1 Obstetrical Drug Guide

Trade Name Demerol Classification Generic Name Opioid analgesic (agonist) Meperidine Opioid analgesic(agonist) Morphine Opioid analgesic (agonist) Butorphanol Opioid analgesic (agonist) Nalbuphine HCl Opioid analgesic (agonist) Fentanyl Opioid analgesic Morphine Opioid antagonist Naloxone Antihistamine/ sedative/ antiemetic Diphenhydramine Analgesic Acetaminophen Narcotic analgesic combination Acetaminophen with codeine Narcotic analgesic Oxycodone HCl Narcotic analgesic combination Oxycodone with acetaminophen Narcotic analgesic Hydrocodone with acetaminophen Opioid analgesic (agonist) Propoxyphene NNarcotic analgesic combination Propoxyphene 1-2 mg in early labor at term; repeat after 4 hrs 10 mg/70 kg q 3-6 hr prn. Maximum 160mg/day 2-20 mcg/kg Maternity Dosage 50-100 mg q 1 to 3 hr prn when contractions become irregular Mode of Admin IM/SC Action of Drug Binds to the opiate receptors. Alters perception of and response to painful stimuli, while producing generalized CNS depression. - pain - Pre-op sedation Binds to opiate receptors in the CNS-alters perception of and painful stimuli, while producing generalized CNS depression - pain Alters perception of and response to painful stimuli, while producing generalized CNS depression. - pain, sedation Binds to opiate receptors in the CNS. Alters perception of and painful stimuli, while producing generalized CNS depression - pain, sedation Binds to opiate receptors in the CNS. Alters perception of and painful stimuli, while producing generalized CNS depression - pain - Supplement in anesthesia Binds to opiate receptors in the CNS, decreasing sodium permeability and inhibiting transmission of pain impulses. - pain Overcomes the effect of narcotic overdose depression, sedation, and hypotension. Onset of action2 minutes. A potent antihistamine, it is capable of blocking the effects of histamine at various receptor sites, either eliminating allergic reaction or greatly modifying it. Inhibits prostaglandins in CNS but lacks anti-inflammatory effects in periphery. Reduces fever through direct action on hypothalamic heart-regulating center. Inhibits the synthesis of prostaglandins. Binds to opiate receptors in the CNS and peripherally blocks pain impulse generation. Side Effects Sedation, confusion, respiratory depression, hypotension nausea, vomiting, constipation

Duramorph

IM/SC

Sedation, confusion, respiratory depression, hypotension, constipation Confusion, dysphoria hallucinations, sedation, nausea, sweating Dizziness, headache, sedation, dry mouth, nausea, vomiting, clammy feeling, sweating Hypoventilation, hypotension, respiratory depression, HTN, nausea, vomiting, constipation, dry mouth, sweating, somnolence, asthenia Dizziness, drowsiness, sedation, hypotension, miosis, constipation, nausea, respiratory depression Elevated PTT, hypertension, nausea, vomiting, sweating, tachycardia, tremulousness Blurring of vision, confusion, constipation, diarrhea, difficulty in urination, diplopia, drug rash, drowsiness, dry mouth, nose, throat, headache epigastric distress, hypotension Nausea, vomiting, rash Drowsiness, sedation, anorexia, constipation, nausea, vomiting

Stadol Nubain

IV/IM SC/IM/IV

Fentanyl

IV/IM

Morphine Narcan Benadryl

2.5-15 mg/70 kg repeat q 2-4 hr prn 0.4-2 mg repeat in 2-3 minutes if indicated 10 mg-50 mg up to 100mg may be given. Total dosage not to exceed 400mg/24hr 325-650mg prn q 4-6 hr do not exceed 4g/day 1-2 tablets q 4hr

SC/IM/IV IV IV/IMPO/SC

Tylenol Tylenol #3

PO PO

Percodan Percocet

5mg q 6 hr prn (1 tablet) 1-2 tablets q 4-6 hrs 65mg (with 650 acetaminophen) q 4 hr not to exceed 390mg/ day 65mg (with 650 acetaminophen) q 4 hr not to exceed 390mg/

PO

Vicodin (Loratab) Darvon

PO PO

Darvocet 100

PO

Acetaminophen inhibits synthesis of prostaglandins and peripherally blocks pain impulse generation, where as Oxycodone binds to opiate receptors in the CNS. Combination has synergistic effect on alleviating pain. Inhibits synthesis of prostaglandins and binds to opiate receptors in the CNS and peripherally blocks pain impulse generation. Propoxyphene relieves pain by stimulating opiate receptors in CNS. Acetaminophen inhibits synthesis of prostaglandins. - mild-mod. pain Propoxyphene relieves pain by stimulating opiate receptors in CNS. Acetaminophen inhibits synthesis of prostaglandins.

Dizziness, sedation, hypotension, constipation, nausea, respiratory depression Hypoventilation, hypotension, respiratory depression, nausea, vomiting, dry mouth, Hypotension, drowsiness, sedation, constipation, nausea, vomiting, respiratory depression Hypotension, drowsiness, sedation, dizziness, constipation, nausea, vomiting, respiratory depression Hypotension, drowsiness, sedation, dizziness, constipation, nausea, vomiting, respiratory depression

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Motrin with acetaminophen Analgesic NSAID Ibuprofen Analgesic NSAID Ketorolac tromethamine day 400-800 mg 3-4 times daily not to exceed 3600mg/day 20mg Po then 10mg q 4-6 hr 60mg IM then 30mg q 6 hr 30mg IV then 30mg q6 hr 10 mg at bedtime 1.5-30 mg at bedtime PO Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis - pain, inflammation, fever Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and inhibits synthesis of prostaglandins, producing peripherally mediated analgesia Produces CNS depression by binding to GABA receptors - sedation, induction of sleep Potentiates action of GABA, an inhibitory neurotransmitter, resulting in increased neuronal inhibition and CNS depression, especially in limbic system and reticular formation. - relief of insomina Acts as a CNS depressant at the subcortical level of the CNS. Has anticholinergic, antihistaminic, and antiemetic properties. - sedation - anxiety, N&V, allergic sx Competitively antagonizes histamine at H1 receptor sites. Produces sedative and antiemetic effects Produces bronchodilation by relaxing bronchial smooth muscle through beta 2-receptor stimulation. Inhibits movement of calcium ions across cell membrane is systemic and coronary vascular smooth muscle and myocardium. Increases CO and decreases peripheral vascular resistance. Reduces myocardial oxygen demand. Relaxes and prevents coronary artery spasm. - BP (systemic vasodilaton) - angina ( coronary vasodilation) Magnesium has CNS depressant effect; prevent/control seizures by blocking neuromuscular transmission and decreasing amount of acetylcholine liberated at end plate by motor nerve impulse. Stimulats uterine and mammary gland smooth muscle, producing uterine contractions similar to spontaneous labor contractions -Induction of labor Directly stimulates uterine and vascular smooth muscle. - Uterine contraction Relaxes smooth muscle of ductus arteriosus. Produces vasodilation, inhibits platelet aggregation and stimulates intestinal and uterine smooth muscle. - IV: Short-term maintenance of patent ductus arteriosus in neonates born with congenital heart defects who require patency to maintain blood oxygenation and perfusion of Headache, GI bleeding, constipation, dyspnea, nausea, vomiting Drowsiness, GI bleeding, asthma, dyspnea, vasodilation, diarrhea, dry mouth

Toradol

PO/IM/IV

Ambien Restoril

Sedative Zolpidem tartrate Sedative Temazepam

PO PO

Amnesia, drugged feeling, drowsiness, dizziness, diarrhea, nausea, vomiting, psychological dependece Palpations, tachycardia , drowsiness, dizziness, confusion, euphoria, ataxia,

Vistaril

Sedative/ Antihistamine Hydroxyzine HCl Sedative/ Antihistamine/ antiemetic Promethazine HCl Bronchodilator Brethaire, Bricanyl Calcium channel blocker Procardia, Adalat

50-100 mg PO qid 25 mg IV tid

PO/IM

Chest tightness, involuntary motor activity, tremors convulsions, dry mouth, wheezing, SOB

Phenergan

6.25-25 mg

PO/IM/IV

Orthostatic hypertension, palpations, bradycardia, tachycardia, drowsiness, sedation, dizziness, faintness Palpations, tachycardia, dizziness, nausea, vomiting, weakness, BP changes such as hypertension Peripheral edema, hypotension, palpations, arrhythmia, lightheadedness, nervousness, headache, sleep disturbances, insomnia, abnormal dreams, blurred vision, jitteriness, chest congestion, wheezing, SOB Cardiac depression, circulatory collapse, hypotension, cardiac arrest, CNS depression, muscle weakness, flaccid paralysis, Painful contractions, increased uterine motility, abruption placentae, water intoxication, hypochloremia Hypotension, N&V, dizziness, HA, cramps Flushing, bradycardia, tachycardia, cardiac arrest, edema, fever, seizures cerebral bleeding, diarrhea

Terbutaline Nifedipine

2.5-5 mg at 6 hr intervals do not exceed 15 mg in 24 hr 10-30 mg not to exceed 180mg/day

PO/ PO

Magnesium Sulfate Pitocin

Electrolyte/Laxativ e Anticonvulsant Epson salt Oxytocic hormone Oxytocin Uterine stimulant (oxytocic) Prostaglandin/ patent ductus arteriosus Alprostadil

10-15g PO 1-5g IM 1-4g IV diluted 0.5-2 mU/min IV 10 units IM after delivery of placenta

PO/IM/IV

IV/IM

Methergine Prostin

PO/ IM/IV 0.010.4 mcg/kg IV, Vaginal suppository

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Hemabate Abortifacients/ oxyltocics/ prostaglandins Carboprost Abortifacient - 250 mcg every 1.5 3.5 hr depending upon uterine response; may be increased to 500 mcg if several doses of 250 mcg produce inadequate response (not to exceed 2 days of continuous therapy or total dose of 12 mg. Refractory Postpartum Uterine Bleeding - 250 mcg; may be repeated every 1590 min (total dose not to exceed 2 mg). 100-200 mcg qid in conjunction with NSAID therapy. 10 mg (1 insert) releases approx. 0.3 mg/hr over 12 hr remove insert upon onset of active labor or 12 hr after insertion 8-14g/day in divided doses q 3-4 hr. 1-24 mU/day divided doses q 4-6 hr. 250mg-1.5 g q 6-12 hr 150-450mg PO 900mg q 8 hr 240 mg 50-500mg IM the lower body. - Vag. suppository: Initiation of labor. Expulsion of fetus. Causes uterine contractions by directly stimulating the myometrium.. - Expulsion of fetus - Control of postpartum bleeding Uterine rupture, diarrhea, N&V, fever, HA

Cytotec Cervidil

Prostaglandin Misoprostol Prostaglandin/ cervical ripening Dinoprostone

PO Intravaginal

Synthetic prostaglandin E1 analog that inhibits gastric acid secretion and exerts mucosal protective properties. - Prevention of gastric ulceration from NSAIDs Produces contractions. Initiates softening, effacement, and dilation of the cervix. Also stimulates GI smooth muscle. - Initiation of labor. - Expulsion of fetus Inhibits bacterial cell wall mucopeptide synthesis. - Bactericidal action; spectrum is broader than penicillin Inhibits mucopeptide synthesis of bacterial cell wall. - bactericidal Inhibits mucopeptide synthesis of bacterial cell wall. - Bactericidal Suppresses bacterial protein syntesis. Facilitates stool softening by detergent activity. Facilitates stool softening by detergent activity.

Headache, diarrhea abdominal pain nausea, flatulence, dyspepsia, vomiting, constipation Transient fall in BP, Syncope, dizziness, arrhythmias, headache, flushing, anxiety, tension, hot flashes, blurred vision, eye pain, anorexia

Ampicillin Penicillin Ancef Clindamycin Surfak Colace Pericolace Senokot MOM

Antibiotic/ penicillin Omniphen Antibiotic/ penicillin Pen V Antibiotic/ cephalosporin Cefazolin sodium Antibiotic/ Lincosamide Cleocin Laxative (stool softener) Docusate calcium Laxative (stool softener) Docusate sodium

PO/IV/IM IV/IM IV/IM PO/IV/ topical PO PO

Thrombophlebitis at injection site, dizziness, fatigue, insomnia, Dizziness, fatigue, insomnia, itchy eyes, stomatitis, sore mouth or tongue, furry tongue Nausea, vomiting, diarrhea, anorexia, abdominal pain Diarrhea, colitis, nausea, vomiting, abdominal pain Palpations, dizziness, fainting, excessive bowel activity, flatulence, abdominal cramping

Laxative Senna Electrolyte/Laxativ eAnticonvulsant Magnesium hydroxide Laxative

2 tablets, 1tsp of granules or 10-15 ml of syrup

PO PO

Directly acts on intestinal mucosa by altering water and electrolyte secretion, inducing peristalsis and defecation. Essential for the activity of many enzymes. Play an important role in neurotransmission and muscular excitability. Are osmotically active in GI tract, drawing water into the lumen and causing peristalsis. Acts as cathartic stimulant

Palpations, dizziness, fainting, excessive bowel activity, diarrhea, nausea, flatulence, abdominal cramping Diarrhea, flushing, sweating

Ducolax

10-15 mg up to 30 mg

PO

Palpations, dizziness, fainting, excessive bowel

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Biscacodyl Mylicon FeSo4 Antiflatulent Simethicone Iron product Ferrous salts Vitamin (H2O soluble) Vitamin B9, Folate Blood modifier Vitamin (fat soluble) Phytonadione Anti-infective Vaccine, inactivated virus Recombivax HB Immune serum Hepatitis B Immune Globulin Electrolyte/laxative / anticonvulsant Epson salt 125 mg qid after meals and at bedtime 30mg PO PO Relieves flatulence by dispersing and preventing formation of mucus-surrounded gas pockets in GI tract. Iron is major factor in oxygen transport and essential mineral component of hemoglobin, myoglobin, and several enzymes. - Prevention/ tx of iron def. Required for protein synthesis and red blood cell function. Stimulates the production of red blood cells, white blood cells, and platelets. Necessary for normal fetal development. Promotes hepatic synthesis of active prothrombin (factor II), proconvertin (factor VII), plasma thromboplastin component (factor IX) and Stuart factor (factor X) - Prevention of bleeding activity, diarrhea, nausea, flatulence, abdominal cramping None well documented Irritation, anorexia, nausea, vomiting, diarrhea, constipation, dark stool, teeth staining with liquid formulation Adverse effects are rare, skin rash, general malaise and bronchspasm. Hypotension, cyanosis, headache, dizziness, pruritic erythematous plaques at IM injection site, rash

Folic Acid

Up to 1 mg/day PO 0.4 mg/day IV/IM 2.5-10mg

PO/IV/IM

Vitamin K

PO/SC/ IM

Erythromycin Eye Ointment Hepatitis B Vaccine HBIG

10 mcg at 0, 1 and 6 months 0.06ml/kg (usually 3-5 ml) admin asap after exposure and repeat 28-30 days later 1-5g as 25%or 50% solution IM 10-15g PO 4-5g in 250 ml D5W IV not to exceed 3ml/min

IM IM

Induces specific antibodies against hepatitis B virus Directly neutralizes hepatitis B virus

Fatigue, weakness, headache, malaise, dizziness, flushing, nausea, diarrhea, upper respiratory infection Local pain and tenderness at injection site, urticaria, angioedema, anaphylactic reactions Cardiac depression, CNS depression, hypocalcemia, hypothermia, hypomagnesemia

Magnesium Sulfate

PO/IM/IV

Calcium Gluconate Lactated Ringers D5LR

Electrolyte replenisher Calcium gluconate Bisphosphonate Zoledronic acid 4mg max dose given in a single infusion over more than 15 minutes IV

Magnesium has CNS depressant effect, prevents/controls seizures by blocking neuromuscular transmission and decreasing amount of acetylcholine liberated at end plate by motor nerve impulse. Orally it attracts/retains water in intestinal lumen, thereby increasing intraluminal pressure and inducing urge to defecate. Maintain cell membrane and capillary permeability. Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle. Essential for bone formation and blood coagulation. Inhibition of bone resorption.

Hypotension, insomnia, redness and swelling at injection sitegranulocytopenia, thrompbocytopenia, pancytopenia, neutropenia