NURS 368 Medications

cefazolin (Ancef) class

anti-infective, first generation cephalosporin

cefazolin (Ancef) indication

GBS, C-section prophylaxis, perinatal reproductive tract infections

docusate sodium (Colace) MOA

softens stool by drawing water into the stool for easier passage to relieve constipation

docusate sodium (Colace) class

laxative, stool softener

docusate sodium (Colace) safe dose

100-300mg once per day or in divided doses; MAX: 300mg/day (tablet), do not use for more than 1 week unless directed to by a physician

docusate sodium (Colace) nursing actions

Take with a full glass of water/juice or on an empty stomach, do not administer within two hours of other laxatives, educate the patient on limiting use to short-term and that it could take 3-5 days to take effect

docusate sodium (Colace) indication

constipation

docusate sodium (colace) side effects

common: diarrhea, abnormal taste in mouth, bitter, nausea, cramping; serious: hepatotoxicity

ferrous sulfate (Feosol) MOA

30% elemental iron that is absorbed and enters blood stream to contribute to iron stores in the liver, spleen, and bone marrow

Ferrous sulfate (Feosol) classification

iron supplement, mineral supplement

Ferrous sulfate (Feosol) safe dose

40-200 mg (1 325 mg tablet has 65 mg iron); MAX: 325 (65 mg iron) mg TID

Ferrous sulfate (Feosol) nursing actions

Best absorbed on an empty stomach can cause GI upset; suggest taking at bedtime or between meals if able, may take with food if unable to tolerate; take with water or juice but not coffee, tea, or milk; avoid taking with antacids or antibiotics as decreases absorption; taking with vitamin C will enhance absorption; do not crush, chew, or break tablets (will stain teeth); warn patients that stools will turn a black color

Ferrous sulfate (Feosol) indications

Prevention/treatment of iron-deficiency anemia

Ferrous sulfate (Feosol) side effects

common: constipation, abdominal pain, nausea, vomiting, heart burn, black stools; serious: allergic reaction, chest pain, shortness of breath, bloody stools, vomiting blood

Ibuprofen (Motrin) MOA

inhibits the synthesis of prostaglandin and platelet aggregation

Ibuprofen (Motrin) classes

analgesic, NSAID

Ibuprofen (Motrin) safe dose

OTC: 200-400mg every 4-6 hours, MAX 1200mg/day; Rx: 400-800mg every 4-6 hours, MAX 3200mg/day

Ibuprofen (Motrin) nursing actions

Reassess pain within one hour of administration; monitor for signs of GI bleeding such as hypotension and black tarry stools; instruct patients to not take more than the maximum dose per day; advise against using with other NSAIDs or aspirin; advise pregnant patients to avoid taking the drug at 20 weeks' gestation or later; take with food or milk

Ibuprofen (Motrin) indication

Pain

Ibuprofen (Motrin) side effects

Common: rash, heartburn, nausea, headache, dizziness; serious: cardiac arrest, congenital heart failure, hypertension, MI, acute renal failure, aseptic meningitis, anaphylaxis, hepatitis/hepatotoxicity, GI bleeding/ulcer

Ketorolac (Toradol) classes

analgesic, NSAID

Ketorolac (Toradol) indication

Pain

Magnesium Sulfate (Epsal) class

mineral/electrolyte replacement, anticonvulsant

Magnesium Sulfate (Epsal) indications

preeclampsia, preterm labor

Multivitamin with folic acid (prenatal vitamin) MOA

a mix of vitamins with increased folic acid to aide in the growth and development of the fetus

Multivitamin with folic acid (prenatal vitamin) classifications

prenatal vitamin

Multivitamin with folic acid (prenatal vitamin) safe dose

1 tablet/day (0.8 mg/tablet)

Multivitamin with folic acid (prenatal vitamin) nursing actions

Take one tablet daily starting 1 month before pregnancy and continue for 2-3 months into pregnancy

Multivitamin with folic acid (prenatal vitamin) indications

reduce risk of NTD's or other birth defects

Multivitamin with folic acid (prenatal vitamin) side effects

Common: bad taste in mouth, loss of appetite, nausea, confusion, irritability, sleep disturbances; serious: allergic condition

Oxytocin (Pitocin) MOA

increases the concentration of calcium in uterine myometrial cells to increase contractility

Oxytocin (Pitocin) classifications

uterine stimulant, posterior pituitary hormone

Oxytocin (Pitocin) safe dose

0.5-1.0 milliunit/min initial, increase 1-2 milliunits/min every 30-60 minutes for desired effects

Oxytocin (Pitocin) nursing actions

Monitor patient frequently for progression of labor and titrate appropriately; monitor fetus for signs of distress through EFM; assess resting tone of uterus to confirm it is less than 20 mmHg

Oxytocin (Pitocin) indications

Labor induction, augmentation, active management of 3rd stage, PPH

Oxytocin (Pitocin) side effects

Common: N/V; serious: fetal bradycardia, water intoxication syndrome, afibrogenemia, PPH, neonatal jaundice

Percocet (acetaminophen + oxycodone) MOA

inhibits COX in CNS, opioid agonist selective to mu receptors

Percocet (acetaminophen + oxycodone) classifications

analgesic

Percocet (combination of acetaminophen and oxycodone) safe dose

Oxycodone HCl 2.5-10mg/acetaminophen 325-650mg every 6 hours; MAX oxycodone 60mg/day and acetaminophen 4000mg/day

Percocet (combination of acetaminophen and oxycodone) nursing actions

Reassess pain within one hour of medication administration; monitor for signs of respiratory depression; add the dose of acetaminophen in Percocet to the patient's 24 hour total of acetaminophen

Percocet (combination of acetaminophen and oxycodone) indication

Pain

Percocet (combination of acetaminophen and oxycodone) side effects

Common: N/V, constipation, dizziness, headache; serious: shock, hepatotoxicity, respiratory depression, anaphylaxis, apnea, agranulocytosis

Rho(D) Immune Globulin (Rhophylac, Rhogam) MOA

suppresses the immune response to Rh+ blood in Rh- females by preventing the production of antibodies after mixing of blood

Rho(D) Immune Globulin (Rhophylac or Rhogam) class

vaccine, immune globulin

Rho(D) Immune Globulin (Rhophylac or Rhogam) safe dose

300mcg at 28 weeks pregnant and every 12 weeks after that, again within 72 hours of delivery

Rho(D) Immune Globulin (Rhophylac or Rhogam) nursing actions

Educate the parents on the importance of Rh blood testing during pregnancy; monitor for signs of hemolysis such as chills, fever, and back pain; inform the provider if fetal and maternal blood have possibly mixed

Rho(D) Immune Globulin (Rhophylac or Rhogam) indication

prophylaxis of Rh isoimmunization affecting pregnancy, (sensitization of Rh- females to Rh+ blood)

Rho(D) Immune Globulin (Rhophylac or Rhogam) side effects

common: injection site pain, nausea, extravascular hemolysis, low hemoglobin, dizziness, headache, malaise; serious: intravascular hemolysis, anaphylaxis, renal failure

Erythromycin Ophthalmic ointment (EryGel, Ilotycin) MOA

antibiotic that binds to the 50s ribosome to inhibit protein synthesis in organisms

Erythromycin Ophthalmic ointment (EryGel, Ilotycin) classifications

antibiotic, ophthalmic agent, macrolide

Erythromycin Ophthalmic ointment (EryGel, Ilotycin) safe dose

1 cm ribbon 0.5% ophthalmic ointment applied to each lower conjunctival sac as soon as possible after delivery; MAX 6 times a day depending on severity of infection

Erythromycin Ophthalmic ointment (EryGel, Ilotycin) nursing care

Administer drops (if ordered) before ointment; instruct parents to continue to administer as ordered, even if eyes look better; instruct parents to notify the prescriber if the infant develops bloody stools or excessive diarrhea

Erythromycin Ophthalmic ointment (EryGel, Ilotycin) indications

prophylaxis of gonococcal conjunctivitis neonatorum

Erythromycin Ophthalmic ointment (EryGel, Ilotycin) side effects

Common: eye irritation, redness, blurred vision; serious: chemical conjunctivitis

Vitamin K (Aqua-mephyton or Phytonadione) MOA

helps liver synthesize factors II (prothrombin), VII, IX, and X to help with the coagulation of blood

Vitamin K (Aqua-mephyton or Phytonadione) class

fat-soluble vitamin, antihemorrhagic

Vitamin K (Aqua-mephyton or Phytonadione) safe dose

0.5-1.0 mg IM at birth, repeat in 6-8 hours if needed

Vitamin K (Aqua-mephyton or Phytonadione) nursing actions

Observe for bleeding or bruising; educate parents on the benefits; do not expose medication to light before administration; ensure vitamin K is given before a circumcision

Vitamin K (Aqua-mephyton or Phytonadione) indication

prophylaxis against hemorrhagic disease of the newborn due to vitamin K deficiency

Vitamin K (Aqua-mephyton or Phytonadione) side effects

Common: redness, edema, pain at injection site; serious: hemolysis, hyperbilirubinemia

Hepatitis B vaccine (Engerix-B, Recombivax-HB) MOA

uses recombinant DNA to derive hepatitis B antigens and produce immunity

Hepatitis B vaccine (Engerix-B, Recombivax-HB) classifications

immune globulin, vaccine

Hepatitis B vaccine (Engerix-B, Recombivax-HB) safe dose

1 dose (0.5 ml) IM given on a 0-, 1-, 6- month schedule; if mom is hepatitis B positive give first dose within 12 hours of birth

Hepatitis B vaccine (Engerix-B, Recombivax-HB) nursing actions

Educate family on the importance of returning for the next two injections of the series; monitor for signs of anaphylaxis; ask about allergies before administering

Hepatitis B vaccine (Engerix-B, Recombivax-HB) indication

prophylaxis of Hepatitis B

Hepatitis B vaccine (Engerix-B, Recombivax-HB) side effects

Common: fatigue, malaise, fever, headache, dizziness; serious: pancytopenia, anaphylaxis

oxycodone (Xtampza) class

opioid analgesic

oxycodone (Xtampza) indication

pain

oxycodone (Xtampza) MOA

opioid agonist

oxycodone (Xtampza) safe dose

9 mg q12h PRN; MAX: 288 mg

oxycodone (Xtampza) nursing actions

Educate patient on symptoms of overdose and respiratory depression; take drug with consistent amount of food; advise against abrupt discontinuation

oxycodone (Xtampza) side effects

Common: pruritis, constipation, N/V, dizziness, headache, sleepiness; serious: severe hypotension, adrenal insufficiency, anaphylaxis, respiratory depression, fetal drug withdrawal syndrome if mother is dependent on drug

acetaminophen (Tylenol) class

analgesic, antipyretic

acetaminophen (Tylenol) indication

pain

acetaminophen (Tylenol) MOA

inhibits COX-2 and prostaglandin synthesis

acetaminophen (Tylenol) safe dose

650 mg q4-6h PRN; MAX: 3250 mg

acetaminophen (Tylenol) nursing actions

Advise patient to not exceed 4000mg in 24 hours as it is unsafe; take with full glass of water

acetaminophen (Tylenol) side effects

Common: pruritis, constipation, N/V, headache, insomnia, agitation, atelectasis; serious: Stevens-Johnson syndrome, toxic epidermal necrolysis, liver failure, pneumonitis

morphine sulfate (AVINza, MS Contin) class

opioid analgesic

morphine sulfate (AVINza, MS Contin) indication

pain

Hepatitis B immune globulin (HBIG, HepaGam B , HyperHEP B) class

immune serum, immunological agent

Hepatitis B immune globulin (HBIG, HepaGam B , HyperHEP B) indication

Prophylaxis of hepatitis B after exposure

betamethasone (Celestone) class

adrenal glucocorticoid, corticosteroid

betamethasone (Celestone) indication

fetal lung maturity

preservative-free morphine (Duramorph) class

opioid analgesic

preservative-free morphine (Duramorph) indication

pain

Ketorolac (Toradol) class

analgesic, NSAID

ketorolac (Toradol) indication

pain

terbutaline (Brethine) class

tocolytic, uterine relaxant

terbutaline (Brethine) indication

suppress preterm labor

carboprost (Hemabate) class

prostaglandin

carboprost (Hemabate) indication

PPH

dinoprostone (Cervadil, Prepadil) class

prostaglandin, uterine stimulant

dinoprostone (Cervadil, Prepadil) indication

cervical ripening, PPH

methylergonovine maleate (Methergine) class

ergot alkaloid, uterine stimulant

methylergonovine maleate (Methergine) indication

PPH

misoprostol (Cytotec) class

prostaglandin

misoprostol (Cytotec) indication

cervical ripening, PPH

tranexamic Acid (TXA, Lysteda) class

blood modifier agent, hemostatic

tranexamic Acid (TXA, Lysteda) indication

PPH