Obstetrical Medications

Pitocin / Oxytocin

Use: Induce labor, augment labor & control bleeding.

Dosage: 10 Units/vials; 10-40 U for bleeding; 1mu q 20 min for induction/augmentation.

Route: IV & IM.

Notes: Multiple uses.

Hemabate / Carboprost

Use: Uterotonic, given for hemorrhage.

Dosage: 250 mcg.

Route: Deep IM.

Notes: Not to be given to women with asthma or pulmonary disease.

Cytotec (misoprostol)

Use: Soften cervix, hemorrhage, induction of labor.

Dosage: 200 mg tablets.

Route: Oral, vaginal, or rectal.

Notes: Multiple uses.

Methergine

Use: Prevention of bleeding (postpartum or after manual placenta removal).

Dosage: 0.2mg IM/IV or 0.2mg tablets.

Route: IM & PO.

Notes: Cannot give to hypertensive women (significantly raises BP).

Sodium citrate

Use: Neutralize stomach contents for general anesthesia (prevents aspiration pneumonia).

Dosage: 30 cc.

Route: PO.

Notes: Monitor for hypertension, preeclampsia, salt-restrictions.

Penicillin G

Use: Infection prevention (given before surgery).

Dosage: Initial: 5 million units IV. Maintenance: 2.5-3 million units IV q4h until delivery.

Route: IV.

Notes: Assess allergies, record exact times.

Ampicillin

Use: Prevention of infection.

Dosage: Single dose of 25-100 mg/kg.

Route: IV / IM.

Notes: Given to patients with a penicillin allergy.

Duramorph

Use: Synthetic morphine for long-term (12-24h) pain relief.

Dosage: Epidural: 1.5-3mg / 5mg; Intrathecal: 0.2-1mg once.

Route: Epidural / Intrathecal.

Notes: Given by CRNA. Can cause significant itching (may need Benadryl).

Naloxone (Narcan)

Use: Reverses narcotics (key for newborns/mothers with plummeted respiratory rates).

Dosage: 0.1 mg/kg.

Route: IV preferred (IM if IV unavailable).

Notes: Must have a direct order (could reverse epidural Duramorph).

Pitocin (oxytocin) - Cesarean

Use: Contract uterus and prevent bleeding.

Dosage: 0.5-1 mUnit/min IV, titrate 1-2 mUnit/min q15-60min until normal pattern reached.

Route: IM or IV.

Notes: Can be injected directly into the uterus during a C-section.

Morphine

Use: Pain relief.

Dosage: 2-5 mg.

Route: IV.

Notes: Monitor for opioid adverse effects (respiratory depression)

Fentanyl

Use: Pain relief.

Dosage: Spinal: 10-15 mcg; Epidural: 50-100 mcg; IV: adjunct to general anesthesia.

Route: Spinal / Epidural / IV.

Notes: Can cause sedation, pruritus, nausea/vomiting.

Zofran

Use: Relief of nausea.

Dosage: 4-8mg.

Route: IV.

Notes: Prevents spinal hypotension, safe for breastfeeding.

Vitamin K

Use: Prevent hemorrhagic disease of the newborn.

Dosage: Single 0.5-1 mg dose within 1 hr of birth.

Route: IM right after birth.

Notes: Newborns' blood does not adequately clot.

Erythromycin eye ointment

Use: Prevent newborn from contracting syphilis of the eyes.

Dosage: Strip of medication from tube.

Route: In each eye.

Notes: Give within 1-2 hrs of delivery. Cleanse eyes inner to outer canthus first.

Betamethasone / Dexamethasone

Use: Mature fetal lungs in premature birth.

Dosage: 12.5 cc X 2 doses.

Route: IM.

Notes: Given to the MOTHER days prior to giving birth.

Nitrous Oxide

Use: Pain relief from uterine contractions.

Dosage: N/A.

Route: Inhaled (Face mask).

Notes: Self-administered.

Nubian

Use: Ease pain of labor contractions.

Dosage: 10 mg.

Route: IV/IM.

Notes: Every 3-6 hours.

Lidocaine

Use: Numb perineal areas for episiotomy repair.

Dosage: N/A.

Route: IM (Injected into tissues).

Notes: Done by CNM or MD, not the nurse.

Magnesium sulfate

Use: Neuro protectant against seizures in preeclampsia.

Dosage: Premixed IV bag: 40g in 1000cc OR 20g in 500cc.

Route: IV.

Notes: Must be on a pump for accurate titration.

Ibuprophen (Motrin)

Use: Postpartum cramping or incisional pain.

Dosage: 200 mg/tablet.

Route: PO.

Notes: Give prior to nursing to help with breastfeeding cramps.

Percocet

Use: Postpartum incision pain or cramping.

Dosage: 325 mg/tablet (usual is 1-2 tablets).

Route: PO.

Notes: Narcotic, requires falls precautions.

Torodol

Use: Relief of incisional pain after cesarean.

Dosage: 20mg (max 120 mg in 24 hrs).

Route: IV or IM.

Notes: Given every 4-6 hours.

Morphine (Postpartum)

Use: Pain of incision after a cesarean.

Dosage: 2-5mg.

Route: IV.

Notes: Not frequently used; mostly C-sections. Watch respirations.

Colace

Use: Soften stool.

Dosage: 1-2 caps, 1X a day.

Route: PO.

Notes: Important for women with an episiotomy or cesarean.

RhoGam

Use: Prevent formation of antibodies.

Dosage: 1 dose.

Route: IM.

Notes: Must be given within 72 hours of birth.

Prenatal vitamins

Use: Replenish nutrients depleted during pregnancy.

Dosage: 1 tablet.

Route: PO.

Notes: Provides critical vitamins (Vitamin D, Choline, DHA) to infant through breast milk.

Iron (ferrous sulfate)

Use: For low hemoglobin and hct.

Dosage: 325 mg.

Route: PO.

Notes: Can constipate; needs a stool softener or daily prunes.