met her gine

7/30/2019 Met Her Gine

1/6

Drug/ Dose/ Route/Frequency

Classification/Mechanism of

Action

Indication/ Contraindication/Side Effects

Principles of Care Treatment Evaluation

MethergineAvailabilityTablets: 200 mcg (0.2mg). Injection: 200mcg (0.2 mg)/ml in 1-ml

ampules.

Generic name:Methylergonovinemaleate

Brandname:

Chethergine

Classification:

Therapeutic:Oxytoc

ic

Pharmacologic:ergot alkaloids

Mechanisms of Action:Directly stimulatesuterine and vascularsmooth muscle.

TherapeuticEffects: Uterinecontraction.

Indication:Prevention and treatment of postpartumor postabortion hemorrhage caused byuterine atony or subinvolution.

Contraindications/PrecautionsContraindicated in: Hypersensitivity;Should not be used to induce labor.Use Cautiously in: Hypertensive oreclamptic patients (more susceptible tohypertensive and arrhythmogenic sideeffects); Severe hepatic or renaldisease; Sepsis.Exercise Extreme Caution in: Thirdstage of labor.

Adverse Reactions/Side Effects

CNS:dizziness, headache.EENT:tinnitus.

Resp:dyspnea.

CV:HYPERTENSION, arrhythmias,

chest pain,

palpitations.GI:nausea, vomiting. GU:cr

amps. Derm:diaphoresis.

Misc:allergic reactions.

Assessment

Monitor blood pressure,

heart rate, and uterineresponse frequently during

medication administration.Notify health careprofessional promptly ifuterine relaxation becomesprolonged or if character ofvaginal bleeding changes.

Assess for signs of

ergotism (cold, numbfingers and toes, chestpain, nausea, vomiting,headache, muscle pain,weakness).

Lab Test

Considerations:

If noresponse tomethylergonovine, calciumlevels may need to beassessed. Effectiveness ofmedication is withhypocalcemia.

May cause serum prolactin

levels

Patient/Family Teaching

Instruct patient to take

medication as directed;do not skip or double up

on missed doses. If adose is missed, omit itand return to regulardose schedule.

Advise patient that

medication may causemenstrual-like cramps.

Caution patient to avoid

smoking, becausenicotine constricts bloodvessels.

Instruct patient to notify

health care professional

if infection develops, asthis may causeincreased sensitivity tothe medication.

Evaluation/DesiredOutcomes

Contractions that

maintain uterine

tone and preventpostpartumhemorrhage.


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Action



Tranexamic Acid

AvailabilitySolution for

injection: 100mg/mL

Trade Name

Cyklokapron

Classification:

Therapeutic:

hemostatic agentsPharmacologic:antifibrinolytics

plasminogen

inactivators

Mechanisms of Action:

Inhibits activation of

plasminogen,thereby preventing

the conversion ofplasminogen to

plasmin

Indication:Prevention or reduction of

hemorrhage

Contraindications/Precautions

Contraindicated in:

Hypersensitivity

Active intravascular clotting

Acquired defective color vision

Subarachnoid hemorrhage

Use Cautiously in:

Renal impairment ( dosing

interval is recommended if

serum creatinine >1.36 mg/dL)

Hematuria originating in the

upper urinary tract

Conditions associated with

thrombus formation

OB: Lactation: Safety not

established

Adverse Reactions/Side EffectsCNS: dizziness.

EENT: visual abnormalities.

CV: hypotension,

thromboembolism, thrombosis.

GI: diarrhea, nausea, vomiting.

Assessment

Observe site of surgery

for excessive bleeding

Patients taking tranexamic

acid for more than several

days should have

ophthalmologic

examinations to detect

visual abnormalities prior

to and at regular intervals

during and after therapy.

Discontinue therapy if

visual changes occur


Advise patient to inform


of any changes invision. Inform patients

on prolonged therapy of

the importance of

regular ophthalmologic

follow-up

Caution patient to avoid

products containing

aspirin or NSAIDs

without consulting


Instruct patient to

notify health careprofessional if signs

and symptoms of

thrombosis (severe,

sudden headache;

pains in chest, groin,

or legs, especially

calves; sudden loss of

coordination; sudden

and unexplainedshortness of breath;

slurred speech; visualchanges; weakness or

numbness in arm or

leg) occur


Prevention of

hemorrhage.


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Action



Oxytocin

IM:

3-10 units IM

aher delivery

of placenta

IV:

Mix 5-20

units in 500

ml of D5W,

NS, or LR;

infuse at 20-

40

milliunits/min, titrated to

severity of

bleeding and

uterine

response

Generic Names:

Pitocin; Syntocinon

Classification:

Ther. class.

hormones

Pharm. class.

oxytocics

Mechanisms of Action:

Binds the oxytocinreceptor which leadsto an increase inintracellular calciumlevels.

Indication:

Postpartum hemorrhage after

infant and placental delivery


Substantial

cephalopelvicdisproportion.

Unfavorable fetal

position or presentationundeliverable withoutconversion before delivery

Obstetric emergencies

where maternal or fetal risk-to benefit ratio favorssurgery.

Fetal distress when

delivery is not imminent.

Umbilical cord prolapse

Uterine activity fails to

progress adequately.

Hyperactive or

hypertonic uterus.

Vaginal delivery is

contraindicated

Uterine or cervical scarring

from previous cesareansection or major cervical oruterine (e.g., transfundal)surgery

Unengaged fetal head

Assessment

Drug isnt

recommended for

routine IM use, but 10y=units may be given

IM after delivery of

placenta to control

postpartum bleeding.

Never give oxytocin

simultaneuosly more

than one route.

Drug is used to induce

or reinforce labor only

when pelvis is known to

be adequate.


Explain use and

administration of drug

in patient and family. Instruct patient to

report adverse

reactions promptyl.


Postpartum

hemorrhage afterinfant and

placental delivery

.


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History of

hypersensitivity to oxytocinor any ingredient in theformulation.


Adverse Reactions

Hypotension or hypertension

Tachycardia

Dysrhythmias

Angina pectoris

Anxiety

Seizure

Nausea and vomiting

Allergic reaction

Uterine rupture (fromexcessive administration)


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Action


Principles of Care Treatment

Amoxicillin

PO 20-40

mg/kg/day

in divided

doses

q8h.Popul

ar Brand

Names

Amoxil, Apo-

Amoxi,

Larotid,Novamoxin,

Polymox,

Trimox,

NuAmox,

Wymox.

Classification:

Therapeutic:

hemostatic agentsPharmacologic:antifibrinolytics

plasminogen

inactivators

Mechanisms

of Action: Inhibitsenzymes

responsible forcell wall synthesis

of susceptible

organisms. This creates an

osmotically

unstable cell wall

that swells and

bursts fromosmotic pressure.

This drug is

bactericidal in

normal doses.

This drug is

excreted through

the renal system.

Indication:

Useful for sinus infections,

pneumonia, otitis media,

skin, and urinary tract

infections.

May be effective against

early on-set or refractory

periodontitis when used

alone or in combination

with metronidazole or

clavulanic acid.


Hypersensitivity to

penicillins; neonates.


They can disrupt the normal

gastrointestinal flora and

cause nausea, vomiting,

diarrhea, abdominal pain,colitis, and anorexia. At high

doses penicillin can have a

toxic effect that can cause

Assessment

Before giving drug, ask patient

about allergic reactions to

amoxicillin. Dont confuse amoxicillin with

amoxapine.


Tell patient to take entire quantity of

drug exactly as prescribed, even

after feeling better. Insrtuct patient to take drug with

food to prevrnt GI upset.

tell patient to call prescriber if a

rash occurs.


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seizures, platelet

dysfunction, hemolytic

anemias of an immunologic

type, encephalitis, and

nephritis.

Pseudomembraneous colitis

is an occasional adversereaction.

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