Medication

Synthetic hormone

Oxytocin
(Pitocin)

Action

Uses

Adverse Effects

Oxytocin is
produced in
posterior
pituitary glad to
stimulate
uterine
contractions
and aids in milk
let-down
[pitocin=synthe
tic form]

Labor induction &

augmentation

Maternal adverse:
Uterine tachysystole,
placental abruption,
uterine rupture,
uneccessary cesarian
birth by nonrassuring
FHR, postpartum
hemorrhage,
infection

Uterine
contraction
postpartum

Fetal adverse:
hypoxemia & acidosis
eventually resulting
in nonreassuring FHR
& patterns

Nursing
Consideration
s
Administered per
pump by itself using
a standard
concentration.
Monitor to
anticipate
Fetal status &
contractions:
First stage [q15 min
and c qdose]
Active pushing
phase 2nd stage
[q5min]
BP, P, RR q30-60
min & c qdose
Limit IV intake to
1000ml q 8hr
Urine output should
be 120ml q4h

Prostaglandin E1
(PGE1)
Misoprostol
(Cytotec)

Ripens cervix
making it
softerbegins
to dilate &
efface
Stimulates
uterine
contractions

Used for
preinduction of
labor when Bishop
score 4 & to
induce labor or
abortion

N/V/D, fever, uterine

tachysystole c or s
nonreassuring FHR &
pattern, fetal
passage of
meconium.

Off-label use:
cervical ripening
& labor induction

Risk of adverse
effects reduced c
lower doseages and
longer intervals
between doses

Document all
timing, doses, &
interventions c
responses
Not FDA approved
for cervical ripening
Infomed consent
needed
C/I if hx CB or other
major uterine sx
Caution c hx
asthma, glaucoma,
renal or hepatic dz,
or CV dz
Bishop score before
& after c
assessment
Supine c lateral tilt
or side-lying postion
30-40 min post
insertion
Swab vagina c
saline soaked gauze
wrapped around
fingers [remove
unabsorbed
medication]
Initiate Pitocin for
induction no sooner
than 4 hrs after last
dose
Reverse c
terbutaline 0.25 mg
SQ

Manage Postpartum Hemmorhage

Dosing
Begin at 1
milliunit/min
& increase by
1-2
milliunits/min
no more than
q30-60min
based on
response
Goal:
Consistent
200-220
MVUs
Consistent
pattern of 1
contraction q
2-3min,
lasting 80-90
sec, and
strong to
palpation

Oxytocin (Pitocin)contracts uterus & bleeding*

Dinoprostone (Prostin E2)contracts uterus

Misoprostol (cytotec)contracts uterus*

[continue monitoring vaginal bleeding and uterine tone for all medications]

Methylergonovi
ne (Methergine)
Ergovine
(Ergotrate)

Contraction of
uterus

Contraction of
uterus to control
hemmorhage

HTN, N/V, H/A

Check BP before
giving, hold if
BP>140/90

0.2 mg IM
q2-4h up to 5
doses

C/I HTN, CV dz

[PO, intrauterine,
IM]
15Methylprostaglan
din F2
(Prostin/15 m)
Carboprost
(Hemabate)

Contraction of
uterus

CNS Depressant

Relaxes smooth
muscle
including uterus

Contraction of
uterus to control
hemmorhage

H/A, N/V/D, fever,

HTN, HR

Avoid c HTN or
asthma

0.25 mg IM or
intrauterine
q15-90 min
up to 8 doses

Tocolytic Therapy for Preterm Labor

Magnesium
Sulfate

Tocolytic Therapy
for Preterm Labor

Hot flashes,
sweating, site
irritation, N/V, D/D,
dry mouth, ileus, H/A,
blurred vision, muscle
weakness, SOB,
transient hypotension
Ca
Intolerable: RR12,
pulmonary edema,
absent DTRs, chest
pain, severe
hypotension, UO
<25-30ml/hr
(100mL/4hr), serum
Mg >10mEq/L
(9mg/dL)

Beta-adrenergic
agonist (beta-mimetic)

Terbutaline
(Brethine)

Relaxes smooth
muscle,
inhibiting
uterine activity
and causing
bronchodilation

Tocolytic Therapy
for Preterm Labor

Fetal (uncommon):
breathing mvmt,
FHR variability,
nonreactive NST
HR, BP,
chest palpitation
BG, K
Tremors, dizzy,
nervous, H/A
Nasal congestion, N/V

Use for stabilization

only! DISCOTINUE
W/I 24-48 HR@
maintenance dose
Get baseline data
Therapeutic serum
Mg levels:4-7.5
mEq/L (5-8mg/dL)
Have 1g (10mL of
10% sol) calcium
gluconate or CaCl
(500mg infused
over 30 min)
C/I myasthenia
gravis

C/I hx cardiac dz,

any diabetes,
severe gestational
HTN, preeclampsia
or eclampsia,
migraines,
hyperthyroidism, or
significant
hemorrhage

Intolerable:
HR >130, BP <90/60,
chest pain,
arrhythmias, MI,
pulmonary edema
[SOB, crackles,
SaO2]

Verify in PTL & >20

weeks but <35
weeks

Fetal: HR, BG,

hyperinsulinemia

Hyperglycemia
more common in
concurrent use c
corticosteroids

Assess BG [>180] &

K [<2.5] before, and
periodically during

IV 40g in
1000mL IVPB
to primary
solution
Loading
dose:4-6g oer
20-30 min
Maintenance
dose: 1-4g/hr
Limit total IV
intake to
125mL/hr

Prostaglandin
synthetase inhibitors
(NSAIDs)

Relaxes uterine
smooth muscle
by inhibiting
prostaglandins

Tocolytic Therapy
for Preterm Labor

Common: N/V,
heartburn
GI bleed,
thrombocytopenia,
asthma in aspirinsenstive patients

Indomethacin
(Indocin)

Fetal:
Neonatal pulmonary
HTN,
oligohydroamnios
[from fetal urine
production],
constriction of ductus
arteriosus

Have Propanolol
(Inderal) to reverse
CV adverse effects
Use when other
methods fail and
gestation <32
weeks
Admin for 48h or
less

Loading dose:
50 mg PO
then 25-50
mg PO q6h
for 48hr

C/I in renal or
hepatic disease,
active PUD, poorly
controlled HTN,
asthma, &
coagulation
disorders
Can mask
maternal fever
Determine amniotic
fluid volume & fetal
ductus A. before tx
& w/I 48h of d/c tx
Admin c food

Calcium Channel
blockers

Nifedipine
(adalat,
Procardia)

glucocorticoid

Betamethasone
Dexamethasone

Relaxes smooth
muscle
including uterus
by blocking Ca
entry

Tocolytic Therapy
for Preterm Labor

BP, H/A, flushing,

dizziness, nausea
Fetal hypotension
(questionable)

Monitor for bleeding

Avoid use with Mg
sulfate [risk of
skeletal muscle
blockade]
Do not give with or
immediately after
terbutaline [BP &
HR effects]

Promotes
release of
enzymes that
induce
production or
relase
surfactant

Antenatal
glucocorticoid
therapy.
Accelerate lung
maturity in
fetuses 24-34
weeks gestation

Pulmonary edema (if

gien c betaadrenergic meds)
May worsen mother
diabetes, HTN, etc.

DO NOT USE SL
ROUTE
FDA has not
approved it for this
use
Give IM deep in
ventral gluteal or
vastus lateralis
muscle
Teach signs of
pulmonary edema

10-20mg PO
q3-6 hr until
contractions
rare; follow c
long-acting
30-60 mg q812 hr for 48
hr while
corticosteroid
s are given

Betamethaso
ne: [12mg IM
for 2 doses
24hrs apart]
Dexamethaso
ne:
[6mg IM for 4
doses 12 hrs
apart]

Assess blood
glucose and lung
sounds

PAIN CONTROL
SEDATIVES
Promote sleep and relieve anxiety
reduce nausea when opioid used

Used in prolonged latent phase; given to augment analgesics &

*barbituates are rarely ever used r/t SE. Benzodiazapines should be avoided during labor d/t maternal amnesia. Diazepam
disrupts thermoregulation in newborns making them less able to maintain body temperature.
Phenothiazines
Often given c
sedation
Phenergan:
opioids to
significant sedation
Promethazine
anxiety &
& has been shown
(Phenergan)
apprehension,

to impain analgesic
Hydroxyzine
sedation, &
efficacy of opioids
(Vistaril)
reduce N/V

Antiemetics
[use in place of
Phenergan whenever
possible]

Reduce N/V

Reglan: *causes
little sedation &
may potentiate
analgesic effects

*causes little
sedation & may
potentiate
analgesic effects

Metoclopramide
(Reglan)
Ondansetron
(Zofran)

Analgesia & Anesthesia

Opioid Agonist
Analgesics

Fentanyl Citrate
(Sublimaze)

Stimulates both
kappa and mu
receptors to
decrease
transmission of
pain impulses

Sufentanil
Citrate
(Sufenta)

Epidurally or
intrathecally
alone or in combo
with locak
anesthetic to
relieve moderate
to severe labor
pain

D/D, N/V

Postop pain post

cesearian

Urinary retention

(others preferred d/t

less SE)

Hydromorphone
hydrochloride
(Dilaudid)

Butorphanol
Tartrate (Stadol)
Nalbuphine
Hydrochloride
(Nubain)

Opioid antagonist
[reversal agent]

Naloxone
hydrochloride
(Narcan)

Narcotic analgesic

Percocet

Maternal or neonate
respiratory
depression

HAVE NARCAN
READY

Sublimaze:25
-50 mg IV, 1-2
mcg c
0.125%
bupivacaine
@ 8-10ml/hr
epidurally
Sufenta: 1015 mcg c
0.125%
bupivacaine
@ 10ml/hr
epidurally

Demerol has
prolonged neonatal
sedation
[normeperidine
metabolite]

Meperidine
(Demerol)

Duramorph
(Morphine)
Opioid Agonistantagonist
analgesics

Alleric reaction, rash,

itching

Sufenta has
stronger analgesic
action will less
placental passage
Duration 0.5-1hr IV,
1-2 hrs epidural

Stimulate kappa
opioid receptors
and block or
weakly
stimulate mu
opioid receptors

Mod to severe
labor pain
Postoperative
pain post cesarian

Results in
analgesia c less
respiratory
depression, N/V

Blocks both mu
and lappa
opioid receptos
from effects of
opioid agonists

Confusion, sedation,
H/A, D/D,
nervousness
Sweating, maternal
palpitations or
tachycardia or
bradycardia
Respiratory
depression

Revereses
respiratory
depression
Reverse pruritis
from epidural
opioids

Pain reliever &

cough

Urinary
retention/urgency
Maternal BP or BP
HR
N/V, sweating,
tremulousness

VS & FHR before,

during, and after
Encourage voiding
q2h & assess
bladder distention
If baby born 1-4
hours p dose,
assess for
respiratory
depression

Contraindicated in
opioid dependent
mothers
[preceiptates
withdrawal
symptoms]

Watch mothers
wuth suppressed

Stadol: 1mg
(0.5-2) IV q34h; 2 mg (14) IM q3-4h
Nubain: 5-10
mg q3h, 1020mg IM q34h

Adult OD:
0.4-2mg IV
q2-3 u to
10mg [can
use IM or SQ]
Postop: 0.10.2mg IV q2-3
min up to 3
doses [can
repeat in 1-2
hrs]
Newborn:
0.1 mg/kg IV,
IM, or SQ, can
repeat q2-3
mn up to 3
doses

(OxycodoneAcetaminophen)

suppressant

cough reflex
Good for aspirin
sensitive people

Local Anesthetics
Regional analgesia (some pain relief & motor block) & anesthesia (complete pain relief & motor block)
Used in: Local perianal infiltration anesthesia
Pudenal nerve block
Spinal anesthesia
anesthesia or analgesia (block)
Local anesthetics
Some relief &
Allergic reactions
Reverse effects c
motor block
rare: respiratory
epi, antihistamines,
depression,
O2, & supportive
Bupivacaine
Used with
hypotension
measures
(Marcaine)
epidural
Lidocaine

Epidural

(Xylocaine)
[-caine]

Dermoplast

Topical analgesic
spray post
episiostomy or
tear

(Benzocaine spray)

Cortisone/
Hydrocortisone
cream

Symptom Management
Medication

Action

Uses

Adverse
Effects

Nursing
Consideration
s

Dosing

Nursing
Consideration
s

Dosing

Relief of gas

Simethicone

Benadryl

Surfak

Stool softener

Labetolol

Control high BP

Newborn Medications
Medication
Vitamin K:
Phytonadione
(AquaMEPHY
TON,
Konakion)

Action
Provides vit K as
newborn lacks
intestinal flora to
produce it.
Promotes
formation of
clotting factors (II,
VII, IX, X) in liver

Uses

Adverse
Effects

Prevention & tx of
hemmorhagic
disease in newborn

Edema, erythema,
pain at injection
site (all rare)
Hemolysis,
jaundice,
hyperbilirubinemia
(have been
reported
particularly in
preterm infants)

25 G, 5/8 needle
Middle third vastus
lateralis
90, aspirate,
inject slow
Massage after c
dry gauze to
promote
absorption
In preterm infant c
no muscle mass is

0.5-1 mg (0.250
0.5 mL) IM within
first 2 hours of
birth [can be
repeated of
bleeding
tendencies]

BOLUS can lead to

cardiac arrest!

Erythromycin
ophthalmic
ointment,
0.5%
Tetracycline
ophthalmic
ointment, 1%

Bacteriostatic &
bacteriocidal

Triple Dye

Antimicrobial

*stump
deteriorates
through a
process of dry
gangrene

Prophylactic tx
against opthalmia
& natorum d/t
exposure to
vaginal bacterial
environment (esp
those c gonorrhea
& chlamydia)

prevent infection
& promote
drying of
umbilical cord
stump

Chemical
conjunctivitis that
lasts 24-48h

ONLY reason to
give IV: dilute and
give over 10-15
minutes while
monitoring closely
c cardiorespiratory
monitor
Inner to outer
canthus on lower
conjunctiva BIL

1-2cm ribbon to
lower conjunctiva
sac of each eye

Vision can blur

temporarily

Admin within 1-2h

of birth

Can also be drop

form

Open eye c thumb

& finger. Do not
touch tube to eye.
After 1 min, wipe
excess ointment.

Cleanse cord &

skin around
stump with dye.
Assess stump for
edema, purulent
drainage, &
redness c each
diaper change
Omphalitis (odor
of stump) is not
indicator of
infection

Narcan*--see above