Trade Name Generic Name Dosage

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Contraindication

Dinoprostone Prostin E, Prepidil, Cervidil Intravaginal administration Cervidil = Intracervical gel Prostin E2 = Intravaginal suppository The dosage of dinoprostone in the vaginal insert is 10 mg designed to be released at approximately 0.3 mg/hour over a 12 hour period. Cervidil should be removed upon onset of active labor or 12 hours after insertion. Uterine Stimulants, Abortifacient, Prostaglandin Prostaglandin E2 Uterine and gastrointestinal smooth muscle stimulation Cervical softening and dilation Increases frequency and strength of uterine contraction. Cervidil Vaginal Insert (dinoprostone, 10 mg) is indicated for the initiation and/or continuation of cervical ripening in patients at or near term in whom there is a medical or obstetrical indication for the induction of labor. Endocervically administered dinoprostone gel is not recommended for the following: Patients in whom oxytocic drugs are generally contraindicated or where prolonged contractions of the uterus are considered inappropriate, such as: o Cases with a history of cesarean section or major uterine surgery. o Cases in which cephalopelvic disproportion is present. o Cases in which there is a history of difficult labor and/or traumatic delivery. o Grand multiparae with 6 or more previous term pregnancies cases with nonvertex presentation. o Cases with hyperactive or hypertonic uterine patterns. o Cases of fetal distress where delivery is not imminent. o In obstetric emergencies where the benefit-to-risk ratio for either the fetus or the mother favors surgical intervention. Patients with hypersensitivity to prostaglandins

Adverse Reaction

Nursing Responsibilities

or constituents of the gel. Patients with placenta previa or unexplained vaginal bleeding during this pregnancy. Patients for whom vaginal delivery is not indicated, such as vasa previa or active herpes genitalia. Vaginal Suppository Hypersensitivity to dinoprostone. Acute pelvic inflammatory disease. Patients with active cardiac, pulmonary, renal, or hepatic disease. Nausea and vomiting; diarrhea Fever Orthostatic hypotension Arrhythmia Store suppositories in freezer and bring to room temperature before insertion. Store cervical gel in freezer and bring to room temperature in room temperature, just prior to use. Do not force warming with external sources (ie, water bath, microwave) Ensure adequate hydration throughout the procedure. Monitor uterine tone and vaginal discharge throughout the procedure and several days after procedure. Be prepared to support patient through labor (cervical ripening). Give oxytocin 6-12 hours after dinoprostone.

Trade Name Generic Name Dosage Classification Action

Indication Contraindication

Adverse Reaction Nursing Responsibilities

Methergine, Methylergobasine, Methylergobrevin, Methylergonovine Methylergonovine maleate PO = 0.2 mg q 6-8 H (max 1 week); IM = 0.2 mg q 2 4 H (max 5 doses) Uterine Stimulants Directly stimulate uterine contractions o Small doses = with normal resting muscle tone o Intermediate doses = more forceful and prolonged contractions with elevated resting muscle tone o Large doses = severe, prolonged contractions Not for induction of labor (intense uterine activity) Prevention and treatment of postpartum and postabortion hemorrhage caused by uterine atony or subinvolution contraindicated in patients hypersensitive to methylergonovine or any component of the formulation. ergot alkaloids are contraindicated with potent inhibitors of CYP3A4 (includes protease inhibitors, azole antifungals, and some macrolide antibiotics); hypertension; toxemia of pregnancy (PIH) Nausea, vomiting, abdominal cramping Hypertension Be alert for adverse reactions and drug interactions. This drug should be used extremely carefully because of its potent vasoconstrictor action. I.V. use may induce sudden hypertension and cerebrovascular accidents. As a last resort, give I.V. slowly over several minutes and monitor blood pressure closely. Monitor Uterine Contractions

Trade Name Generic Name Dosage

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Pitocin, Syntocinon Oxytocin For stimulation of labor: 10 units (1ml) of drug infused in 1L D5LRS before deliver For Reduction of Postpartum bleeding: 1 amp after delivery of placenta Uterine Stimulants Stimulates the smooth muscles of uterus, blood vessels and mammary glands Third trimester = active labor Induction of labor at term; control of postpartum bleeding; adjunctive therapy in management of abortion Contraindicated in patients hypersensitive to the drug or any of its component. Also contraindicated in cephalopelvic disproportion or delivery that requires conversion, as in tranverse 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. Cardiovascular: hypertension; increased heart rate, systemic venous return, and cardiac output, and arrhytmias CNS: seizures, coma from water intoxication Gastrointestinal: Nausea, vomiting, GU: titanic uterine contractions, abruption placentae, impaired uterine blood flow, pelvic hematoma Hematologic: afibrinogenemia Respiratory: anoxia, asphyxia Monitor and record uterine contractions, heart rate, BP, intrauterine pressure, fetal heart rate, and blood loss q15. Be alert for adverse reaction Monitor I/O. Antidiuretic effect may lead to fluid overload, seizures, and coma Never give oxytocin simultaneously by more than one route. Have 20% solution magnesium sulfate available for relaxation of the myometrium.

Trade Name Generic Name Dosage Classification Action

If contractions are less than 2 minutes apart, if theyre above 50mm Hg ,or if they last 90sec. or longer, stop infusion, and turn patient on her side, and notify physician or midwife. Apresoline Hydralazine 5 mg/dose then 5-10 mg every 20-30 minutes as needed. (TIV) Hydralazine Directly relaxes arteriolar smooth muscle Vasodilaion Lowers Blood Pressure Pre-eclampsia /eclampsia Contraindicated to pt.s hypersensitive to the drug and any of its component and in those with coronary artery disease or mitral valvular rheumatic heart disease. Use cautiously in patients with suspected cardiac disease, CVA, or severe renal impairment, and in those taking other antihytensives. CNS: peripheral neuritis, headache, dizziness CV: orthostatic hypotension, tachycardia, arrythmias, angina, palpitations. GI: n/v, diarrhea, anorexia Hematologic: neutropenia, leukopenia, agranulocytopenia Metabolic: weight gain, sodium retention Skin: rash Assess blood pressure before starting therapy and regularly thereafter. Instruct client to take oral form with meals. Inform client that orthostatic hypotension can be minimized by rising slowly and not changing position suddenly. Tell pt. not to abruptly stop taking drug, but to call the one who prescribed it if adverse reaction occurs. Tell client to limit sodium intake.

Indication Contraindication

Adverse Reaction

Nursing Responsibilities

Trade Name Generic Name Dosage Classification Action

Indication

Contraindication

Adverse Reaction Nursing Responsibilities

Ferrous Sulfate Ferrous Sulfate (FeSO4) 200mg/day PO Antianemic, Iron Males: 12-20mg Females: 8-15mg Iron is absorbed from the duodenum and upper jejunum by an active mechanism through the mucosal cells where it combines with the protein transferrin. Prophylaxis and treatment of iron deficiency and iron-deficiency anemias. Dietary supplement for iron. Optimum therapeutic responses are usually noted within 2-4 weeks. Hemosiderosis, hemochromatosis, peptic ulcer, regional enteritis, and ulcerative colitis. Hemolytic anemia, pyridoxine-responsive anemia, and cirrhosis of the liver. Use in those with normal iron balance. Constipation, gastric irritation, nausea, abdominal cramps, anorexia, diarrhea, dark colored stools. Substitution of one iron salt for another without proper adjustment may result in serious over or under dosing. Eggs, milk, coffee, or tea consumed with a meal or 1 hr after may significantly inhibit absorption of dietary iron. Ingestion of calcium and iron supplements with food can decrease iron absorption by one-third; iron absorption is not decreased if calcium carbonate is used and taken between meals. Do not crush or chew sustained-release products.

Trade Name Generic Name Dosage

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Indication Contraindication

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Magnesium sulfate Magnesium sulfate Anticonvulsant: o IM = loading dose (10 g of 50% solution [20 mL] divided into 2 doses); maintenance dose (4 5 g of 50% solution [10 mL] q4H deep IM; alternate buttocks o IV = loading does (4 g MgSO4 in 250 mL of D5W infuse at 10 mL per minute; maintenance dose (1 2 g per hour by continuous infusion) Preterm labor: IV = loading dose (4 g of MgSO4 over 15 30 minutes; maintenance dose (1 3 g per hour by continuous infusion) CNS depressant CNS depressants = potentiate CNS depressant effects of MgSO4 (barbiturates, analgesics, general anesthetics, tranquilizers, and alcohol Neuromuscular blocking agents = concurrent use with MgSO4 will further depress muscular activity. Seizures of eclampsia (toxemia of pregnancy) Conditions:Kidney Disease, Serious Kidney Problems, High Amount of Magnesium in the Blood, Low Amount of Calcium in the Blood Allergies:Magnesium Magnesium Sulfate Deep tendon reflexes = absent Decreased urine output Decreases respiratory rate, blood pressure, fetal heart rate (fetal distress) Confusion Neonates = hypotension, hyporeflexia, respiratory depression Pregnancy safety: Magnesium sulfate is administered to treat toxemia of pregnancy. It is recommended that the drug not be administered in the 2 hours before delivery, if possible. IV calcium gluconate or calcium chloride should be available as an antagonist to magnesium if needed. Convulsions may occur up to 48 hr after delivery, necessitating continued therapy. The

Trade Name Generic Name Dosage Classification Action

Indication Contraindication Adverse Reaction

Nursing Responsibilities

"cure" for toxemia is delivery of the baby. Magnesium must be used with caution in patients with renal failure, since it is cleared by the kidneys and can reach toxic levels easily in those patients. Prophylactic administration of magnesium sulfate for patients with acute mvocardial infarction should be considered. Phenergan promethazine HCI 25-50 mg (sedation); 10-25mg q 4hr as needed (antiemetic) (1amp) anti-emetics, antihistamines, sedative/hypnotics Selectively blocks H1 receptors, diminishing the effects of histamine on cells of the upper respiratory tract and eyes and decreasing the sneezing, mucus production, itching and tearing that accompany allergic reactions. blocks cholinergic receptors in the vomiting center that are believed to mediate the nausea and vomitting caused by gastric irritation. Preoperative sedation, treatment and prevention of nausea and vomiting, adjunct to anesthesia and analgesia. Hypersensitivity, comatose patient, prostatic hypertrophy, bladder neck obstruction, narrow angle glaucoma CNS: neuroleptic malignant syndrome, confusion, disorientation, sedation, dizziness, extrapyramidal reaction, fatigue, insomnia, nervousness; EENT: blurred vision, diplopia, tinnitus; CV: bradycardia, hypertension, hypotension, tachycardia; GI: constipation, drug-induced hepatitis, dry mouth; Derm: photosensitivity, rashes; Hema: blood dyscrasias Monitor BP, pulse and respiratory rate frequently. Assess level of sedation after administration. Assess patient for nausea and vomiting before and after administration. Administer each 25mg slowly over at least 1 hr. Do not give rectal supp or tabs to children younger than 2 years old because of risk of fetal respiratory depressions Give IM injections deep into muscle Do not administer SQ, tissue necrosis may

 Trade Name Generic Name Dosage

occur Arteriospasms and gangrene of artery may occur when administered intra-arterially. Reduce dosage of barbiturates given concurrently within promethazine by least half.

Classification Action

Indication

Contraindication

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Nursing Responsibilities

Xylocaine Lidocaine For normal vaginal delivery: 50mg/ml of a 5% hyperbaric solution or 9mg-15mg (0.6ml1ml) of a 1.5% solution. For Cesarean Section: Up to 75 mg (1.5ml) of a 5% hyperbaric solution. Infiltration and Nerve Blocker Lidocaine Stabilizes the neuronal membrane Inhibits sodium ion movemnts Conduction of impulses are inhibited Local loss of pain sensation Injected prior to normal spontaneous delivery to anesthetize the area of the perineum to be used for episiotomy. Used as a local anesthesia for Cesarean section Hypovolemia Heartblock Other Conduction Disturbances Dizziness Paresthesia Drowsiness Confusion Respiratory Depression Convulsions Observe for untoward reactions such as drowsiness, depressed respiration, or seizures.

Trade Name Generic Name Dosage Classification Action

Buscopan Hyoscine Butylbromide Given via IV, 1mg/ml to promote cervical effacement. Hyoscine Butylbromide Inhibits muscarinic actions of acetylcholine in the ANS Affecting neural pathway Relieves spasticity, nausea and vomitting; reduces secretions; and blocks cardiac vagal reflexes. Promotes cervical effacement To reduce secretions perioperatively. Contraindicated in patients with angle-closure glaucoma, obstructive uropathy, asthma, COPD, myasthenia gravis, paralytic ileus, intestinal atony, & unstable CV. CNS: dizziness, headache, restlessness, disorientation, irritability, fever GI: constipation, dry mouth, nausea, vomiting CV: palpitations, tachycardia, flushing EENT: dilated pupils, blurred vision, photophobia, dysphagia GU: urinary hesitancy, urinary retention Skin: rash, dryness Be alert for adverse reactions and drug interactions. Encourage pt. to void Monitor BP for possible hypotension. Monitor cervical effacement and dilatation.

Indication Contraindication

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Trade Name Generic Name Dosage

Classification Action

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Fumide , Furomide , Lasix, Luramide FUROSEMIDE (fur-oh'se-mide) Edema Adult: PO 2080 mg in 1 or more divided doses up to 600 mg/d if needed IV/IM 2040 mg in 1 or more divided doses up to 600 mg/d Hypertension Adult: PO 1040 mg b.i.d. (max: 480 mg/d) Electrolytic and water balance agent; loop diuretic Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis. History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation. CV: Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes, circulatory collapse. Metabolic: Hypovolemia, dehydration, hyponatremia hypokalemia, hypochloremia metabolic alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia. GI: Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal cramping, acute pancreatitis, jaundice. Urogenital: Allergic interstitial nephritis,

Nursing Responsibilities

irreversible renal failure, urinary frequency. Hematologic: Anemia, leukopenia, thrombocytopenic purpura; aplastic anemia, agranulocytosis (rare). Special Senses: Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred vision. Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde, necrotizing angiitis (vasculitis). Body as a Whole: Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis, pain at IM injection site. Assessment & Drug Effects Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter. Monitor for S&S of hypokalemia. Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions. Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.

Trade Name Generic Name Dosage Classification

Action

Indication

Contraindication Adverse Reaction

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Dormicum, Hypnovel, and Versed Midazolam IV: inject 2.5 mg for 2 minutes (never as bolus) IM: 0.07-0.08 mg/kg Therapeutic: Anti-anxiety agents, sedative/hypnotics Pharmacologic: benzodiazepines Physiologic Mechanism: Short-term sedation Postoperative amnesia Pharmacologic Mechanism: Acts at many levels of the CNS to produce generalized CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter. Preprocedural sedation. Aids in the induction of anesthesia and as part of balanced anesthesia. Hypersensitivity to benzodiazepines. Chronic respiratory insufficiency. Rarely cardioresp adverse events, nausea, vomiting, headache, hiccoughs, laryngospasm, dyspnoea, hallucination, oversedation, drowsiness, ataxia, rash, paradoxical reactions, amnesic episodes. Assess level of sedation and level of consciousness throughout and for 2-6 hr following administration. Monitor BP, pulse and respiration continuously during IV administration. Oxygen and resuscitative equipment should be immediately available. If overdose occurs, monitor pulse, respiration , and BP continuously. Maintain patent airway and assist ventilation as needed. If hypotension occurs, treatment includes IV fluids, repositioning and vasopressors. The effects of midazolam can be reversed with

flumazenil (Romazicon).

Trade Name Generic Name Dosage

Classification Action

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Contraindication

Apo-Diazepam, Diastat, Diazemuls , E-Pam , Meval , Novodipam , Valium, Valrelease, Vivol DIAZEPAM (dye-az'e-pam) Status Epilepticus Adult: IV/IM 510 mg, repeat if needed at 10 15 min intervals up to 30 mg, then repeat if needed q24h Withdrawal Adult: PO 210 mg b.i.d. to q.i.d. or 1530 mg/d sustained release IV/IM 210 mg, repeat if needed in 34 h Geriatric: PO 12 mg 12 times/d (max: 10 mg/d) Child: PO >6 mo, 12.5 mg b.i.d. or t.i.d. Central nervous system agent; benzodiazepine anticonvulsant; anxiolytic Psychotherapeutic agent related to chlordiazepoxide; reportedly superior in antianxiety and anticonvulsant activity, with somewhat shorter duration of action. Like chlordiazepoxide, it appears to act at both limbic and subcortical levels of CNS. Drug of choice for status epilepticus. Management of anxiety disorders, for short-term relief of anxiety symptoms, to allay anxiety and tension prior to surgery, cardioversion and endoscopic procedures, as an amnesic, and treatment for restless legs. Also used to alleviate acute withdrawal symptoms of alcoholism, voiding problems in older adults, and adjunctively for relief of skeletal muscle spasm associated with cerebral palsy, paraplegia, athetosis, stiff-man syndrome, tetanus. Body as a Whole: Throat and chest pain. CNS: Drowsiness, fatigue, ataxia, confusion, paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia.

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Nursing Responsibilities

CV: Hypotension, tachycardia, edema, cardiovascular collapse. Special Senses: Blurred vision, diplopia, nystagmus. GI: Xerostomia, nausea, constipation, hepatic dysfunction. Urogenital: Incontinence, urinary retention, gynecomastia (prolonged use), menstrual irregularities, ovulation failure. Respiratory: Hiccups, coughing, laryngospasm. Other: Pain, venous thrombosis, phlebitis at injection site. Injectable form: Shock, coma, acute alcohol intoxication, depressed vital signs, obstetrical patients, infants <30 d of age. Tablet form: Infants <6 mo of age, acute narrow-angle glaucoma, untreated openangle glaucoma; during or within 14 d of MAO inhibitor therapy. Safe use during pregnancy (category D) and lactation is not established. Assessment & Drug Effects Monitor for adverse reactions. Most are dose related. Physician will rely on accurate observation and reports of patient response to the drug to determine lowest effective maintenance dose. Monitor for therapeutic effectiveness. Maximum effect may require 12 wk; patient tolerance to therapeutic effects may develop after 4 wk of treatment. Observe necessary preventive precautions for suicidal tendencies that may be present in anxiety states accompanied by depression. Observe patient closely and monitor vital signs when diazepam is given parenterally; hypotension, muscular weakness, tachycardia, and respiratory depression may occur. Lab tests: Periodic CBC and liver function tests during prolonged therapy. Supervise ambulation. Adverse reactions such as drowsiness and ataxia are more likely to occur in older adults and debilitated or those receiving larger doses. Dosage adjustment may be necessary. Monitor I&O ratio, including urinary and bowel elimination.

Trade Name Generic Name Dosage Classification Action

Plasil, Maxolon, Reglan Metoclopramide Antiemetic, GI stimulant Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit, little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin. relief of symptoms of acute and recurrent diabetic gastroparesis -short- term therapy for adults with GERD parenteral: prevention of nausea and vomiting prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable treatment of nausea and vomiting of a variety of etiologies contraindicated with allergy to metoclopramide, GI hemorrhage, mechanical obstruction or perforation, epilepsy. use cautiously with previously detected breast cancer, lactation, pregnancy CNS: restlessness, drowsiness, fatigue, insomnia, dizziness, anxiety CV: transient hypertension GI: nausea, diarrhea monitor BP carefully during IV administration keep diphenhydramine injection readily available in case extrapyramidal reactions occur

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have phenotolamine readily available in case of hypertensive crisis take drug exactly as prescribed use of alcohol, sleep remedies, or sedatives can cause serious sedation. report involuntary movement of the face, eyes, and limbs

Trade Name Generic Name Dosage Classification Action

Indication

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Adverse Reaction

Nubain Nalbuphine Hydrochloride Injection 10 mg/ml, 20mg/ml Narcotic agonist-antagonist analgesic 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 receptors Relief of moderate to severe pain Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery Hypersensitivityto nalbuphine, sulfites; lactation. Use cautiously with emotionally unstable clients or those with a history of narcotic abuse; pregnancy prior to labor, laboror delivery, bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery. CNS: Sedation, clamminess, sweating, headache,nervousness, restlessness,depression crying, confusion, faintness, hostility, unusual dreams, hallucinations, euphoria, dysphoria, unreality, dizziness, vertigo,floating feeling, feeling of heaviness, numbness, tingling, flushing, warmth, blurred vision. CV: Hypotension, Hypertension, bradycardia, tachycardia DERMATOLOGIC: Itching, burning, urticaria GI: Nausea,vomiting, cramps,dyspepsia, bitter taste, dry mouth

 Nursing Responsibilities

GU: Urinary urgency RESPIRATORY: Respiratory depression, dyspnea, asthma Monitor respiratory rate before and after giving nubain because it causes respiratory depression Monitor I and O to determine if there is excessive fluid loss Monitor Bp before and after administering the medication to prevent any complication

Trade Name Generic Name Dosage Classification Action

Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Tranexamic Acid Anti-fibrinolytic, antihemorrhagic Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the antifibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis. Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas: Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction orother oral surgical procedures. Obstetrical and gynecological: abortion, postpartum hemorrhage and menometrorrahgia. Allergic reaction to the drug or hypersensitivity Presence of blood clots (eg, in the leg, lung, eye, brain), have a historyof blood clots, or are

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at risk for blood clots Current administration of factor IX complex concentrates or anti-inhibitorcoagulant concentrates Severe allergic reactions such as rash, hives, itching, dyspnea, tightnessin the chest, swelling of the mouth, face, lips or tongue* Calf pain, swelling or tenderness* Chest pain* Confusion* Coughing up blood* Decreased urination* Severe or persistent headache* Severe or persistent body malaise* Shortness of breath* Slurred speech* Slurred speech* Vision changes Unusual change in bleeding pattern should be immediately reported to the physician. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush,or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.