Oxytocin (Pitocin) – hormone releases when infant suckles – uterine

stimulant – helps control postpartum bleeding – administered for boggy uterus

– stimulates milk let down
- IV administration – observe for particulate matter – primary line of LR
- Initiated at low dose – after initial dosage - ↑1-2 units q15-60 minutes
until regular contractions occur then ↓ - MAX dose is
40milliunits/minute
- Goal: stable contractions every 2 – 3 minutes that last 40 to 60
seconds – uterus should relax to full baseline resting tone between
contractions – changes in effacement & dilation of cervix
- SIDE EFFECTS: anaphylactic reaction, cardiac arrhythmia, HTN,
↑pulse, barky/tachycardia, N&V, uterine rupture, water
intoxication(N&V, tachycardia, hypotension, cardiac arrthymia) if
pitocin is given in electrolyte free solution or at a rate exceeding
20milliunits/minute, ↓BP if rapid IV bolus administration postpartum
- For labor assess: labor contractions (frequency,intensity,duragion),
fetal heart tones, VS,
- For postpartum assess: fundal height, consistency, amount &
character of lochia
Methylergonovine maleate (Methergine) oral and IM – induces a rapid
and sustained tetanic uterotonic effect which shortens the third stage of labor
and reduces blood loss – works on uterine and vascular smooth muscle –
increases vasoconstriction to treat hemorrhage postpartum
- The onset of action after I.M. administration, is 2-5 minutes, and after
oral administration, 5-10 minutes.
- Not generally given IV – onset of action after I.V. administration is
immediate; given slowly over a period of no less than 60 seconds with
careful monitoring of BP
- NOT FOR PATIENT WITH: LABILE OR HIGH BP – PREECLAMPSIA -
BEFORE DELIVERY OF PLACENTA – PID - PERIPHERAL VASCULAR
DISEASE – DM, SEIZURE DISORDER
- SIDE EFFECTS: most common side effect is HTN, headache,
dizziness, palpations, Dysrhythmias, N&V, abdominal cramps
- NURSING CONSIDERATIONS: check calcium level prior to
administering, if hypocalcemia dosage correction made to increase
effectiveness, monitor BP closely, VA, assess fundal tone, fundal
height and amount and character of lochia
- Monitor for decreased breast milk production – only one week PP for
nursing mother

Hemabate – form of prostaglandin (a hormone-like substance that occurs

naturally in the body). Prostaglandins help to control functions in the body
such as blood pressure and muscle contractions - used to stimulate uterine
contractions – causes complete abortion in 16 hours when administered
between 13 – 20 weeks gestation – controls postpartum uterine hemorrhage
caused by uterine atony not controlled by other methods
- Contradictions: certain conditions such as pelvic inflammatory disease,
a breathing disorder, heart disease, liver disease, kidney disease, DM,
seizure disorder, history of past uterine surgery
- SIDE EFFECTS: severe pelvic cramping, vaginal bleeding, high fever,
N&V, diarrhea, headache
- NURSING CONSIDERATIONS: monitor BP, VS – monitor contractions
(observe for duration, contact physician if >1 minute or absence of
contractions) – monitor fundal height – monitor consistency/character
of lochia
Prostaglandin E2 (Cervidil) – prostaglandin - Cervidil Vaginal Insert 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 – stimulates uterine contractions for complete abortion –
expulsion of uterine contents in fetal death up to 28 weeks
- onset of action within 30 minutes – repeat q3-5 hours
- SIDE EFFECTS: headache, fever, N&V, diarrhea, abdominal pain,
hypotension, leg cramps, joint swelling, Dysrhythmias, uterine rupture
- Contraindications: cephalopelvic disproportion, in patient’s where
oxytocic drugs are contraindicated – in patients with history of
previous uterine hypertony, glaucoma,
- NURSING CONSIDERATIONS: uterine activity carefully monitored for
uterine hyperstimulation. If uterine hyperstimulation is encountered or
if labor commences, the vaginal insert should be removed. Cervidil
should also be removed prior to amniotomy – monitor fetal status and
progression od cervical dilation and effacement - Any evidence of
uterine hyperstimulation, sustained uterine contractions, fetal distress,
or other fetal or maternal adverse reactions, should be a cause for
consideration of removal of the insert. – assess for fever 30 minutes
after administration

Misoprostol (Cytotec) – used to ripen cervix and induces labor – tablet form
that is inserted vaginally
- Only for third trimester
- ¼ tablet or 25mcg should be initial dose
- Recurrent administration not to exceed dosing intervals of more than 3
– 6 hours
- SIDE EFFECTS: N&V
- Contraindications: not for use in presence of uterine contractions three
times in 10 minutes – not for maternal asthma – not for hx of cesarean
birth or other uterine scar – not for patient with bleeding during
pregnancy – not in the presence of placenta previa – not when
nonreassuring fetal heart rate
- NURSING CONSIDERSTIONS: obtain baseline VS, patient supine with
right hip wedge for usually 1 hour then assume any comfortable
position – monitor for hyperstimulation and FHR abnormalities for at
least 2 hours following insertion
OXYTOXICS - stimulates the smooth muscle of the uterus to contract-
used to induce or augment labor at term, control postpartum
hemorrhage, correct postpartum uterine atony, produce uterine
contractions after cesarean section or other uterine surgery, and
induce therapeutic abortion. These drugs are used with extreme
caution in with severe hypotension and hypertension, partial placenta
previa, prolapsed umbilical cord, cephalopelvic disproportion, or grand
multiparity. Contraindicated with cases of active genital herpes. The risk
of using these agents is much higher in mothers who have undergone
recent uterine surgery or who have suffered recent sepsis or trauma. The
most serious adverse reaction is sustained tetanic contraction of the
uterus, resulting in fetal hypoxia or rupture of the uterus.

TOCOLYTICS – use of meds in an attempt to suppress uterine

contractions
Magnesium sulfate – CNS depressant – muscle relaxant (decreases motor
nerve impulses – lowers calcium levels in uterine cell muscles) - drug of
choice for patient with cardiopulmonary disease, DM or infection - generally
administered IV as it allows for immediate onset of action – must be given by
infusion pump for accurate dosage – painful and irritating to tissues if given IM
– excreted via kidneys
Therapeutic level 4.8 – 9.6gm/dL (reflexes often disappear at levels of 8–12 –
respiratory depression at levels of 15-17)
- Mag sulfate for preeclampsia is antiseizure/anticonvulsant medication
– may have compromised renal function – dose may need to be
adjusted based on serum magnesium levels – given for 24 hours after
birth as prophylasix against postpartum seizures
- Mag sulfate for preterm labor is tocolytic - generally have normal
renal function - may require level of mag sulfate to achieve a
therapeutic range

- Pulmonary edema & respiratory depression (<12 resp/minute) most

serious side effect
- Calcium gluconate is given to reverse effects of mag sulfate – should be
readily available at bedside
- Signs of mag toxicity: depression or absence of reflexes, oliguria, confusion,
respiratory depression, circulatory collapse & respiratory paralysis
- Other SIDE EFFECTS: flushing, sweating, nasal congestion, visual blurring,
headache, dizziness, lethargy, N&V, slurred speech
- CROSSES THE PLACENTA - FETAL SIDE EFFECTS: neurologic depression or
respiratory depression, loss of reflexes (hypotonia), lethargy – monitor for 24 –
48 hours after birth for signs of toxicity
- NURSING CONSIDERATIONS: monitor BP closely, monitor serum mag levels
usually q6-8 hours for therapeutic range – monitor resp, below 12/bpm is sign
toxicity may be developing – assess knee jerk for evidence of diminished or
absent reflexes (often first sign of developing toxicity) – monitor I&O – monitor
fetal heart tones -
Tylenol #3 – narcotic analgesic – combo of 300mg
acetaminophen & 30mg codine
- used to treat mild to moderately severe pain
- Antipyretic reduces fever
- Tablet form
- Max dosing 4000/360
- SIDE EFFECTS: drowsiness, dizziness, GI upset, SOB,
nausea, constipation, purities,
- CONTRAINDICATIONS: GI disorders, head injury,
respiratory disorder – NOT TO BE TAKEN WITH ALCOHOL –
not for nursing mothers(codine appears in breastmilk)
- NURSING CONSIDERATIONS: patient safety – allergy
awareness – monitor VS – assess pain – take with food for
GI upset

Percocet – opioid analgesic – oxycodone &

acetaminophen-
- Used for moderate to moderately severe pain
- Dosing 2.5/5/7.5/10 oxycodine to 350 acetaminophen &
10/650
- SIDE EFFECTS: drowsiness, dizziness, confusion, N&V,
constipation, GI upset, respiratory depression,
hypotension
- CONTRADICTIONS: not with alcohol – not for patient with
physical drug dependence – caution use with CNS
depression – respiratory disorders, renal/hepatic disorders

Demerol (meperidine) – opioid analgesic-

- Used to relieve moderate to severe pain – preoperatively
and postoperatively
- Route: PO/SUBCUT/IM/IV
- SIDE EFFECTS: drowsiness, dizziness, palpations,
bradycardia, hypotension, V&V, (tachycardia with IV)
- CONTRAINDICATIONS: pregnancy, breastfeeding, heart
disease, respiratory depression, renal/hepatic disease &
elderly
- NURSING CONSIDERATIONS: monitor BP, respirations
<10/bpm notify physicial, assess renal function prior to
use poor renal function can lead to toxic metabolite
accumulation & seizures – monitor VS after parenteral
route
Nubain (nalbuphine)– opioid analgesic
- Used for moderate to severe pain
- Route: SUBQ/I/IV – not to exceed 160mg/day
- SIDE EFFECTS: drowxiness, dizziness, confusion,
headache, sedation, euphoria, N&V, anorexia,
constipation, cramps, rash, diaphoresis
- CONTRADICTIONS: pregnancy, breastfeeding, MI,
increased ICP, respiratory depression, renal/hepatic
disorders, bowel impaction – no alcohol – increased
effects with other CNS depressants – not for use with
herbals

Stadol (butorphanol) – mixed opiate analgesic

- Used for mild to moderate pain
- Also used to treat migraine headache
- Route: IM/IV/Nasal/
- SIDE EFFECTS: drowsiness, dizziness, confusion,
headache, sedation, euphoria, weakness, hallucinations,
N&V, anorexia, constipation, cramps
- CONTRAINDICATIONS: pregnancy, breastfeeding,
increased ICP, respiratory depression, renal/hepatic
function, bowel impaction

Motrin – non-opioid analgesic

- Used to treat mild to moderate pain – not to exceed
3.2gm per day (3200mg)
- Fever
- Inflammation
- Dysmenorrheal
- SIDE EFFECTS: GI upset, dizziness, headache, drowsiness,
anorexia, edema, fluid retention
- CONTRAINDICATIONS: avoid in 2nd/3rd trimester, asthma,
severe renal/hepatic disease, don’t take with aspirin –
decreases effects of furosemide – decreases effects if
insulin(hypoglycemia) – may diminish effect of ACE
inhibitor used to treat HTN – elevates lithium levels -
enhances effects of warfarin
Toradol (ketorolac) – nonopioid analgesic
- Used to treat mild to moderate pain
- Anti-inflammatory
- Antipyretic effects
- Decreases ocular itching in seasonal allergic conjunctivitis
(ophthalmic)
- Dosing route: PO, IV, IM, gtt – Not to exceed 40mg daily
- SIDE EFFECTS: GI upset, drowsiness, HTN, flushing,
syncope, tinnitus, blurred vision
- CONTRAINDICATIONS: not during L&D as it may adversely
affect fetal circulation – not for nursing mothers – not for
liver/renal disease – not for concomitant use with other
NSAIDS – no alcohol – caution with soft contact use
wearers
- NURSING CONSIDERATIONS: monitor blood counts can
cause platelets to ↓ - give with full glass of water to
enhance absorption

Americaine Spray – topical anesthetic

- Used to decrease inflammation, itching & pain associated
with hemorrhoids
- SIDE EFfECTS: burning, rash, irritation
- CONTRAINDICATIONS: hypersensitivity
- NURSING CONSIDERATIONS: assess location prior to use
for infection, redness, drainage, inflammation
- Teach patient to wash hands before & after use

Witch Hazel (Tucks) – topical anesthetic

- Hemorrhoid pad
- Eases pain, irritation, burning
- Relieves itching
- Aids in protecting anal/rectal area
- CONTRAINDICATIONS: not for use if rectal bleeding
present – not for use if infection present -
- NURSING CONSIDERATIONS: teach patient to wash hands
before/after use - clean area with mild soap – rinse and
pat dry – can apply up to 6x a day or after each BM –
discard after use – not to be put directly into rectum
Lanolin Cream (Lansinoh) – sooths, heals, protects sore
cracked nipples
- Promotes healthy skin
- Provides moisture barrier – allows skin to rehydrate from
within
- Safe & pure – does not need to be removed before
breastfeeding
- CONTRAINDICATIONS: not for use for bacterial infection
- NURSING CONSIDERATIONS: teach to apply to entire
nipple area after each breastfeeding – if soreness does
not start to ease within 24 hours of commencing use, or if
problem persists consult lactation specialist of healthcare
professional

Vitamin K – needed for adequate blood clotting

- Administered in newborns for prevention of hemorrhagic
disease
- IM to vastus lateralis within 1 hour of birth

Penicillin G – decreases maternal bacterial load

- For group B strep tested @ 36 weeks
- For mother with sexually transmitted disease (gonorrhea,
syphilis, herpes simples virus, rubella)
- Women with GBS colonization should receive intrapartum
antibiotic prophylaxis for perinatal GBS disease
prevention
- peak serum concentrations are attained immediately
after completion of the infusion.
- SIDE EFFECTS: diarrhea
- NURSING CONSIDERATIONS: monitor blood cultures, VS,
observe for changes in infant, monitor I&O
Erythromycin eye ung – routine – put into babies eyes to
protect against germs that may have entered eyes during
passage through the birth canal – prevents conjunctivitis
- Ointment may temporarily blur vision

Calcium Gluconate – used to counteract the toxic effects

of magnesium sulfate
- IV USE – not to exceed 200mg per minute – generally
not given without physician present
- Should have at hand when administering mag sulfate
- Antidote for respiratory depression from mag sulfate

Rhogam – administered to Rh- mom who gives birth to

Rh+ baby
- Also administered for transfusion of Rh incompatible
blood or blood products when Rh- mom exposed to Rh+
- Also administered to Rh- mom with Rh+ fetus during
amniocentesis, CVS, Ectopic pregnancy
- DOSE/ROUTE: IM @ 28 weeks and again within 72 hours
after delivery of confirmed Rh+ baby
- SIDE EFFECTS: swelling, redness, mild pain at injection
site – rare systemic allergic reaction
- NURSING CONSIDERATIONS: obtain type & cross-match of
mom’s blood & neonate cord blood – assess for
intravascular hemolysis, backpain, chills, hemoglobinuria,
renal insufficiency – may suppress antibody formation of
rubella if given with rubella vaccine
Rubella Vaccine – avoid pregnancy following vaccination
for 3 months
- Used to stimulate active immunity against rubella virus
- Not to be given during pregnancy – live vaccine Appears
in breast milk
- If woman gets Rhogam & rubella at same time woman
must be tested for rubella immune status in 3 months –
rhogam may suppress antibody formation
- CONTRAINDICATIONS: hypersensitivity to eggs, neomycin,
cancer, radiation, corticosteroids, pregnancy,
immunocomromised, active untreated TB
- SIDE EFFECTS: Irritation at injection site: redness, itching,
swelling, warmth, nodule formation

Narcan (naloxone) – used to reverse opioid overdose

*respiration
- Pure opiate agonist
- Reverses opioid overdose effects of respiratory
depression sedation & hypotension
- ROUTE: IV/SUBQ/IM 0.4 to 2mg & repeat q 2-3 minutes if
needed….max 10mg
- SIDE EFFECTS: drowsiness, nervousness, rapid pulse,
increased systolic, N&V, pulmonary edema, pain
- NURSING CONSIDERATIONS: monitor VS q3-5 minutes,
cardiac status, tachycardia, HTN – assess for pain
because narcan reverses the effects of pain meds –
patient will have pain

Depo-Provera –
- Used to decrease uterine bleeding, absence of
menorrhea, contraception, along with estrogen
replacement therapy
- DOSE/ROUTE: PO for uterine bleeding 5-10mg – IM
contraception 150mg q12 weeks
- SIDE EFFECTS: weight gain, edema, dizziness, headache,
migranes, depression, break through bleeding,
hypotension, N&V, spontaneous abortion
- CONTRADICTION: nor for breastfeeding – don’t use longer
than 2 years – increase breast cancer, reproductive
disorders & reproductive CA – bone density loss
- NURSING CONSIDERATIONS: monitor BP at beginning of
treatment – tell patient to report weekly weight gain of
5#, monitor liver function if on long term
Ancef (defazolin) 1st generation cephalosporin –
antiinfective
- Used for gram- organisms
- Upper & lower tract respiratory tract infection
- Used for UTI
- Used to treat sepsis
- Skin, bone, joint, biliary, genital, endocardites, surgical
prophylaxis
- DOSE/ROUTE: individualized to type & severity of
infection – IV/IM adult max dose 12g daily, child 6g
- SIDE EFFECTS: headache, N&V, chills, itching, diarrhea,
dizziness, weakness, oral thrush, GI upset
- CONTRADICTIONS: not for pregnancy or breastfeeding,
renal disease, not for those who are hypersensitive to
penicillins
- NURSING CONSIDERATIONS: assess for previous
sensitivity – obtain culture & sensitivity propr to
Hepatitis B Vaccine – prevention of hepatitis B virus-
- Newborns should receive monovalent HepB soon after
birth or prior to discharge
- Infants born to HepB positive mothers should receive
HepB + 0.5mL of hepB immunoglobulin within 12 hours of
birth
- DOSE/ROUTE: IM anterolateral thigh – series of 3
5mcg/0.5mL dose
- 1st dose at elected date – 2nd dose 1 month later – 3rd dose
6 months after first
- SIDE EFFECTS: caution in administration to breastfeeding
mothers - Irritation at injection site: redness, itching,
swelling, warmth, nodule formation
- NURSING CONSIDERATIONS: record manufacturer, lot #,
date administered, name & address of person
administering