Appendix B: Common OB/GYN Medications

# Name Dosage Indications Side Nursing

for Use Effects Implications &
(OB/GYN) Contraindicatio
ns
1 Pitocin Induction or -Oxytoxic/ Edema, redness Be aware of purpose
Augmentation of Synthetic of the skin, and anticipated effect
labor: Hormone neonatal of Oxytocin.
Concentration: jaundice, fetal Monitor blood
10 units/ 1000cc -Induction of trauma from too pressure, fluid intake
15 units/ 250 cc labor at term rapid propulsion and output, and labor
20 units/ 1000cc through the closely if using
30 units/ 500cc -Control of pelvis. May oxytocin for
*Titrate per postpartum produce induction; fetal
institution policy bleeding antidiuretic monitoring is
effect (i.e., water strongly
Postpartum: -Contraction intoxication and recommended (see
uterine bleeding Stress Test excess uterine Adverse Reactions).
contractions); *Pregnancy risk
IV: maximum: high doses or factor X.
40 units/1000 hypersensitivity Note breast-feeding
mL to oxytocin may caution.
cause uterine
IM 10 units tachysystole, Must be given
spasm, tetanic with infusion
contraction, or pump for
rupture of the induction of labor
uterus; and uterine
contractions
observed for hyper
stimulation and/or
fetal distress.
Turn off
medication if this
occurs and notify
health care
provider.

*Report sudden,
severe HA
immediately to
healthcare
providers.

2 Erythromycin -1 cm of ointment -Prophylaxis -Minor ocular -Contraindicated in

ophthalmic in length should of irritations, patients with hx of
ointment 0.5%: be instilled into ophthalmia redness, and hypersensitivity to
each lower neonatorum hypersensitivit erythromycin.
conjunctival sac. due to N. y reactions. -Caution should be
gonorrhoeae advised to nursing
or C.
 trachomatis. mothers.

3 Vitamin K -single dose of -vitamin k -gastric upset, - monitor for frank

(AquaMEPHYTO 0.5-1mg IM w/in deficiencies, unusual taste, or occult bleeding,
N) 0.5 mg IM 1 hour of birth treat certain flushing, rash, BP, pulse, inform all
bleeding and urticaria, personal on bleeding
clotting hemolytic tendencies, apply
problems in anemia, pressure at all
baby, erythema at venipuncture sites
excessive injection site, for at least 5
anti- swelling, minutes, avoid
coagulants allergic rxn unnecessary
injections

4 Demerol IV: 25 to 50 mg Opioid Tachycardia, Implement safety

every 1 to 2 hrs. agonist sedation, N/V, measures as
PCA Pump: 15 analgesic dizziness, appropriate, use
mg every 10 altered mental side rails, and
minutes as status, assist with
needed until euphoria, ambulation,
birth. decreased continue non-
gastric pharmacologic
motility, pain relief
delayed measures. Dont
gastric give if birth us
emptying, and expected to occur
urinary w/i 1 to 4 hours
retention. after
administration b/c
it may cause
respiratory
depression in the
newborn.
5 RhoGam -1 vial (300mcg) -Routine -Headache, -Contraindicated if
IM in deltoid or antepartum mild fever, pt is allergic to other
gluteal muscle. prevention at mild pain, human immune
28 weeks swelling, or globulins or if they
gestation in redness at have any anti-
wiomen with injection site. immunoglobulin A
Rh- negative antibody.
blood,
suppress -Caution if
antibody breastfeeding
 formation -Give standard does
after birth, to mother at 28
miscarriage, weeks of gestation
pregnancy as prophylaxis.
termination. -Give standard dose
within 72 hours after
birth if neonate is
Rh+ -Verify if the
women is Rh
negative and has not
been sensitized.
Explain the purpose
of the procedure and
have consent.

6 -Max dose: 4.5 -Cause loss -Flushing or -May result in fetal

Xylocaine mg/kg/dose local of feeling redness of the and neonatal
injectable during skin, itching, toxicity. Can cross
certain small red spots the placenta. -Be
procedures. on skin, warm aware of APGAR
An anesthetic skin. scores of neonates or
that prevents any birth defects.
transmission -Caution when
of painful breastfeeding.
impulses to Lidocaine can be
the brain. excreted into human
milk.

7 Magnesium IV: -CNS Hot flash, Assess maternal &

Sulfate 40g/1000cc of LR Depressant sweating, fetal baseline
or Sterile Water -Smooth hypocalcemia, Hourly Mag Checks
Loading Dose: Muscle SOB, transient Obtain Labs for
4-6g over 20- Relaxer hypotension baseline CBC, BMP
30min especially Monitor Kidney fx
Maintenance Dose: during loading (excreted in kidneys)
1-2 gram/hr dose Foley (?)
*Must be on PUMP *Intolerance/ Mag therapeutic level
Mag Checks: 4-8mg/ dl depending
RR< 12/min, on facility
N/V
Pulmonary Antidote must be
Edema readily available:
Absent DTR, calcium gluconate
LOC 1gram IM
Extreme
Muscle TIVF=125cc/hr
 Weakness
Chest Pain If imminent delivery
UOP< 30cc/hr notify pedi/ neo team
Fetal non-
reactive NST
Contraindicatio
ns:
Myasthenia
Gravis
Heart blocks,
myocardial
damage
Caution with
renal
insufficiency
8 Calcium Injectable solution: Calcium Bradycardia Contraindications:
Gluconate 100mg/mL (10%) Supplementati Hypotension Hypersensitivity
Tablet: on; Headache IM/SC administration
50mg Hypocalcemia Constipation Ventricular fibrillation
500mg Diarrhea during CPR
650mg Flatulence Hypercalcemia
Capsule: 500mg Nausea Digoxin poisonings
Vomiting Sarcoidosis
Hypomagnesaem Cautions
ia Hepatic or renal
Hypophosphate impairment,
mia cardiovascular disease,
Extravasation acidosis, history of
necrosis renal calculi
Cardiac arrest may
occur
Constipation, bloating,
and gas may occur
with oral
administration
Use caution in patients
with severe
hyperphosphatemia
Adult and Pediatric
Advanced Life
Support programs no
longer recommend
routine calcium for
CPR
Rapid IV infusion
associated with
hypotension,
bradycardia, syncope,
cardiac arrest, cardiac
arrhythmias, sense of
oppression or heat
waves, tingling
sensation, vasodilation
9 Cytotec PO- PPH 400-800 Prostoglandin HA, N/V/D,
mcg abdominal pain, -Use with caution in pt
Stimulates the flatulence,
 PR- PPH myometrium miscarriage, with renal dz or
400-800 mcg to ctx spotting, duodenal ulcers
cramping -Need to report
severe Diarrhea
-Monitor bleeding and
pad counts, monitor
vitals for S/S of
hypovolemic shock
1 Cervidil -Vaginal insert: -induce labor -Abdominal - monitor uterine
0 10 mg at 0.3 in pregnant cramps, activity, fetal status,
mg/hour over 12 women at or diarrhea, fever, dilation status,
hours. near term. nausea, and cervical effacement.
Softening vomiting. Assess for
and dilation hypertonus,
of the cervix. sustained uterine
contractility, fetal
distress. Insert
should be removed
at onset of active
labor

1 Prostin Gel GEL: 0.5 mg -vaginal -uterine - monitor uterine

1 repeat in 6 hrs if ripening contractile activity, fetal status,
response is agent abnormalities, dilation status,
unfavorable -abortifacient warm feeling in cervical effacement.
INSERT: one vagina, back Assess for
10mg insert pain, amniotic hypertonus,
fluid embolism, sustained uterine
fever. contractility, fetal
Headache, distress. Insert
drowsiness, should be removed
syncope, at onset of active
couging labor
dyspnes,
wheezing,
hypotension,
diarrhea, N&V,
uterine rupture,
UTI, allergic
rxn, chills fever

1 Ampicillin -IM, IV: 500 mg treats -Skin rash, GI -Severe renal

2 to 3 g q 6 hr. infections effects. insufficiency.
-Assess pt for
 infection. obtain hx.
Obtain specimen for
culture and
sensitivity.
-Observe for signs
of anaphylaxis.
-Monitor bowel
functions.

1 Penicillin G- 250,000 to Penicillins Diarrhea Caution with renal

3 400,000 are used to (mild) insufficiency. Assess
units/kg/day. treat headache for infection, obtain
V- 250-500 mg infections sore mouth or a hx to determine
PO four times caused by tongue
bacteria. previous use or
per day. vaginal reaction to
They work
by killing the itching and penicillin, obtain
bacteria or discharge specimen for
preventing white patches culture, observe for
their growth. in the mouth anaphylaxis,
(G) and/or on the
monitor serum
Pneumococ tongue.
sodium
cal Fast or
concentration.
pneumonia irregular
and severe breathing
infections. fever
joint pain
lightheadedne
ss or fainting
(sudden)
puffiness or
swelling
around the
face
red, scaly skin
shortness of
breath
skin rash,
hives, itching.
1 Cefotan/Cefotetan -IM, IV: 1-2 g Infection Tx Seizures, Caution in renal
4 every 12 hours. diarrhea, impairment or hx of
-Urinary tract nausea, skin GI disease.
infections: 500 rashes, Asses for infection,
mg-2g every 12 bleeding, obtain hx, obtain
hours. leukopenia, specimen, observe
thrombocytope for anaphylaxis,
 nia, local site monitor bowel
pain, allergic movement, monitor
reaction. labs.

1 Cleocin -PO: 150-450 mg Treatment of Dizziness, Okay for use in the

5 q 6 hr. skin headache, 3rd trimester, may
infections. vertigo, appear in breast
-IM, IV: 300-600 arrhythmias, milk. Assess for
mg q 6-8 hours. hypotension, infection, obtain
diarrhea, bitter specimens,
taste, N+V, monitor bowel
local rash and eliminations and
irritation. GI effects, and
assess for allergic
reactions.

1 Insulins (for Dose depends on Control of Hypoglycemia, -Assess for signs of

6 diabetics: blood glucose, hyperglycemi local redness hypoglycemia,
response, and a in pt with and swelling, monitor body
other factors. DM. allergic weight, monitor
reactions. blood glucose every
6 hours during
therapy. Monitor for
signs of toxicity.

1 Fentanyl -V (in labor) Opiate, Over sedation, Contraindicated with

7 25-100 mcg q 2-3 narcotic, clamminess, hypersensitivity to
hrs for pain analgesic sweating, opiods, acute brochial
-Push each ml over lethargy, asthma, upper airway
1 min confusion, light obstruction
headedness,
circulatory Caution with
depression, bradycardia, hx of
cardiac arrest, seizure, lactation, and
respiratory renal dysfunction
depression
1 Stadol 1-2 mg Iv or IM in Opiate, Causes Use cautiously with
8 early labor, repeat q narcotic hallucinations brochospasm, COPD,
4 hr Analgesic respiratory depression,
Over sedation, anoxia, increased ICP
clamminess, Inform of Side Effects
sweating, and not to get out of
lethargy, bed without assistance
confusion, light Watch for respiratory
headedness, depression of newborn
circulatory if this
depression, drug is used during
cardiac arrest, labor and delivery;
 respiratory Excretion in breast
depression milk unknown/use
caution.
NST before
administration,
crosses placenta
Anticipate Narcan if
administered > 7 cm
No grapefruit juice
while taking this
med
*Inform patient that
they may become
dizzy/drowsy. Can
cause fatigue-
monitor for SEs.
1 Nubain IV, IM, SQ Opiate, Nausea; Alcohol and other
9 Adults: 5-10 narcotic Vomiting, CNS depressants add
mg/70 Analgesic Sedation; to CNS depression,
kg every 3-6 Dizziness; crosses placenta and
hours; Works on Sweaty, clammy can cause respiratory
maximum single Mu receptor skin depression in the
dose: 20 mg; Constipation. newborn if given too
maximum. daily Post-op or close to delivery.
dose:160 mg during labor Watch for respiratory
depression of
newborn if this
drug is used during
labor and delivery;
Excretion in breast
milk unknown/use
caution.
NST before
administration,
crosses placenta
Anticipate Narcan
if administered > 7
cm

2 Bupivicaines, for -Epidural: 10-20 Local or Seizures, Assess for systemic

0 epidural use and ml of 0.25% regional anxiety, toxicity, monitor BP,
spinal anesthesia: partial to anesthesia for dizziness, HR, and RR
moderate block, surgical, headache, continuously.
0.5 % moderate to obstetric, or irritability, Monitor for return
complete block, diagnostic blurred vision. of sensation after
or 0.75% procedures. Tinnitus, procedure.
complete block cardiovascular
solution. collapse,
bradycardia,
hypotension,
n+v, urinary
retention,
 pruritus,
metabolic
acidosis,
tingling and
numbness,
allergic
reaction, fever.

2 Ibuprofen PO: 400-800 mg Treatment of Headache, Contraindicated in

1 3-4 times daily. mild to dizziness, hypersensitive pt.
IV: 400-800 mg q moderate drowsiness, Active GI bleeding
6 hr prn. pain and intraventricular or ulcer disease. Use
fever. hemorrhage, with caution in
blurred vision, cardiovascular
tinnitus, disease. May cause
arrhythmias, hyperbilirubinemia
edema, in neonates. Assess
hypertension. for allergies, signs
GI bleeding, and symptoms of GI
hepatitis, bleeding, skin rash,
constipation, pain, fever.
abdominal
discomfort, Monitor preterm
cystitis, neonates for signs of
hematuria, bleeding, infection
renal failure, and
dermatitis,
anemia. decreased urine
Allergic output. Monitor
reaction. labs.

2 Toradol PO: adults <65: Short term Stroke, Contraindicated in

2 20 mg initially management drowsiness, hypersensitive pt
followed by 10 of pain. dizziness, and as well as hx of
mg q 4-6 hr. euphoria, peptic ulcer disease
-Adults > 65: 10 headache, nasal or GI bleeding.
mg q 4-6 hr. -IM: discomfort, Have an alcohol
single dose 60 throat irritation, intolerance,
mg. asthma, coronary artery
dyspnea, M.I, bypass graft, renal
edema, pallor, impairment. Assist
GI bleeding dry pt for asthma, sigs
 mouth of rash, pain, and lab
dermatitis, tests.
renal toxicity,
urinary Monitor for signs of
frequency, bleeding and
injection site complications.
pain, and
allergic
reaction.

2 Tylox/Percoset PO: Adults > 50 -Decrease -confusion, - assess type,

3 kg: 5-10 mg q3- pain sedation, location and
4hr. controlled dizziness, intensity of pain
release tabs q dysphoria, prior and 1hr after
12hrs. Adults <50 euphoria, administration,
kg or children 6- hallucinations, assess BP, pulse,
12 yrs 1.25 mg headaches, respirations before
q6hr PRN or blurred vision, and periodically
0.2mg/kg q3-4hr diplopia, resp. after admin. Assess
depression, bowl fxn routinely
urinary
retention,
flushing
sweating,
physical
dependence,
psychological
dependence,
tolerance

2 Tylenol #3 -PO: 1-2 tabs -decrease -agitation, - assess alcohol use,

4 q4hrs PRN pain, pain anxiety, pain(type location
management headaches, intensity) 30-60
fatigue, minutes after admin.
insomnia, Rash, fever, fatigue
dyspnea, HTN,
hepatotoxic,
N&V,
neutropenia,
pancytopenia,
muscle spasms,
trismus, rash,
 utecaria, SJS

2 Darvocet PO: 1 tab q4hrs -decrease -dizziness, - assess type,

5 PRN. MAX 6 mild to sedation, location and
tabs/day moderate stupor, intensity of pain
pain delirium, prior and 1hr after
somnolence, administration,
ataxia, assess BP, pulse,
syncope, resp. respirations before
depression, and periodically
N&V, after admin. Assess
constipation, bowl fxn routinely
withdrawal

2 Ofirmev -PO: 325-650 mg -decrease -N&V, - assess type,

6 (Tylenol IV) q4-6 hr PRN. pain constipation, location and
MAX: 4 g/day injection site intensity of pain
pain and injury prior and 1hr after
site rxn, administration,
abdominal assess BP, pulse,
pain, diarrhea, respirations before
headache, and periodically
dizziness after admin. Assess
bowl fxn routinely

2 Morphine PO (<50 kg) 0.3 -severe pain -can cause resp. - assess type,
7 Sulfate mg/kg q3-4 hrs depression in location and
initially newborn and intensity of pain
IM:IV:SC: (adults withdrawal prior and 1hr after
>50 kg) 4-10mg syndrome. administration,
q3-4hrs Affects assess BP, pulse,
IM:IV:SC: (adults lactation. For respirations before
<50kg) 0.05-0.2 mother: and periodically
mg/kg confusion, after admin. Assess
sedation, bowl fxn routinely,
IV: Neonates dizziness, assess
0.01-0.03 dysphoria, consciousness,
mg/kg/hr euphoria, assess for opioid
hallucinations, addiction, abuse,
headache, resp. misuse, prior to
depression, admin
hypotension,
bradycardia,
N&V,
constipation,
flushing
itching,
sweating,
urinary
retention