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Topic Description: This topic focuses on common drugs used to clients experiencing the Labor/ Delivery process and their newborns. The
drugs presented according to trade names, generic names and other important drug information such as classification, mechanism of
action, indication, contraindication, adverse reactions, and dosage of specific drugs, giving emphasis on the nurses’ responsibilities when
administering these drugs.
Central Objectives: At the end of 2-hour ward class, the learners shall augment their knowledge, develop beginning skills and manifest
desirable attitude in the administration of LR-DR drugs.
J. Side Effects
- are the unintended, secondary
effects a medication predictably will
cause. It may be harmless or
injurious.
K.Adverse Reactions
- are generally considered severe
responses to medication.
L. Contraindications
- A factor that prohibits the
administration of a drug or
performance of an act or procedure
in the care of a specific patient.
M. Nursing Responsibilities
- Where the nurse is responsible for
evaluating the effects of the
medications on the client’s health
status, teaching clients about their
medications and their side effects,
ensuring the medication regimen,
and evaluating client technique when
the client administers medications
that are not given by mouth.
N.Analgesics
- Drug that relieves pain.
O.Anesthesia 10
- The absence of all sensation min. • Active
especially sensitivity to pain, as participation in
induced by an anesthetic substance the socialized
or by hypnosis or as occurs with discussion
traumatic or pathophysiologic
damage to nerve tissue.
P. Agonist
- Drugs that produce a response
Q.Antagonist
- Drugs that block a response
• Supervise ambulation.
Promethazine sometimes produces
marked sedation and dizziness.
• Be aware that antiemetic action
may mask symptoms of unrecognized
disease and signs of drug overdosage
as well as dizziness, vertigo, or
tinnitus associated with toxic doses of
aspirin or other ototoxic drugs.
• Patients in pain may develop
involuntary (athetoid) movements of
upper extremities following
parenteral administration. These
symptoms usually disappear after
pain is controlled.
• Monitor respiratory function in
patients with respiratory problems,
particularly children. Drug may
suppress cough reflex and cause
thickening of bronchial secretions.
IV.B. Demerol
IV.B.1. Generic Name
• Meperidine hydrochloride
IV.B.2. Brand Name
• Demerol
IV.B.3 Classification
• central nervous system agent;
narcotic (opiate) agonist analgesic
IV.B.4 Dosage
• Moderate to Severe Pain
Adult: PO/SC/IM/IV 50–150 mg q3–4h
prn
Child: PO/SC/IM/IV 1–1.5 mg/kg q3–4h
(max: 100 mg q4h) prn
• Preoperative
Adult: IM/SC 50–150 mg 30–90 min
before surgery
Child: IM/SC 1–2.2 mg/kg 30–90 min
before surgery
• Obstetric Analgesia
Adult: IM/SC 50–100 mg when pains
become regular, may be repeated
q1–3h
IV.B.5. Indication
• Relief of moderate to severe pain, for
preoperative medication, for support
of anesthesia, and for obstetric
analgesia.
IV.B.6. Mechanism of Action
• Synthetic morphine-like compound.
Chemically dissimilar to morphine, but
in equianalgesic doses it is
qualitatively comparable. Usual doses
produce either no pupillary change or
slight miosis, but overdosage results
in marked miosis or mydriasis. Also,
unlike morphine, has little or no
antidiarrheic or antitussive action.
Produces CNS stimulation in toxic
doses.
IV.B.7. Side Effects/ Adverse Effects
• Body as a Whole: Allergic (Pruritus,
urticaria, skin rashes, wheal and flare
over IV site), profuse perspiration.
• CNS: Dizziness, weakness, euphoria,
dysphoria, sedation, headache,
uncoordinated muscle movements,
disorientation, decreased cough
reflex, miosis, corneal anesthesia,
respiratory depression.
• Toxic doses: muscle twitching,
tremors, hyperactive reflexes,
excitement, hypersensitivity to
external stimuli, agitation, confusion,
hallucinations, dilated pupils,
convulsions.
• CV: Facial flushing, light-headedness,
hypotension, syncope, palpitation,
bradycardia, tachycardia,
cardiovascular collapse, cardiac
arrest (toxic doses).
• GI: Dry mouth, nausea, vomiting,
constipation, biliary tract spasm.
• Urogenital: Oliguria, urinary
retention.
• Respiratory: Respiratory depression
in newborn, bronchoconstriction
(large doses).
• Skin: Phlebitis (following IV use),
pain, tissue irritation and induration,
particularly following subcutaneous
injection.
• Metabolic: Increased levels of serum
amylase, BSP retention, bilirubin,
AST, ALT.
IV.B.8. Contraindication
• Hypersensitivity to meperidine;
convulsive disorders; acute
abdominal conditions prior to
diagnosis; pregnancy prior to labor
[(category B), at term (category D)],
lactation.
IV.C. Buscopan
IV.C.1. Generic Name
• Hyoscine butylbromide
IV.C.2. Brand Name
• Buscopan
IV.C.3 Classification
• anticholinergic (Oral route, Parenteral
route, Rectal route, Transdermal
route)
IV.C.4 Dosage
• Typical dose is 10mg 3 times daily.
• Adult dose may be increased if
required up to to 20mg 4 times daily
(max 80mg/day).
IV.C.5. Indication
• This medication is used to relieve
bladder or intestinal spasms.
IV.C.6. Mechanism of Action
• Buscopan acts by interfering with the
transmission of nerve impulses by
acetylcholine in the parasympathetic
nervous system (specifically the
vomiting center).
IV.C.7. Side Effects/ Adverse Effects
• Constipation, dry mouth, trouble
urinating, or nausea could occur. If
these continue or are bothersome,
notify your doctor promptly. Very
unlikely but report: rash, itching,
swelling of the hands or feet, trouble
breathing, increased pulse, dizziness,
diarrhea, vision problems, eye pain. If
you notice other effects not listed
above, contact your doctor or
pharmacist.
IV.C.8. Contraindication
• Glaucoma, myasthenia gravis,
paralytic ileus, pyloric stenosis,
prostatic enlargement, porphyria
IV.C.9. Nursing Responsibilities
Certain medicines should not be
used during pregnancy or
breastfeeding. However, other
medicines may be safely used in
pregnancy or breastfeeding providing
the benefits to the mother outweigh
the risks to the unborn baby.
• This medicine should be used with
caution during pregnancy, and only if
the expected benefit to the mother is
greater than the possible risk to the
foetus, particularly in the first
trimester. Seek medical advice from
your doctor.
• It is not known if this medicine
passes into breast milk. It should be
used with caution in nursing mothers,
and only if the benefits to the mother
outweigh any risks to the nursing
infant. Discuss this with your doctor.
• You should notify the doctor
immediately if the patient
experience any of the following while
using this medicine: red and painful
eye, possibly with headache, loss of
vision or blurred vision, or seeing
haloes around lights. These
symptoms may be caused by an
increase in pressure inside the
eyeball and require urgent
investigation by her doctor.
IV.D. Syntocinon
IV.D.1. Generic Name
• Oxytocin
IV.D.2. Brand Name
• Syntocinon
IV.D.3 Classification
• hormones and synthetic substitutes;
oxytocic
IV.D.4 Dosage
• Antepartum
Adult: IV Start at 1 mU/min, may
increase by 1 mU/min q15min (max:
20 mU/min)
• Postpartum
Adult: IV Infuse a total of 10 U at a
rate of 20–40 mU/min after delivery
• To Promote Milk Ejection
Adult: Nasal 1 spray or 1 drop in 1 or
both nostrils 2–3 min before nursing
or pumping
IV.D.5. Indication
• To initiate or improve uterine
contraction at term only in carefully
selected patients and only after
cervix is dilated and presentation of
fetus has occurred; used to stimulate
letdown reflex in nursing mother and
to relieve pain from breast
engorgement. Uses include
management of inevitable,
incomplete, or missed abortion;
stimulation of uterine contractions
during third stage of labor;
stimulation to overcome uterine
inertia; control of postpartum
hemorrhage and promotion of
postpartum uterine involution. Also
used to induce labor in cases of
maternal diabetes, preeclampsia,
eclampsia, and erythroblastosis
fetalis.
IV.D.6. Mechanism of Action
• Synthetic, water-soluble
polypeptide consisting of eight amino
acids, identical pharmacologically to
the oxytocic principle of posterior
pituitary.
IV.D.7. Side Effects/ Adverse Effects
• Body as a Whole: Fetal trauma from
too rapid propulsion through pelvis,
fetal death, anaphylactic reactions,
postpartum hemorrhage, precordial
pain, edema, cyanosis or redness of
skin.
• CV: Fetal bradycardia and arrhythmias,
maternal cardiac arrhythmias,
hypertensive episodes, subarachnoid
hemorrhage, increased blood flow,
fatal afibrinogenemia, ECG changes,
PVCs, cardiovascular spasm and
collapse.
• GI: Neonatal jaundice, maternal
nausea, vomiting.
• Endocrine: ADH effects leading to
severe water intoxication and
hyponatremia, hypotension.
• CNS: Fetal intracranial hemorrhage,
anxiety.
• Respiratory: Fetal hypoxia, maternal
dyspnea.
• Urogenital: Uterine hypertonicity,
tetanic contractions, uterine rupture,
pelvic hematoma.
IV.D.8. Contraindication
• Hypersensitivity to oxytocin;
significant cephalopelvic
disproportion, unfavorable fetal
position or presentations that are
undeliverable without conversion
before delivery, obstetric
emergencies in which benefit-to-risk
ratio for mother or fetus favors
surgical intervention, fetal distress in
which delivery is not imminent,
prematurity, placenta previa,
prolonged use in severe toxemia or
uterine inertia, hypertonic uterine
patterns, previous surgery of uterus
or cervix including cesarean section,
conditions predisposing to
thromboplastin or amniotic fluid
embolism (dead fetus, abruptio
placentae), grand multiparity,
invasive cervical carcinoma,
primipara >35 y of age, past history
of uterine sepsis or of traumatic
delivery, intranasal route during
labor, simultaneous administration of
drug by two routes.
IV.D.9. Nursing Responsibilities
IV.E. Methergine
IV.E.1. Generic Name
• Methylergonovine maleate
IV.E.2. Brand Name
• Methergine
IV.E.3 Classification
• autonomic nervous system agent;
adrenergic antagonist
(sympatholytic); ergot alkaloid;
oxytocic
IV.E.4 Dosage
• Postpartum Hemorrhage
Adult: PO 0.2–0.4 mg q6–12h until
danger of atony passes (2–7 d) IM/IV
0.2 mg q2–4h (max: 5 doses)
IV.E.5. Indication
• Routine management after delivery
of placenta and for postpartum
atony, subinvolution, and
hemorrhage. With full obstetric
supervision, may be used during
second stage of labor.
IV.E.6. Mechanism of Action
• Ergot alkaloid that induces rapid,
sustained tetanic uterine contraction
that shortens third stage of labor and
reduces blood loss.
IV.E.7. Side Effects/ Adverse Effects
• GI: Nausea, vomiting (especially with
IV doses).
• CV: Severe hypertensive episodes,
bradycardia.
• Body as a Whole: Allergic phenomena
including shock, ergotism.
IV.E.8. Contraindication
• Hypersensitivity to ergot
preparations; to induce labor; use
prior to delivery of placenta;
threatened spontaneous abortion;
prolonged use; uterine sepsis;
hypertension; toxemia; lactation.
IV.E.9. Nursing Responsibilities
IV.F. Stadol
IV.F.1. Generic Name
• Butorphanol tartrate
IV.F.2. Brand Name
• Stadol
IV.F.3 Classification
• central nervous system agent;
analgesic; narcotic (opiate) agonist-
antagonist
IV.F.4 Dosage
• Pain Relief
Adult: IM 1–4 mg q3–4h as needed
(max: 4 mg/dose) IV 0.5–2 mg q3–4h
as needed
IV.F.5. Indication
• Relief of moderate to severe pain,
preoperative or preanesthetic
sedation and analgesia, obstetrical
analgesia during labor, cancer pain,
renal colic, burns.
IV.F.6. Mechanism of Action
• Synthetic, centrally acting analgesic
with mixed narcotic agonist and
antagonist actions. Acts as agonist
on one type of opioid receptor and as
a competitive antagonist at others.
Site of analgesic action believed to
be subcortical, possibly in the limbic
system. On a weight basis, analgesic
potency appears to be about 5 times
that of morphine, 40 times that of
meperidine, and 15–30 times that of
pentazocine. Narcotic antagonist
potential is approximately 30 times
that of pentazocine and 1/40 that of
naloxone. Respiratory depression
does not increase appreciably with
higher doses, as it does with
morphine, but duration of action
increases. Like pentazocine,
analgesic doses may increase
pulmonary arterial pressure and
cardiac work load.
IV.F.7. Side Effects/ Adverse Effects
• CNS: Drowsiness, sedation,
headache, vertigo, dizziness, floating
feeling, weakness, lethargy,
confusion, light-headedness,
insomnia, nervousness, respiratory
depression.
• CV: Palpitation, bradycardia.
• GI: Nausea.
• Skin: Clammy skin, tingling
sensation, flushing and warmth,
cyanosis of extremities, diaphoresis,
sensitivity to cold, urticaria, pruritus.
• Genitourinary: Difficulty in urinating,
biliary spasm.
IV.F.8. Contraindication
• Narcotic-dependent patients. Safety
during pregnancy prior to labor
(category C), lactation, or in children
<8 y is not established.
IV.F.9. Nursing Responsibilities
IV.G. Valium
IV.G.1. Generic Name
• Diazepam
IV.G.2. Brand Name
• Valium
IV.G.3 Classification
• central nervous system agent;
benzodiazepine anticonvulsant;
anxiolytic
IV.G.4 Dosage
• Anxiety, Muscle Spasm, Convulsions,
Alcohol Withdrawal
Adult: PO 2–10 mg b.i.d. to q.i.d. or
15–30 mg/d sustained release IV/IM
2–10 mg, repeat if needed in 3–4 h
IV.G.5. Indication
• Management of anxiety disorders, for
short-term relief of anxiety
symptoms, to allay anxiety and
tension prior to surgery,
cardioversion and endoscopic
procedures, as an amnesic, and
treatment for restless legs. Also used
to alleviate acute withdrawal
symptoms of alcoholism, voiding
problems in older adults, and
adjunctively for relief of skeletal
muscle spasm associated with
cerebral palsy, paraplegia, athetosis,
stiff-man syndrome, tetanus.
IV.G.6. Mechanism of Action
• Psychotherapeutic agent related to
chlordiazepoxide; reportedly superior
in antianxiety and anticonvulsant
activity, with somewhat shorter
duration of action. Like
chlordiazepoxide, it appears to act at
both limbic and subcortical levels of
CNS.
IV.G.7. Side Effects/ Adverse Effects
• Body as a Whole: Throat and chest
pain.
• CNS: Drowsiness, fatigue, ataxia,
confusion, paradoxic rage, dizziness,
vertigo, amnesia, vivid dreams,
headache, slurred speech, tremor;
EEG changes, tardive dyskinesia.
• CV: Hypotension, tachycardia,
edema, cardiovascular collapse.
• Special Senses: Blurred vision,
diplopia, nystagmus.
• GI: Xerostomia, nausea, constipation,
hepatic dysfunction.
• Urogenital: Incontinence, urinary
retention, gynecomastia (prolonged
use), menstrual irregularities,
ovulation failure.
• Respiratory: Hiccups, coughing,
laryngospasm.
• Other: Pain, venous thrombosis,
phlebitis at injection site.
IV.G.8. Contraindication
• Injectable form: Shock, coma,
acute alcohol intoxication, depressed
vital signs, obstetrical patients,
infants <30 d of age.
• Tablet form: Infants <6 mo of age,
acute narrow-angle glaucoma,
untreated open-angle glaucoma;
during or within 14 d of MAO inhibitor
therapy. Safe use during pregnancy
(category D) and lactation is not
established.
IV.G.9. Nursing Responsibilities
IV.I. Nubain
IV.I.1. Generic Name
• Nalbuphine hydrochloride
IV.I.2. Brand Name
• Nubain
IV.I.3 Classification
• central nervous system agent;
analgesic; narcotic (opiate) agonist-
antagonist
IV.I.4 Dosage
• Moderate to Severe Pain
Adult: IV/IM/SC 10–20 mg q3–6h prn
(max: 160 mg/d)
Child: IV/IM/SC 0.1–0.15 mg/kg q3–6h
prn
IV.I.5. Indication
• Symptomatic relief of moderate to
severe pain. Also preoperative
sedation analgesia and as a
supplement to surgical anesthesia.
IV.I.6. Mechanism of Action
• Binds with opiate receptors in the
CNS, altering both perception of and
emotional response to pain.
• Relieves pain and enhances
anesthesia.
IV.I.8. Contraindication
• Contraindicated in patients with
hypersensitive to drug.
• Use cautiously in substance
abusers, and in those with emotional
instability, head injury, increased
intracranial pressure, impaired
ventilation, MI accompanied by
nausea and vomiting, upcoming
biliary surgery, and hepatic or renal
disease.
IV.I.9. Nursing Responsibilities
IV.J. Vitakay
IV.J.1. Generic Name
IV.J.2. Brand Name
IV.J.3 Classification
IV.J.4 Dosage
IV.J.5. Indication
IV.J.6. Mechanism of Action
IV.J.7. Side Effects/ Adverse Effects
IV.J.8. Contraindication
IV.J.9. Nursing Responsibilities
IV.L. Aquamephyton
IV.L.1. Generic Name
IV.L.2. Brand Name
IV.L.3 Classification
IV.L.4 Dosage
IV.L.5. Indication
IV.L.6. Mechanism of Action
IV.L.7. Side Effects/ Adverse Effects
IV.L.8. Contraindication
IV.L.9. Nursing Responsibilities
IV.N. Apresoline
IV.N.1. Generic Name
IV.NJ.2. Brand Name
IV.N.3 Classification
IV.N.4 Dosage
IV.N.5. Indication
IV.N.6. Mechanism of Action
IV.N.7. Side Effects/ Adverse Effects
IV.N.8. Contraindication
IV.N.9. Nursing Responsibilities
IV.P.Yutopar
IV.P.1. Generic Name
IV.P.2. Brand Name
IV.P.3 Classification
IV.P.4 Dosage
IV.P.5. Indication
IV.P.6. Mechanism of Action
IV.P.7. Side Effects/ Adverse Effects
IV.P.8. Contraindication
IV.P.9. Nursing Responsibilities
IV.Q. Bricanyl
IV.Q.1. Generic Name
IV.Q.2. Brand Name
IV.Q.3 Classification
IV.Q.4 Dosage
IV.Q.5. Indication
IV.Q.6. Mechanism of Action
IV.Q.7. Side Effects/ Adverse Effects
IV.Q.8. Contraindication
IV.Q.9. Nursing Responsibilities
References:
Books
• Potter & Perry (2005).Fundamental of nursing. 6th ed. Philippines: Elsevier (Singapore) PTE LTD.
• Clayton & Stock (2001).Basic pharmacology for nurses. 12th ed. Philippines: Elsevier Science (Singapore) PTE LTD.
• Kee, J. L. & Hayes, E. R. (2003).Pharmacology: a nursing process approach. 4th ed. Philippines: Elsevier Science (Singapore) PTE
LTD.
• Mosby’s pocket dictionary of medicine, nursing, & allied health. 4th ed. (2002). Philippines: Elsevier (Singapore) PTE LTD.
• Shanon, M. T. et. al.(2007). Prentice Hall Nurse's Drug Guide 2007. New Jersey: Prentice Hall.
Internet
• http://en.wikipedia.org/wiki/Mechanism_of_action
• http://www.drugs.com/cons/buscopan.html
• http://www.netdoctor.co.uk/medicines/100000395.html
• http://www.medicinenet.com/hyoscine_butylbromide-oral/article.htm
• http://www.flexyx.com/B/Buscopan.html