Question

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Medication related to pregnancy: provide (reference dose/safe dose), (rational/indication), and( nursing implication, interaction and teaching)

Oxytocin (Pitocin)

Rh immune globulin (Rhogam)

Surfactant

Magnesium Sulfate

Docusate (Colace)

Answer 1

Oxytocin (Pitocin)

Action: Acts directly on myofibrils, producing uterine contraction; stimulates milk ejection by the breast; vasoactive antidiuretic effect.

DOSAGE:

Available forms: Inj 10 units/ml

Postpartum hemorrhage: IV 10-40 units in 1000 ml non hydrating diluent infused at 20-40 mU/min

IM 10 units after delivery of placenta

contraction stress test(CST): IV 0.5 mU/min, increase evry 20min until 3 contravtions within 10 min

stimulation of labor: IV 1-2 mU/min, increase by 1-2 mU q15-60min untill contractions occur; then decrease dose

Incomplete abortion: IV INF 10 units/500ml D₅W or 0.9% NaCl at 10-20 mU/ min, maximum 30 umits/12hr

INDICATIONS;

• stimulation of labor
• induction of labor
• missed / incomplete abortion
• postpartum bleeding

INTERACTIONS:

Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) The administration of prophylactic vasopressors with oxytocin can cause severe, persistent hypertension, as the 2 drugs may have a synergistic and additive vasoconstrictive effect. This interaction was noted when oxytocin was given 3 to 4 hours after prophylactic vasoconstrictor in conjunction with caudal anesthesia. The incidence of such an interaction may be decreased if vasopressors are not administered prior to oxytocin.

NURSING IMPLICATIONS:

Assess:

• Input and output ratio
• Respiratoy rate, rhythm, depth, notify any abnormalities.
• blood pressure, pulse, watch for changes that indicate hemorrhage.
• Length, intensity, duration of contractions, notify if contractions lasting over 1 min or absence of contractions, turn patient to side, discontinue oxytocin.
• Fetal heart tones, fetal distress; watch for accelerations, decelerations, notify if roblem occur; turn patiet to left side if fetal heart tone change in rate , administer oxygen.
• Asess for any signs and symptoms of water intoxication - confusion, anuria, drowsiness

,TEACH patient and family

To report increased blood loss, abdominal cramps, foul smell lochia, fever.

The contractions similar to menstrual cramps,gradually increasing in intensity.

Rh immune globulin (Rhogam):

ACTION;

Suppresses immune response of non sensitized Rh_o(D or D^u)-negative patients who are exposed to Rh_o(D or D^u)- positive blood.

DOSAGE AND ROUTES:

Usual Adult Dose for Idiopathic (Immune) Thrombocytopenic Purpura

Rhophylac(R): 250 international units (50 mcg) per kg, IV, at 2 mL per 15 to 60 seconds
WinRho(R):
-Initial dose: 250 international units (50 mcg) per kg, IV, over 3 to 5 minutes; may be divided into 2 doses on separate days if desired.
-Maintenance dose: 125 to 300 international units/kg (25 to 60 mcg/kg), IV, over 3 to 5 minutes

Use: Immune thrombocytopenic purpura (ITP):
-Raising platelet counts in Rho (D)-positive, non-splenectomized chronic ITP

Usual Adult Dose for Rh-Isoimmunization

Dose and route varies for each product.

Rh-incompatible pregnancy:
RhoGAM(R): 1500 international units (300 mcg), IM, at gestational week 26 to 28, or within 72 hours of birth of an RHo (D) positive baby.
Rhophylac(R): 1500 international units (300 mcg), IV or IM, at gestational week 29 to 30; repeat dose within 72 hours of birth of an RHo (D) positive baby.
WinRho(R): 1500 international units (300 mcg), IV or IM, at gestational week 28; give an additional 600 international units (120 mcg) dose within 72 hours of birth of an RHo (D) positive baby.

Comments:
-If RhoGAM(R) or WinRho(R) are administered early in pregnancy, administer at 12 week intervals to maintain adequate anti-Rh levels.
-If the Rh status of the baby is not known at 72 hours, administer WinRho(R).

Amniocentesis and chorionic villus sampling before 34 weeks gestation:
RhoGAM(R): 1500 international units (300 mcg), IM
WinRho(R): 1500 international units (300 mcg), IV or IM, immediately after the procedure

Abortion or miscarriage of up to 12 weeks gestation:
BayRho-D Mini-Dose(R): 1 syringe, IM, within 3 hours, or as soon as possible (within 72 hours of pregnancy termination).
HyperRHO S/D Mini-Dose(R): 1 syringe, IM, within 3 hours, or as soon as possible (within 72 hours of pregnancy termination).
MICRhoGAM(R) or RhoGAM(R): 250 international units (50 mcg), IM, within 72 hours of actual or threatened pregnancy termination.

Abortion or miscarriage after 12 weeks gestation:
RhoGAM(R): 1500 international units (300 mcg), IM

Abortion, amniocentesis, or any other manipulation after 34 weeks gestation:
WinRho(R): 600 international units (120 mcg), IV or IM, within 72 hours

Ectopic pregnancy:
RhoGAM(R): 1500 international units (300 mcg), IM

Excessive fetomaternal hemorrhage:
Rhophylac(R): 1500 international units (300 mcg), IV or IM, within 72 hours of complication, plus:
-100 international units (20 mcg) per mL fetal red blood cells in excess of 15 mL if transplacental bleeding is quantified
OR
-an additional 1500 international units (300 mcg) dose if transplacental bleeding cannot be quantified

Obstetric complications/invasive procedures:
RhoGAM(R): 1500 international units (300 mcg), IM
Rhophylac(R): 1500 international units (300 mcg), IV or IM, within 72 hours of the at-risk event.

Threatened abortion at any time:
WinRho(R): 1500 international units (300 mcg), IV or IM, immediately

Threatened pregnancy loss after 12 weeks gestation with continuation of pregnancy:
RhoGAM(R): 1500 international units (300 mcg), IM

Incompatible transfusions:
MICRhoGAM(R) or RhoGAM(R):
-Transfusion of less than 2.5 mL of incompatible blood: 250 international units (50 mcg), IM, within 72 hours of exposure
RhoGAM(R):
-Transfusion of 2.5 to 15 mL incompatible blood: 1500 international units (300 mcg), IM, within 72 hours of exposure.
-Transfusion of over 15 mL incompatible blood: 20 mcg per mL transfused blood, IM, within 72 hours of exposure. May be given as a single dose or at spaced intervals within 72 hours of exposure.

Rhophylac(R): 100 international units (20 mcg) per 2 mL transfused blood (or per 1 mL erythrocyte concentrate), IM or IV, within 72 hours of exposure.
WinRho(R):
IV administration:
45 international units (9 mcg) per mL whole blood
90 international units (18 mcg) per mL red blood cells
-Administer 3,000 international units (600 mcg) IV every 8 hours until the total dose (calculated from the above doses) is administered.
IM administration:
60 international units (12 mcg) per mL whole blood
120 international units (24 mcg) per mL red blood cells
-Administer 6000 international units (1200 mcg) IM every 12 hours until the total dose (calculated from the above doses) is administered.

INDICATIONS:

Suppression of Rh isoimmunization in:
-Pregnancy and obstetric conditions in non-sensitized, Rho (D)-negative women with an Rh-incompatible pregnancy
-Routine antepartum and postpartum Rh prophylaxis
-Rh prophylaxis in obstetric complications or invasive procedures
-Incompatible transfusions in Rho (D)-negative individuals (given Rho (D)-positive blood cells)

INTERACTIONS:

Decrease antibody response with live vaccines like measles, mumps and rubella.

NURSING IMPLICATIONS:

Asess for allergies, reactions to immunisations; previous immunization with this drug.

assess for intravascular hemolysis, chills,back pain, hemoglobinurea, rnal insufficiency.

Type, crossmatch mother and newborn's cord blood., before giving the drug.

TEACH patient/ family how the drug works, drug must be given after subsequent deliveries if subsequent babies are Rh positive