OB Drugs

OB Drugs Magnesium Sulfate Correct Answer: Anticonvulsant 4/5mg IM SE: Flushing sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and CNS depression Monitor serum Mg levels (therapeutic range 3-6mg/100mL) OB Use: Seizure prevention in Eclampsia and preeclampsia Betamethasone Correct Answer: Glucocorticoid 12mg IM SE: Fluid retention/accumulation, hyperglycemia, glucose intolerance, hypokalemia, GI upset, mood changes, insomnia, restlessness, mania, catatonia, depression, delusions, hallucinations and violent behavior. Monitor: BP vitals, mood OB USE: Help preterm babies develop surfactant...decrease lung disease and increase lung function Pitocin (oxytocin) Correct Answer: Drug class: synthetic hormone Usual dose/route: IV standard concentration of 10 units to 1000ml, 20 units to 1000ml and 30 units in 500ml Admin through a second line connected to main line and always by pump. Begin dosage at 1 milliunit per minute and increase the rate by 1-2 milliunits per minute no more frequently than every 30-60 minutes based on progression of labor. Side effects: MATERNAL: uterine tachysystole (more than 5 contractions in 10 min or a series of single contractions lasting greater than or = to 2 min or contractions of normal duration occurring within 1 minute of each other), placental abruptions, uterine rupture, unnecessary c section due to abnormal FHR and patterns, postpartum hemorrhaging, and infection. FETAL: hypoxemia and acidosis eventually resulting in abnormal FHR and patterns. Use in obstetrics: primarily used for labor induction and augmentation, stimulate lactation, prevent hemorrhage post-partum. Patient teaching: explain reasons for usage, effects of the drug (expect contractions, intensity and more frequent) monitoring to anticipate. Cytotec (Misoprostol) Correct Answer: Drug class: Prostaglandin E1 (PGE1) Usual dose/route: 100 or 200 mcg tablet which is prepared in pharmacy to ensure proper dosage. Initial dose is 25mcg inserted transvaginally into the posterior of the vaginal fornix using the tips of the index and middle fingers WITHOUT lubricant. Repeat every 3-6 hours up to 6 doses in a 24 hour period or until and effective contraction pattern is established, the cervix ripens (Bishop score of 8 or more) or adverse reactions occur. Side effects: higer doses more likely to cause nausea vomiting, diarrhea, fever, uterine tachysystole, with or withought an abnormal FHR and patterns or fetal passage of meconium. The risk for adverse reactions is reduced with lower doses at longer intervals between doses. Use in obstetrics: Used to ripen the cervix making it softer and causing it to begin to dilate and efface, stimulating contractions. Patient teaching: : explain procedure to patient and family. Void before insertion, must maintain a supine with lateral tilt or side lying position for 30-40 minafter insertion. Methergine (Methylergonovine maleate) Correct Answer: Drug class: ADRENERGIC ANTAGONIST; ERGOT; OXYTOCIC Usual dose/route: 0.2 mg IM every 2-4hours up to 5 doses may also be given intrauterine or orally. Side effects: hypertension, nausea, vomiting, headache. Use in obstetrics: contraction of the uterus. Patient teaching: Report severe cramping or ↑bleeding.Report cold or numb fingers/toes, n/v, chest/muscle pain. Rubella vaccine Correct Answer: Drug class: Vaccine Usual dose/route:I0.5 mL subcutaneously into the outer aspect of the upper arm. Side effects: Difficulty in breathing or swallowing, hives, itching, especially of feet or hands, reddening of skin, especially around ears, swelling of eyes, face, or inside of nose, unusual tiredness or weakness (sudden and severe). Use in obstetrics: when rubella vaccine is given postpartum it is to prevent future problems from congenital rubella syndrome for a fetus (first trimester). Patient teaching: You should not receive a booster vaccine if you had an allergic reaction after the first shot. Keep track of any and all side effects you have after receiving this vaccine. When you receive a booster dose, you will need to tell the doctor if the previous shots caused any side effects. Becoming infected with measles, mumps, or rubella is much more dangerous to your health than receiving the vaccine to protect against these diseases. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is extremely low. Rhogam (Rh immune globulin) Correct Answer: Drug class: immunoglobulin Usual dose/route:300 ug given within 72 hours and suppressed 30 mL whole blood or 15 mL of red blood cells Side effects: Headache chills fever decreased hemoglobin Use in obstetrics: given to the RH negative mother @ 28 weeks & 72 hours after delivery. special immune globulins that prevent mother's sensitization to the Rh positive baby in her Rh negative blood Patient teaching: RhoGAM may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to RhoGAM. Using RhoGAM alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks. Avoid vaccinations with live virus vaccines (eg, measles, mumps, oral polio) for 3 months after using RhoGAM. Vaccinations may be less effective. RhoGAM is made from human plasma. There is an extremely low risk of developing a viral infection or Creutzfeldt-Jakob disease (CJD) after using RhoGAM. Discuss any questions or concerns with your doctor. RhoGAM may affect certain lab test results. Make sure your doctor and other lab personnel know you are using RhoGAM. LAB TESTS, including blood counts and antibody titers, may be required to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments. Neonatal vitamin K (Phytonadione) Correct Answer: Drug class: Vitamin Usual dose/route: Administer a 0.5- to 1-mg (0.25- to 0.5-ml) dose intramuscularly within 2 hours of birth; can be repeated if the newborn shows bleeding tendencies. Side effects: Edema, erythema, and pain at the injection site occur rarely; hemolysis, jaundice, and hyperbilirubinemia have been reported, particularly in preterm infants. Purpose for giving to newborn: This intervention provides vitamin K because the newborn does not have the intestinal flora to produce this vitamin in the first week after birth. It also promotes formation of clotting factors (II, VII, IX, X) in the liver. Vitamin K is used for the prevention and treatment of hemorrhagic disease in the newborn. Parent teaching: Wear gloves. Administer in the middle third of the vastus lateralis muscle by using a 25-gauge, 5/8-inch needle. Inject into skin that has been cleaned, or allow alcohol to dry on puncture site for 1 minute to remove organisms and prevent infection. Stabilize the leg firmly, and grasp the muscle between the thumb and fingers. Insert the needle at a 90-degree angle; release the muscle; aspirate, and inject the medication slowly if no blood return occurs. Massage the site with a dry gauze square after removing needle to increase absorption. Observe for signs of bleeding from the site.