A Drug Study On

OXYTOCIN

In Partial Fulfillment of the

Requirements in NCM-207 RLE

DELIVERY ROOM ROTATION

Submitted to:
CNYDRILLE M. VILLAROSA, RN, LPT

Submitted by:
GIAN KYLE D. ARADILLOS, ST.N.
BSN 2L - GROUP 3

FEBRUARY 11, 2023

Generic Name: Carbetocin
Brand Name: Duratocin
Classification: Obstetric Drugs, Oxytocin and Analogues

Mode of Action:   Carbetocin is a synthetic analogue of oxytocin with a longer duration of activity.
It selectively binds to oxytocin receptors in the uterine smooth muscle, thereby stimulating
rhythmic uterine contractions and increasing both the frequency of existing contractions and
uterine tone. Additionally, it enhances uterine involution early in postpartum.

Suggested Dose:
Adult: 100 mcg as a single dose via slow IV inj. over 1 minute or IM inj. to be given as soon as
possible after delivery of the infant, preferably before the removal of the placenta.

Under epidural or spinal anesthesia: 100 mcg as a single dose via slow IV inj. over 1 minute to be
given as soon as possible after delivery of the infant, preferably before the removal of the
placenta.
Ordered dose: For the prevention of uterine atony and excessive bleeding after caesarean section under
epidural or spinal anesthesia, a single dose of 100 micrograms may be given by slow intravenous injection over 1
minute. Carbetocin must only be given after delivery of the infant, preferably before removal of the placenta.

Indication: Prophylaxis of postpartum hemorrhage due to uterine atony after vaginal delivery
and Prophylaxis of postpartum hemorrhage due to uterine atony after caesarean section.

Contraindication: Hypersensitivity to carbetocin or oxytocin. Serious CV disorders, epilepsy.

Hepatic and renal impairment. The use of carbetocin at any stage prior to delivery of the infant
is not appropriate due to its prolonged uterotonic effects that persist for several hours.
Therefore, carbetocin must not be administered during pregnancy and labor before delivery of
the infant for any reason (including electively or medically induced labor). Carbetocin should not
be used for the induction of labor.

Side Effects: Abdominal pain, dizziness, faintness, feeling of warmth, headache, light-
headedness, itching skin, trembling and unusual tiredness or weakness.
Adverse Effects:
Significant: May produce antidiuretic effect, which may lead to the risk of hyponatremia or water
intoxication.
Blood and lymphatic system disorders: Anemia.
Cardiac disorders: Tachycardia.
Gastrointestinal disorders: Abdominal pain, nausea, vomiting, metallic taste.
General disorders and administration site conditions: Feeling of warmth, chills, pain, pyrexia.
Musculoskeletal and connective tissue disorders: Back pain, muscular weakness.
Nervous system disorders: Headache, tremor, dizziness.
Respiratory, thoracic and mediastinal disorders: Chest pain, dyspnea.
Skin and subcutaneous tissue disorders: Pruritus, diaphoresis.
Vascular disorders: Hypotension, flushing.

Drug Interaction: Severe hypertension may occur when given 3-4 hours after prophylactic
administration of a vasoconstrictor in conjunction with caudal-block anesthesia. May enhance the
blood pressure enhancing effect of ergot alkaloids (e.g. methylergometrine). Prostaglandins may
potentiate the effect of carbetocin. Certain inhalation anesthetics (e.g. halothane, cyclopropane)
may enhance the hypotensive effect and weaken the effect of carbetocin on the uterus.

Nursing Responsibilities:
 1. Monitor patient for persistent postpartum bleeding.
Rationale: in case persistent vaginal or uterine bleeding occurs after administration, determine
and consider the possible causes (e.g. retained placental fragments, genital tract lacerations,
blood coagulation disorders)
2. Closely monitor blood pressure, particularly in patients with eclampsia or pre-eclampsia.
Rationale: to avoid rare risks of maternal stroke, seizure, and death
3. Measure a 24-hour intake and output. Observe for signs of voiding difficulty.
Rationale: Assessment of the client’s intake and output will help determine fluid loss. Monitoring
urine output is a good gauge of blood loss because the kidneys need sufficient arterial blood flow
and pressure to function.
4. Maintain bed rest.
Rationale: This will help to promote patient’s healing and recovery.
5. Assess for the presence of a vulvar and vaginal hematoma.
Rationale: The client may also develop signs of concealed blood loss if the hematoma is large.
Larger ones may require incision and drainage of the clots. The client should report signs of
concealed blood loss accompanied by maternal complaints of severe pain, perineal or vaginal
pressure, or inability to void. Small hematomas usually resolve without treatment or with cold
application.
6. Assess the location of the uterus and the degree of contractility of the uterus.
Rationale: The degree of uterine contractility will measure the status of the blood loss. Uterine
atony allows the blood vessels at the placenta site to bleed freely and usually massively because
the muscle fibers that compress the bleeding vessels are flaccid.
7. Assess the lochia for color, quantity, and clots.
Rationale: Observing the lochia provides for an estimate of the actual blood loss. Lochia rubra should
be dark red. During the first few hours, the amount of lochia should be no more than one saturated
perineal pad per hour. Small clots may appear in the drainage, but large clots are not normal.
8. Assess and record the characteristics, amount, and site of the bleeding, including the stage of
labor.
Rationale: The amount of blood loss and the presence of blood clots will help determine the necessary
interventions. The characteristics and quantity of blood passed can suggest excessive bleeding.
Bibliography:

MIMSOnline Team, C. B. (n.d.). Carbetocin: Indication, Dosage, Side Effect, Precaution | MIMS
Philippines. In Carbetocin: Indication, Dosage, Side Effect, Precaution | MIMS Philippines.
https://www.mims.com/philippines/drug/info/carbetocin?mtype=generic

Carbetocin (Intravenous Route) Side Effects - Mayo Clinic. (n.d.). In Carbetocin (Intravenous Route)
Side Effects - Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/carbetocin-intravenous-
route/side-effects/drg-20062512

BSN, R.N., P. M. (2016, September 21). 8 Postpartum Hemorrhage Nursing Care Plans. In Nurseslabs.
https://nurseslabs.com/postpartum-hemorrhage-nursing-care-plans/

Sweetman, S. C. (Ed.). (2009). Martindale The Complete Drug Reference Thirty-sixth edition. Retrieved February
9, 2023, from https://vnras.com/wp-content/uploads/2018/04/Martindale-The-Complete-Drug-Reference_-
36th-Edition.pdf