Maternal/L&D/Postpartum/Newborn Medications PDF

**Maternal/ L&D/ Postpartum/Newborn Medications** **Butorphanol (Stadol)** - **Route(s):** IV - **OB Indications:** Pain management during labor. - **Contraindications:** Hypersensitivity to butorphanol; opioid dependency (risk of withdrawal symptoms). - **Side Effects:** Decreased...

**Maternal/ L&D/ Postpartum/Newborn Medications** **Butorphanol (Stadol)** - **Route(s):** IV - **OB Indications:** Pain management during labor. - **Contraindications:** Hypersensitivity to butorphanol; opioid dependency (risk of withdrawal symptoms). - **Side Effects:** Decreased fetal heart rate (FHR) variability, respiratory depression (mother and neonate). - **Nursing Considerations:** Administer the smallest effective dose (1-2 mg IV); monitor FHR, maternal respiratory rate, and sedation level. Have naloxone available. - **Client Teaching:** Explain potential side effects and that medication crosses the placenta; report excessive drowsiness or difficulty breathing. **Nalbuphine (Nubain)** - **Route(s):** IV - **OB Indications:** Pain management during labor. - **Contraindications:** Hypersensitivity to nalbuphine; opioid dependency. - **Side Effects:** Decreased FHR variability, fetal bradycardia, respiratory depression. - **Nursing Considerations:** Administer 10-20 mg IV; time administration to minimize neonatal effects (deliver within 1 hour or after 4 hours); monitor FHR, maternal respiratory rate, and pain level. - **Client Teaching:** Inform about potential neonatal effects; report excessive sedation or difficulty breathing. **Promethazine (Phenergan)** - **Route(s):** IM, IV (caution: can damage veins). - **OB Indications:** Nausea and vomiting (N/V) during labor; adjunct to anesthesia. - **Contraindications:** Hypersensitivity to promethazine; severe respiratory depression. - **Side Effects:** Drowsiness (fall risk). - **Nursing Considerations:** Monitor for sedation and fall risk; ensure IV site integrity if given IV. - **Client Teaching:** Avoid activities requiring alertness; request assistance with ambulation. **Magnesium Sulfate** - **Route(s):** IV (loading dose 4-6 g over 30-45 min, maintenance 1-4 g/hr). - **OB Indications:** Preterm labor; seizure prophylaxis in preeclampsia. - **Contraindications:** Myasthenia gravis; severe renal failure. - **Side Effects:** Blurred vision, headache, dizziness, nausea/vomiting. - **Nursing Considerations:** Monitor BP, HR, RR, lung sounds, DTRs, LOC, and I&Os; keep calcium gluconate at bedside for magnesium toxicity. - **Client Teaching:** Explain purpose and potential side effects; report visual changes or difficulty breathing immediately. **Calcium Gluconate** - **Route(s):** IV - **OB Indications:** Antidote for magnesium sulfate toxicity. - **Contraindications:** Hypercalcemia. - **Side Effects:** Tingling, hypotension, bradycardia. - **Nursing Considerations:** Administer slowly; monitor ECG and serum calcium levels. - **Client Teaching:** Explain that this medication counteracts magnesium toxicity. **Ephedrine** - **Route(s):** IV - **OB Indications:** Treat maternal hypotension. - **Contraindications:** Hypertension, hyperthyroidism. - **Side Effects:** Palpitations, tachycardia. - **Nursing Considerations:** Monitor BP and HR every 3-5 minutes. - **Client Teaching:** Inform patient about purpose and potential side effects (e.g., increased heart rate). **Dinoprostone (Cervidil)** - **Route(s):** Vaginal (tampon-like insert). - **OB Indications:** Cervical ripening for labor induction. - **Contraindications:** Active labor; uterine scarring. - **Side Effects:** Uterine hyperstimulation, fever, chills. - **Nursing Considerations:** Monitor FHR, contractions, cervical dilation, and maternal vital signs. - **Client Teaching:** Explain purpose; report severe pain or excessive contractions. **Misoprostol (Cytotec)** - **Route(s):** PO, vaginally (cervical ripening); rectally (postpartum hemorrhage). - **OB Indications:** Cervical ripening; postpartum hemorrhage. - **Contraindications:** Previous uterine surgery (risk of rupture). - **Side Effects:** Uterine hyperstimulation, fever, diarrhea. - **Nursing Considerations:** Monitor FHR, contractions, cervical dilation, and bleeding. - **Client Teaching:** Inform about purpose and possible side effects; report excessive contractions. **Penicillin G** - **Route(s):** IV (5 million units loading dose, then 2.5-3.0 million units every 4 hours). - **OB Indications:** Treatment of Group B Streptococcus (GBS). - **Contraindications:** Hypersensitivity to penicillins. - **Side Effects:** Allergic reactions, diarrhea. - **Nursing Considerations:** Monitor for allergic reactions; educate on purpose for neonatal infection prevention. - **Client Teaching:** Inform about purpose; report signs of allergic reaction. **Nifedipine (Procardia)** - **Route(s):** PO - **OB Indications:** Preterm labor (inhibits uterine activity). - **Contraindications:** Hypotension, allergy to nifedipine. - **Side Effects:** Dizziness, flushing, hypotension. - **Nursing Considerations:** Monitor BP, contractions; caution with concurrent magnesium sulfate. - **Client Teaching:** Advise against sudden position changes; report dizziness or chest pain. **Oxytocin (Pitocin)** - **Route(s):** IV (infusion pump), IM - **OB Indications:** Induction, augmentation of labor; postpartum hemorrhage. - **Contraindications:** Fetal distress, uterine rupture risk. - **Side Effects:** Uterine hyperstimulation, water intoxication. - **Nursing Considerations:** Monitor FHR, contractions, cervical dilation, and bleeding; never give undiluted IV bolus. - **Client Teaching:** Explain purpose and potential side effects. **Betamethasone (Celestone)** - **Route(s):** IM (12 mg q24h for 2 doses). - **OB Indications:** Promote fetal lung maturity; reduce respiratory distress syndrome risk. - **Contraindications:** Hypersensitivity. - **Side Effects:** Hyperglycemia, transient leukocytosis. - **Nursing Considerations:** Monitor maternal glucose; educate on benefits for preterm infants. - **Client Teaching:** Inform parents about importance for preterm delivery outcomes. **Terbutaline (Brethine)** - **Route(s):** SubQ - **OB Indications:** Uterine relaxation (tachysystole, preterm labor). - **Contraindications:** Cardiac arrhythmias, poorly controlled diabetes. - **Side Effects:** Tachycardia, palpitations, tremors. - **Nursing Considerations:** Monitor HR, BP, and contractions. - **Client Teaching:** Explain purpose and side effects; report chest pain or difficulty breathing. **Labetalol** - **Route(s):** IV, PO - **OB Indications:** Treat hypertensive disorders of pregnancy. - **Contraindications:** Asthma, bradycardia. - **Side Effects:** Dizziness, bradycardia, fatigue. - **Nursing Considerations:** Monitor BP and HR; caution with severe asthma. - **Client Teaching:** Explain purpose; report lightheadedness or slow heart rate. **Tranexamic Acid (TXA)** - **Route(s):** IV (1 g over 10 min; repeat after 30 min if needed). - **OB Indications:** Postpartum hemorrhage. - **Contraindications:** Thromboembolic disorders. - **Side Effects:** Nausea, vomiting, thrombosis. - **Nursing Considerations:** Administer within 3 hours of delivery; monitor bleeding and clotting. - **Client Teaching:** Explain purpose; report pain, swelling, or redness in extremities. **Vitamin K (Phytonadione)** - **Route(s):** IM - **OB Indications:** Prevent hemorrhagic disease in the newborn. - **Nursing Considerations:** Administer soon after birth; monitor injection site. - **Client Teaching:** Explain that vitamin K is essential for blood clotting and is routinely administered in the U.S. **Erythromycin Eye Ointment** - **Route(s):** Topical (ophthalmic). - **OB Indications:** Prevent inflammation of the eyes caused by gonorrhea and chlamydia. - **Nursing Considerations:** Administer within 1-2 hours of birth; gently wipe excess ointment after 1 minute. - **Client Teaching:** Inform parents that this is a routine and mandatory preventive measure in the U.S. **Hepatitis B Vaccine** - **Route(s):** IM - **OB Indications:** Prevent hepatitis B infection. - **Nursing Considerations:** Requires parental consent; administer in the opposite leg from vitamin K; adhere to schedule (birth, 1-2 months, 6 months). - **Client Teaching:** Explain importance of vaccination; for infants of Hepatitis B-positive mothers, also administer HBIG. **Naloxone** - **Route(s):** IV, IM, SubQ - **OB Indications:** Correct respiratory depression due to narcotics during labor. - **Nursing Considerations:** Have available during narcotic administration; monitor neonatal respiratory status. - **Client Teaching:** Explain purpose and that it counteracts opioid effects. **Morphine** - **Route(s):** IV, IM - **OB Indications:** Treatment for neonatal abstinence syndrome. - **Nursing Considerations:** Monitor neonatal withdrawal symptoms and adjust dosing as needed. - **Client Teaching:** Explain purpose of therapy and importance of monitoring infant response. **Ampicillin** - **Route(s):** IV - **OB Indications:** Prophylaxis for neonatal sepsis, especially in suspected GBS cases. - **Nursing Considerations:** Administer as ordered; monitor for allergic reactions. - **Client Teaching:** Explain purpose to prevent neonatal infections. **Gentamycin** - **Route(s):** IV - **OB Indications:** Used with ampicillin for neonatal sepsis. - **Nursing Considerations:** Monitor for ototoxicity and nephrotoxicity; ensure correct dosing. - **Client Teaching:** Inform parents about its role in treating serious infections.