Question

Choose at least three medication from the following list and describe the medication in detail including but not limited to:
a. Generic name, Trade name, Classification of medication, Dosage, Routes.

b. Why the patient would take this medication, action of medication, side effects / adverse effects, any lab values needed, contraindications, nursing implications, desired outcomes.

1. Pitocin

2. Stadol

3. Methergine

Answer 1

PITOCIN

A.

• Generic Name- Oxytocin
• Trade Name- Pitocin
• Classification of medication - Oxytocic hormone
• Dosage:-

Labor induction: 0.5-1mUnit/min IV

Post partum hemorrhage:10 units IM after delivery of placenta

Incomplete or inevitable abortion: 10-20 mUnit/min; not to exceed 30 units/12 hours ​​​​​​​​​​​​​​​​​​​​​​​​

• Routes- intravenous, intramuscular

B.

• ​​​​​​Indication -

1. Labor inductions

2. Post partum hemorrhage

3. Incomplete or inevitable abortion

• Action of medication

Uterine stimulant, vasopressive, & antidiuretic effects; activates G-protein-coupled receptors that trigger increases in intracellular calcium levels in uterine myofibrils, which results in uterine contractions; increases local prostaglandin production, which further stimulates uterine contraction.

• Side effects/ Adverse effects

1. sinus bradycardia,
2. Tachycardia
3. Fetal death
4. Neonatal jaundice
5. Permanent CNS or brain damage.

• ​​​​​​Contraindications

1. ​​​​Significant cephalopelvic disproportion
2. Unfavorable fetal position
3. Obstetric emergency that favour surgery
4. Fetal distress where delivery is not imminent
5. Hyperactive or hypersonic uterus.
6. Hypersensitivity

• 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.

Patient & family education

• Be aware of purpose and anticipated effect of oxytocin.
• Report sudden, severe headache immediately to healthcare providers

​​​​​​

​​​​​​​

STADOL

A.

• Generic Name- Butorpganol
• Trade Name- Stadol
• Classification of medication - Narcotic analgesic
• Dosage:

IV: 1 mg IV q3-4hr PRN, dosage range 0.5-2 mg q3-4hr

IM: 2 mg IM q3-4 hr,dosage range 1-4 mg q3-4hr.

1 mg/ spray( nasal spray)

• ROUTE

intramuscular, intravenous, intranasal

B. INDICATION

1. Preoperative

2. Preanesthesia

3. Renal and hepatic impairment

4. Labor pain

• ACTION OF MEDICINE

Narcotic agonist-analgesic of kappa opiate receptors and partial agonist of mu opiate receptors; inhibits ascending pain pathways, which causes alteration in response to pain; produces analgesia, respiratory depression, and sedation.

• SIDE EFFECT/ADVERSE EFFECT

1. Nasal congestion

2. .Nausea and/or vomiting

3. .Insomnia .

4. Anorexia.

5. Anxiety

6. Burred vision.

7. Bronchitis.

8. Confusion.

9. Constipation

10. Epistaxis

• CONTRAINDICATIONS

​​​Absolute:

1.opioid dependence,

2. respiratory depression,

3.respiratory failure

Relative:

1.cardiac arrhythmias,

2.cardiovascular disease,

3.coronary insufficiency,

4.myocardial infarction,

5.Toxin-mediated diarrhea

​​​​​​​NURSING IMPLICATIONS

• use caution with concurrent use of MAOIs (Monoamino oxidase inhibitors)
• may cause confusion, hallucinations, sedation
• monitor for CNS depression
• assess blood pressure pulse and respirations during administration
• administer slowly through IV line

METHERGINE

A.

• Generic Name- Methylegonovine maleate
• Trade Name- Methergine
• Classification of medication - Ergot alkaloids
• Dosage:0.2 mg IM/IV q2-4hr PRN; not to exceed 5 doses, THEN 0.2-0.4 mg PO q6-8hr PRN for 2-7 days

  Administer IV only in emergency because of potential for Hypertension & CVA

  Administer over >1 minute and monitor BPBP

• ROUTE- Intravenous, intramuscular and oral route

B.

INDICATION

1. Post partum hemorrhage

ACTION OF MEDICATION:

Produces vasoconstriction to increase strength, duration, & frequency of uterine contraction which in turn impedes uterine blood flow

SIDE EFFECT/ADVERSE EFFECTS

​​​​​​1.Nausea/vomiting

2.Dizziness

3.Headache

4.Tinnitus

5.Diaphoresis

6.Palpitation

7Transient chest pain

8.Dyspnea

9.Thrombophlebitis

10.Hematuria

11.Water intoxication

• CONTRAINDICATIONS

​​​​​​​

1.Hypertension

2. heart disease

3. Toxemia,

4. Pregnancy,

5.Hypersensitivity,

6.mitral valve stenosis,

7.Prolonged use

8. Cases of threatened spontaneous abortion

9. Avoid during breastfeeding

• NURSING IMPLICATIONS

1. ​​​​​can cause hypertension, cramps, nausea, vomiting, dyspnea
2. monitor BP, heart rate, uterine response
3. assess calcium levels – effectiveness ↓ with hypocalcemia
4. monitor uterine bleeding and notify physician of any changes