Drug study for commonly used medication in DR

a.oxytocin
generic name:oxytocin

drug classification\general action: HORMONES AND SYNTHETIC

SUBSTITUTES; OXYTOCIC:

mechanism action: Synthetic, water-soluble polypeptide consisting of eight amino acids,

identical pharmacologically to the oxytocic principle of posterior pituitary.

dosage,frequency,route:

Antepartum
Adult: IV Start at 1 mU/min, may increase by 1 mU/min q15min (max: 20 mU/min)

Postpartum
Adult: IV Infuse a total of 10 U at a rate of 20–40 mU/min after delivery

To Promote Milk Ejection

Adult: Nasal 1 spray or 1 drop in 1 or both nostrils 2–3 min before nursing or pumping

side effects\adverse effects:

 nausea,
 vomiting,
 severe allergic reactions,
 bleeding after child birth,
 abnormal heart beats,
 high blood pressure, and
 rupture of the uterus.

adverse effects:

Body as a Whole: Fetal trauma from too rapid propulsion through pelvis, fetal death,
anaphylactic reactions, postpartum hemorrhage, precordial pain, edema, cyanosis or redness of
skin. CV: Fetal bradycardia and arrhythmias, maternal cardiac arrhythmias, hypertensive
episodes, subarachnoid hemorrhage, increased blood flow, fatal afibrinogenemia, ECG changes,
PVCs, cardiovascular spasm and collapse. GI: Neonatal jaundice, maternal nausea,
vomiting. Endocrine:ADH effects leading to severe water intoxication and hyponatremia,
hypotension. CNS: Fetal intracranial hemorrhage, anxiety. Respiratory: Fetal hypoxia, maternal
dyspnea. Urogenital: Uterine hypertonicity, tetanic contractions, uterine rupture, pelvic
hematoma

nursing implications\responsibilities: Nursing Implications

Assessment & Drug Effects

 Start flow charts to record maternal BP and other vital signs, I&O ratio, weight, strength,
duration, and frequency of contractions, as well as fetal heart tone and rate, before
instituting treatment.
 Monitor fetal heart rate and maternal BP and pulse at least q15min during infusion
period; evaluate tonus of myometrium during and between contractions and record on
flow chart. Report change in rate and rhythm immediately.
 Stop infusion to prevent fetal anoxia, turn patient on her side, and notify physician if
contractions are prolonged (occurring at less than 2-min intervals) and if monitor
records contractions about 50 mm Hg or if contractions last 90 seconds or longer.
Stimulation will wane rapidly within 2–3 min. Oxygen administration may be necessary.
 If local or regional (caudal, spinal) anesthesia is being given to the patient receiving
oxytocin, be alert to the possibility of hypertensive crisis (sudden intense occipital
headache, palpitation, marked hypertension, stiff neck, nausea, vomiting, sweating,
fever, photophobia, dilated pupils, bradycardia or tachycardia, constricting chest pain).
 Monitor I&O during labor. If patient is receiving drug by prolonged IV infusion, watch for
symptoms of water intoxication (drowsiness, listlessness, headache, confusion, anuria
weight gain). Report changes in alertness and orientation and changes in I&O ratio (i.e.,
marked decrease in output with excessive intake).
 Check fundus frequently during the first few postpartum hours and several times daily
thereafter.
 Incidence of hypersensitivity or allergic reactions is higher when oxytocin is given by IM
or IV injection rather than by IV infusion (diluted solution).
Patient & Family Education
 Be aware of purpose and anticipated effect of oxytocin.
 Report sudden, severe headache immediately to healthcare providers.

B.METHERGINE
GENERIC NAME: methylergonovine (METH-il-ER-goe-NOE-veen)

DRUG CLASSIFICATION/GENERAL ACTION: AUTONOMIC NERVOUS SYSTEM

AGENT; ADRENERGIC ANTAGONIST (SYMPATHOLYTIC); ERGOT ALKALOID; OXYTOCIC

MECHANISM OF ACTION: Ergot alkaloid that induces rapid, sustained tetanic uterine contraction
that shortens third stage of labor and reduces blood loss.

DOSAGE,FREQUENCY,ROUTE:

Postpartum Hemorrhage
Adult: PO 0.2–0.4 mg q6–12h until danger of atony passes (2–7 d) IM/IV 0.2 mg q2–4h (max: 5
doses)

SIDE EFFECT/ADVESE ACTION:

More common
 Abdominal pain
 headache
 increased blood pressure
Rare
 Blood in the urine
 change in skin color
 chest pain or discomfort
 difficult or labored breathing
 difficulty with swallowing
 dizziness
 fast, pounding, or irregular heartbeat or pulse
 hives
 lightheadedness, dizziness, or fainting
 pain or discomfort in the arms, jaw, back, or neck
 pain, tenderness, or swelling of the foot or leg
  puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
 slow or fast heartbeat
 skin rash
 sweating
 vomiting
Incidence not known
 Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
 confusion
 dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting
position
 fainting
 inability to speak
 seizures
 severe or sudden headache
 slurred speech
 temporary blindness
 weakness in the arm or leg on one side of the body, sudden and severe

 NURSING IMPLICATION: Monitor fundal height and consistency and the amount
and character of the lochia.
 Assess the blood pressure before and routinely throughout drug administration.
 Observe for adverse effects or symptoms of ergot toxicity(ergotism) such as nausea and
vomiting,headache,muscle pain,cold or numb fingers and toes,chest pain and general
weakness.

C.cytotec

GENERIC NAME: MISOPROSTOL

DRUG CLASSIFICATION/GENERAL ACTION & mechanism action:
DRUGCLASS AND MECHANISM: Misoprostol is a synthetic (man-made) prostaglandin that is
used to reduce the risk of stomach ulcers in patients treated with nonsteroidal
antiinflammatory drugs (NSAIDs, for example,aspirin, ibuprofen, etc.) that are used for pain and
various inflammatory conditions, for example, arthritis. Misoprostol is used primarily in patients
at high risk for stomach ulcers when treated with NSAIDs, for example, the elderly, patients
with concomitant debilitating diseases, and patients with a history of ulcers. Prostaglandins are
chemicals that are made within many organs of the body including the stomach. In the
stomach, prostaglandins are believed to protect the inner lining of the stomach from the ulcer-
producing effects of NSAIDs. Scientists now believe that NSAIDs produce ulceration by
preventing the production of prostaglandins in the stomach. Synthetic prostaglandins such as
misoprostol given orally "replace" the prostaglandins whose production is inhibited by NSAIDs
and have been shown to protect the lining of the stomach from NSAID-induced ulcers.
Misoprostol was approved by the FDA in December 1988.

DOSAGE,FREQUENCY,ROUTE:

 Duodenal Ulcer

 Gastric Ulcer

 NSAID-Induced Ulcer Prophylaxis

 Labor Induction

 Postpartum Bleeding

 Cervical Ripening

 Abortion

 Gynecologic Surgery

SIDE EFFECT/ADVESE ACTION: The medical abortion normally causes side

effects such as pain and cramping, as well as bleeding accompanied by the passage of
blood clots and tissue. Nausea, vomiting, diarrhea, headache, dizziness, and hot
flashes or fever may also occur.

NURSING IMPLICATIONs: Assessment & Drug Effects

  Monitor for diarrhea; may be minimized by giving drug after meals and at bedtime.
Diarrhea is a common adverse effect that is dose related and usually self-limiting (often
resolving in 8 d).
Patient & Family Education
 Avoid using concurrent magnesium-containing antacids because of increased incidence
of diarrhea.
 Report postmenopausal bleeding to physician; it may be drug related.
 Avoid pregnancy during misoprostol therapy; use an effective contraception method
while taking drug.
 Drug has abortifacient property. Contact physician and immediately discontinue drug if
you becomes pregnant.
 Do not breast feed while taking this drug.

D.vitamin k.

GENERIC NAME: Vitamin K(Pytonadione)

DRUG CLASSIFICATION/GENERAL ACTION& mechanismaction:

Phytonadione is used in prophylaxis and treatment of hemorrhagic disease of the newborn. It

promotes liver formation of the clotting factors II, VII, IX and X. At birth, the newborn does not
have bacteria in the colon that necessary for synthesizing fat-soluble vitamin K.Therefore,the
newborn may have deceased levels of prothrombin during the first 5 to 8 days of life reflected
by a prolongation of prothrombin time.

DOSAGE,FREQUENCY,ROUTE: Intramuscular injection is given in the vastus lateralis

thigh muscle.A one time onlyprophylactic dose of 0.5 to 1 mg is given intramuscularly in the
birthing area within 1 hour of birth

SIDE EFFECT/ADVESE ACTION: Pain and edema may occur at injection site. Allergic
reaction such as rash and urticaria,may also occur.

 NURSING IMPLICATIONs: Document the giving of the medication to newborn

to prevent an accidental doubling of the dose.
  Observe for bleeding (usually occurs on second or third day). Bleeding may be seen as
generalized ecchymoses or bleeding from umbilical cord, circumcision site, nose or
gastrointestinal tract.
 Observe for jaundice and kernicterus,especially in preterm infants.
 Observe for signs of local inflammation.
 Apply pressure to the injection site to prevent further bleeding
 Protect drug from light.
 Give vitamin K before circumcision procedure

lidocaine

GENERIC NAME: TOPICAL (LYE-doe-kane)

DRUG CLASSIFICATION/GENERAL ACTION: Anesthetic – topical or

local, Antiarrythmics

MECHANISM OF ACTION: When administered intramuscularly or intravenously,

Lidocaine suppresses the automaticity and spontaneous depolarization of the ventricles during
diastole by altering the flux of sodium ions across the cell membrane with little or no effect on
the heart. Locally, it produces local anesthesia effect by inhibiting the transport of ions across
the neural membranes. Thus, initiation and conduction of normal nerve impulses is prevented.

DOSAGE,FREQUENCY,ROUTE:

 SIDE EFFECT/ADVESE ACTION: Drowsiness

 Dizziness
 Nervousness
 (mucosal use) decreased or absent gag reflex
  Bradycardia
 Hypotension
 Burning sensation

 NURSING IMPLICATIONs: When Lidocaine is administered as an antiarrhythmic

the nurse should monitor the ECG continuously. Blood pressure and respiratory status
should be monitored frequently during the drug administration.
 When administered as an anesthetic, the numbness of the affected part should be
assessed.
 Serum Lidocaine levels should be monitored frequently during prolonged
use. Therapeutic serum lidocaine levels range from 1.5 to 5 mcg/ml.
 If signs of overdose occur (listed above), stop the infusion immediately and monitor the
patient closely.
 For throat sprays, make sure that the patient’s gag reflex is intact before allowing the
patient to eat or drink.
 When IM injections are used, the medication should be administered in the deltoid
muscle only while frequently aspirating to prevent IV injection.
 For direct IV injection only 1% and 2% solutions are used.
 Undiluted IV loading dose of Lidocaine is administered at 1 mg/kg at a rate of 25 to 50
mg over 1 minute. The dose may be repeated after 5 minutes

demerol

GENERIC NAME: meperidine

DRUG CLASSIFICATION/GENERAL ACTION: CENTRAL NERVOUS SYSTEM

AGENT; NARCOTIC (OPIATE) AGONIST ANALGESIC

MECHANISM OF ACTION: Synthetic morphine-like compound. Chemically dissimilar to

morphine, but in equianalgesic doses it is qualitatively comparable. Usual doses produce either
no pupillary change or slight miosis, but overdosage results in marked miosis or mydriasis. Also,
unlike morphine, has little or no antidiarrheic or antitussive action. Produces CNS stimulation in
toxic doses

DOSAGE,FREQUENCY,ROUTE:

Moderate to Severe Pain

Adult: PO/SC/IM/IV 50–150 mg q3–4h prn
Child: PO/SC/IM/IV 1–1.5 mg/kg q3–4h (max: 100 mg q4h) prn

Preoperative
Adult: IM/SC 50–150 mg 30–90 min before surgery
Child: IM/SC 1–2.2 mg/kg 30–90 min before surgery

Obstetric Analgesia
Adult: IM/SC 50–100 mg when pains become regular, may be repeated q1–3h

SIDE EFFECT/ADVESE ACTION: Body as a Whole: Allergic (Pruritus, urticaria, skin

rashes, wheal and flare over IV site), profuse perspiration. CNS: Dizziness, weakness, euphoria,
dysphoria, sedation, headache, uncoordinated muscle movements, disorientation, decreased
cough reflex, miosis, corneal anesthesia, respiratory depression. Toxic doses: muscle twitching,
tremors, hyperactive reflexes, excitement, hypersensitivity to external stimuli, agitation,
confusion, hallucinations, dilated pupils, convulsions. CV: Facial flushing, light-headedness,
hypotension, syncope, palpitation, bradycardia, tachycardia, cardiovascular collapse, cardiac
arrest (toxic doses). GI: Dry mouth, nausea, vomiting, constipation, biliary tract
spasm. Urogenital: Oliguria, urinary retention. Respiratory: Respiratory depression in newborn,
bronchoconstriction (large doses). Skin: Phlebitis (following IV use), pain, tissue irritation and
induration, particularly following subcutaneous injection. Metabolic: Increased levels of serum
amylase, BSP retention, bilirubin, AST, ALT.

 NURSING IMPLICATIONs: Give narcotic analgesics in the smallest effective dose

and for the least period of time compatible with patient's needs.
 Assess patient's need for prn medication. Record time of onset, duration, and quality of
pain.
 Note respiratory rate, depth, and rhythm and size of pupils in patients receiving
repeated doses. If respirations are 12/min or below and pupils are constricted or dilated
(see ACTIONS AND USES) or breathing is shallow, or if signs of CNS hyperactivity are
present, consult physician before administering drug.
  Monitor vital signs closely. Heart rate may increase markedly, and hypotension may
occur. Meperidine may cause severe hypotension in postoperative patients and those
with depleted blood volume.
 Schedule deep breathing, coughing (unless contraindicated), and changes in position at
intervals to help to overcome respiratory depressant effects.
 Chart patient's response to drug and evaluate continued need.
 Repeated use can lead to tolerance as well as psychic and physical dependence of the
morphine type.
 Be aware that abrupt discontinuation following repeated use results in morphine-like
withdrawal symptoms. Symptoms develop more rapidly (within 3 h, peaking in 8–12 h)
and are of shorter duration than with morphine. Nausea, vomiting, diarrhea, and
pupillary dilatation are less prominent, but muscle twitching, restlessness, and
nervousness are greater than produced by morphine.
Patient & Family Education
 Do not smoke and walk without assistance after receiving the drug. Bed side rails may
be advisable.
 Be aware nausea, vomiting, dizziness, and faintness associated with fall in BP are more
pronounced when walking than when lying down (these symptoms may also occur in
patients without pain who are given meperidine). Symptoms are aggravated by the
head-up position.
 Do not drive or engage in potentially hazardous activities until any drowsiness and
dizziness have passed.
 Do not take other CNS depressants or drink alcohol because of their additive effects.
 Do not breast feed while using this drug.