MEDICATION MOA RT LABS TO

REVIEW
SIDE EFFECTS NURSING
RESPONSIBILITIES
Misoprostol
(Cytotec)


Stage 3
(Also used in
first trimester to
terminate
pregnancy)
Action
Replaces protective
prostaglandins consumed
with prostaglandin-
inhibiting therapies (e.g.,
NSAIDs).
Therapeutic Effect:
Reduces acid secretion
from gastric parietal cells,
stimulates bicarbonate
production from
gastric/duodenal mucosa.
Uses
Prevention of NSAID-
induced gastric ulcers and
in pts at high risk for
developing gastric
ulcer/gastric ulcer
complications
Chemical termination of
pregnancy (in conjunction
with mifepristone)
PO BUN,
Hematocrit,
CBC
ALT, AST,
Hgb,
Creatinine
Frequent
Abdominal pain
Diarrhea
Occasional
Nausea,
Flatulence
Dyspepsia
Headache
Baseline assessment
Question for possibility of
pregnancy before initiating
therapy (Pregnancy Category X)

Bicitra
(Cytra-2,
Liqui-Dual
Citra,
Oracit)
GI System
(electrolyte
modifier)

Stage 1
(prior to
epidural)
Action
This medication is used to
make the urine less acidic.
This medication can also
prevent and treat certain
metabolic problems
(acidosis) caused by kidney
disease.
Citric acid and citrate salts
(which
contain potassium and
sodium)
PO sodium levels
pH (acidity)
of your urine
blood
electrolyte
bicarbonate
levels
Nausea,
vomiting,
diarrhea, and
stomach pain
During pregnancy, this
medication should be used only
when clearly needed. This
medication may worsen high
blood pressure during pregnancy
(toxemia of pregnancy).
Methergine
(Methylergonovine)
Stage 2
(, given after
delivery,
shortens 3
rd

stage of labor)
Action
Stimulates alpha-
adrenergic, serotonin
receptors, producing
arterial vasoconstriction
Causes vasospasm of
coronary arteries
Directly stimulates uterine
muscle.

PO

calcium
levels
Nausea, uterine
cramping,
vomiting
Baseline assessment
Determine baseline serum
calcium level, B/P, pulse. Assess
for any evidence of bleeding
before administration.
Intervention/evaluation
Monitor uterine tone, bleeding,
B/P, pulse q15min until stable
(about 12 hrs)
Assess extremities for color,
warmth, movement, pain.
Report chest pain promptly
Provide support with ambulation
if dizziness occurs.

Magnesium
Sulfate
(Epsom Salt)
Stage 1
Action
Essential for enzyme
activity, nerve conduction,
muscle contraction
Maintains and restores
magnesium levels.
Anticonvulsant:
Blocks neuromuscular
transmission, amount of
acetylcholine released at
motor end plate.
Produces seizure control
Uses
Treatment/prevention of
hypomagnesemia
Prevention and treatment
of seizures in eclampsia;
Torsade de pointes
(atypical ventricular
tachycardia);
Treatment of arrhythmias
due to hypomagnesemia
(ventricular
tachycardia/ventricular
fibrillation)

IV
IM
PO
Mg,
electrolytes

Common
Muscle
Weakness
Lack of Energy
Blurry Vision
Slurred Speech
Headache
Nausea and
Vomiting
Flushing

Baseline assessment
Assess if pt is sensitive to
magnesium.
Antacid: Assess GI pain (duration,
location, quality, time of
occurrence, relief with food,
causative/excacerbative factors).
Laxative: Assess for weight loss,
nausea, vomiting, and history of
recent abdominal surgery.
Systemic: Assess renal function,
serum magnesium.
Intervention/evaluation
Antacid: Assess for relief of
gastric distress. Monitor renal
function (esp. if dosing is long
term or frequent).
Laxative: Monitor daily pattern of
bowel activity, stool consistency.
Maintain adequate fluid intake.
Systemic: Monitor renal function,
magnesium levels, EKG for
cardiac function.
Test patellar reflexes (knee jerk
reflexes) before giving repeat
parenteral doses (used as
indication of CNS depression;
suppressed reflexes may be sign
of impending respiratory arrest).
Patellar reflex must be present,
respiratory rate should be 16/min
or over before each parenteral
dose. Initiate seizure precautions.
Oxytocin
(Pitocin,
Syntocinon)
Endocrine
system
(pituitary drug)

(Stage 1 & 3)
Uses
Induction of labor at term,
control of post-partum
bleeding. Adjunct in
management of abortion.


IV

electrolytes Occasional:
Tachycardia,
premature
ventricular
contractions,
hypotension,
nausea,
vomiting. Rare:
Nasal:
Lacrimation/tea
ring, nasal
irritation,
rhinorrhea,
unexpected
uterine
bleeding/contra
ctions.


Baseline assessment Assess
baselines for vital signs, B/P, fetal
heart rate. Determine frequency,
duration, strength of
contractions.
Intervention/evaluation
Monitor B/P, pulse, respirations,
fetal heart rate, intrauterine
pressure, contractions (duration,
strength, frequency) q15min.
Notify physician of contractions
that last longer than 1 min, occur
more frequently than every 2
min, or stop. Maintain careful
I&O; be alert to potential water
intoxication. Check for blood loss.
Terbutaline
(Brethine)
(Bricanyl)

(CNS system.
Stimulant)

(Stage 2)
Action
Stimulates beta2-
adrenergic receptors,
resulting in relaxation of
uterine, bronchial smooth
muscle
Therapeutic Effect:
Inhibits uterine
contractions
Relieves bronchospasm,
reduces airway resistance.
Uses
Symptomatic relief of
reversible bronchospasm
due to bronchial asthma,
bronchitis, emphysema
Delays premature labor in
pregnancies between 20
and 34 wks

IV
PO
Frequent (38%
23%):
Tremor, anxiety
Occasional
(11%10%):
Drowsiness,
headache,
nausea,
heartburn,
dizziness

Baseline assessment
Bronchospasm: Offer emotional
support (high incidence of
anxiety due to difficulty in
breathing, Sympathomimetics
response to drug). Preterm labor:
Assess baseline maternal pulse,
B/P, frequency and duration of
contractions, fetal heart rate.
Intervention/evaluation
Bronchospasm: Monitor rate,
depth, rhythm, type of
respiration; quality, rate of pulse.
Assess lung sounds for rhonchi,
wheezing, and rales. Monitor
ABGs. Observe lips, fingernails for
cyanosis (blue or dusky color in
light-skinned pts; gray in dark-
skinned pts). Observe for
clavicular retractions, hand
tremor. Evaluate for clinical
improvement (quieter, slower
respirations, relaxed facial
expression, and cessation of
clavicular retractions). Preterm
labor: Monitor for frequency,
duration, strength of
contractions. Diligently monitor
fetal heart rate.
Penicillin
G benzathine

(Stage 2)

Action
Inhibits bacterial cell wall
synthesis by binding to one
or more of the penicillin-
binding proteins of
bacteria. Therapeutic
Effect:
Bactericidal. Uses
Treatment of mild to
moderate severe
infections caused by
organisms susceptible to
low concentrations of
penicillin including
streptococcal (Group A)
upper respiratory
infections, syphilis, yaws.
Prophylaxis of infections
caused by susceptible
organisms (e.g., rheumatic
fever prophylaxis).


IM

CBC,
urinalysis,
renal
function
tests.
Occasional:
Lethargy, fever,
dizziness, rash,
pain at injection
site. Rare:
Seizures,
interstitial
nephritis.


Baseline assessment
Question for history of allergies,
particularly penicillins,
cephalosporins.


Penicillin G
potassium

(Stage 2)

Action
Inhibits bacterial cell wall
synthesis by binding to one
or more of the penicillin-
binding proteins of
bacteria.
Therapeutic Effect:
Bactericidal.
Uses
Treatment of susceptible
infections due to gram-
positive organisms, gram-
negative organisms,
actinomycosis, clostridium,
diphtheria, Listeria, N.
meningitidis, pasteurella
including anthrax,
endocarditis, respiratory
tract infections,
meningitis, neurosyphilis,
skin/skin structure
infections.
IV CBC,
urinalysis,
renal
function
tests.
Occasional:
Lethargy, fever,
dizziness, rash,
pain at injection
site. Rare:
Seizures,
interstitial
nephritis.


Baseline assessment
Question for history of allergies,
particularly penicillins,
cephalosporins.


Penicillin V
potassium

(Stage 3)

Action
Inhibits cell wall synthesis
by binding to bacterial cell
membranes.
Therapeutic Effect:
Bactericidal.
Uses
Treatment of mild to
moderate infections of
respiratory tract, skin/skin
structure, otitis media,
necrotizing ulcerative
gingivitis; prophylaxis for
rheumatic fever, dental
procedures.

PO

Hgb levels Frequent:
Mild
hypersensitivity
reaction (chills,
fever, rash),
nausea,
vomiting,
diarrhea.
Rare:
Bleeding,
allergic
reaction.


Baseline assessment
Question for history of allergies,
particularly penicillins,
cephalosporins.
Intervention/evaluation
Hold medication, promptly report
rash (hypersensitivity), diarrhea
(with fever, abdominal pain,
mucus or blood in stool may
indicate antibiotic-associated
colitis). Monitor I&O, urinalysis,
renal function tests for
nephrotoxicity. Be alert for
superinfection: fever, vomiting,
diarrhea, anal/genital pruritus,
oral mucosal change (ulceration,
pain, and erythema). Review Hgb
levels; check for bleeding (overt
bleeding, ecchymosis, swelling of
tissue).










Betamethasone
(Celestone,
Celestone
Phosphate,
Celestone
Soluspan)
(Stage 3)

Action:
Controls rate of protein
synthesis, depresses
migration of
polymorphonuclear
leukocytes/fibroblasts,
reverses capillary
permeability, prevents or
controls inflammation.
Therapeutic Effect:
Decreases tissue response
to inflammatory process.
Uses
Systemic:
Anti-inflammatory,
immunosuppressant,
corticosteroid replacement
therapy.
Topical:
Relief of inflammatory and
pruritic dermatoses. Foam:
Relief of inflammation,
itching associated with
dermatosis.
IM
PO
TOPICAL
Calcium
levels,
Hematocrit,
Hgb, RBC, PT,
PTT
Frequent:
Systemic:
Increased
appetite,
abdominal
distention,
nervousness,
insomnia, false
sense of well-
being.
Topical:
Burning,
stinging,
pruritus.
Baseline assessment
Question for hypersensitivity to
any corticosteroid, sulfite.
Obtain baseline values for height,
weight, B/P, serum glucose,
electrolytes.
Obtain baseline results of initial
tests (tuberculosis [TB] skin test,
X-rays, EKG).
Intervention/evaluation
Monitor B/P, blood glucose,
electrolytes.
Apply topical preparation
sparingly. Do not use on broken
skin or in areas of infection.
Do not apply to wet skin, face,
and inguinal areas.

Ropivacaine
(Naropin,
Naropin
Polyamp,
Naropin SDV,
Naropin
Novaplus)

Action
Most local anesthetics fall
into one of two groups:
esters or amides. Both
provide anesthesia and
analgesia by reversibly
binding to and blocking
sodium (Na) channels. This
slows the rate of
depolarization of the nerve
action potential; thus,
propagation of the
electrical impulses needed
for nerve conduction is
prevented.
Uses
Local anesthetics suppress
pain by blocking impulses
along axons. Suppression
of pain does not cause
generalized depression of
the entire nervous system.
Local anesthetics may be
given topically and by
injection (local infiltration,
peripheral nerve block
[axillary], IV regional [Bier
block], epidural, and spinal).
Nerve
block
Hypotension,
bradycardia,
headache,
pruritus,
nausea,
vomiting,
dizziness,
anxiety,
tinnitus,
dyspnea,
cardiac arrest,
arrhythmias,
seizures,
syncope, chills


Baseline assessment
Pt should be in recumbent
position before drug is
administered by parenteral
route. Assess onset, type,
location, duration of pain. Obtain
vital signs before giving
medication. If respirations are
12/min or less (20/min or less in
children), withhold medication,
contact physician. Effect of
medication is reduced if full pain
recurs before next dose.
Intervention/evaluation
Monitor vital signs 1530 min
after subcutaneous/IM dose, 5
10 min after IV dose (monitor for
hypotension, change in
rate/quality of pulse). Monitor
pain level, sedation response.
Monitor daily pattern of bowel
activity, stool consistency; avoid
constipation. Check for adequate
voiding. Initiate deep breathing,
coughing exercises, particularly in
pts with pulmonary impairment.
Therapeutic serum level: 100550
ng/ml; toxic serum level: greater
than 1,000 ng/ml.
Demerol
(meperidine)
(Isonipecaine)
(Pethidine)
(Neperdine)

Analgesic

NARCAN
is
antidote

Action
Binds to opioid receptors
within CNS. Therapeutic
Effect: Alters pain
perception, emotional
response to pain.
Uses
Relief of moderate to
severe pain.


IV
IM
PO
plasma
amylase &
lipase
concentration

Frequent:
Sedation,
hypotension
(including
orthostatic
hypotension),
diaphoresis,
facial flushing,
dizziness,
nausea,
vomiting,
constipation.
Baseline assessment
Pt should be in recumbent
position before drug is
administered by parenteral
route. Assess onset, type,
location, duration of pain. Obtain
vital signs before giving
medication. If respirations are
12/min or less (20/min or less in
children), withhold medication,
contact physician. Effect of
medication is reduced if full pain
recurs before next dose.
Intervention/evaluation
Monitor vital signs 1530 min
after subcutaneous/IM dose, 5
10 min after IV dose (monitor for
hypotension, change in
rate/quality of pulse). Monitor
pain level, sedation response.
Monitor daily pattern of bowel
activity, stool consistency; avoid
constipation. Check for adequate
voiding. Initiate deep breathing,
coughing exercises, particularly in
pts with pulmonary impairment.
Therapeutic serum level: 100
550 ng/ml; toxic serum level:
greater than 1,000 ng/ml.
Morphine
sulfate
(Avinza, Kadian,
Morphine IR, MS
Contin, MSIR,
Oramorph SR,
Roxanol)
NARCAN
is
antidote

Action
Binds with opioid
receptors within CNS
Therapeutic Effect:
Alters pain perception,
emotional response to
pain
Uses
Relief of moderate to
severe, acute, or chronic
pain; analgesia during
labor
Drug of choice for pain due
to MI, dyspnea from
pulmonary edema not
resulting from chemical
respiratory irritant
DepoDur: Epidural
(lumbar) single dose
management of surgical
pain. Infumorph: Use in
devices for managing
intractable chronic pain
IV plasma
amylase &
lipase
concentration

Ambulatory pts,
that not in
severe pain
may experience
nausea,
vomiting more
frequently than
those in supine
position or who
have severe
pain.
Frequent:
Sedation,
decreased B/P
(including
orthostatic
hypotension),
diaphoresis,
facial flushing,
constipation,
dizziness,
drowsiness,
nausea,
vomiting..
Baseline assessment
Pt should be in recumbent
position before drug is given by
parenteral route. Assess onset,
type, location, duration of pain.
Obtain vital signs before giving
medication. If respirations are
12/min or less (20/min or less in
children), withhold medication,
contact physician. Effect of
medication is reduced if full pain
recurs before next dose.
Intervention/evaluation
Monitor vital signs 510 min after
IV administration, 1530 min
after subcutaneous, IM. Be alert
for decreased respirations, B/P.
Check for adequate voiding.
Monitor daily pattern of bowel
activity and stool consistency.
ketorolac
(Toradol)

Immune system
drug, Anti-
inflammatory &
Disease-
modulating
Agent
Action
Inhibits prostaglandin
synthesis, reduces
prostaglandin levels in
aqueous humor.
Therapeutic Effect:
Reduces intensity of pain
stimulus, reduces
intraocular inflammation.
Uses
PO, injection: Short-term
(5 days or less) relief of
mild to moderate pain.
Ophthalmic: Relief of
ocular itching due to
seasonal allergic
conjunctivitis. Treatment
postop for inflammation
following cataract
extraction, pain following
incisional refractive
surgery.
IV
IM
PO

BUN, serum
creatine, CBC
with diff,
electrolytes,
bleeding
time, & liver
function
tests
Frequent (17%
12%):
Headache,
nausea,
abdominal
cramps/pain,
dyspepsia
(heartburn,
indigestion,
epigastric pain).


Baseline assessment
Assess onset, type, location,
duration of pain. Obtain baseline
renal/hepatic function tests.
Intervention/evaluation
Monitor renal/hepatic function
tests, urinary output. Monitor
daily pattern of bowel activity,
stool consistency. Observe for
occult blood loss. Assess for
therapeutic response: relief of
pain, stiffness, swelling;
increased joint mobility, reduced
joint tenderness, improved grip
strength. Be alert to signs of
bleeding (may also occur with
ophthalmic route due to systemic
absorption).


Hydralazine
(Apresoline)
Action
Competes with histamine
for receptor sites in GI
tract, blood vessels,
respiratory tract
Diminishes vestibular
stimulation, depresses
labyrinthine function.
Therapeutic Effect:
Produces anxiolytic,
anticholinergic,
antihistaminic, analgesic
effects; relaxes skeletal
muscle; controls nausea,
vomiting.
Uses
Treatment of anxiety,
preop sedation, antipruitic

PO
IM
None
significant
Frequent:
Drowsiness, dry
mouth, marked
discomfort with
IM injection.
Occasional:
Dizziness,
ataxia, asthenia
(loss of
strength,
energy), slurred
speech,
headache,
agitation,
increased
anxiety.
Baseline assessment
Anxiety: Offer emotional support
to anxious pt. Assess motor
responses (agitation, trembling,
tension), autonomic responses
(cold/clammy hands,
diaphoresis). Antiemetic: Assess
for dehydration (poor skin turgor,
dry mucous membranes, and
longitudinal furrows in tongue).
Intervention/evaluation
For those on long-term therapy,
hepatic/renal function tests,
blood counts should be
performed periodically. Monitor
lung sounds for signs of
hypersensitivity reaction.
Monitor serum electrolytes in pts
with severe vomiting. Assess for
paradoxical reaction, particularly
during early therapy. Assist with
ambulation if drowsiness, light-
headedness occur.







Nubain
(Nalbuphine )
Short acting
Action
Binds with opioid
receptors within CNS. May
displace opioid agonists,
competitively inhibiting
their action; may
precipitate withdrawal
symptoms. Therapeutic
Effect: Alters pain
perception, emotional
response to pain.
Uses
Relief of moderate to
severe pain, preop
analgesia, obstetric
analgesia, adjunct to
anesthesia. OFF-LABEL:
Opioid-induced pruritus.


IV
IM
plasma
amylase &
lipase
concentration

Frequent
Sedation.
Occasional
Diaphoresis,
cold/clammy
skin, nausea,
vomiting,
dizziness,
vertigo, dry
mouth,
headache.


Baseline assessment
Obtain vital signs before giving
medication. If respirations are
12/min or less (20/min or less in
children), withhold medication,
contact physician. Assess onset,
type, location, duration of pain.
Effect of medication is reduced if
full pain recurs before next dose.
Low abuse potential.
Intervention/evaluation
Monitor for change in
respirations, B/P, rate/quality of
pulse. Monitor daily pattern of
bowel activity and stool
consistency. Initiate deep
breathing, coughing exercises,
particularly in pts with pulmonary
impairment. Assess for clinical
improvement, record onset of
relief of pain. Consult physician if
pain relief is not adequate.
Ritodrine


used to stop
premature labor
Action
Inhibits HIV-1 and HIV-2
proteases, rendering these
enzymes incapable of
processing polypeptide
precursors leading to
production of
noninfectious, immature
HIV particles. Therapeutic
Effect: Slows HIV
replication, reducing
progression of HIV
infection.
Uses Treatment of HIV
infection in combination
with other antiretroviral
agents.


PO Frequent:
GI disturbances
(abdominal
pain, anorexia,
diarrhea,
nausea,
vomiting),
circumoral and
peripheral
paresthesias,
altered taste,
headache,
dizziness,
fatigue,
asthenia (loss
of strength,
energy).


Baseline assessment
Pts beginning combination
therapy with ritonavir and
nucleosides may promote GI
tolerance by beginning ritonavir
alone and subsequently adding
nucleosides before completing 2
wks of ritonavir monotherapy.
Obtain baseline laboratory
testing, esp. serum hepatic
function tests, triglycerides
before beginning ritonavir
therapy and at periodic intervals
during therapy. Offer emotional
support to pt/family.
Intervention/evaluation
Closely monitor for evidence of
GI disturbances, neurologic
abnormalities (particularly
paresthesias). Monitor serum
hepatic function tests, serum
glucose, CD4 cell count, plasma
levels of HIV RNA.







Calcium
Gluconate
(Tums)

GI Drug,
electrolyte
modifier


Therapeutic
Effect:
Replaces calcium
in deficiency
states; controls
hyperphosphate
mia in end-stage
renal disease,
relieves
heartburn,
indigestion.

Action:
Essential for function,
integrity of nervous,
muscular, skeletal systems.
Plays an important role in
normal cardiac/renal
function, respiration,
blood coagulation, cell
membrane and capillary
permeability. Assists in
regulating release/storage
of
neurotransmitters/hormo
nes. Neutralizes/reduces
gastric acid (increases pH).
Calcium acetate: Combines
with dietary phosphate,
forming insoluble calcium
phosphate.
Uses:
Parenteral: Acute
hypocalcemia (e.g.,
neonatal hypocalcemia
tetany, alkalosis),
electrolyte depletion,
cardiac arrest (strengthens
myocardial contractions),
hyperkalemia (reverses
cardiac depression),
Hypermagnesemia (aids in
reversing CNS depression).
IV

electrolytes,
serum Mg,
Ph, & K
concentratio
ns
Frequent:
PO: Chalky
taste.
Parenteral:
Pain, rash,
redness,
burning at
injection site,
flushing, feeling
of warmth,
nausea,
vomiting,
diaphoresis,
hypotension
Baseline assessment Assess
B/P, EKG and cardiac rhythm,
renal function, serum
magnesium, phosphate,
potassium concentrations.
Intervention/evaluation
Monitor B/P, EKG, cardiac
rhythm, serum magnesium,
phosphate, potassium, renal
function. Monitor serum, urine
calcium concentrations. Monitor
for signs of hypercalcemia.

Stadol
(Butorphanol)
Short acting
Action
Binds to opiate receptor
sites in CNS. Reduces
intensity of pain stimuli
incoming from sensory
nerve endings. Therapeutic
Effect: Alters pain
perception, emotional
response to pain
Uses
Management of pain
(including postop pain).
Nasal: Management of
moderate to severe pain,
including migraine
headache pain. Parenteral:
Preop, preanesthetic
medication, supplement
balanced anesthesia, relief
of pain during labor.
IV
Nasal
Spray
(Stadol
NS):
10 mg/ml.

.
plasma
amylase &
lipase
concentration

Frequent:
Parenteral:
Drowsiness,
dizziness.
Nasal:
Nasal
congestion
Baseline assessment
Obtain vital signs before giving
medication. If respirations are
12/min or less (20/min or less in
children), withhold medication,
contact physician. Assess onset,
type, location, duration of pain.
Effect of medication is reduced if
full pain recurs before next dose.
Protect from falls. During labor,
assess fetal heart tones, uterine
contractions.
Intervention/evaluation
Monitor for change in
respirations, B/P, rate/quality of
pulse. Initiate deep breathing,
coughing exercises, particularly in
those with pulmonary
impairment. Change pts position
q24h. Assess for clinical
improvement, record onset of relief
of pain.
Phytonadione
Aqua
(Vitamin K
1
)
stage 2
First hour after
birth

Cardiovascular
Drug, Affecting
coagulation

Antidote
for
WARFARIN
Action
Promotes hepatic
formation of coagulation
factors II, VII, IX, X.
Therapeutic Effect:
Essential for normal
clotting of blood.
Uses
Prevention, treatment of
hemorrhagic states in
neonates; antidote for
hemorrhage induced by
oral anticoagulants,
hypoprothrombinemic
states due to vitamin K
deficiency. Will not
counteract anticoagulation
effect of heparin.
IM
IV
PO
PT
IR
Occasional:
Pain, soreness,
swelling at IM
injection site,
pruritic
erythema (with
repeated
injections),
facial flushing,
altered taste.


Intervention/evaluation
Monitor PT, international
normalized ratio (INR) routinely
in those taking anticoagulants.
Assess skin for ecchymoses,
petechiae. Assess gums for
gingival bleeding, erythema.
Assess urine for hematuria.
Assess Hct, platelet count,
urine/stool culture for occult
blood. Assess for decrease in B/P,
increase in pulse rate, complaint
of abdominal/back pain, severe
headache (may be evidence of
hemorrhage). Question for
increase in amount of discharge
during menses. Assess peripheral
pulses. Check for excessive
bleeding from minor cuts,
scratches.
PNV
Prenatal vitamins are used
to provide the additional
vitamins needed
during pregnancy.
Minerals may also be
contained in prenatal
multivitamins.

PO None
significant
Upset stomach;
headache; or
Unusual or
unpleasant
taste in your
mouth.


Avoid taking any other
multivitamin product within 2
hours before or after you take
your prenatal vitamins. Taking
similar vitamin products together
at the same time can result in a
vitamin overdose or serious side
effects.
Avoid the regular use of salt
substitutes in your diet if your
multivitamin contains potassium.
If you are on a low-salt diet, ask
your doctor before taking a
vitamin or mineral supplement.
Do not take this medication with
milk, other dairy products,
calcium supplements, or antacids
that contain calcium. Calcium
may make it harder for your body
to absorb certain ingredients of
the prenatal vitamin.










Iron Sulfate
(ferrous sulfate)
Uses
Ferrous sulfate provides
the iron needed by the
body to produce red blood
cells.

It is used to treat or
prevent iron-deficiency
anemia, a condition that
occurs when the body has
too few red blood cells
because of pregnancy,
poor diet, excess bleeding,
or other medical problems.
PO Serum iron,
total iron-
binding
capacity,
reticulocyte
count, Hgb,
ferritin.


Constipation
Stomach Upset

Although symptoms of iron
deficiency usually improve within
a few days, you may have to take
ferrous sulfate for 6 months if
you have severe iron deficiency.
This medication should be taken
on an empty stomach, at least 1
hour before or 2 hours after
eating.
Ferrous sulfate drops come with
a special dropper for measuring
the dose. Ask your pharmacist to
show you how to use it. The
drops may be placed directly in
the mouth or mixed with water
or fruit juice (not with milk).
Ducolax


GI system,
Laxative/ bowel
preps/
Anitflatulents
Action
Direct effect on colonic
smooth musculature by
stimulating intramural
nerve plexi. Therapeutic
Effect: Promotes fluid and
ion accumulation in colon
increasing peristalsis,
producing laxative effect.
Uses
Treatment of constipation,
colonic evacuation before
examinations or
procedures.
PO

electrolytes Frequent: Some
degree of
abdominal
discomfort,
nausea, mild
cramps,
faintness.
Occasional:
Rectal
administration:
burning of
rectal mucosa,
mild proctitis.
Intervention/evaluation
Encourage adequate fluid intake.
Assess bowel sounds for
peristalsis. Monitor daily pattern
of bowel activity and stool
consistency; record time of
evacuation. Assess for abdominal
disturbances. Monitor serum
electrolytes in those exposed to
prolonged, frequent, or excessive
use of medication.


(Reglan
(Metoclopramide)
Routes


Action
Stimulates motility of upper GI
tract
Decreases reflux into
esophagus. Raises threshold
activity in chemoreceptor
trigger zone
Therapeutic Effect:
Accelerates intestinal transit,
gastric emptying. Relieves
nausea, vomiting.
Uses
Facilitates placement of enteral
feeding tubes; stimulates
gastric emptying, intestinal
transit in conjunction with
radiography; treatment of
gastroparesis,
gastroesophogeal reflux
disease (GERD); prevents or
treats cancer chemotherapy-
induced nausea, vomiting;
prevents or treats postop
nausea, vomiting. Orally-
Disintegrating Tablets:
Treatment of gastroparesis,
GERD.
IV
PO

ALERT
Doses of 2
mg/kg or
greater, or
increased
length of
therapy, may
result in a
greater
incidence of
side effects.
Frequent (10%):
Drowsiness,
restlessness,
fatigue,
lethargy

Baseline assessment
Antiemetic: Assess for
dehydration (poor skin turgor,
dry mucous membranes, and
longitudinal furrows in tongue).
Assess for nausea, vomiting,
abdominal distention, and bowel
sounds.
Intervention/evaluation
Monitor for anxiety, restlessness,
extrapyramidal symptoms (EPS)
during IV administration. Monitor
daily pattern of bowel activity
and stool consistency. Assess skin
for rash. Evaluate for therapeutic
response from gastroparesis
(nausea, vomiting, bloating).
Monitor renal function, B/P,
heart rate.

Methyldopa
(Aldomet)
Lowers blood pressure by
decreasing the levels of
certain chemicals in your
blood. This allows your
blood vessels (veins and
arteries) to relax (widen)
and your heart to beat
more slowly and easily.
Methyldopa is used to
treat hypertension (high
blood pressure).


ORAL slow heart rate;
pale or
yellowed skin,
fever, confusion
or weakness;
nausea, upper
stomach pain,
itching, loss of
appetite, dark
urine, clay-
colored stools,
jaundice
(yellowing of
the skin
or eyes);
skin rash,
bruising, severe
tingling,
numbness,
pain, muscle
weakness;
feeling short of
breath, even
with mild
exertion;
swelling in your
hands, ankles,
or feet;
easy bruising,
unusual
bleeding (nose,
mouth, vagina,
or rectum),
purple or red
pinpoint spots
under your
skin; or
Muscle
movements you
cannot control.












You should not take
this medication if you are allergic
to methyldopa, or if you have
liver disease (especially cirrhosis),
or a history of liver problems
caused by taking methyldopa. Do
not use methyldopa if you have
used an MAO inhibitor such as
furazolidone (Furoxone),
isocarboxazid (Marplan),
phenelzine (Nardil), rasagiline
(Azilect), selegiline (Eldepryl,
Emsam, Zelapar), or
tranylcypromine (Parnate) in the
last 14 days. A dangerous drug
interaction could occur, leading
to serious side effects.

Procardia
(Nifedipine)
Cardiovascular
system,
Affecting
contractility/
rhythm/
circulating
blood volume
Action
Inhibits calcium ion
movement across cell
membranes, depressing
contraction of cardiac,
vascular smooth muscle
Therapeutic Effect:
Increases heart rate,
cardiac output
Decreases systemic
vascular resistance, B/P
Uses
Treatment of angina due
to coronary artery spasm
(Prinzmetals variant
angina), chronic stable
angina (effort-associated
angina)
Extended-release
Treatment of essential
hypertension
PO
SUB
LINGUAL
LFT, RFT,
CBC, serum
glucose, K
Frequent
Peripheral
edema,
headache,
flushed skin,
dizziness.
Occasional
Nausea,
shakiness,
muscle
cramps/pain,
drowsiness,
palpitations,
nasal
congestion,
cough,
dyspnea,
wheezing.
Baseline assessment
Concurrent therapy of sublingual
nitroglycerin may be used for
relief of anginal pain
Record onset, type (sharp, dull,
squeezing), radiation, location,
intensity, duration of anginal
pain; precipitating factors
(exertion, emotional stress)
Check B/P for hypotension
immediately before giving
medication.
Intervention/evaluation
Assist with ambulation if light-
headedness, dizziness occurs
Assess for peripheral edema.
Assess skin for flushing. Monitor
serum hepatic enzymes,
signs/symptoms of CHF.

Bupivacaine
(Marcaine HCl,
Marcaine Spinal,
Sensorcaine,
Sensorcaine-
MPF,
Sensorcaine-
MPF Spinal)

Inducing spinal anesthesia
for certain medical or
surgical procedures.
Bupivacaine Solution is an
anesthetic. It works by
blocking the generation
and conduction of nerve
impulses.


Nerve
block
Mild dizziness
or drowsiness.
Baseline assessment
Pt should be in recumbent
position before drug is
administered by parenteral
route. Assess onset, type,
location, duration of pain. Obtain
vital signs before giving
medication. If respirations are
12/min or less (20/min or less in
children), withhold medication,
contact physician. Effect of
medication is reduced if full pain
recurs before next dose.
Intervention/evaluation
Monitor vital signs 1530 min
after subcutaneous/IM dose, 5
10 min after IV dose (monitor for
hypotension, change in
rate/quality of pulse). Monitor
pain level, sedation response.
Monitor daily pattern of bowel
activity, stool consistency; avoid
constipation. Check for adequate
voiding. Initiate deep breathing,
coughing exercises, particularly in
pts with pulmonary impairment.
Therapeutic serum level: 100
550 ng/ml; toxic serum level:
greater than 1,000 ng/ml.


Fentanyl
( Fentora,
Onsolis)
CNS, Analgesics

NARCAN is antidote



Action
Binds to opioid receptors in CNS,
reducing stimuli from sensory
nerve endings, inhibits ascending
pain pathways. Therapeutic
Effect: Alters pain reception,
increases pain threshold.
Uses
For sedation, pain relief, preop
medication; adjunct to general or
regional anesthesia. Duragesic:
Management of chronic pain
(transdermal). Actiq: Treatment
of breakthrough pain in chronic
cancer or AIDS-related pain.
Fentora: Breakthrough pain in pts
on chronic opioids. Onsolis:
Breakthrough pain in pts with
cancer currently receiving opioids
and tolerant to opioid therapy.
IV
IM BUCAL
plasma amylase
& lipase

Frequent:
IV: Postop
drowsiness, nausea,
vomiting.
Transdermal (10%
3%): Headache,
pruritus, nausea,
vomiting,
diaphoresis,
dyspnea, confusion,
dizziness,
drowsiness,
diarrhea,
constipation,
decreased appetite.
Occasional: IV:
Postop confusion,
blurred vision,
chills, orthostatic
hypotension,
constipation,
difficulty urinating.
Transdermal (3%
1%): Chest pain,
arrhythmias,
erythema, pruritus,
syncope, agitation,
skin irritations.

Baseline assessment Resuscitative
equipment, opiate antagonist (naloxone
0.5 mcg/kg) must be available. Establish
baseline B/P, respirations. Assess type,
location, intensity, duration of pain.
Intervention/evaluation
Assist with ambulation. Encourage post-
op pt to turn, cough, deep breathe q2h.
Monitor respiratory rate, B/P, heart rate,
oxygen saturation. Assess for relief of
pain.

Phenergan
(Promethazine)
GI System,
Antiemetics/
Antihistamine
Action
Antihistamine: Inhibits histamine
at histamine receptor sites.
Antiemetic:
Diminishes vestibular stimulation
Depresses labyrinthine function
Acts on chemoreceptor trigger
zone
Sedative-hypnotic:
Produces CNS depression by
decreasing stimulation to brain
stem reticular formation
Therapeutic Effect:
Prevents allergic responses
mediated by histamine (urticaria,
pruritus). Prevents, relieves
nausea/vomiting
Produces mild sedative effect
Uses
Treatment of allergic conditions,
Motion sickness,
Nausea
Vomiting
May be used as mild sedative












PO
IV
Serum
electrolytes,
serum bilirubin,
AST, ALT
Expected:
Drowsiness,
disorientation;
hypotension,
confusion, syncope
in elderly
Frequent:
Dry mouth, nose,
throat; urinary
retention;
thickening of
bronchial secretions

Baseline assessment
Assess allergy symptoms. Assess B/P,
pulse for bradycardia, tachycardia if pt is
given parenteral form. If used as
antiemetic, assess for dehydration (poor
skin turgor, dry mucous membranes, and
longitudinal furrows in tongue).
Intervention/evaluation
Monitor serum electrolytes in pts with
severe vomiting. Assist with ambulation if
drowsiness, light-headedness occurs.
Monitor for relief of nausea, vomiting,
allergic symptoms

RhoGAM

(RHo (D)
immune
globulin)
Action
Prevent production of anti-Rh(D)
antibodies in Rh(D)-negative
patients who were exposed to
Rh(D)-positive blood. Increase
platelet counts in patients with
ITP. Therapeutic Effects:
Prevention of antibody response
and hemolytic disease of the
newborn (erythroblastosis fetalis)
in future pregnancies of women
who have conceived a Rh (D)-
positive fetus. Prevention of
Rh(D) sensitization following
transfusion accident. Decreased
bleeding in patients with ITP.
IV
IM
CNS: dizziness,
headache.
CV: hypertension,
hypotension.
Derm: rash.
GI: diarrhea,
nausea, vomiting.
Hemat: ITP:
anemia,
intravascular
hemolysis.
MS: arthralgia,
myalgia. Local: pain
at injection site.
Misc: fever.

Assessment
IV: Assess vital signs periodically during
therapy in patients receiving IV Rh(D)
immune globulin .ITP: Monitor patient for
signs and symptoms of intravascular
hemolysis (IVH) (back pain, shaking chills,
fever, hemoglobinuria), anemia, and renal
insufficiency. If transfusions are required,
use Rh(D) negative packed red blood cells
to prevent exacerbation of IVH.
Lab Test Considerations: Pregnancy: Type
and crossmatch of mother and newborns
cord blood must be performed to
determine need for medication. Mother
must be Rh (D)-negative and Du-negative.
Infant must be Rh(D)-positive. If there is
doubt regarding infants blood type or if
father is Rh(D)-positive, medication
should be given. An infant born to a
woman treated with Rh(D) immune
globulin antepartum may have a weakly
positive direct Coombs test result on cord
or infant blood.ITP: Monitor platelet
counts, RBC counts, hemoglobin, and
reticulocyte levels to determine
effectiveness of therapy .
Zofran
(Ondansetron)


GI System,
Antiemetics/
Antihistamine
Action
Blocks serotonin, both
peripherally on vagal nerve
terminals and centrally in
chemoreceptor trigger
zone
Therapeutic Effect:
Prevents nausea/vomiting
Uses
Prevention/treatment of
nausea/vomiting due to
cancer chemotherapy
(including high-dose
cisplatin)
Prevention of postop
nausea, vomiting.
Prevention of radiation-
induced nausea, vomiting.
Treatment of postop
nausea, vomiting.
OFF-LABEL:
Postanesthetic shivering,
vomiting due to viral
illness
Treatment of early-onset
alcoholism, Hyperemesis
gravidarum
IV
PO
Serum
electrolytes,
serum
bilirubin,
AST, ALT
Frequent
(13%5%):
Anxiety,
dizziness,
drowsiness,
headache,
fatigue,
constipation,
diarrhea,
hypoxia, urinary
retention.
Occasional
(4%2%):
Abdominal
pain,
xerostomia,
fever, feeling of
cold,
redness/pain at
injection site,
paresthesia,
asthenia (lack
of strength,
energy)
Rare (1%):
Hypersensitivity
reaction (rash,
pruritus),
blurred vision


Baseline assessment
Assess degree of nausea,
vomiting. Assess for dehydration
if excessive vomiting occurs (poor
skin turgor, dry mucous
membranes, and longitudinal
furrows in tongue). Provide
emotional support.
Intervention/evaluation
Monitor pt in environment.
Assess bowel sounds for
peristalsis. Provide supportive
measures. Assess mental status.
Monitor daily pattern of bowel
activity and stool consistency.
Record time of evacuation


Motrin
(Diphenhydramine
Ibuprofen )
Action
Inhibits prostaglandin
synthesis. Produces
vasodilation acting on
heat-regulating center of
hypothalamus.
Therapeutic Effect:
Produces analgesic, anti-
inflammation effects,
decreases fever.
Uses
Treatment of fever,
juvenile rheumatoid
arthritis (JRA),
osteoarthritis, minor pain,
mild to moderate pain,
primary dysmenorrheal.
NeoProfen: Closes
clinically significant patent
ductus arteriosus (PDA) in
premature infants
weighing between 500 and
1,500 g who are no more
than 32 wks gestational
age when usual medical
management is ineffective.
PO Serum,
plasma,
URINE
Occasional:
Nausea with or
without
vomiting,
dyspepsia,
dizziness, rash.
Rare (less than
3%): Diarrhea
or constipation,
flatulence,
abdominal
cramps or pain,
pruritus.


Baseline assessment
Assess onset, type, location,
duration of pain, inflammation.
Inspect appearance of affected
joints for immobility, deformities,
skin condition. Assess
temperature.
Intervention/evaluation
Monitor for evidence of nausea,
dyspepsia. Monitor CBC,
hepatic/renal function tests,
occult blood loss. Monitor daily
pattern of bowel activity and
stool consistency. Assess skin for
rash. Observe for bleeding,
bruising. Evaluate for therapeutic
response: relief of pain, stiffness,
swelling; increased joint mobility;
reduced joint tenderness;
improved grip strength. Monitor
temperature for fever.


Zantac
(ranitidine)
Action
Inhibits histamine action at
histamine 2 receptors of
gastric parietal cells.
Therapeutic Effect: Inhibits
gastric acid secretion (fasting,
nocturnal, when stimulated
by food, caffeine, insulin).
Reduces volume, hydrogen
ion concentration of gastric
juice.
Uses
Short-term treatment of
active duodenal ulcer.
Prevention of duodenal ulcer
recurrence. Treatment of
active benign gastric ulcer,
pathologic GI hypersecretory
conditions, acute
gastroesophageal reflux
disease (GERD), includes
erosive esophagitis.
Maintenance of healed
erosive esophagitis. Part of
regimen for H. pylori
eradication to reduce risk of
duodenal ulcer recurrence.
OTC: Relieve heartburn, acid
indigestion, sour stomach.
PO
IM
IV
serum AST,
ALT levels,
creatinine,
BUN
Occasional
(2%): Diarrhea.
Rare (1%):
Constipation,
headache (may
be severe).

.


Baseline assessment
Obtain history of
epigastric/abdominal pain.
Obtain baseline hepatic/renal
function tests.
Intervention/evaluation
Monitor. Assess mental status in
elderly. Question present
abdominal pain, GI distress
Pepcid
(Famotidine,
calcium, and
magnesium)

Action
Inhibits histamine action
H2 receptors of parietal
cells. Therapeutic Effect:
Inhibits gastric acid
secretion (fasting,
nocturnal, or stimulated by
food, caffeine, insulin).
Uses
Short-term treatment of
active duodenal ulcer.
Prevention, maintenance
of duodenal ulcer
recurrence. Treatment of
active benign gastric ulcer,
pathologic GI
hypersecretory conditions.
Short-term treatment of
gastroesophageal reflux
disease (GERD), including
erosive esophagitis. OTC
formulation for relief of
heartburn, acid
indigestion, sour stomach.
PO
IM
IV
Occasional
(5%):
Headache.



Baseline assessment
Assess epigastric/abdominal pain.
Intervention/evaluation
Monitor daily pattern of bowel
activity and stool consistency.
Monitor for diarrhea,
constipation, and headache.
Assess confusion in elderly.


Beractant
(Survanta)
Action
Lowers alveolar surface
tension during respiration,
stabilizing alveoli.
Therapeutic Effect:
Improves lung compliance,
respiratory gas exchange.
Uses
Prevention and treatment
(rescue therapy) of
respiratory distress
syndrome (RDShyaline
membrane disease) in
premature infants.
Prevention: Body weight
less than 1,250 g in infants
at risk for developing or
with evidence of
surfactant deficiency (give
within 15 min of birth).
Rescue Therapy:
Treatment of infants with
RDS confirmed by X-ray,
requiring mechanical
ventilation (give within 8
hrs of birth).


Intra
tracheal


Frequent:
Transient
bradycardia,
oxygen (O2)
desaturation,
increased
carbon dioxide
(CO2)
retention.

Occasional:
Endotracheal
tube reflux.


Baseline assessment
Drug must be administered in
highly supervised setting.
Clinicians caring for neonate
must be experienced with
intubation, ventilator
management. Offer emotional
support to parents.
Intervention/evaluation
Monitor infant with arterial or
transcutaneous measurement of
systemic O2, CO2. Assess for
adventitious breath sounds
(rales, rhonchi).


Erythromycin 1%
stage 2
First hour after
birth
Action
Penetrates bacterial cell
membranes, reversibly
binds to bacterial
ribosomes, inhibiting
protein synthesis.
Therapeutic Effect:
Bacteriostatic.
Uses
Treatment of susceptible
infections due to S.
pyogenes, S. pneumoniae,
S. aureus, M. pneumoniae,
Legionella, diphtheria,
pertussis, chancroid,
Chlamydia, N. gonorrheae,
E. histolytica, syphilis,
nongonococcal urethritis,
Campylobacter
gastroenteritis. Topical:
Treatment of acne
vulgaris. Ophthalmic:
Prevention of gonococcal
ophthalmia neonatorum,
superficial ocular
infections.
OFF-LABEL:
Systemic: Treatment of
acne vulgaris, chancroid,
Campylobacter enteritis,
gastroparesis, Lyme
disease, preoperative gut
sterilization. Topical:
Treatment of minor
bacterial skin infections.
Ophthalmic: Treatment of
blepharitis, conjunctivitis,
keratitis, chlamydial
trachoma.
PO
TOPICAL
Frequent:
IV: Abdominal
cramping/disco
mfort,
phlebitis/throm
bophlebitis.
Topical: Dry
skin (50%).
Occasional:
Nausea,
vomiting,
diarrhea, rash,
urticaria.
Rare:
Ophthalmic:
Sensitivity
reaction with
increased
irritation,
burning,
itching,
inflammation.
Topical:
Urticaria.


Baseline assessment
Question for history of allergies
(particularly erythromycins),
hepatitis.
Intervention/evaluation
Monitor daily pattern of bowel
activity and stool consistency.
Assess skin for rash. Assess for
hepatotoxicity (malaise, fever,
abdominal pain, GI disturbances).
Be alert for superinfection: fever,
vomiting, diarrhea, anal/genital
pruritus, oral mucosal changes
(ulceration, pain, erythema).
Check for phlebitis (heat, pain,
red streaking over vein). Monitor
for high-dose hearing loss.

.
Narcan
(Naloxone)
CNS Drug,
Opioid Reversal
Agent
Action
Displaces opioids at opioid-
occupied receptor sites in
CNS. Therapeutic Effect:
Reverses opioid-induced
sleep/sedation, increases
respiratory rate, raises B/P to
normal range.
Uses
Complete or partial reversal of
opioid depression including
respiratory depression. Diagnosis
of suspected opioid tolerance or
acute opioid overdose. Neonatal
opiate depression. Coma of
unknown origin
IV
IM
None known;
little or no
pharmacologic
effect in absence
of narcotics.


Baseline assessment
Maintain clear airway. Obtain weight
of children to calculate drug dosage.
Intervention/evaluation
Monitor vital signs, esp. rate, depth,
rhythm of respiration, during and
frequently following administration.
Carefully observe pt after satisfactory
response (duration of opiate may
exceed duration of naloxone,
resulting in recurrence of respiratory
depression). Assess for increased
pain with reversal of opiate.


Benadryl
(Diphenhydramine)
Respiratory
System, Anti-
allergy/ Anti-
inflammatory
Agent
Action
Competitively blocks
effects of histamine at
peripheral H1 receptor
sites. Therapeutic Effect:
Produces anticholinergic,
antipruritic, antitussive,
antiemetic, antidyskinetic,
sedative effects.
Uses
Treatment of allergic
reactions, parkinsonism;
prevention/treatment of
nausea, vomiting, vertigo
due to motion sickness;
antitussive; short-term
management of insomnia.
Topical form used for relief
of pruritus, insect bites,
skin irritations.
IV
IM
PO
Frequent:
Drowsiness,
dizziness,
muscle
weakness,
hypotension,
urinary
retention,
thickening of
bronchial
secretions, dry
mouth, nose,
throat, lips; in
elderly:
sedation,
dizziness,
hypotension.
Occasional:
Epigastric
distress,
flushing,
visual/hearing
disturbances,
paresthesia,
diaphoresis,
chills.
Baseline assessment
If pt is having acute allergic
reaction, obtain history of
recently ingested foods, drugs,
environmental exposure, and
emotional stress. Monitor B/P
rate, depth, rhythm, type of
respiration; quality, rate of pulse.
Assess lung sounds for rhonchi,
wheezing, and rales.
Intervention/evaluation
Monitor B/P, esp. in elderly
(increased risk of hypotension).
Monitor children closely for
paradoxical reaction.


Percocet

(Acetaminophen/
Oxycodone)
Action
Binds with opioid
receptors within CNS.
Therapeutic Effect: Alters
perception of and
emotional response to
pain.

Uses
Relief of mild to
moderately severe pain.


PO May increase
serum
amylase,
lipase.

ALERT
Effects are
dependent on
dosage amount.
Ambulatory pts,
those not in
severe pains
may experience
dizziness,
nausea,
vomiting, and
hypotension
more
frequently than
those in supine
position or
having severe
pain. Frequent:
Drowsiness,
dizziness,
hypotension
(including
orthostatic
hypotension),
anorexia.
Baseline assessment
Assess onset, type, location,
duration of pain. Effect of
medication is reduced if full pain
recurs before next dose. Obtain
vital signs before giving
medication. If respirations are
12/min or less (20/min or less in
children), withhold medication,
contact physician.
Intervention/evaluation
Palpate bladder for urinary
retention. Monitor daily pattern
of bowel activity and stool
consistency. Initiate deep
breathing, coughing exercises,
esp. in pts with pulmonary
impairment. Monitor pain relief,
respiratory rate, mental status,
B/P.