PHARMACOTHERAPEUTICS

IN OBSTETRICS
 INTRODUCTION
• Drugs used in obstetrics have a huge impact on the outcome
of both mother and baby.

• Drugs used during first trimester can produce congenital

malformation and the period of greatest risk is from the third
to eleven weeks of pregnancy

• During second and third trimester drugs can affect the

growth and functional development of the fetus or they can
have toxic effect on fetus tissues.
FDA CLASSIFICATION OF DRUGS

CATEGORY DESCRIPTION

A Controlled studies of pregnant women show no risk trimester

Animal studies show no risk, or animals show risk unconfirmed

B
in humans
Animal studies show risk, caution is advised, benefits may
C
outweigh risks
Evidence of risk to human fetus, benefits may outweigh risks in
D
serious conditions

X Drugs are contraindicated

DRUGS USED IN PREGNANCY
 Cont.,..

List of drugs used in pregnancy are:-

Folic acid Iron Calcium

Anti - HT Toccolytic
Diuretics
drugs agents
 FOLIC ACID:

Preparation:
•Injection- 10ml vial (5mg/ml with 1.5% benzyl
alchoal)
•Tablet- 0.4mg , o.8mg , 1mg
Action:

•Stimulates normal erythropoiesis and

nucleoprotein synthesis.
 Cont.,..
Indications:

1.Megaloblastic or macrocytic anemia during pregnancy

to prevent fetal damage.

2.Prevent fetal neural tube defect during pregnancy.

Contraindications:

1. untreated vitamin B12 deficiency.

 Cont.,..
Adverse effects:
1. Abdominal cramps

2. Diarrhoea

3. Rash

4. Irritability

5. nausea or bloating
Dosage and route of administration:
•0.4mg or 400mcg OD orally.

•0.4-0.8mg IM Or subcutaneously daily.

 Cont.,..

Nursing considerations:
1.Patient with H/O fetal neural tube defect in pregnancy
should increase folic acid intake 1 month before and 3
months after conception.

2.Patient with intestinal malabsorption may need

parentral administration.
 Iron (ferrous fumarate):

Preparation:
•Each 100mg provides 33mg of elemental iron.
Tablet- 90mg,200mg,300mg,325mg,350mg
Action:
•Provides elemental iron, an essential component in the
formation of haemoglobin.
 Cont.,.,

Indications:

1. Iron deficiency.
2. As a supplement during pregnancy.
Contraindications:
3. Primary haemolytic anemia.
4. Peptic ulcer disease.
5. Ulcerative colitis.
6. Repeated blood transfusions.
 Cont.,.,
Adverse effects:
1. Metallic taste.

2. Temporary stained teeth.

3. Nausea or vomiting.

4. GI irritation.

5. Black stools.
Dosage and routes of administration:
• 30mg OD orally

• Injection- 20mg elemental iron/ml in 5ml and 10ml single dose vial (iron
sucrose )

• Dose-15mg/kg body weight or max 1000mg in single Inj IM Or diluted with 100ml of
NS for IV.
 Cont.,.,

Nursing considerations:
1.Advised patient to avoid taking tablet with milk or
along with antacids.
2.Caution patient to crush tablet.

3.Caution patient not to substitute one iron salt for another

because amount of elemental iron may vary.

4.Advised patient to report for constipation or change in

stool colour.
 Calcium (calcium citrate):
Preparation:

•each tablet contains 211mg or 10.6meq of

elemental calcium
•tablet- 250mg, 500mg
Action:
•Replaces calcium and maintain calcium level
Indication:
•Supplement
 Cont.,.,
Contraindications
1. Cancer patients with bone metastasis.
2. Hypercalcemia.
3. Hypophosphatemia.
4. Renal calculi
Adverse effects:
5. Headache
6. Irritability.
7. Hypercalcemia.
8. Chalky taste.
5. Nausea or
vomitings.
Dosage and route
 Cont.,.,

Nursing considerations:
1. Advise patient to take oral calcium 1 or 1.5 hours
after meals if GI upset occurs.
2. Monitor calcium level if the patient is having mild
renal impairment.
3. Advise patient to report for any kind of abdominal
pain, vomiting or nausea occurs.
 ANTIHYPERTENSIVE DRUGS:

Here are the choice of drugs given during

pregnancy are:-
1.Alpha and Beta blockers- Labetalol
hydrochloride.
2.calcium channel blockers-Nifedipine.
3.alpha blockers-Methyldopa.
4.vasodilators-Hydralazine hydrochloride.
Anti hypertensive drugs contraindicated in
pregnancy:
These drugs should be avoided because they may can
cause poor fetal renal function, malformation or can cause
IUGR.
1. ACE inhibitors.

2. Minoxidil.

3. Sodium Nitoprusside.

4. Diltiazem.

5. Atenolol.

6. Propranolol.
 Labetalol Hydrochloride:

Preparation:
•Injection-5mg/ml in 2oml vial

•Tablets- 100mg,2oomg ,300mg

Action:
•Reduced peripheral vascular resistance as a result
of alpha and beta blockade.
 Cont.,.,

Indications:
1.Hypertension.
2.Hypertensive emergencies.
Contraindications:
1.Hypersensitive to drug or its component.
2.Bronchial asthma.
3.Hepatic or heart failure
4.Prolonged hypotension.
5.Severe bradycardia.
 Cont.,.,
Adverse effects:
1. Dizziness.
2. Fatigue.
3. Nausea or vomiting.
4. Headache.
5. Vertigo.

Dosage and route of administration:

• 50mg or 100mg tablet OD orally

•20mg/20ml Inj IV bolus wait for 10min if no response then

give 40mg slow bolus.
 Cont.,.,
Nursing considerations:
1. Advised patient to remain in supine position for
3hrs after infusion.
2. Monitor BP frequently.

3. In diabetic patient monitor glucose level

closely.

4. Advised patient that dizziness can be minimized by

rising slowly and avoiding sudden position change.
 Nifedipine:
Preparations:
•Capsule-10mg,20mg

•Tablet-20mg,30mg,60mg,90mg

Action:
•Thought to inhibit calcium ion reflex across cardiac and
smooth muscle cells, decreasing contractility and oxygen
demand and also dilates arteries and arterioles.
 Cont.,.,
Indications:
1. Hypertension.
2. Classic chronic stable angina pectoris.
Contraindications:
3.Heart failure.
4.Hypotension.
5.Severe GI narrowing
Adverse effects:
6. Dizziness.
7. Syncope.
8. Heart failure.
9. Muscle cramps.
10.Peripheral edema.
 Cont.,.,

Dosage and route of administrations:

•5-20mg OD orally.

Nursing considerations:
1. Monitor BP & HR regularly.

2. Advise patient to avoid taking this drug with grapefruit

juice.
3. Watch for symptoms for heart failure.

4. Advise patient if chest pain worsen

immediately report to doctor.
 Methyldopa:
Preparations:
•Tablet-250mg,500mg

•Inj-50mg/ml

Action:
•Inhibit the central vasomotor centre, decreasing
sympathetic outflow to the heart, kidney and peripheral
vasculature.
 Cont.,.,

Adverse effects:
Indications:
1. Decrease mental acuity
1. Hypertension
2. Sedation
2. Hypertensive crisis
Contraindications: 3. Headache or depression

3. Hepatic disease or liver 4. Bradycardia

cirrhosis 5. Hepatic necrosis

4. Lactating mother. 6. Hepatitis

 Cont.,.,

Dosage and routes of administration:

250mg BD or TDS max 2g daily titrated by BP
1. Monitor BP reNursing considerations:
2. gularly.
3. Monitor patient coomb’s test result.
4. Report for involuntary movements.

5.Tell patient to check weight daily and notify if he

gains 2 or more pounds in a week
 Hydralazine Hydrochloride:
Preparation:
•Inj-20mg/ml in 1ml vial

•Tablet-10mg,25g,50mg,100mg
Action:
•Direct acting peripheral vasodilator that relexes arteriolar smooth
muscle.
Indications:

1. Hypertension

2. Severe essential hypertension

 Cont.,.,

Contraindications: Adverse effects:

1. Coronary artery disease. •Neutropenia.
•Leukopenia.
2. Rheumatic heart disease.
•Thrombocytopenia.
3. Stroke.
•Orthostatic hypotension
4. Severe renal impairment.
 Cont.,.,

Dosage and route of administration:

•25mg tablet BD and if necessary may increase to 50mg BD.
•5mg diluted in 10ml of NS slow IV at 15-20minutes interval.

Nursing considerations:
•Monitor patient BP, pulse rate, body weight frequently.
•Monitor patient for muscle and joint pain, fever or throat pain.
•Advised patient to take drug after food to increase absorption.
 DIURETICS

Diuretics are used in the following conditions

during pregnancy:
1. PIH with massive edema
a
2. Eclampsia with pulmonary edema.

3. Severe anemia in pregnancy with heart failure.

4. Prior to blood transfusion in severe anemia.

5.As an adjunct to certain antihypertensive drugs.

 Furosemide (lasix):
Preparation:
Indications:
•Inj-10mg/ml
1. Acute pulmonary
•Tablets-20mg,40mg,80mg,500mg
edema.
Action:
•Inhibits sodium and chloride
2. Edema.

reabsorption at proximal and distal 3. Hypertension.

tubules and loop of Henle.
 Cont.,.,
Contraindications:
• Anuria Dosage and routes of
• Hepatic cirrhosis administration:
• Allergic to sulfonamides •40 mg tablet, daily following
Adverse effects:
breakfast.
•Maternal: Weakness, fatigue,
•In acute conditions, the drug
muscle cramps, hypokalemia.
•Fetal: May occur due to
is administered parenterally in
decreased leading to fetal doses of 40-120 mg daily.
compromise, hyponatremia.
 Cont.,.,

Nursing considerations:
•Monitor weight, BP and pulse rate routinely for long
term use.
•Monitor patient I/O chart.
•Watch the signs for hypokalemia such as muscle
weakness and cramps.
•Monitor uric acid if patient is having gout.
•Advise the patient to take drug in the morning after
food.
•Advised patient to avoid direct sunlight to prevent
photosensitivity reactions.
 TOCOLYTIC AGENTS

These drugs can inhibit uterine contractions & used to

prolonged the pregnancy. In women who develop premature
uterine contractions, in addition to putting them to absolute bed
rest & sedating, Tocolytic drugs are administered in an attempt
to inhibit uterine contraction.

Here are the drugs used are:-

1. Isoxsuprine Hydrochloride

2. Ritrodrine hydrochloride
 Isoxsuprine hydrochloride
(Duvadilan)
Preparation:
•Tablet -10mg

•Inj-10mg/ml

Action:
•Acts directly on vascular smooth muscle, causes cardiac stimulation & uterine
relaxation And thus causing relaxing the veins and arteries and making them
wider to increase the blood flow to certain parts of the body.

Indication:
1. Prevent Preterm labour.

2. Inhibit uterine contractions.

 Cont.,.,

Contraindications: Adverse effects:

• Hypersensitivity. • Hypotension

• Postpartum. • Tachycardia
• Nausea or vomiting
• Pulmonary edema
• Cardiac arrhythmias
• Hyperglycemia or hypokalemia
 Cont.,.,
Dosage & routes of administration:
•Initial: IV drip 100 mg in 5% dextrose @Rate0.2ug/minute.
•To continue at least 2 hours after the contractions cease

•Maintenance: IM 10mg 6 hourly for 24 hrs or tab 10mg 6- 8hrly.

Nursing considerations:
•Assess patient BP, pulse during treatment.
•Take BP lying & standing as orthostatic hypotension is common.
•Monitor for Intensity & length of uterine contractions and FHS.
•Advise patient to make position changes slowly as fainting may
occur.
 Ritodrine hydrochloride (yutopar):
Preparation:
Contraindications:
•Inj-5ml amp-10mg/ml=50mg per amp.
• Hypersensitivity.
•Tablet-10mg
• Eclampsia.
Action:
• Hypertension.
•Acts directly on vascular smooth
• Dysrthythmias.
muscle, causes cardiac stimulation &
uterine relaxant.
Indications:
•Prevent preterm labour.
 Cont.,.,
Adverse effects:
• Hyperglycemia
• Headache
• Restlessness or sweating
• Chills and drowsiness
• Nausea or vomiting
• Altered maternal & fetal
heart tone & palpitations.
Dosage and routes of administration:
Initial: IV drip 100 mg in 5% dextrose @
0.1 mg/minute gradually increased by
0.05mg/min ,To continue for at least 2 hrs
after contractions cease.
Maintenance: Tab 10mg 6-8 hourly PO
10 mg given half hour before termination
of iv, then 10 mg q2 hr x 24 hrs, then 10-
20 mg q4th, not to exceed 120 mg/day.
 Cont.,.,

Nursing considerations:
1.Assess Maternal & fetal heart tones during infusion and also Intensity &
length of uterine contractions

2.Monitor Fluid intake to prevent fluid overload, discontinue if

this occurs.

3.Administer only clear solutions after dilution 150 mg in 500 ml D5W or

NS, give at 0.3 mg/ml By Using infusion pumps/monitor carefully

4.Positioning of patient in left lateral recumbent position to decrease

hypotension & increase renal blood flow.

5.Advise patient to remain in bed during infusion.

DRUGS USED IN LABOR
 Cont.,.,

Here are the drugs used in labor are:

Oxytocics Anaesthesia &

Analgesia

Anticoagulant
 OXYTOCICS

•Oxytocics are the drugs that have the power to excite

contractions of the uterine muscles.
•Among a large number of drugs belonging to this group
the ones that are important and extensively used are :-

1. Oxytocin

2. Ergot derivatives

3. Prostaglandins
 Oxytocin:
•Oxytocin is an octapeptide synthesized in the
hypothalamus and stored in the posterior pituitary.
Action:
Preparations:
•Acts directly on
Synthetic oxytocin available for parenteral use
myofibrils producing
includes:-
uterine contractions
•Syntocinon : 5units/ml in ampoules of 1 ml
stimulates milk ejection
•Pitocin: 10 units/ml in ampoule of 0.5 ml
by the breasts.
•Syntometrine : A combination of
syntocinon on 5 units & ergometrine
0.5mg
•Oxytocin nasal solution :40 unit/ml.
 Cont.,.,

Indications:

Therapeutic Diagnostic

Pregnancy Puerperium
• Contraction stress test

• Oxytocin sensitivity test

Labour
 Cont.,.,
Early Late pregnancy Labour Puerperium
pregnancy

 To  To induce  Augmentation  To minimize

accelerate labour of labour blood loss
abortion  To facilitate  Uterine  To control
 To stop cervical ripening inertia postpartum
bleeding Active hemorrhage
following management of
evacuation third stage of
 Adjunct to labour
induction of  Following
abortion expulsion of
placenta.
 Cont.,.,
Contraindications:

•Grand multipara.
Pregnancy
•Contracted pelvis.
•History of lscs.
•Malpresentation.

•Obstructed labour.
Labour
•In coordinate uterine coordination.
•Fetal distress.

•Hypovolemia.
Any time
•Cardiac disease.
 Cont.,.,
Adverse effects:
Maternal:
•Uterine hyper stimulation
•Uterine rupture
•Antidiuresis
•Water intoxication
•Hypotension
Fetal:
•Fetal distress.
•Fetal hypoxia.
•Fetal death.
 Cont.,.,

Nursing considerations:
1.Assess Patient I/O Ratio, Uterine contraction, BP, pulse &
respiration.

2.Administer By IV infusion After having crash cart available in

the ward.

3.Evaluate patient Length & duration of contractions and Notify

physician of contractions lasting over one minute or absence of
contractions.
 Ergot derivatives:
•Ergot alkaloids are either natural or semi synthetic.

Preparations:
•Ergometrine- 0.25mg/ 0.5mg
ampoules & 0.5-1mg tablets.
•Methergine - 0.2 mg ampoules & 0.5-1mg tablets.
•Syntometrine Ergometrine - 0.5 mg+ syntocinon 5.0 units
ampoules.
 Cont.,.,
Note:
•Ergometrine & Methergine can be used parenterally or orally. As the
drug produces titanic uterine contractions, it should only be used after
delivery of the anterior shoulder or following delivery of baby.

•It should not be used in induction of labor or abortion.

•Syntometrine should always be administered IM.

Mode of Action:

Ergometrine acts directly on the myometrium. It stimulates uterine

contractions & decreases bleeding.
 Cont.,.,
Indications:

Therapeutic Prophylactic

To stop atonic uterine Prophylaxis against

bleeding following excessive
Delivery, abortion or hemorrhage
expulsion of following
hydatidiform mole delivery
 Cont.,.,
Contra-Indications:
Prophylactic:-
• Suspected plural pregnancy.
• Organic cardiac disease.
• Severe pre-eclampsia and eclampsia.
• Rh negative mother.
Therapeutic:
• Heart disease or severe hypertensive disorder.
 Cont.,.,

Dosage and routes of

Adverse effects:
administration:
1. Rise of BP due to
•For active management of 3rd stage of
vasoconstriction action.
labour-0.2mg(amp) to be given IM.
2. Prolonged use in puerperium
may interfere by decrease •For control of atonic PPH
concentration of prolactin & -1amp slowly over 60
gangrene of toes due to seconds, may be repeated after
vasoconstriction. 2hrs.
•Tablet(0.125mg)TDS
 Cont.,.,

Nursing considerations:
1.Assess patient BP, pulse, respiration, signs of hemorrhage

2.Administer Orally/IM deep, have emergency cart readily

available.

3.Evaluate for decrease blood loss

4.Advised patient to report for increased blood loss, abdominal

cramps, headache, sweating, nausea, vomiting/ dyspnea.
 Prostaglandins:

Prostaglandins are synthesized from one of the

essential fatty acids, archidonic acid, which is widely
distributed throughout the body. In the female, these
are identified in the menstrual fluid, endometrium,
decidua & amniotic membrane.
 Cont.,.,

Preparations:
•Tablet- 0.5mg

1. PG E2 –
Prostin E2
( Dinoprosto
ne)
Gel-0.5mg E2
in 2.5ml gel-
comes in pre
loaded syringe.
 Cont.,.,

Action:
•Both PGE2 & PGF2 alpha have an oxytocic effect
on the pregnant uterus. They also sensitize the
myometrium to oxytocin. PGF2 alpha acts
predominantly on the myometrium, while PGE2 acts
mainly on the cervix.
 Cont.,.,

Indications:
Contraindications:
1.For induction of abortion during 2nd
1. Hypersensitivity.
trimester & expulsion of hydatidiform
mole. 2. Uterine fibroids.

2.For induction of labor in IUD of fetus. 3. Cervical stenosis.

3.In augmentation/ acceleration of labor. 4. PID.

4.To stop bleeding from the open uterine sinuses

as in refractory cases of atonic PPH
5. Cervical ripening.
 Cont.,.,

Side effects: Dosage & routes of administration:

1. Headache •Tablets: containing 0.5 mg prostin E2.
2. Dizziness •Vaginal suppository: containing 20 mg PGE2 or 50 mg
3. Hypertension PGF2 alpha.
4. leg cramps •Vaginal pessary: 3mg PGE2.
5. Joint swelling. •Injectable ampoules/vials of prostinE2 - 1 mg/ml prostin
F2 alpha.

•5mg/ml Misoprostol 50mg given 4 hourly by oral, vaginal/

rectal route for induction of labour.
 Cont.,.,
Nursing considerations:
1.Assess patient RR, rhythm & depth, vaginal discharge, itching/
irritation

2.Administer Antiemetic/ antidiarrheal preparations prior to giving

this drug, high in vagina, after warming the suppository by running
warm water over package

3.Evaluate patient for length & duration of contractions, notify

physician of contractions lasting over 1 minute or absence of
contractions, fever & chills

4.Advised patient to remain supine for 10-15 minutes after

vaginal insertion.
 ANESTHESIA &
ANALGESIA
ANAESTHESIA:
Anaesthesia is a state of controlled, temporary loss of sensation
or awareness that is induced for medical purposes.
ANALGESIA:
Analgesia is the absence of pain, particularly the relief of pain
without the loss of consciousness; absence of pain or noxious
stimulation.
 Cont.,.,

Here are the list of anaesthesia & analgesia used in labor are:
Acetaminophen. Bupivaccine.
Ibuprofen.
Fentanyl.
Diclofenac suppository. Naloxone.
Nitrous oxide. Lidocaine.
Pethidine hcl.
Acetaminophen (paracetamol):
Preparation:
•Tablet-80mg,160mg,500mg

•Suppository-80mg,120mg

•Oral solution-16m/ml,80mg/ml

Action:
•Produce analgesia by inhibiting prostaglandins and other substances that
sensitizes pain receptors.

Indications:
1. Mild to moderate pain.

2. Fever
 Cont.,.,

Contraindications:

1. Liver disease

2. Hypersensitivity
Adverse effects:

3. Neutropenia

4. Hemolytic anemia

5. Hypoglycemia

6. Urticaria
 Cont.,.,

Dosage and route of administration:

•500mg tablet thrice a day for 5 days

Nursing considerations:

1.Advise the patient to not to exceed the prescribed

dose.

2.Advise the patient hat drug is only for short term use and
avoid taking OTC drugs without prescription.

3.Advise patient to take tablet after meal to prevent GI

symptoms.
Ibuprofen:

Dose & Route Action Indication Side effects Nursing considerations

Tab • Fever. • Stomach • Assess vital signs.

•Inhibits
400mg.
Route: Oral cyclooxygenase • Headache. upset • First trimester
and lipoxygenase, • Mild Pain. • Heart burn exposure should be
leading to reduced • Dysmenorrh • Dizziness minimised.
prostaglandin. ea. • Bloating, • Assess for allergic
gas reaction.
• Diarrhoea
or
constipation
.
Diclofenac suppository:

Dose & Action Indication Side effects Nursing

Route considerations

Tab •Inhibits • Pain • Head ache • Assess the level of

12.5 mg to
100 mg. cyclooxygenase • Inflammation • Drowsiness pain.
Route: and lipoxygenase, • Dysmenorrhea • Appetite • Assess and manage
Suppository
leading to reduced • Alkylosing • Gas the side effects of
prostaglandin spondylitis. • Irritation of medication.
synthesis. bowel. • Monitor vital signs.
Nitrous oxide:

Dose & Action Indication Side effects Nursing

Route considerations
•Gas 50% •Exact action •
oxygen and 50% unknown. Labor • Dizziness • Assess vital signs.
nitrous oxide •It is thought to have pain. • Fatigue • Assess for allergic
•100 to 800 an effect on gamma • Low pain • Headache reaction.
aminobutryic acid cells
ppm. tolerance • Excessive
(GABA) increasing
Route: inhibition of nerve sweating
Inhalation cells causing
• Shivering.
drowsiness & sleep.
Pethidine hydrochloride:

Dose & Action Indication Side effects Nursing

Route considerations

Inj. 100 mg per •Binds opioid • Labor pain • Delirium • Monitor blood
2 ml.
Route: IV receptors in the • Preoperative • Respiratory pressure, pulse,
central nervous sedation. depression. respiration.
system. • Obstetric • Hypotension. • Assess for allergic
analgesia. reaction.
• Assess the level
of pain.
Bupivaccine:

Dose & Action Indication Side effects Nursing

Route considerations

Inj. •Opiate receptor

2.5 ml • Labor pain • Dizziness • Assess for allergic
agonist- antagonist.
Of 0.5% • Conduction and • Fatique reaction.
Route:
labor • Headache • Monitor vital signs
Parental
or anaesthesia. • Excessive • Proper
Topical sweating administration of
• Shivering. medication.
• Nausea and
vomiting.
Fentanyl:

Dose & Action Indication Side effects Nursing

Route considerations

Inj. •Binds to various • Labor pain • Dizziness • Assess foe

50 to 100mcg opiod receptors. • Anesthesia • Fatique hypersensitivity
Route: IV • Preoperative • Headache reaction.
analgesia. • Excessive • Monitor vital signs.
• Regional sweating.
anesthesia • Shivering.
• Post operstive
pain relief
Naloxone:

Dose & Action Indication Side effects Nursing

Route considerations

Inj. •Opiate antagonist. • Tachycardia • Nausea, • Check for expiry.

0.4 to mg • Restlessness vomiting • Assess for
Route: • Agitation • Fever. hypersensitivity
•Endotracheal • Sweatimg. reaction.
•Intranasal • Tremers or • Monitor vital signs.
•IM shivering.
•IV • Restless
• Irritable
Lidocaine:

Dose & Action Indication Side effects Nursing

Route considerations

Inj:1 to 1.5mg •Depress action • Local pain • Nausea, • Check for expiry.
per kg potential • Episiotomy vomiting • Assess for
Route: ID • Per vaginal • Fever. hypersensitivity
examination • Sweating. reaction.
• Tremors or • Monitor vital signs
shivering.
• Restless
• Irritable
 ANTI COAGULANT
Vitamin K(phytonadione
At birth, the newborn does not have bacteria in the colon
that necessary for synthesizing fat soluble vitamin k.
Therefore newborns have decreased level of Prothrombin
during the first 5 to 8 days of life.
Preparation:
•INJ- 2ml vial=2mg/ml.
 Cont.,.,
Action:
•It promotes the hepatic formation of the clotting factors II,VII,IX and X.

Indications:
1. It is used to treat or prevent certain bleeding problems.
2. It helps liver to produce blood clotting factors
Contraindications:
•Hypersensitivity

Adverse effects:
1. Pain and edema may
occur at injection site.
2. Allergic reaction such
as rash and urticarial
 Cont.,.,

Dosage and routes of administration:

•0.5mg IM within 1 hour of birth.
Nursing considerations:

1.Document the giving of the medication newborn to prevent

an accidental doubling.

2.Observe for bleeding usually occurs on 2ndand 3rd day.

3.Observe for jaundice.

4.Observe for local inflammation.

DRUGS GIVEN DURING PUERPERIUM
 Cont.,.,

Here are the drugs given during puerperium are:

Iron Folic Calcium

acid

Acetamin Lactation
ophen suppress
ant
 Lactation suppressants
(Bromocriptine mesylate)
Preparation:
•Tablet-0.8mg,2.5mg
Action:
•It blocks the release of a prolactin from the pituitary gland.

Indications:
• Suppression of lactation
• Pregnancy with prolactinoma.
• Infertility.
• Amenorrhoea.
 Cont.,.,

Adverse effects:
1.Dizziness or lightheadedness especially when getting up from lying
position.
2. Confusion
3. Hallucinations
4. Hypertension
5. Seizures
6. Myocardial infarction

Dosage and routes of administration:

•2.5mg tablet orally once in a day.
 Cont.,.,

Nursing considerations:
•Monitor patient for adverse reactions
•Drug may lead to early post partum conception .after menses
resumes, test for pregnancy every 4 weeks or as soon as
period is missed.
•Assess orthostatic vital signs before initiation of the therapy.
•Instruct the patient to take drug with meal.
 OTHER CLASSIFICATION OF
DRUGS

Antibiotics Antiepileptics Vaccines

 ANTIBIOTICS
Here are the ANTIBIOTICS that are commonly used:
Erythromycin:

Dose & Action Indication Side effects Nursing

Route considerations
•Inhibits protein • Fever • Nausea • Check for
250- 500 mg
Route: Oral synthesis by • Infection • Vomiting hypersensitivity
binding the P site of • PPROM • Abdominal before
the 50S ribosomal • STD pain administration.
sub unit • Bacterial • Diarrhoea • Monitor intake and
endocarditis • Anorexia output
• Group B
streptococcus
Ampicillin:

Dose & Action Indication Side effects Nursing

Route considerations
•Bactericidal by • Fever • Nausea • Check for
250- 500 mg
Route: Oral inhibition of cell • Infection • Vomiting hypersensitivity
wall mucopeptide • Group B • Abdominal before
synthesis. streptococcus discomfort administration.
• Rashes • Monitor intake and
output
 ANTIEPILEPTICS
Here are the ANTIEPILEPTICS that are commonly
used:
Diazepam:

Dose & Action Indication Side effects Nursing

Route considerations
•Binds • Eclampsia • Severe • Monitor blood
2 to 10 mg
benzodiazepine and • Pre-eclampsia burning pressure
Route:
possibly GABA • Seizure • Drowsiness • Maintain intake
Parenteral
receptors centrally. • Status • Muscle output charge
epilepticus weakness • Administer drug
• Muscle spasm • Headache regularly
• Anxiety • Tremor • Do not administer
• Ptyalism intra arterially;
may produce
arteriospasm
Phenytoin:

Dose & Action Indication Side effects Nursing

Route considerations

•Regulates motor • Eclampsia • Headache • Administer by slow

300 to 400 mg cortex neural • Pre eclampsia • Nausea IV
Route: IV voltage- • Seizure • Vomiting • Monitor blood
dependence sodium • Status • Drowsiness pressure
and calcium epilepticus • Trouble • Check serum level
channels sleeping after 72 hours
• Nervousnes
s
 VACCINES
Here are the VACCINES that are indicated:
Tetanus toxoid (T.T):

Dose & Action Indication Side effects Nursing

Route considerations
•Active • Tetanus • Injection site • Check for
0.5 ml
immunization susceptibility soreness hypersensitivity
Route: IM.
• Fever • 2 doses should be
• Malaise administer in
• Hypotension pregnancy in a
• Pruritis interval of 4 weeks
• Generalized
aches
Influenza:

Dose & Action Indication Side effects Nursing

Route considerations
•Active • Non immune • Injection site • Check for
0.5 ml
immunization status soreness hypersensitivity
Route: IM.
• Pregnancy • Fever • Check for history
• Malaise of gullien barer
• Hypotension syndrome
• Pruritis • Provide education
• Generalized • Protect staff and
aches patient
Oral Polio Vaccine (OPV):

Dose & Action Indication Side effects Nursing

Route considerations
2 drops •Active • To prevent • Injection site • Should be
immunization poliomyelitis
Route: Oral soreness administered in
• Fever women as cold
• Malaise • Maintain cold
• Hypotension chain
• Pruritis
EFFECTS OF MATERNAL MEDICATIONS
ON FETUS & BREAST FEEDING
INFANTS
 Cont.,.,

1.During early embryogenesis, the drugs taken by the mother reach

the conceptus through the tubal/ uterine secretions by diffusion.

2.The harmful effect on the blastocyst is usually death, in case of

survival there is chance of congenital anomalies.

3.From 2nd-12th week (period of organogenesis) drugs can cause serious

damages

4.Gross congenital malformations & even death of the fetus may result,
depending on route, length of time & dose of exposure.
 Cont.,.,

5.From 2nd trimester transfer of drugs takes place through the

utero-placental circulation due to lowered serum albumin
concentration which results from haemodilution

6.As the albumin binding capacity of the drugs is decreased

more free drug is available for placental transfer

7.The metabolism of the drug may be hampered by the increase in

plasma steroids, increased utero-placental blood flow, increased
placental surface area & decreased thickness of placental
membrane are the additional cause for increased drug transfer
 Cont.,.,

5.Fetotoxic/ teratogenic drugs are prescribed only

when the benefits out weigh the potential risks. Prior
counselling is mandatory & minimum therapeutic
dosage is used for shortest possible duration.
 Maternal medications with
established teratogenic properties &
their effects

Cytotoxic drugs: multiple fetal malformations &

abortion.
Androgenic steroids, hydroxy progesterone:
masculinization of the female offspring.
Lithium: increased congenital malformations when
used in the 1st trimester, neonatal goitre, hypotonia &
cynosis.
Diethyl stillbestrol: vaginal stenosis, cervical hoods
uterine hypoplasia in female fetuses.
Drugs identified as having effects on lactation &
the neonates

• Bromides: rash, drowsiness, poor feeding

• Iodides: neonatal hypothyroidism

• Chloramphenicol: bone marrow toxicity

• Oral pill: suppression of lactation

• Bromocriptine: suppression of lactation

• Ergot: suppression of lactation

•Metronidazole: anorexia, blood dyscrasias, weakness,

neurotoxic disorders
 Cont.,.,

• Anticoagulants: hemorrhagic tendency

• Isoniazid: anti-DNA activity &

hepatotoxicity

• Antithyroid drugs & radioactive iodine:

hypothyroidism & goiter

• Diazepam, opiates, phenobarbitone: sedation

effect with poor sucking reflex.
 REFERENCES
Annamma Jacob “ A Comprehensive Textbook of Midwifery & Gynecological
Nursing” 3rd edition. Jaypee Brothers Medical Publishers (P) Ltd page no. 604-
619
D.C.Dutta’s “Textbooks of Obstetrics” 7th edition. New Central Book Agency
(P) Ltd page no.666.
A.K Debdas “Drug handbook in Obstetrics”,3rd edition.Jaypee brothers and
medical publishers private limited, New Delhi.
Wolter Kluwer “Drug handbook”32ndedition.Lippincot William &Wilkinson
publisher ,London.
Weiner C P “Drugs for pregnant an lactating women” 3rd edition, Elseiver’s
publication.