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.

Generic Name: Oxytocin Brand Name: Pitocin Classification: Oxytocic. subarachnoid hemorrhage Fetal effects: fetal bradycardia. 2nd or 3rd degree AV blocks Adverse Effects: . obstetric emergencies that favor surgical intervention. 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. which results in milk ejection in lactating women.• Be prepared to support patient through labor. Adverse Effects: CV: cardiac arrhythmias. and causes myoepithelium of the lacteal glands to contract. stimulates the uterus. spinal and caudal anesthesia Contraindications: • Contraindicated with allergy to lidocaine or amide-type local anesthetics. CHF cardiogenic shock. low Apgar scores GI: nauseas. induction or augmentation of labor when vaginal delivery is contraindicated. difficulty breathing. and slowing conduction velocity Indications: • Infiltration anesthesia. 3. prolonged use in severe toxemia. palpitations. uterine hypertonicity. stimulation or reinforcement of labor in selected cases of uterine inertia. PVCs. uterine rupture. increasing excitation threshold. • Regulate rate of oxytocin delivery. eye pain. peripheral and sympathetic nerve blocks. rash. especially the gravid uterus just before parturition. uterine inertia. neonatal jaundice. 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. monitor rate and strength of contractions • Monitor BP during administration 4. reducing height and rate of rise of the action potential. Indications: • Antepartum: to initiate or improve uterine contractions to achieve early vaginal delivery. hypertension. vomiting GU: postpartum hemorrhage. management of inevitable or incomplete abortion. • Teach client to report severe pain. previous cesarian section. pelvic hematoma. hypertonic uterine patterns. unfavorable fetal positions or presentations. Give oxytocin infusion 612 hr after dinoprostone. central nerve blocks. 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. hormone Therapeutic Actions: • Synthetic form of an endogenous hormone produced in the hypothalamus and stored in the posterior pituitary. fetal monitoring is preferred.

Abortifacient Therapeutic Actions: • Stimulates the myometrium of the pregnant uterus to contract.Assess allergy to the drug . tachycardia. hypertension. unusual or bad taste Respiratory: Respiratory difficulties. chest pain GI: vomiting. at higher doses. diarrhes. Generic Name: Terbutaline Sulfate Brand Name: Brethine Classification: Tocolytic Therapeutic Actions: . fear.Monitor uterine tone and vaginal discharge during procedure and several days after to assess drug effects and recovery .Teach client to report chest pain. weakness. tremor 6.Contraindicated with allergy to prostaglandin preparations.Tocolytic to prevent preterm labor Contraindications: .Evacuation of the uterus in instance of missed abortion or intrauterine fetal death in the 2nd trimester . insomnia. paersthesias. septic meningitis. numbness. Indications: . urinary or fecal incontinence Nursing Considerations: • Check drug concentrations carefully • Establish safety precautions if CNS changes occur • Teach client to report difficulty speaking. pain or numbness at site. backache. Generic Name: Carboprost tromethamine Brand Name: Hemabate Classification: Prostaglandin. thick tongue.Contraindicated with hypersensitivity to terbutaline. weakness. nausea Nursing Considerations: . thus evacuating the contents of the uterus. CNS stimulation. insomnia. palpitations.hepatic. swelling or pain at site 5. tremors CV: cardiac arrhythmias. dizziness CV: hypotension. edema GU: urinary retention. pulmonary edema. acute PID. tachyarrythmias. anxiety.Termination of pregnancy 13-20 wk from the first day of the LMP . changes in BP and ECG GI: Nausea. flushing. apprehension. tingling. coughing. hyperkinesias. drug tolerance can occur .In low doses. dizziness. erythema. beta 1 selectivity is lost and the drug acts at beta 2 receptors to cause typical sympathomimetic cardiac effects Indications: . persistent sensory CV: hypotension Dermatologic: urticaria.Postpartum hemorrhage due to uterine atony unresponsive to conventional methods Contraindications: . difficulty breathing. pulmonary. vomiting. Adverse Effects: CNS: restlessness.Ensure adequate hydration . heartburn. arrhythmias. syncope. renal disease Adverse Effects: CNS: headache. similar to the contractions of the uterus during labor. lactation.Maintain a beta-adrenergic blocker on standby in case cardiac arrhythmias occur .Use minimal doses for minimal periods of time. anxiety.CNS: headache. pruritus. active cardiac. bronchospasm Nursing Considerations: . angina pain. acts relatively selectively at beta 2-adrenergic receptors to cause bronchodilation and relax the pregnant uterus.

perianal irritation Metabolic: Magnesium intoxication. N/V.Preeclampsia/eclampsia .7. DO NOT GIVE 2 HR PRECEEDING DELIVERY BECAUSE OF RISK OF MAGNESIUM TOXICITY IN THE NEONATE. drowsiness.Nalbuphine acts as an agonist at specific opioid receptors in the Cns to produce analgesia.For obstetric analgesia during labor and delivery Contraindications: . tachycardia Dermatologic: itching. do not administer because respiratory failure may occur . fainting. faintness.Contraindicated with hypersensitivity to nalbuphine. nausea.Assess history of allergy to the drug and other contraindications . dyspepsia. abdominal pain.Contraindicated with allergy to magnesium product.Cofactor of many enzyme systems involved in neuromuscular transmission and muscular excitability Indications: . urticaria GI: N/V. asthma Nursing Considerations: . hypocalcemia with tetany Nursing Considerations: . dyspnea.threatening situations . sweating CV: palpitations GI: excessive bowel activity. unusual dreams. heart block.Monitor knee-jerk reflex before repeated parenteral administration. hostility. nervousness. sedation. crying. facilitates for assisted or controlled respiration on standby in case of respiratory depression . hepatitis.Relief of moderate to severe pain . if happens.Provide narcotic antagonist.Reserve IV use in eclampsia for immediate life. lactation Adverse Effects: CNS: sedation. burning. headache. clamminess. cramps. hypertension. Adverse Effects: CNS: weakness. blurred vision CV: hypotension.Assess hypersensitivity to the drug . fecal impaction. sulfites. depression. restlessness. impaired visual acuity. sweating. acute surgical abdomen. confusion.Monitor magnesium levels during parenteral therapy . hallucinations. loss of appetite 8. Generic Name: Nalbuphine hydrochloride Brand Name: Nubain Classification: Narcotic agonisy-antagonist analgesic Therapeutic Actions: .Reassure patient about addiction liability. dry mouth GU: Urinary urgency Respiratory: Respiratory depression. bitter taste. bradycardia. anticonvulsant. laxarive Therapeutic Actions: . euphoria. dizziness. Generic Name: Magnesium sulfate Brand Name: Epsom salt Classification: electrolyte.Inform clients about these side effects: dizziness.Inhibition of premature labor Contraindications: . myocardial damage. most patients who receive opiates for medical reasons do not develop dependence syndrome . sedation but also acts to cause hallucinations and is an antagonist at mu receptors Indications: .

Inform patients that these side effects may occur: diuresis.Acts as an agonist at opioid receptors in the CNS to produce analgesia. hives.History of allergy to prostaglandins. flatulence. lactation Adverse Effects: GI: nausea. excessive bleeding. abdominal pain. dyspepsia. N/V Monitor urine output 9. constipation GU: Miscarriage. hallucinations CV: Palpitations. clamminess.headedness. or menstrual pain. Generic Name: Generic Name: Midazolam hydrochloride Brand Name: Versed Classification: Benzodiazepine (short-acting).Assess history of allergy to butorphanol .- Do not give orally with abdominal pain.With mifepristone as an abortifacient . increase or decrease in blood pressure Dermatologic: Ras. spotting. vertigo. inhibits gastric acid secretion and increases bicarbonate and mucus production. CNS depressant Therapeutic actions: . sensitivity to cold EENT: diplopia. blurred vision GI: N/V Respiratory: slow. light. sedation.antagonist analgesic Therapeutic Actions: . vomiting. flushing. abdominal pain .Contraindicated with hypersensitivity to butorphanol. physical dependence on a narcotic analgesic. pruritus. dizziness. lethargy. palpitations Misoprostol Brand Name: Cytotec Classification: Prostaglandin Therapeutic Actions: . severe menstrual bleeding 10. spotting. restlessness. dizziness. pregnancy lactation Adverse Effects: CNS: sedation. warmth. diarrhea. confusion. menstrual disorders Nursing Considerations: . headache. pregnancy. and dependence . euphoria.Cervical ripening and labor induction Contraindications: . lactation. nausea.To supplement balances anesthesia and to relieve prepartum pain Contraindications: .A synthetic prostaglandin E1 analog. has low abuse potential Indications: . cramping. insomnia. muscular tremors. protecting the lining of the stomach Indications: .Relief of moderate to severe pain .Report severe diarrhea.Assess history of allergy to the drug .containing foods that may contribute to overdose . Generic Name: Butorphanol tartrate Brand Name: stadol Classification: Narcotic agonist. agitation.Remind patient to report abnormal heart rate. depression DM. unusual dreams.Monitor diet for presence of caffeine. sweating. shallow respiration Nursing Considerations: . but also acts to produce hallucinations.

ataxia. psychoses. AST. Adverse effects CNS: Transient. acute alcoholic intoxication. headache. alkaline phosphatase. restlessness. mild drowsiness (initially). microcephaly. sedation. dermatitis GI: Constipation. therapeutic. shock. acute narrow-angle glaucoma. paresthesias. elevations of blood enzymes: LDH. difficulty in swallowing. diarrhea. light-headedness. delirium. has little effect on cortical function. burning.IV or IM: Sedation. confusion. and amnesia prior to diagnostic. diplopia. lactation. inguinal hernia. visual and auditory disturbances. coma. shock. pruritus. or endoscopic procedures or surgery . dry mouth. stupor. elderly or debilitated patients. jaundice GU: Incontinence. mild paradoxical excitatory reactions (during first 2 wk of treatment). CV collapse. ALT. psychomotor retardation. hypotension. anxiolytic and amnesia effects occur at doses below those needed to cause sedation. an inhibitory neurotransmitter. Indications . neonates. 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. slurred speech. vomiting. urinary retention.Exact mechanisms of action not understood. edema Dermatologic: Urticaria. diaphoresis. acute narrow-angle glaucoma. nausea.Induction of general anesthesia . extrapyramidal symptoms. . with impaired liver or kidney function. vertigo. psychoses. hiccups. fever. gynecomastia. acute alcoholic intoxication with depression of vital signs. fatigue. cardiac defects. nervousness. dystonia. pregnancy (cleft lip or palate. hepatic dysfunction.Continuous sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in the critical care setting . difficulty in concentration. hypertension. pregnancy. nystagmus.Contraindicated with hypersensitivity to benzodiazepines. potentiates the effects of GABA. rigidity. depressed hearing. lethargy. dysarthria. menstrual irregularities Hematologic: Decreased Hct. disorientation.Use cautiously in elderly or debilitated patients. palpitations. tremor. muscular disturbances. crying. apathy. lactation . anorexia. depression. pain. skin rash. vivid dreams. coma. nasal congestion CV: Bradycardia. gastric disorders. euphoria.Unlabeled uses: Treatment of epileptic seizure or refractory status epilepticus - Contraindications and cautions . tachycardia. acts mainly at the limbic system and reticular formation. salivation. blood dyscrasias Other: Phlebitis and thrombosis at IV injection sites. pyloric stenosis have been reported when used in first trimester. neonatal withdrawal syndrome reported in infants). anxiolysis. changes in libido. impaired liver or kidney function.

have flumazenil available as antidote if overdose should occur. Carefully monitor P. reduce dosage by at least 50% and monitor patient closely. and oxygen consumption. renal function tests. decreased systemic vascular resistance. and respirations carefully during administration. myocardial blood flow. avoid driving a car or engaging in other dangerous activities if these occur). bradypnea. difficulty voiding. palpitations. Generic Name: Fresofol Brand Name: Propofol Classification: sedative hypnotic. difficulty concentrating. adventitious sounds. bowel sounds. Keep patients in bed for 3 hr. dyspnea. normal output. which may produce arteriospasm or gangrene.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 . anesthetic agent Therapeutic Actions: .Propofol is a short-acting hypnotic. reflexes. epileptics. Keep resuscitative facilities readily available. GI upset. rash or skin lesions. tachycardia Respiratory: apnea. and for at least 2–6 hr after administration of midazolam. sensory nerve function. orientation. dizziness (these may become less pronounced after a few days. fatigue.produce sedation or amnesia as a supplement to local or regional anesthetics Contraindications: . affect. CBC Do not administer intra-arterially.Contraindicated in pediatric patients for monitored anesthesia care (MAC) sedation or for sedation in intensive care. accompany ambulating patient). use cautiously in lactation Adverse Effects: CV: Arterial hypotension. Its mechanism of action has not been well-defined. respiratory rate. liver evaluation. ophthalmologic examination. hyperventilation. skin color. Establish safety precautions if CNS changes occur (use side rails. wheezing. Arrange to reduce dose of midazolam if patient is also being given opioid analgesics. do not permit ambulatory patients to operate a vehicle following an injection. BP. consult your health care provider if these become bothersome).induction of general anesthesia in adults and in pediatric patients greater than 3 years of age . Client may experience these side effects: Drowsiness. BP. Do not use small veins (dorsum of hand or wrist) for IV injection. weakness. Administer IM injections deep into muscle. Indications: . drowsiness that persists. swelling of throat . Report severe dizziness. crying (it may help to know that these are effects of the drug. LFTs. lesions. Monitor level of consciousness before. P. normal output. during. nervousness. visual or hearing disturbances. dreams.- - - - - - - Physical: Weight.

.Shake well before use. restlessness. In addition. and physical dexterity may be impaired for some time after administration. bronchial plugging.For IV. urinary hesitancy Resp: dyspnea. Do not use if there is evidence of separation of phases of emulsion. . fainting DERM: skin rash. . . . epigastric distress DERM: flushing. increased intraocular pressure. delirium.Buscopan Tablets should not be administered to patients with myasthenia gravis.Avoid strict heat . increased ICP. euphoria. Indications: . they should not be given to patients with a known hypersensitivity to hyoscine-N-butylbromide or any other component of the product.Minimize pain associated with administration by infusing into larger veins. Anticholinergic Therapeutic Actions: . Avoid mixing blood or plasma in same IV catheter. . Generic Name: Hyoscine-N-butylbromide Brand Name: Buscopan Classification: Antispasmodic. do not mix with other therapeutic agents prior to administration.CNS: increased ICP. blurred vision. difficulty of swallowing. blurred vision. drowsiness. seizure.Buscopan Tablets are indicated for the relief of spasm of the genitourinary tract or gastro. dyshidrosis GU: Urinary retention. flushing GI: Dry mouth. Nursing Considerations: . palpitations.Should be administered only by personnel who are trained in administration of general anesthesia and familiar with drug. lightheadedness.acts by interfering with the transmission of nerve impulses by acetylcholine in the parasympathetic nervous system.Drug compatibility should be monitored closely in patients requiring adjunctive therapy . disorientation. . dilated pupils.intestinal tract and for the symptomatic relief of Irritable Bowel Syndrome Contraindications: . anaphylactic shock. tachycardia. nausea.Avoid driving & operating machinery after parenteral administration.Use safety precautions after administration. constipation. anxiety. tension. irritability. flushing. lethargy. megacolon and narrow angle glaucoma.Assess history of allergy to the components of the drug. coordination.Advise patient that mental alertness. dizziness. photopobia. depressed respiration EENT: mydriasis. hallucination. anaphylactic reactions. urticaria Nursing Considerations: . impaired memory CV: hypotension. Adverse Effects: CNS: dizziness. drowsiness. hallucinations. confusion. headache.

- Raise side rails as a precaution because some patients become temporarily excited or disoriented and some develop amnesia or become drowsy. . as needed. such as respiratory paralysis. Reorient patient. Keep emergency equipment available. 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.

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