DRUG STUDY

MODE OF ACTIONS/ INDICATIONS Mechanism of Action: Causes potent and selective stimulation of uterine and mammary gland smooth muscles producing sustained contractions Induces labor and milk ejection and reduces postpartum bleeding Indication: To induce or stimulate labor NURSING CONSIDERATION Vital signs (including fetal heart rate) and uterine tone should be closely monitored. Monitor patient extremely closely during first and second stages of labor because of risk of cervical laceration, uterine rupture and maternal and fetal death. Assess fluid intake and output. Watch for signs and symptoms of water intoxication.

DRUG NAME GENERIC NAME: Oxytocin BRAND NAME: Pitocin CLASSIFICATION: Pharmalogic Class: Posterior pituitary hormone Therapeutic Class: Uterine-active agent ROUTE: IV DOSAGE: 10 units/ml in1ml ampule

EFFECTS Cardiovascular: hypertension; increased heart rate, systemic venous return, and cardiac output, and arrhythmias CNS: seizures, coma from water intoxication Gastrointestinal: Nausea, vomiting, GU: titanic uterine contractions, abruption placentae, impaired uterine blood flow, pelvic hematoma Hematologic: a fibrinogenemia Respiratory: anoxia, asphyxia

CONTRADICTION -Contraindicated in patients hypersensitive to the drug or any of its component. -Also contraindicated in cephalopelvic disproportion or delivery that requires conversion, as in transverse lie; in fetal distress when delivery isnt imminent; in prematurity and in severe toxemia, hypertonic uterine patterns, total placenta previa or vasa previa. -Also contraindicated in fetal distress

DRUG NAME GENERIC NAME: Hyoscine-Nbutylbromide BRAND NAME: Buscopan CLASSIFICATION: Antispasmodic; Anticholinegic ROUTE: IV DOSAGE: Dilute required dose to 10ml with normal saline. Inject slowly over 3-5 minutes.

MODE OF ACTIONS/ INDICATIONS Therapeutic Actions: Hyoscine-Nbutylbromide (HNBB) acts by interfering with the transmission of nerve impulses by acetylcholine in the parasympathetic nervous system. Buscopan exerts a spasmolytic action on the smooth muscle of the gastrointestinal, biliary and urinary tracts. As a quaternary ammonium derivative, hyoscineN- butylbromide does not enter the central nervous system. Therefore, anticholinergic side effects at the central nervous system do not occur. Peripheral anticholinergic effects result from a ganglion-blocking action within the visceral wall as well as from antimuscarinic activity. 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

EFFECTS Adverse Effects: CNS: dizziness, anaphylactic reactions, anaphylactic shock, increased ICP, disorientation, restles sness, irritability, dizziness, drowsiness, headache, confusion, hallucination, delirium, impaired memory

CONTRADICTION Buscopan Tablets should not be administered to patients with myasthenia gravis, mega colon and narrow angle glaucoma. In addition, they should not be given to patients with a known hypersensitivity to hyoscine-Nbutyl bromide or any other component of the product.

NURSING CONSIDERATION 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.

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.

DRUG NAME

MODE OF ACTIONS/ INDICATIONS

EFFECTS Increased serum osmolality Hypernatremia Hypokalemia Altered thermoregulation Pulmonary edema Cardiovascular overload

CONTRADICTION Renal failure Hearth disease Dehydration Liver dysfunction Diabetes mellitus Lactic acidosis Alkalosis hyperkalemia

NURSING CONSIDERATION Do not administer unless solution is clear and container is undamaged. Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin. Solution containing acetate should be used with caution as excess administration may result in metabolic alkalosis. Solution containing dextrose should be used with caution in patients with known subclinical or overt diabetes mellitus. Discard unused portion. In very low birth weight infants, excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage. Properly label the IV Fluid Observe aseptic technique when changing IV fluid

NAME: Mechanism of Action 5% dextrose in Hypertonic lactated ringers solutions are those (D5LR) that have an Electrolytes in effective osmolality 1000mL greater than the Sodium- 130 body fluids. This mmol pulls the fluid into Potassium- 4 the vascular by mmol osmosis resulting in Calcium- 1.4 mmol Chloride- 109 an increase vascular mmol volume. It raises Lactate- 28 mmol intravascular Osmolality- 406 osmotic pressure mOsm and provides fluid, electrolytes and CLASSIFICATION: calories for energy. Hypertonic ROUTE: IV DOSAGE: 1000 mL @ 30 gtts/min or as prescribed by the physician. Indications of D5NM Treatment for persons needing extra calories who cannot tolerate fluid overload. Treatment of shock.

Pathophysiology

Hx of urinary infection Low socioeconomic class Inadequate prenatal care Single parenthood

Uterine contraction before end of 37th week of gestation (persistent uterine contractions)

Preterm Birth Bleeding Feeling of pelvic pressure/ abdominal tightening Persistent dull, low backache

Vaginal spotting

Menstrual like cramping

Intestinal cramping

Primary neonatal complications: -Respiratory distress syndrome -infections -cerebral palsy -visual impairment Vaginal discharge