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DRUG STUDY

1. Generic Name: Methylergonovine maleate


Brand Name: Methergine
Classification: Oxytocic
Therapeutic Actions:
• A partial agonist or antagonist at alpha receptors; as a result, it increases the
strength, duration, and frequency of uterine contractions.
Indications:
• Routine management after delivery of the placenta.
• Treatment of postpartum atony and hemorrhage; subinvolution of the uterus.
• Uterine stimulation during the second stage of labor following the delivery of
the anterior shoulder, under strict medical supervision.
Contraindications
• Contraindicated with allergy to methylergonovine, hypertension, toxemia,
lactation, pregnancy.
Adverse Effects:
CNS: Dizziness, headache, tinnitus, diaphoresis
CV: Transient hypertension, palpitations, chest pains, dyspnea
GI: Nausea and vomiting
Nursing Considerations:
• Assess history of allergy to the drug.
• Administer by IM injection or orally unless emergency requires IV use.
Complications are more frequent with IV use.
• Monitor postpartum women for BP changes and amount and character of
vaginal bleeding.
• Avoid prolonged use of the drug.
• Teach client to report difficulty breathing, headache, numb or cold
extremities, severe abdominal cramping.

2. Generic Name: Dinoprostone (prostaglandin E2)


Brand Name: Cervidil
Classification: Prostaglandin; abortifacient
Therapeutic Actions:
• Stimulates the myometrium of the pregnant uterus to contract; similar to the
contractions of the uterus during labor, thus evacuating the contents of the
uterus.
Indications:
• Termination of pregnancy 12-20 wks from the first day of the LMP.
• Evacuation of the uterus in the management of missed abortion or
intrauterine fetal death up to 28 wk gestational stage
• Initiation of cervical ripening before induction of labor
Contraindications:
• Contraindicated with allergy to prostaglandins; acute PID; active cardiac
hepatic; pulmonary, renal disease; women in whom prolonged uterine
contractions are inappropriate.
Adverse Effects:
CNS: Headache, paresthesias, anxiety, weakness, syncope, dizziness
CV: Hypotension, arrthymias, chest pain
Fetal: Abnormal heart rates
GI: vomiting, diarrhea, nausea
Respiratory: Coughing, dyspnea
Nursing Considerations:
• Monitor uterine tone and vaginal discharge throughout the procedure
and several days after the procedure.
• Ensure adequate hydration throughout the procedure.
• Be prepared to support patient through labor. Give oxytocin infusion 6-
12 hr after dinoprostone.
• Teach client to report severe pain, difficulty breathing, palpitations,
eye pain, rash.

3. Generic Name: Oxytocin


Brand Name: Pitocin
Classification: Oxytocic; hormone
Therapeutic Actions:
• Synthetic form of an endogenous hormone produced in the hypothalamus
and stored in the posterior pituitary; stimulates the uterus, especially the
gravid uterus just before parturition, and causes myoepithelium of the lacteal
glands to contract, which results in milk ejection in lactating women.
Indications:
• Antepartum: to initiate or improve uterine contractions to achieve early
vaginal delivery; stimulation or reinforcement of labor in selected cases of
uterine inertia; management of inevitable or incomplete abortion; 2nd
trimester abortion
• Postpartum: to produce uterine contractions during the third stage of labor to
control postpartum bleeding or hemorrhage
• Lactation defieciency
Contraindications:
• Significant cephalopelvic disproportion, unfavorable fetal positions or
presentations, obstetric emergencies that favor surgical intervention,
prolonged use in severe toxemia, uterine inertia, hypertonic uterine patterns,
induction or augmentation of labor when vaginal delivery is contraindicated,
previous cesarian section.
Adverse Effects:
CV: cardiac arrhythmias, PVCs, hypertension, subarachnoid hemorrhage
Fetal effects: fetal bradycardia, neonatal jaundice, low Apgar scores
GI: nauseas, vomiting
GU: postpartum hemorrhage, uterine rupture, pelvic hematoma, uterine
hypertonicity, spasm
Nursing Considerations:
• Ensure fetal position and size and absence of complications that are
contraindicated with oxytocin therapy
• Ensure continuous observation for induction of labor; fetal monitoring is
preferred.
• Regulate rate of oxytocin delivery; monitor rate and strength of contractions
• Monitor BP during administration

4. Generic Name: Lidocaine hydrochloride


Brand Name: Dilocaine
Classification: Local anesthetic
Therapeutic Actions:
• Blocks the generation and conduction of action potentials in sensory nerves
by reducing sodium permeability, reducing height and rate of rise of the
action potential, increasing excitation threshold, and slowing conduction
velocity
Indications:
• Infiltration anesthesia, peripheral and sympathetic nerve blocks, central
nerve blocks, spinal and caudal anesthesia
Contraindications:
• Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF
cardiogenic shock, 2nd or 3rd degree AV blocks
Adverse Effects:
CNS: headache, backache, septic meningitis, persistent sensory
CV: hypotension
Dermatologic: urticaria, pruritus, erythema, edema
GU: urinary retention, urinary or fecal incontinence
Nursing Considerations:
• Check drug concentrations carefully
• Establish safety precautions if CNS changes occur
• Teach client to report difficulty speaking, thick tongue, numbness, tingling,
difficulty breathing, pain or numbness at site, swelling or pain at site

5. Generic Name: Terbutaline Sulfate


Brand Name: Brethine
Classification: Tocolytic
Therapeutic Actions:
- In low doses, acts relatively selectively at beta 2-adrenergic receptors to
cause bronchodilation and relax the pregnant uterus; at higher doses, beta 1
selectivity is lost and the drug acts at beta 2 receptors to cause typical
sympathomimetic cardiac effects
Indications:
- Tocolytic to prevent preterm labor
Contraindications:
- Contraindicated with hypersensitivity to terbutaline, tachyarrythmias,
tachycardia, hypertension, lactation.
Adverse Effects:
CNS: restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesias,
insomnia, tremors
CV: cardiac arrhythmias, palpitations, angina pain, changes in BP and ECG
GI: Nausea, vomiting, heartburn, unusual or bad taste
Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm
Nursing Considerations:
- Use minimal doses for minimal periods of time; drug tolerance can occur
- Maintain a beta-adrenergic blocker on standby in case cardiac arrhythmias
occur
- Teach client to report chest pain, dizziness, insomnia, weakness, tremor

6. Generic Name: Carboprost tromethamine


Brand Name: Hemabate
Classification: Prostaglandin; Abortifacient
Therapeutic Actions:
• Stimulates the myometrium of the pregnant uterus to contract; similar to the
contractions of the uterus during labor, thus evacuating the contents of the
uterus.
Indications:
- Termination of pregnancy 13-20 wk from the first day of the LMP
- Evacuation of the uterus in instance of missed abortion or intrauterine fetal
death in the 2nd trimester
- Postpartum hemorrhage due to uterine atony unresponsive to conventional
methods
Contraindications:
- Contraindicated with allergy to prostaglandin preparations, acute PID; active
cardiac,hepatic, pulmonary, renal disease
Adverse Effects:
CNS: headache, paersthesias, flushing, anxiety, weakness, syncope, dizziness
CV: hypotension, arrhythmias, chest pain
GI: vomiting, diarrhes, nausea
Nursing Considerations:
- Assess allergy to the drug
- Monitor uterine tone and vaginal discharge during procedure and several
days after to assess drug effects and recovery
- Ensure adequate hydration
7. Generic Name: Nalbuphine hydrochloride
Brand Name: Nubain
Classification: Narcotic agonisy-antagonist analgesic
Therapeutic Actions:
- Nalbuphine acts as an agonist at specific opioid receptors in the Cns to
produce analgesia, sedation but also acts to cause hallucinations and is an
antagonist at mu receptors
Indications:
- Relief of moderate to severe pain
- For obstetric analgesia during labor and delivery
Contraindications:
- Contraindicated with hypersensitivity to nalbuphine, sulfites; lactation
Adverse Effects:
CNS: sedation, clamminess, sweating, headache, nervousness, restlessness,
depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations,
euphoria, blurred vision
CV: hypotension, hypertension, bradycardia, tachycardia
Dermatologic: itching, burning, urticaria
GI: N/V, cramps, dyspepsia, bitter taste, dry mouth
GU: Urinary urgency
Respiratory: Respiratory depression, dyspnea, asthma
Nursing Considerations:
- Assess hypersensitivity to the drug
- Provide narcotic antagonist, facilitates for assisted or controlled respiration
on standby in case of respiratory depression
- Reassure patient about addiction liability; most patients who receive opiates
for medical reasons do not develop dependence syndrome
- Inform clients about these side effects: dizziness, sedation, drowsiness,
impaired visual acuity, nausea, loss of appetite

8. Generic Name: Magnesium sulfate


Brand Name: Epsom salt
Classification: electrolyte; anticonvulsant; laxarive
Therapeutic Actions:
- Cofactor of many enzyme systems involved in neuromuscular transmission
and muscular excitability
Indications:
- Preeclampsia/eclampsia
- Inhibition of premature labor
Contraindications:
- Contraindicated with allergy to magnesium product; heart block, myocardial
damage, abdominal pain, N/V, acute surgical abdomen, fecal impaction,
hepatitis. DO NOT GIVE 2 HR PRECEEDING DELIVERY BECAUSE OF RISK OF
MAGNESIUM TOXICITY IN THE NEONATE.
Adverse Effects:
CNS: weakness, dizziness, fainting, sweating
CV: palpitations
GI: excessive bowel activity, perianal irritation
Metabolic: Magnesium intoxication, hypocalcemia with tetany

Nursing Considerations:
- Assess history of allergy to the drug and other contraindications
- Reserve IV use in eclampsia for immediate life- threatening situations
- Monitor magnesium levels during parenteral therapy
- Monitor knee-jerk reflex before repeated parenteral administration, if
happens, do not administer because respiratory failure may occur
- Do not give orally with abdominal pain, N/V
- Monitor urine output

9. Generic Name: Butorphanol tartrate


Brand Name: stadol
Classification: Narcotic agonist- antagonist analgesic
Therapeutic Actions:
- Acts as an agonist at opioid receptors in the CNS to produce analgesia,
sedation, but also acts to produce hallucinations; has low abuse potential
Indications:
- Relief of moderate to severe pain
- To supplement balances anesthesia and to relieve prepartum pain
Contraindications:
- Contraindicated with hypersensitivity to butorphanol, physical dependence on a
narcotic analgesic, pregnancy lactation
Adverse Effects:
CNS: sedation, clamminess, sweating, headache, vertigo, dizziness, lethargy,
confusion, unusual dreams, agitation, euphoria, hallucinations
CV: Palpitations, increase or decrease in blood pressure
Dermatologic: Ras, hives, pruritus, flushing, warmth, sensitivity to cold
EENT: diplopia, blurred vision
GI: N/V
Respiratory: slow, shallow respiration
Nursing Considerations:
- Assess history of allergy to butorphanol , depression DM, lactation, and
dependence
- Monitor diet for presence of caffeine- containing foods that may contribute to
overdose
- Inform patients that these side effects may occur: diuresis, restlessness,
insomnia, muscular tremors, light- headedness, nausea, abdominal pain
- Remind patient to report abnormal heart rate, dizziness, palpitations

10. Generic Name: Misoprostol


Brand Name: Cytotec
Classification: Prostaglandin
Therapeutic Actions:
- A synthetic prostaglandin E1 analog; inhibits gastric acid secretion and
increases bicarbonate and mucus production, protecting the lining of the
stomach
Indications:
- With mifepristone as an abortifacient
- Cervical ripening and labor induction
Contraindications:
- History of allergy to prostaglandins; pregnancy; lactation
Adverse Effects:
GI: nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, constipation
GU: Miscarriage, excessive bleeding, spotting, cramping, menstrual disorders
Nursing Considerations:
- Assess history of allergy to the drug
- Report severe diarrhea, spotting, or menstrual pain, severe menstrual
bleeding

Generic Name: Midazolam hydrochloride


Brand Name: Versed
Classification: Benzodiazepine (short-acting); CNS depressant
Therapeutic actions:
- Exact mechanisms of action not understood; acts mainly at the limbic
system and reticular formation; potentiates the effects of GABA, an
inhibitory neurotransmitter; anxiolytic and amnesia effects occur at
doses below those needed to cause sedation, ataxia; has little effect on
cortical function.
Indications
- IV or IM: Sedation, anxiolysis, and amnesia prior to diagnostic,
therapeutic, or endoscopic procedures or surgery
- Induction of general anesthesia
- Continuous sedation of intubated and mechanically ventilated patients
as a component of anesthesia or during treatment in the critical care
setting
- Unlabeled uses: Treatment of epileptic seizure or refractory status
epilepticus

Contraindications and cautions


- Contraindicated with hypersensitivity to benzodiazepines; psychoses,
acute narrow-angle glaucoma, shock, coma, acute alcoholic
intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac
defects, microcephaly, pyloric stenosis have been reported when used
in first trimester; neonatal withdrawal syndrome reported in infants);
neonates.
- Use cautiously in elderly or debilitated patients; with impaired liver or
kidney function, lactation.

Adverse effects
CNS: Transient, mild drowsiness (initially); sedation, depression, lethargy,
apathy, fatigue, light-headedness, disorientation, restlessness, confusion,
crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity,
tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration,
vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild
paradoxical excitatory reactions (during first 2 wk of treatment), visual and
auditory disturbances, diplopia, nystagmus, depressed hearing, nasal
congestion
CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension,
palpitations, edema
Dermatologic: Urticaria, pruritus, skin rash, dermatitis
GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting,
difficulty in swallowing, gastric disorders, elevations of blood enzymes: LDH,
alkaline phosphatase, AST, ALT, hepatic dysfunction, jaundice
GU: Incontinence, urinary retention, changes in libido, menstrual
irregularities
Hematologic: Decreased Hct, blood dyscrasias
Other: Phlebitis and thrombosis at IV injection sites, hiccups, fever,
diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain,
burning, and redness after IM injection
Dependence: Drug dependence with withdrawal syndrome when drug is
discontinued (more common with abrupt discontinuation of higher dosage
used for longer than 4 mo)

Nursing considerations

- History: Hypersensitivity to benzodiazepines; psychoses, acute


narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with
depression of vital signs; elderly or debilitated patients; impaired liver
or kidney function; pregnancy, lactation
- Physical: Weight; skin color, lesions; orientation, affect, reflexes,
sensory nerve function, ophthalmologic examination; P, BP; respiratory
rate, adventitious sounds; bowel sounds, normal output, liver
evaluation; normal output; LFTs, renal function tests, CBC
- Do not administer intra-arterially, which may produce arteriospasm or
gangrene.
- Do not use small veins (dorsum of hand or wrist) for IV injection.
- Administer IM injections deep into muscle.
- Arrange to reduce dose of midazolam if patient is also being given
opioid analgesics; reduce dosage by at least 50% and monitor patient
closely.
- Monitor level of consciousness before, during, and for at least 2–6 hr
after administration of midazolam.
- Carefully monitor P, BP, and respirations carefully during
administration.
- Keep resuscitative facilities readily available; have flumazenil available
as antidote if overdose should occur.
- Keep patients in bed for 3 hr; do not permit ambulatory patients to
operate a vehicle following an injection.
- Establish safety precautions if CNS changes occur (use side rails,
accompany ambulating patient).
- Client may experience these side effects: Drowsiness, dizziness (these
may become less pronounced after a few days; avoid driving a car or
engaging in other dangerous activities if these occur); GI upset;
dreams, difficulty concentrating, fatigue, nervousness, crying (it may
help to know that these are effects of the drug; consult your health
care provider if these become bothersome).
- Report severe dizziness, weakness, drowsiness that persists, rash or
skin lesions, visual or hearing disturbances, difficulty voiding.

Generic Name: Fresofol


Brand Name: Propofol
Classification: sedative hypnotic; anesthetic agent
Therapeutic Actions:
- Propofol is a short-acting hypnotic. Its mechanism of action has not
been well-defined.
Indications:
- induction of general anesthesia in adults and in pediatric patients
greater than 3 years of age
- maintenance of anesthesia utilizing balanced techniques with other
appropriate agents such as opioids and inhalation anesthetics in adults
and pediatric patients greater than 2 months of age
- produce sedation or amnesia as a supplement to local or regional
anesthetics

Contraindications:
- Contraindicated in pediatric patients for monitored anesthesia care
(MAC) sedation or for sedation in intensive care; epileptics; use
cautiously in lactation
Adverse Effects:
CV: Arterial hypotension; decreased systemic vascular resistance,
myocardial blood flow, and oxygen consumption, palpitations, tachycardia
Respiratory: apnea, hyperventilation, bradypnea, dyspnea, wheezing,
swelling of throat
CNS: increased ICP, lethargy, drowsiness, euphoria, hallucinations, blurred
vision, anxiety, tension, seizure, lightheadedness, fainting
DERM: skin rash, flushing, urticaria
Nursing Considerations:
- Assess history of allergy to the components of the drug.
- Use safety precautions after administration.
- Advise patient that mental alertness, coordination, and physical
dexterity may be impaired for some time after administration.
- For IV, do not mix with other therapeutic agents prior to
administration. Avoid mixing blood or plasma in same IV catheter.
- Minimize pain associated with administration by infusing into larger
veins.
- Should be administered only by personnel who are trained in
administration of general anesthesia and familiar with drug.
- Shake well before use. Do not use if there is evidence of separation of
phases of emulsion.

Generic Name: Hyoscine-N-butylbromide


Brand Name: Buscopan
Classification: Antispasmodic; Anticholinergic
Therapeutic Actions:
- acts by interfering with the transmission of nerve impulses by
acetylcholine in the parasympathetic nervous system.
Indications:
- Buscopan Tablets are indicated for the relief of spasm of the genito-
urinary tract or gastro- intestinal tract and for the symptomatic relief of
Irritable Bowel Syndrome
Contraindications:
- Buscopan Tablets should not be administered to patients with
myasthenia gravis, megacolon and narrow angle glaucoma. In
addition, they should not be given to patients with a known
hypersensitivity to hyoscine-N-butylbromide or any other component of
the product.
Adverse Effects:
CNS: dizziness, anaphylactic reactions, anaphylactic shock, increased ICP,
disorientation,
restlessness, irritability, dizziness, drowsiness, headache, confusion,
hallucination, delirium, impaired
memory
CV: hypotension, tachycardia, palpitations, flushing
GI: Dry mouth, constipation, nausea, epigastric distress
DERM: flushing, dyshidrosis
GU: Urinary retention, urinary hesitancy
Resp: dyspnea, bronchial plugging, depressed respiration
EENT: mydriasis, dilated pupils, blurred vision, photopobia, increased
intraocular pressure,
difficulty of swallowing.
Nursing Considerations:
- Drug compatibility should be monitored closely in patients requiring
adjunctive therapy
- Avoid driving & operating machinery after parenteral administration.
- Avoid strict heat
- Raise side rails as a precaution because some patients become
temporarily excited or disoriented and some develop amnesia or
become drowsy.
- Reorient patient, as needed, Tolerance may develop when therapy is
prolonged
- Atropine-like toxicity may cause dose related adverse reactions.
Individual tolerance varies greatly
- Overdose may cause curare-like effects, such as respiratory paralysis.
Keep emergency equipment available.