ergot alkaloid FDA Pregnancy Class: C Morphine Sulfate 800 mg/dose Not to exceed 3200 mg/day NSAID FDA Pregnancy Class: D Adverse Effects Nursing Care Teachings Flushing Sweating hypotension depressed deep tendon reflexes CNS depression (respiratory depression) Monitor for signs and symptoms of labor progression or worsening signs/symptoms of preeclampsia Avoid using for more than 57 days for preterm labor Avoid use during active labor or within 2 hours of delivery due to potential for magnesium toxicity in neonate Stimulates contractions in uterus, decreases bleeding postpartum Stimulates contractions in uterus, decreases bleeding postpartum Nausea Vomiting Stomach pain Thrombophlebitis Leg cramps Diaphoresis (excessive sweating) Dizziness Tinnitus If taken during third stage of labor, the risk of hemorrhage and infection increases Should not breastfeed during treatment involving Methergine Can reduce the production of breast milk Pump and dump for 12 hours after last dose of Methergine Reduces hormones that cause inflammation and pain Assess for allergies before administration Closely monitor mother and fetus for AE Warn of side effects when taking pain reducer during labor Inform to report of any AE after administration Consult with provider if breastfeeding; unknown if passes in breast milk Assess for allergies before administration Assess BP and pulse Assess for BP and cardiac rhythm following administration Warn of side effects before administration Inform to report any AE especially dyspnea Used to help manage pain during labor and PP Motrin Narcan Nifedipine Therapeutic Effects & Indications It depresses the central nervous system, acts as an anticonvulsant, and decreases frequency and intensity of uterine contractions. In pregnancy it prevents and controls seizures and decreases frequency and intensity of uterine contractions. Additionally, in smaller doses it can stop preterm labor contractions. Initial dose: 20 mg PO 20 mg every 3-8 hrs if Calcium Channel Blocker FDA Pregnancy Class: C Prevents passage of calcium into cardiac & smooth muscle that prevents contractions Indigestion Nausea Occult blood loss Anorexia Drowsiness Gi bleeding Peripheral edema Acute renal failure Anaphylaxis Shortness of breath/difficulty breahing Fluid build up within ankles, feet, and legs Mild hypotension Monitor vitals Test patellar reflex Monitor newborn for hypotension, hyporeflexia, and respiratory depression Monitor intake/output levels Do NOT administer if mother is hypertensive or has preeclampsia Generic /Trade Name Normal Dosage contractions continue Maxe dose: 160 mg/d 15-20 mg IM (during early labor) Classification Opioid agonistantagonist analgesic FDA Pregnancy Category: D Penicillin Used to treat high blood pressure with pregnant patients Used to prevent premature delivery of fetus by stopping labor before 37 weeks of gestation Serves as an agonist at kappa opioid receptors Serves as antagonist at mu opiod receptors Can be used as analgesia during labor Helps to significantly reduce pain when in labor Nubain Oxycodone Hydrochloride Therapeutic Effects & Indications Can stop contractions of the uterus through the blockage of calcium Adult: 5-15 mg PO q 4-6 hr Opiod naïve (did not take opiod in last 30 days): 10-30 mg PO q 4 hr Capsules: 5 mg PO q 6 hr Oral Solution: 10-30 mg PO q 4 hr as needed 3g via IV at start of labor 1.5g every 4 hours up until deliver of the newborn Opiod agonist analgesic FDA Pregnancy Class: C Binds to opiate receptors in CNS altering the perception and sensation of pain Relief of moderate to moderately severe pain Used to manage pain associated with labor Antibiotic FDA Pregnancy Class: B Beta-lactam ring binds to DD-transpeptidase leading to the prevention of cell wall formation within the bacteria Adverse Effects Nursing Care Teachings Increase in blood glucose levels Monitor for AE Do not crush meds; swallow whole when taking Do not take while breastfeeding; can be passed into breastmilk. In mother: Dizziness Headaches Tiredness Irregular Heartbeat Nausea/vomiting Loss of appetite In Fetus Feal bradycardia Hypotonia Cyanosis Apnea Life threatening respiratory depression Only administer when benefits significantly outweigh the risks Naloxone counteract effects of Nubain on fetus Monitor for respiratory depression and HR of fetus after administration Inform of severe, life threatening SE on fetus Nubain is a synthetic opiod, can lead to addiction May be beneficial to inform Pt of less life-threatening options available for pain management during labor Bronchospasm Cardiac arrest Constipation Dizziness Drowsiness Flushing Respiratory arrest Sedation Shock If breastfeeding, assure Pt takes dose 4-6 hours before next feeding. Can cause drowsiness in infant Use pediatric formulas to determine child does for immediate-release form Adjust does for elderly patients, those with hepatic impairment and impaired adults Inform Pt that may experience constipation; complementary laxative or stool softener may be highly recommended Is passed through breastmilk; may be difficult to breastfeed o Infant may experience increased tiredness Assess for allergies to penicillin Should not be administered until labor has started Monitor for signs of allergic reaction Assess vitals regularly to assess PP infection Why medication is being given Risks to fetus if med is not administered Risks while breastfeeding o Can pass through breastmilk and may cause Fever Vomiting Rash Allergic reactions: Breathing difficulty Generic /Trade Name Normal Dosage 10 mg PO from 36 weeks until delivery Neonates: 0.51.0 mg IM ONCE after birth Classification Pharmacologic:fatsoluble vitamins FDA Pregnancy Class: C Phytonadione Therapeutic Effects & Indications Administered during labor to treat the bacteria Group B stretococcous Helps prevent GBS transmission to fetus May be used to treat PP infections It depresses the central nervous system, acts as an anticonvulsant, and decreases frequency and intensity of uterine contractions. Used to prevent bleeding for people who are Vitamin K deficient or who have blood clotting problems Adverse Effects Nursing Care Edema with skin and throat Low BP Fainting Upset stomach Unusual taste Rash Flushing Scleroderma-like lesions Teachings rash, diarrhea, or an allergic reaction to the newborn Importance of informing provider of any allergies to penicillin Do not take anticoagulants while Look for unusual bleeding or bruising Inform others tending to patient of tendency to bleed to prevent further trauma Look for signs of internal bleeding or hypovolemic shock Do not take anticoagulants while taking this drug Do not increase or decrease normal vitamin K intakevia diet without consulting your health care provider If you miss a does, take it as soon as you rememberbut do not double up on doses No known issues with breastfeeding Use not recommended during pregnancy (can cause jaundice in baby) If using anti-seizure medication during pregnancy, can be at an increased risk of vitamin K deficiency Pitocin Initial Dose: 0.5 – 1 mU/min IV Should be increased to 1-2 mU/min until desired contractions are reached Oxytotic Hormone FDA Pregnancy Class: C Hormone that leads to an increase in prostaglandins causing uterine contractions Used antepartum in order to induce labor and cause uterine contractions Used postpartum to promote uterine contractions to prevent PP hemorrhaging IrregularHR Nausea/vomiting Cramping/Stomach Pain Loss of appetite If administered anterpartum: may lead to abnormal heart rate breathing issues jaundice within the fetus Monitored for excessive bleeding and irregular HR following administration During labor the frequency of contractions should be monitored to evaluate if the amount given may be reduced Patients should also be monitored for pain due to contractions Pt should be informed of the increased within the contractions that will occur following the administration of Pitocin Contractions will induce pain, therefore patients should be told of options that they have for pain relief Pt should also be informed of the risks that are associated with the induction of labor before the medication is administered Generic /Trade Name Normal Dosage One tablet taken daily PO or as directed by provider Classification Multivitamin and mineral supplements FDA Pregnancy Class: B Prenatal Vitamin 28 weeks gestation: 300 mcg IM 72 hours postdelivery: 300 mcg IM Immune Globulins FDA Pregnancy Class: C Rhogam 40-125 mg PO Pharmacologic: Antiflatulent FDA Pregnancy Category: C Simethicone Therapeutic Effects & Indications Used to treat vitamin deficiencies Prenatal vitamins include folic acid that decreases the chance of the fetus developing birth defects including spina bifida Prenatal vitamins also include iron that can help prevent anemia Prohibits production of ant Rh-D antibodies which can lead to Rh sensitization within the mother Administered at 28 weeks gestation to Rh negative mothers Administered again post-partum (72 hours following delivery) if Rh negative mother gives birth to Rh positive newborn and the mother is negative for anti-Rh antibodies coalescence and dispersion of the gas bubbles allowing their removal from the GI tract as flatulence or belching. Used to treat gas, bloating, painful pressure, fullness Safe to use when breastfeeding and pregnant Adverse Effects Nursing Care Possible allergic reactions in some pregnant women including swelling, hives, or difficulty breathing Stomach pains Headaches Nausea Assess Pt and ask for any over OTC Pt should be told of specific prenatal vitamins needed bases on their deficiencies Ask about allergic reactions or adverse effects to prenatal vitamin Pain at site of injection Fever Draw labs prior to administration of Rhogam to ensure if Rh negative and fetus is Rh positive Monitor following the administration of Rhogam for allergic reactions or AE Interferes with other live vaccines None Significant Does not cross placenta Generally safe to use during pregnancy Assess for pain Teachings Education on importance of taking prenatal vitamins to reduce the chance of birth defects Encourage to start prenatal vitamins once pregnancy has been determined Consult with provider if allergic reactions occur Do not take with other vitamin supplements Do not take with milk Take with food Take while breastfeeding Why Pt is receiving Rhogam Warn about pain at IM site Inform about possible allergic reactions Advise not to receive live vaccines for 3 months following Develop regular bowel habits and exercise regularly Take this product by mouth, usually after meals and at bedtime or as directed by your doctor. Swallow the capsules whole. Generic /Trade Name Normal Dosage 50 mcg/day may lower dosage to 25 mcg/day after 2-3 weeks Classification Pharmacologic: hormones FDA Pregnancy risk: Category A Synthroid 20 mg PO, 10 mg every 4-6 hr as needed Pharmacologic: NSAID FDA Pregnancy Category: C Toradol 1g in 10mL IV Second dose: 1g given within 30 min if bleeding persists or 24 hours if bleeding returns Tranexamic Acid (TXA) Antiifibrinolytics FDA Pregnancy Class: B Therapeutic Effects & Indications Replacement of or supplement to endogenous thyroid hormones. Increases metabolic rate Thyroid supplementation for hypothyroidism Treatment for goiters Adverse Effects Headache Insomnia Irritability Abdominal cramps Nursing Care Teachings Assess patient pulse and BP before and during therapy. Assess for tachyarrythmia and chest pain May take several weeks before they notice an improvement in symptoms. Replacement therapy is to be taken for life. If planning pregnancy or is breastfeeding, notify healthcare provider. Pregnancy increases thyroid therapy. *does not cross placenta, minimal amounts enter breastmilk Inhibits enzyme needed for prostaglandin synthesis (blocks pain) Used for treatment of moderate severe pain, usually after surgery May adversely affect fetal circulation and inhibit contractions Increased risk of premature closure of ductus arteriosus May cause temporary infertility Assess for prolonged bleeding following discontinuation Assess BP, may cause fluid retention and edema Brand name is Toradol, has been discontinued in the U.S. Generic name is ketorolac Synthetic opiod Avoid using during pregnancy beginning at 30 weeks Can be passed through breastmilk Inhibits enzymatic breakdown by reducing the binding of TPA and plasminogen to fibrin Increases rishs of neurological issues Can lead to unwanted blood clots Diarrhea Vomiting Nausea Only give to patients experiencing PP hemorrhaging Administer immediately Not to be given within 3 or more hours of onset of hemorrhaging Evaluate if bleeding ceasesd; administer another dose if not Monitor for signs of DVT as TXA promotes blood clotting Why med is being administered Inform care provider if bleeding continues or returns after administration of med If feeling lightheaded or pain in lower extremities, notify care provider Prevents significant blood loss in women who are experiencing post-partum hemorrhaging Given to women who have lost more than 500mL of blood following vaginal deliveries and 1000mL of blood following Csections Generic /Trade Name Normal Dosage 4-8 mg every 8 hours Classification Antagonist FDA Pregnancy Class: B Zofran Therapeutic Effects & Indications Blocks serotonin (substance that causes nausea and vomiting) Reduces nausea and vomiting (morning sickness) Adverse Effects Headache Diarrhea Constipation Weakness Tiredness Dizziness Nursing Care Teachings Assess for SE/AE Assess for rash Assess for involuntary movements Take as directed Advise patient to notify health care professional if have symptoms of irregular heart beat, involuntary movement of eyes, face, or limbs, vision loss, blurred vision or if symptoms don’t go away Safe in breastfeeding (but no studies to prove this), Zofran can be given to infants as early as 1 month old
