Name____________________ Drug & Class Demerol (Meperidene Hydrochloride) Opioid Analgesic; CNS agent; narcotic antagonist PO Onset: 15 min Peak: 60-90 min Duration: 2-4 hrs IM Onset: 10-15 min Peak: 30-50 min Duration: 2-4 hrs IV Onset: 1 min Peak: 5-7 min Duration: 2-4 hrs SubQ Onset: 10-15 min Peak: 30-50 min Duration: 2-4 hrs During labor IM & IV routes are most commonly used; Crosses placenta within 90 seconds of maternal administration Pharmacologic Action Binds with opiate receptors in the CNS, altering perception of and emotional response to pain. Analgesia, sedation, euphoria, respiratory depression, cough suppression, and suppression of bowel motility Given in 1st stage of labor, b/c the baby will be born floppy if given later Drug Worksheet Therapeutic Use Adverse Effects Drug Interactions Relief of moderate to severe pain; sedation Repeated dosing results in accumulation of normeperidine, a toxic metabolite that can cause dysphoria, irritability, tremors, and seizures MAO inhibitors: may increase CNS excitation or depression that can be severe or fatal Maternal Effects: nausea, vomiting, itching, urinary retention, sedation, respiratory depression, dizziness Fetal Effects: alteration in fetal electroencephalogram, decreased or absent respiratory movements, decrease in fetal movements, decreased variability with the FHR Newborn Effects: take longer to breathe after birth, have lower Apgar scores, lower O2Sa CNS depressants, general anesthetics, hypnotics, other opioid analgesics, phenothiazines, sedatives, tricyclic antidepressants: may cause respiratory depression, hypotension, profound sedation, or coma Precautions & Contraindications Contraindications: Narcotic dependency, know convulsive disorders such as epilepsy, hypersensitivity to the drug, those who have received MAO inhibitors within past 14 days Precautions: Avoid use during breast feeding. May lead to neonatal depression. Nursing Actions related to the Modalities Direct Care Monitor the woman’s respiratory rate and quality of respirations to detect signs of respiratory depression. Monitor fetal heart rate for signs of late decelerations. Anticipate urinary retention-offer a bedpan and monitor for bladder distention. Drug or Drug Class: Teaching/Counseling Social Support Demerol has been associated with delays in Due to strict bed rest patient needs others to initiation of successful breastfeeding including help with bedpan, fluid, food, and other needs more sucking problems such as lack of sucking and incorrect sucking technique. Bed rest with no ambulation is necessary as sedation and dizziness are common side effects. Advise patient to avoid alcohol during therapy Woman remains on bed rest and does not ambulate after administration as many women experience dizziness and sedation. Clinical Experiences with Drugs of This Class: Drug (Generic & Trade Name) Dose & Route Why this Client was Receiving the Drug Comments or Notes