OB Meds

Acetaminophen + Codeine, Hydrocodone + APAP, Oxycodone + APAP

• Brand Names: Tylenol with Codeine, Norco, Percocet

• Classification: opioid agonist + nonopioid

• Nursing interventions: monitor pain, sedation, respirations/RD, bowel function; count total APAP; monitor breastfed infant for sleepiness

• Patient Education: avoid alcohol/driving

• Category C; neonatal RD with near delivery/prolonged use

Fentanyl

• Brand name: Sublimaze

• Classification: potent opioid agonist

• Nursing interventions: monitor pain, sedation, respirations/RD, BP, HR; have naloxone ready

• Category C; neonatal RD with near delivery/prolonged use

Morphine Sulfate

• Brand name: Duramorph

• Classification: opioid agonist

• Nursing interventions: monitor pain, sedation, respirations/RD, BP, urinary retention, pruritis; neuraxial morphine requires delayed respiratory monitoring

• Category C; neonatal RD with near delivery/prolonged use

Meperidine

• Brand name: Demerol

• Classification: opioid agonist

• Nursing interventions: monitor pain, sedation, respirations/RD, BP, FHR; avoid MAOIs

• Category C; neonatal RD with near delivery/prolonged use; often avoided due to being an active metabolite (body creates something else when breaking down the medication; e.g. codeine processed by the liver and becomes morphine)

Nalbuphine

• Brand name: Nubain

• Classification: agonist-antagonist (Kappa agonist, mu antagonist; helps lower the risk of addiction and RD); analgesic and tx for opioid induced pruritis

• Nursing interventions: monitor pain, sedation, respirations/RD, BP, FHR

• Category B

Naloxone

• Brand name: Narcan

• Classification: opioid antagonist (reverses opioid effects; tx for maternal OD or severe opioid induced RD)

• Nursing interventions: support airway/ventilation; shorter acting than opioids so may repeat; may cause mat/fet/NB withdrawal; maternal resuscitation outweighs fetal withdrawal risk)

Bupivacaine

• Brand name: Marcaine

• Classification: epidural/spinal local anesthetic for labor and c/s; blocks sodium channels and nerve conduction

• Nursing interventions: monitor BP, HR, oxygenation, FHR with neuraxial use; watch out for hypotension, tinnitus, metallic taste, seizures, arrhythmias

• Category C

Lidocaine

• Brand name: Xylocaine

• Classification: local 1% infiltration anesthetic for lacerations/episiotomies

• Nursing interventions: aspirate before injecting; monitor CNS/cardiac toxicity; common sx circumoral numbness, tinnitus, metallic taste

• Category B

Nitrous Oxide

• Brand name: Nitronox (50% nitrous, 50% oxygen)

• Classification: inhaled minimal analgesic and moderate anxiolytic

• Nursing interventions: monitor sedation, dizzness, n/v; avoid with patient inability to hold mask, impaired consciousness, pneumothorax, bowel obstruction, vitamin b12 deficiency

• Patient education: patient controlled; rapid onset/offset

Ibuprofen

• Brand name: Motrin, Advil

• Classification: PP NSAID; inhibits prostaglandin synthesis to reduce pain, fever, and inflammation; tx for uterine cramping, perineal/incisional pain

• Nursing interventions: give with food; assess for bleeding and GI ulcers; avoid combining NSAIDs; compatible with breastfeeding

• Patient education: avoid from 20 weeks and >30 weeks due to oligohydraminos and ductus arteriosis risk

Ketorolac tromethamine

• Brand name: Toradol

• Classification: Potent IV NSAID

• Nursing interventions: assess bleeding, GI ulcers, renal fx, any concurrent NSAIDs/ACs; use lowest dose and shortest duration; NOT a labor analgesic, is a PP analgesic; avoid from 20 weeks and >30 weeks

Diazepam

• Brand name: Valium

• Classification: benzo; enhances GABA inhibition; rarely used for seizures, anxiety, and muscle spasms; NOT first line for preeclampsia

• Nursing interventions: monitor airway, sedation, respirations, BP, falls; long half life and can cause neonatal RD or CNS depression, sedation, and withdrawal

• Patient education: avoid alcohol/opioids; DO NOT stop chronic use abruptly

• Category D

Alprazolam

• Brand name: Xanax

• Classification: benzo; enhances GABA inhibition; used for severe anxiety and panic when benefits outweighs risks

• Nursing interventions: monitor sedation, respirations/RD, falls

• Patient education: avoid alcohol/opioids; DO NOT stop chronic use abruptly

• Category D; possible neonatal sedation, hypotonia, and withdrawal with late/chronic exposure

Diphenhydramine

• Brand name: Benadryl

• Classification: antihistamine with sedative and anticholinergic effects; tx for allergies, pruritis, sleep, opioid pruritis

• Nursing interventions: monitor sedation, urinary retention; rapid IV administration can cause hypotension

• Patient education: avoid alcohol/driving

• Category B

Zolpidem

• Brand name: Ambien

• Classification: Nonbenzo hypnotic; used for short term insomnia

• Patient education: warn about next day impairment, falls, and complex sleep behaviors

• Category C

Oxytocin

• Brand name: Pitocin

• Used for: uterine contractions, induction (starts labor before contractions begin), augmentation (strengthens those contractions), and PPH

• Nursing interventions: use infusion pump, continuous FHR/UC monitoring; reduce/stop for tachysystole or fetal hypoxia/intolerance; reposition, IV bolus, and notify provider; monitor fluid balance/hyponatremia with prolonged high dose infusion;

Dinoprostone

• Brand name: Cervidil

• Used for: cervical ripening (by prostaglandin E2) and induction

• Nursing interventions: vaginal insert; continuous FHR/UC monitoring; remove for tachysystole; risk for fetal tachysystole and hypoxia

Misoprostol

• Brand name: Cytotec

• Used for: cervical ripening and PPH

• Nursing interventions: continuous FHR/UC monitoring; watch for tachysystole, fever, chills, diarrhea; check uterine scar hx

• Category X for ulcer prevention during pregnancy because it can cause abortion

Terbutaline

• Brand name: Brethine

• Used for: tocolysis; relaxes uterus to tx tachysystole

• Nursing interventions: check maternal HR, BP, glucose, potassium, and lung sounds

• Category B

Nifedipine

• Brand name: Procardia

• Used for: tocolysis and hypertension; calcium channel blocker that relaxes vascular/uterine muscles

• Nursing interventions: monitor BP, HR, headache, flushing, dizziness, hypotension; DO NOT use sublingually; caution use with magnesium

• Category C

Indomethacin

• Brand name: Indocin

• Classification: NSAID used for short term tocolysis in early gestation

• Nursing interventions: limit to <48 hours; monitor fluid volume, fetal ductal effects; maternal GI/renal/bleeding risk

• Category C before third trimester'; category D in third trimester

Betamethasone

• Brand name: Celestone

• Classification: glucocorticoid that helps fetal lung/organ maturation; antenatal and used for preterm birth

• Nursing interventions: monitor glucose and assess for any infection

• Patient education: explain maternal hyperglycemia (watch for diabetics) and temporary FHR changes

• Category C

Labetalol

• Brand name: Trandate

• Classification: alpha1/beta blocker that lowers vascular resistance and HR for severe hypertension/preeclampsia

• Nursing interventions: check BP/HR before and after; monitor for hypotension/bradycardia; neonate may have temporary bradycardia/hypoglycemia

• Category C

Magnesium Sulfate

• Brand name: Magnesium Sulfate

• Classification: CNS depressant, seizure prophylaxis in preeclampsia; fetal neuroprotection in preterm births

• Nursing interventions: monitor respirations, reflexes, urine output, mental status; have calcium gluconate available; toxicity if absent reflexes, RD, oliguria, cardiac arrest

Calcium Gluconate

• Brand name: Calcium Gluconate

• Classification: antidote for magnesium sulfate toxicity and tx for symptomatic hypocalcemia

• Nursing interventions: keep at bedside during magnesium sulfate infusion; monitor ECG and IV site/symptoms; give slowly to prevent bradycardia/arrhythmia

Carboprost

• Brand name: Hemabate

• Classification: prostaglandin F2α used for PPH atony

• Nursing interventions: assess bleeding, uterine tone, and VS; contraindicated in asthma; expect diarrhea, vomiting, fever, bronchospasm

Methylergonovine

• Brand name: Methergine

• Classification: ergot alkaloid used to tx excessive PPH atony

• Nursing interventions: check BP before each dose; contraindicated in hypertension/preeclampsia and vascular disease; monitor chest pain, severe headache, hypertension, and uterine tone

Tranexamic Acid (TXA)

• Brand name: Cyklokapron

• Classification: antifibrinolytic that blocks plasminogen and stabilizes clots (which prevents more bleeding) to tx PPH

• Nursing interventions: give after PPH diagnosis; infuse slowly to avoid hypotension

Rho(D) immune globulin

• Brand name: RhoGAM

• Classification: passive anti-D antibodies that prevent Rh sensitization/Rh(D) alloimmunization

• Nursing interventions: verify maternal Rh negative status; verify infant Rh

Vitamin K

• Brand name: AquaMEPHYTON

• Classification: hepatic synthesis of vitamin K clotting factors II, VII, IX, and X; prevention of vitamin K deficiency bleeding where a newborn cannot form blood clots properly

• Patient education: explain that the shot prevents fatal internal/brain bleeding; administer IM in vastus lateralis

Hepatitis B vaccine

• Brand name: Engerix-B

• Classification: newborn prophylactic vaccine that gives active immunity to HepB within 24 hours of birth or within 12 hours of when maternal HBsAg positive/unknown

• Nursing interventions: verify product, age specific dose, and maternal HBsAg

Rubella/MMR vaccine

• Classification: postpartum live vaccine

• Nursing interventions: do NOT give during pregnancy because it is a live vaccine and can infect fetus and possibly cause a miscarriage

• Patient education: mother can still breastfeed; avoid pregnancy for at least 28 days

Penicillin G

• Brand name: Pfizerpen

• Classification: beta lactam antibiotic that blocks bacterial cell wall synthesis; first line intrapartum GBS prophylactic

• Nursing interventions: verify for any allergies; monitor for anaphylaxis; given ideally at least 4 hours before delivery

• Category B

Ampicillin

• Brand name: Principen, Omnipen

• Classification: beta lactam antibiotic that blocks bacterial cell wall synthesis; intrapartum GBS prophylactic; also tx for chorioamnionitis and UTIs

• Nursing interventions: verify penicillin allergy; monitor for anaphylaxis, rash, diarrhea

• Category B

Clindamycin

• Brand name: Cleocin

• Classification: lincosamide that blocks bacterial protein synthesis; GBS prohphylactic in high risk PCN allergies; tx for BV and PP infections

• Nursing interventions: monitor for severe diarrhea, C. diff

• Category B

Cefazolin

• Brand name: Ancef

• Classification: 1st generation cephalosporin that blocks bacterial cell wall synthesis; C/S prophylaxis and GBS prophylaxis for PCN allergies

• Nursing interventions: verify allergy hx; given before surgery

• Category B

Cefoxitin

• Brand name: Mefoxin

• Classification: 2nd generation cephalosporin that blocks cell wall synthesis; tx for PP and pelvic infections (e.g. endometritis and PID)

• Nursing interventions: check beta-lactam allergy; monitor for diarrhea/C. diff

• Category B

Azithromycin

• Brand name: Zithromax

• Classification: macrolide that inhibits bacterial protein synthesis; tx for chlamydia in pregnancy; C/S prophylactic; tx for respiratory infections

• Nursing interventions: check for allergy; QT prolongation risk; ensure mother completes course and partner abstinence until tx

Acyclovir

• Brand name: Zovirax

• Used for: tx of genital herpes simplex virus (HSV)

• Nursing interventions: encourage hydration

• Patient education: suppresses but does not permanently remove/prevent HSV

Doxycycline

• Brand name: Vibramycin

• Classification: tetracycline that inhibits bacterial protein synthesis; used only for serious life threatening infections where no other antibiotic worked

• Category D; prolonged use can cause fetal teeth/bone abnormalities

Erythromycin

• Brand name: Ery-Tab

• Classification: prophylactic ointment for serious bacterial infections (e.g. gonococcal conjunctivitis)

• Nursing interventions: avoid estolate form in pregnancy; assess QT risk, liver fx, GI effects

• Category B

Chlorhexidine

• Brand name: Hibiclens

• Classification: antiseptic skin preparation before neuraxial procedures and surgery

• Nursing interventions: external only; avoid eyes/ears

Povidone-iodine

• Brand name: Betadine

• Classification: antiseptic skin/vaginal preparation

• Nursing interventions: avoid prolonged use in pregnancy/newborns because it can affect thyroid; check for allergy

epinephren

• Brand name: EpiPen

• Classification: beta adrenergic agonist and first line treatment for anaphylaxis

• Nursing interventions: don’t delay; call emergency response; give oxygen and IV fluids

Theophylline

• Brand name: Theo-24

• Classification: methylxanthine bronchodilator that helps control asthma

• Category C

Copper IUD

• Brand name: ParaGard

• Classification: nonhormonal IUD that produces local spermicide inflammatory reaction to prevent fertilization; long acting contraceptive and is most effective form of emergency contraception

• Nursing interventions: confirm no pregnancy or active pelvic infection, contraindicated in known pregnancy

• Patient education: expected to have longer/heavier menses at first

Levonorgestrel IUD

• Brand name: Mirena

• Classification: local progestin IUD that thickens mucus to prevent fertilization; long acting contraceptive; can tx heavy menstrual bleeding

• Nursing interventions: confirm no pregnancy or active pelvic infection, contraindicated in known pregnancy

• Patient education: expected to have lighter or absent menses

Medroxyprogesterone

• Brand name: Depo-Provera

• Classification: IM/SC injection and long acting contraceptive; progestin suppresses ovulation and thickens mucus

• Nursing interventions: not used during pregnancy, can use postpartum

• Patient education: expected irregular bleeding; has delayed return to fertility, weight change, and bone density loss; encourage calcium/vitamin D

Progestin-only Pill

• Brand name: Micronor

• Classification: daily pill contraceptive that thickens mucus and prevent ovulation; compatible use during postpartum and breastfeeding

• Patient education: take at exact same time daily; product specific missed pill instructions; irregular bleeding expected

Docusate

• Brand name: Colace

• Classification: stool softener that allows water into the stool to prevent/tx constipation, especially in postpartum

• Nursing interventions: hold for diarrhea, severe abdominal pain, or obstruction

• Patient education: encourage fluids/fiber

Bisacodyl

• Brand name: Dulcolax

• Classification: stimulant laxative that increases intestinal motility; used to tx short term constipation, especially in postpartum

• Nursing interventions: assess bowels, pain, obstruction, and hydration

• Patient education: swallow tablets whole