5 11triage meds

8/9/2019 5 11Triage Meds

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Triage MedicationsLeah Pirman

Drug name: Dinoprostone (Prepidil Gel, Cervidil vaginal insert)

Dose, route, frequency:

o Cervical ripening: Endocervical gel: 0.5 mg: if response is unfavorable may repeat in 6 hr not to e!ceed ".5 mg#$%

hr&' (aginal insert: one "0 mg insert

Indications for OB use:o Endocervical gel) vaginal insert: used to ripen the cervi! in pregnancy at or near term *hen induction of labor is

indicated

o +ction: Produces contractiosn similar to those occurring during labor at term by stimulating the myometrium. ,nitiates

softening) effacement) and dilation of the cervi!. +lso stimulates -, smooth muscleo Therapeutic effects: ,nitiation of labor e!pulsion of fetus

Common Side Effects:/terine contractile abnormalities) *arm feeling in the vagina) bac pain) amniotic fluid embolism) and

fever

Contraindications: This is contraindicated in hypersensitivity to prostaglandins or additives in the gel. The gel#insert should

be avoided in situations in *hich prolonged uterine contractions should be avoided including previous c1section or uterine

surgery) cephalopelvic disproportion) traumatic delivery or difficult labor) multiparity) hyperactive or hypertonic uterus) fetaldistress) vasa previa) active herpes genitalis) ob emergency re2uiring surgical interventions) situations in *hich vaginal

delivery is contraindicated' presence of acute pelvic inflammatory disease or ruptured membranes' concurrent o!ytocic therapy

*ait for 30 min after removing insert before using o!ytocin&

EffectsImplications for pregnancy or !reastfeeding: This is a category 4 drug in pregnancy

o Possible fetal distress hypo!ia

o hould only be used during labor or to induce labor) not used during pregnancy unless *ishing to induce labor or e!pel

productso This has not been measured in human mil after e!ogenous administrations) but it is a normal component of breast mil

in small amounts *here it may help protect the infants -, tracto ,t can suppress lactation but research suggests it should probably not be used postpartum in mothers *ho *ish to

breastfeed

"ursing #ctions as applica!le:

o Monitor fre2uency) duration) and force of contractions uterine resting tone

o Monitor vitals throughout therapy

o +uscultate breath sounds *atch for hypersentivity&

o Monitor amount and type of vagianl discharge

o Monitor uterine status) fetal status) and dilation and effacement of cervi!


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o ,nform patient she may e!perience a *arm feeling in her vagina

Drug name: Misoprostol (Cytotec)

Dose, route, frequency:

o Antiulcer: P7 $00 mcg % ! daily *ith or after meals at bedtime or %00 mcg t*ice daily) *ith the last dose at bedtime.o Termination of pregnancy: P7 %00 mcg single dose $ days after mifepristone if abortion has not occurred 8%9 days in

conunction *ith mifepristone&

o Misoprostol is available either as a "00 or $00 mcg tablet. Therfore) tablets mustbe broen to prepare correct dose.

;ecommended initial dose is $5 mcg intravaginally into the posterior vaginal forni! using the tips of inde! and

middle finger *ithout use of lubricant. ;epeat every 316 hours up to 6 doses in a $% hour period or until aneffective contraction pattern is established) the cervi! ripens) or significant adverse effects

o /sed PP to prevent hemorrhage

"000mg rectally or $00 mg orally *ith %00mg ublingually

o PP hemorrhage prophyla!is not as useful as o!ytocin) but used as last alternative&1 600 mg oral dose at time of delivery

of fetal shoulder

o T!: incomplete abortion off labeled use& oral 600 mc as single

o induction of labor before o!ytocin *hen s) including aspirin) in high1ris patients. /sed *ith

mifepristone for termination of pregnancy. /nlabeled use: treatment of duodenal ulcers) cervical ripening) and labor induction.

o +ction: acts as a prostaglandin analogue) decreasing gastric acid secretion) and increasing the production of protective

mucus. 4auses uterine contractions

Common Side Effects:headache) abdominal pain) diarrhea) nausea) vomiting) constipation) miscarriage

o hivering is a common side effect *ith rectal or L Blac$ Bo% &arning:use during pregnancy may cause abortion) birth defects) or premature birth. =ot to be used to decreased

=+,> induced ulcers in a *oman of childbearing potential unless she is capable of complying.

Contraindications: 4ontraindicated in hypersensitivity to prostaglandins.

o +void concurrent use *ith o!ytocin

o ,n patients *ith history of c1section or maor uterine surgeries

o Maternal infection) fever) vaginal bleeding

o OB: hould not be used to prevent =+,>1induced gastric inury because of potential for fetal harm or death


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o /se e!treme caution *hen used for cervical ripening) may cause uterine rupture

EffectsImplications for pregnancy or !reastfeeding: This is a pregnancy category ? drug. ,t is contraindicated during pregnancy.

4ases of congenital malformation has been reported. @ollo*ing an unsuccessful abortion: teratogenic producing limb) sull defects)gastroschisis congenital defect in abdominal *all that doesnt close&) bilateral palsy of cranial nerves) cleft lip and palate) fetal

vascular disruptiono 'actation: May cause severe diarrhea in the nursing infant

o ,t is e!creted in human breast mil) no reports of severe adverse effects


o +ssess patient routinely for epigastric of abdominal pain) and for fran or occult blood in stool) emesis) or gastric

aspirateo Monitor uterine cramping and bleeding during therapy

o +ssess dilation of cervi! periodically during therapy

o +dvise patient to avoid alcohol and foods that may cause an increase in -, irritation

o Teach appropriate lifestyle and diet if used to prevent ulcers

o +ssess maternal1fetal unit) before each insertion and during treatment follo*ing agency protocol for fre2uency. +ssess

maternal vital signs and health status) @A; and pattern) and status of pregnancy) including indications for cervicalripening or induction or labor) signs of labor or impending labor) and the


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o S(:0.$5 mg every $0 minutes to 3 hours' hold for pulse "$0 beats per minute. Terbutaline has not yet been approved

for and should not be used for prolonged tocolysis beyond %D1F$ hours&

Indications for OB use:Management of preterm labor tocolytic& G unlabeled use

Common Side Effects:=ervousness) restlessness) tremor) nausea) vomiting) hypoalemia) tachycardia) palpitations) headache

Contraindications: 4ontraindicated in hypersensitivity to adrenergic amines. /se cautiously in those near term in pregnancyand lactation

EffectsImplications for pregnancy or !reastfeeding: This is a pregnancy category < drug

o ,t is sho*n to cross the placenta and the fetus may e!perience the general adverse effects reported in the mother

o Myocardial necrosis is e!pected to be related to terbutaline use

o ,t is e!creted in small amounts into human mil

,t is considered to be compatible *ith breast1feeding by the +merican +cademy of Pediatrics


o Monitor maternal pulse and


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o =ifedipine is e!creted into human mil. Manufacturer recommends that due to the potential for serious adverse

reactions in nursing infants) a decision should be made to discontinue nursing or discontinue the drug

>elay breast1feeding 31% hours after a dose significantly decreases the amount of nifedipine to *hich a nursing

infant may potentially be e!posed

"ursing #ctions as applica!le:o Monitor


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o Monitor L74

o +ssess dro*siness) side effects from lac of sleep

)eferences

Dinoprostone. ;etrieved from http:##***.drugs.com#breastfeeding#dinoprostone.html

Misoprostol. ;etrieved from http:##***.drugs.com#pregnancy#misoprostol.html

=agtalon1;amos) H. $0"%&.Maternal%ne&born nursing care "sted.&. Philadelphia) P+: @. +. >avis 4ompany.

ifedipine. ;etrieved from http:##***.drugs.com#pregnancy#nifedipine.html

Terbutaline. ;etrieved from http:##***.drugs.com#pregnancy#terbutaline.html

$olpidem. ;etrieved from http:##***.drugs.com#pregnancy#Bolpidem.html

5 11triage meds

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