ALDOMET

Generic name: Methyldopa

Brand name: Aldomet

Classification: Cardiovascular Agent; Central-Acting, Antihypertensive; Autonomic Nervous

System Agent; Alpha-Adrenergic Agonist (Sympathomimetic)

Availability:
— Injection: 50 mg/mL
— Oral suspension: 50 mg/mL
— Tablets: 125 mg, 250 mg, 500 mg

Action: Structurally related to catecholamines and their precursors. Has weak

neurotransmitter properties; inhibits decarboxylation of dopa, thereby reducing concentration of
dopamine, a precursor of norepinephrine. It also inhibits the precursor of serotonin.

Uses: Treatment of sustained moderate to severe hypertension, particularly in patients

with kidney dysfunction. Also used in selected patients with carcinoid disease. Parenteral form has
been used for treatment of hypertensive crises but is not preferred because of its slow onset of
action.

Contraindication: Active liver disease (hepatitis, cirrhosis); pheochromocytoma; blood dyscrasias.

Safety during pregnancy (category C) is not established.

Route and Dosage:

— Oral:
 Make dosage increases in evening to minimize daytime sedation. Some patients maintain
adequate BP control with a single evening dose.
* Hypertension: 250 mg b.i.d. or t.i.d., may be increased up to 3 g/d in divided doses IV 250–
500 mg q6h, may be increased up to 1 g q6h
— Intravenous:
 PREPARE: Intermittent: Dilute in 100–200 mL of D5W, as needed, to yield 10 mg/mL.
 ADMINISTER: Intermittent: Give over 30–60 min.

Adverse effects:
 Body as a Whole: Hypersensitivity (Fever, skin eruptions, ulcerations of soles of feet, flu-like
symptoms, lymphadenopathy, eosinophilia)
 CNS: Sedation, drowsiness, sluggishness, headache, weakness, fatigue, dizziness, vertigo,
decrease in mental acuity, inability to concentrate, amnesia-like syndrome, parkinsonism, mild
psychoses, depression, nightmares
 CV: Orthostatic hypotension, syncope, bradycardia, myocarditis, edema, weight gain (sodium
and water retention), paradoxic hypertensive reaction (especially with IV administration)
 GI: Diarrhea, constipation, abdominal distension, malabsorption syndrome, nausea, vomiting,
dry mouth, sore or black tongue, sialadenitis, abnormal liver function tests, jaundice, hepatitis,
hepatic necrosis (rare)
 Hematologic: Positive direct Coombs' test (common especially in African-Americans),
granulocytopenia
 Special Senses: Nasal stuffiness
  Endocrine: Gynecomastia, lactation, decreased libido, impotence, hypothermia (large doses),
positive tests for lupus and rheumatoid factors
 Skin: Granulomatous skin lesions

Nursing consideration:
 Check BP and pulse at least q30min until stabilized during IV infusion and observe for
adequacy of urinary output.
 Take BP taken at regular intervals in lying, sitting, and standing positions during period of
dosage adjustment if physician requests.
 Be aware that transient sedation, drowsiness, mental depression, weakness, and headache
commonly occur during first 24–72 h of therapy or whenever dosage is increased. Symptoms
tend to disappear with continuation of therapy or dosage reduction.
 Monitor fluid and electrolyte balance and I&O. Report oliguria and changes in I&O ratio. Weigh
patient daily, and check for edema because methyldopa favors sodium and water retention.
 Be alert to and report symptoms of mental depression (e.g., anorexia, insomnia, inattention to
personal hygiene, withdrawal). Drug-induced depression may persist after drug is withdrawn.
 Do not breast feed while taking this drug without consulting physician.

CALCIUM CARBONATE

Generic name: Calcium carbonate

Brand name: Apo-Cal, BioCal, Calsan, Titralac, Tums

Classifications: Fluid and Electrolytic Balance Agent; Replacement Solution; Antacid

Availability: Tablets: 125 mg, 250 mg, 650 mg, 750 mg, 1.25 g, 1.5 g

Action: Rapid-acting antacid with high neutralizing capacity and relatively prolonged
duration of action. Decreases gastric acidity, thereby inhibiting proteolytic action of pepsin on gastric
mucosa. Also increases lower esophageal sphincter tone. Although classified as a nonsystemic
antacid, a slight to moderate alkalosis usually develops with prolonged therapy. Acid rebound, which
may follow even low doses, is thought to be caused by release of gastrin triggered by action of
calcium in small intestines.

Uses: Relief of transient symptoms of hyperacidity as in acid indigestion, heartburn,

peptic esophagitis, and hiatal hernia. Also used as calcium supplement when calcium intake may be
inadequate and in treatment of mild calcium deficiency states. Control of hyperphosphatemia in
chronic renal failure (calcium acetate).

Contraindications: Hypercalcemia and hypercalciuria (e.g., hyperparathyroidism, vitamin D

overdosage, decalcifying tumors, bone metastases), calcium loss due to immobilization, severe renal
disease, renal calculi, GI hemorrhage or obstruction, dehydration, hypochloremic alkalosis, ventricular
fibrillation, cardiac disease, pregnancy (category C).

Route and dosage:

— Oral:
 When used as antacid, give 1 h after meals and at bedtime.
 When used as calcium supplement, give 1–1 ½ h after meals, unless otherwise directed by
physician.
  Chewable tablet should be chewed well before swallowing or allowed to dissolve
completely in mouth, followed with water. Powder form may be mixed with water.
 Ensure that sustained-release form of drug is not chewed or crushed. It must be swallowed
whole.
*Supplement for Osteoporosis: 1–2 g b.i.d. or t.i.d.
*Antacid: 0.5–2 g 4–6 times/d

Adverse effects:
 GI: Constipation or laxative effect, acid rebound, nausea, eructation, flatulence, vomiting, fecal
concretions
 Metabolic: Hypercalcemia with alkalosis, metastatic calcinosis, hypercalciuria,
hypomagnesemia, hypophosphatemia (when phosphate intake is low)
 CNS: Mood and mental changes
 Urogenital: Polyuria, renal calculi

Nursing considerations:
 Note number and consistency of stools. If constipation is a problem, physician may prescribe
alternate or combination therapy with a magnesium antacid or advise patient to take a laxative
or stool softener as necessary.
 Observe for S&S of hypercalcemia in patients receiving frequent or high doses, or who have
impaired renal function (see Appendix F).
 Do not continue this medication beyond 1–2 wk, since it may cause acid rebound, which
generally occurs after repeated use for 1 or 2 wk and leads to chronic use. It is potentially
dangerous to self-medicate. Do not take antacids longer than 2 wk without medical
supervision.
 Avoid taking calcium carbonate with cereals or other foods high in oxalates. Oxalates combine
with calcium carbonate to form insoluble, nonabsorbable compounds.
 Do not use calcium carbonate repeatedly with foods high in vitamin D (such as milk) or sodium
bicarbonate, as it may cause milk-alkali syndrome: hypercalcemia, distaste for food, headache,
confusion, nausea, vomiting, abdominal pain, metabolic alkalosis, hypercalciuria, polyuria, soft
tissue calcification (calcinosis), hyperphosphatemia and renal insufficiency. Predisposing
factors include renal dysfunction, dehydration, electrolyte imbalance, and hypertension.
 Do not breast feed while taking this drug without consulting physician.

CEFUROXIME

Generic name: Cefuroxime sodium, Cefuroxime acetil

Brand name: Kefurox, Zinacef, Ceftin

Classifications: Antiinfective; Antibiotic; Second-Generation Cephalosporin

Availability:
— Injections: 750 mg, 1.5 g
— Oral suspension: 125 mg/5 mL, 250 mg/5 mL
— Tablets: 125 mg, 250 mg, 500 mg

Action: Semisynthetic second-generation cephalosporin antibiotic with structure similar

to that of the penicillins. Resistance against beta-lactamase-producing strains exceeds that of first
generation cephalosporins. Antimicrobial spectrum of activity resembles that of cefonicid.
Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of
susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing
the bacterium. Partial cross-allergenicity between other beta-lactam antibiotics and cephalosporins
has been reported.

Uses: Infections caused by susceptible organisms in the lower respiratory tract, urinary
tract, skin, and skin structures; also used for treatment of meningitis, gonorrhea, and otitis media and
for perioperative prophylaxis (e.g., open-heart surgery), early Lyme disease.

Contraindication: Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category

B), lactation.

Route and Dosage:

— Oral:
 Cefuroxime tablets and oral suspension are not substitutable on a mg-for-mg basis.
*Moderate to Severe Infections: 250–500 mg q12h IV/IM 750 mg–1.5 g q6–8h
— Intramuscular:
 Shake IM suspension gently before administration. IM injections should be made deeply
into large muscle mass. Rotate injection sites.
*Bacterial Meningitis: 3 g q8h
*Surgical Prophylaxis: 1.5 g 30–60 min before surgery, then 750 mg q8h for 24 h

Adverse effects:
 Body as a Whole: Thrombophlebitis (IV site); pain, burning, cellulitis (IM site); superinfections,
positive Coombs' test
 GI: Diarrhea, nausea, antibiotic-associated colitis
 Skin: Rash, pruritus, urticarial
 Urogenital: Increased serum creatinine and BUN, decreased creatinine clearance

Nursing considerations:
 Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of
allergies, particularly to drugs, before therapy is initiated.
 Inspect IM and IV injection sites frequently for signs of phlebitis.
 Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs &
Symptoms, Appendix F) rarely occurs, this potentially life-threatening complication should be
ruled out as the cause of diarrhea during and after antibiotic therapy.
 Monitor for manifestations of hypersensitivity. Discontinue drug and report their appearance
promptly.
 Monitor I&O rates and pattern: Especially important in severely ill patients receiving high
doses. Report any significant changes.
 Do not breast feed while taking this drug.

FERROUS SULFATE

Generic name: Ferrous sulfate

Brand name: Feosol, Fer-In-Sol, Fer-Iron, Ferospace, Ferralyn, Fesofor

Classifications: Bloods Formers, Coagulators and Anticoagulants; Iron Preparation

Availability:
— Tablets: 167 mg, 200 mg, 324 mg, 325 mg
 — Sustained release tablets, capsules: 160 mg
— Syrup: 90 mg/5 mL
— Elixir: 220 mg/5 ml
— Drops: 75 mg/0.6 mL

Action: Standard iron preparation against which other oral iron preparations are usually
measured. Corrects erythropoietic abnormalities induced by iron deficiency but does not stimulate
erythropoiesis. May reverse gastric, esophageal, and other tissue changes caused by lack of iron.

Uses: To correct simple iron deficiency and to treat iron deficiency (microcytic,
hypochromic) anemias. Also may be used prophylactically during periods of increased iron needs, as
in infancy, childhood, and pregnancy.

Contraindication: Peptic ulcer, regional enteritis, ulcerative colitis; hemolytic anemias (in absence
of iron deficiency), hemochromatosis, hemosiderosis, patients receiving repeated transfusions,
pyridoxine-responsive anemia; cirrhosis of liver.

Route and Dosage:

— Oral:
 Give on an empty stomach if possible because oral iron preparations are best absorbed
(i.e., between meals). Minimize gastric distress if needed by giving with or immediately after
meals with adequate liquid.
 Do not crush tablet or empty contents of capsule when administering.
 Do not give tablets or capsules within 1 h of bedtime.
 Consult physician about prescribing a liquid formulation or a less corrosive form, such as
ferrous gluconate, if the patient experiences difficulty in swallowing tablet or capsule.
 Dilute liquid preparations well and give through a straw or placed on the back of tongue
with a dropper to prevent staining of teeth and to mask taste. Instruct the patient to rinse
mouth with clear water immediately after ingestion.
 Mix elixir with water; not compatible with milk or fruit juice;Drops may be given in water or in
fruit or vegetable juice, according to manufacturer.
*Iron Deficiency: (30% elemental iron) 750–1500 mg/d in 1–3 divided doses; Fumarate
(33% elemental iron) 200 mg t.i.d. or q.i.d
*Iron Supplement: Pregnancy, 300–600 mg/d in divided doses

Adverse effects:
 GI: Nausea, heartburn, anorexia, constipation, diarrhea, epigastric pain, abdominal distress,
black stools
 Special Senses: Yellow-brown discoloration of eyes and teeth (liquid forms.)
 Massive Overdosage: Lethargy, drowsiness, nausea, vomiting, abdominal pain, diarrhea, local
corrosion of stomach and small intestines, pallor or cyanosis, metabolic acidosis, shock,
cardiovascular collapse, convulsions, liver necrosis, coma, renal failure, death.

Nursing considerations:
 Continue iron therapy for 2–3 mo after the hemoglobin level has returned to normal (roughly
twice the period required to normalize hemoglobin concentration).
 Monitor bowel movements as constipation is a common adverse effect.
 Note: Ascorbic acid increases absorption of iron. Consuming citrus fruit or tomato juice with
iron preparation (except the elixir) may increase its absorption.
 Be aware that milk, eggs, or caffeine beverages when taken with the iron preparation may
inhibit absorption.
  Be aware that iron preparations cause dark green or black stools.
 Report constipation or diarrhea to physician; symptoms may be relieved by adjustments in
dosage or diet or by change to another iron preparation.
 Do not breast feed while taking this drug without consulting physician.

FUROSEMIDE

Generic name: Furosemide

Brand name: Fumide , Furomide , Lasix, Luramide

Classifications: Electrolytic And Water Balance Agent; Loop Diuretic

Availability:
— Injections: 10 mg/mL
— Oral solutions: 10 mg/mL, 40 mg/5 mL
— Tablets: 20 mg, 40 mg, 80 mg

Action: Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with

pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not
clearly defined; decreases renal vascular resistance and may increase renal blood flow.

Uses: Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease,
including nephrotic syndrome. May be used for management of hypertension, alone or in combination
with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly
with mannitol for treatment of severe cerebral edema, particularly in meningitis.

Contraindication: History of hypersensitivity to furosemide or sulfonamides; increasing oliguria,

anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation

Route and Dosage:

— Oral
 Give with food or milk to reduce possibility of gastric irritation.
 Schedule doses to avoid sleep disturbance (e.g., a single dose is generally given in the
morning; twice-a-day doses at 8 a.m. and 2 p.m.).
 Note: Slight discoloration of tablets reportedly does not alter potency.
*Edema: 20–80 mg in 1 or more divided doses up to 600 mg/d if needed IV/IM 20–40 mg in
1 or more divided doses up to 600 mg/d
*Hypertension: 10–40 mg b.i.d. (max: 480 mg/d)
— Intramuscular
 Protect syringes from light once they are removed from package.
 Discard yellow or otherwise discolored injection solutions.
 PREPARE: Direct: Give undiluted.
 ADMINISTER: Direct: Give undiluted at a rate of 20 mg or a fraction thereof over 1 min.
With high doses a rate of 4 mg/min is recommended to decrease risk of ototoxicity.

Adverse effects:
 CV: Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes,
circulatory collapse
  Metabolic: Hypovolemia, dehydration, hyponatremia hypokalemia, hypochloremia metabolic
alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN,
hyperuricemia
 GI: Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal
cramping, acute pancreatitis, jaundice
 Urogenital: Allergic interstitial nephritis, irreversible renal failure, urinary frequency
 Hematologic: Anemia, leukopenia, thrombocytopenic purpura; aplastic anemia,
agranulocytosis (rare)
 Special Senses: Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent),
blurred vision
 Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea
tarde, necrotizing angiitis (vasculitis)
 Body as a Whole: Increased perspiration; paresthesias; activation of SLE, muscle spasms,
weakness; thrombophlebitis, pain at IM injection site.

Nursing considerations:
 Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs.
Sudden death from cardiac arrest has been reported.
 Monitor for S&S of hypokalemia.
 Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive
diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension.
Weigh patient daily under standard conditions.
 Monitor urine and blood glucose & HbA1C closely in diabetics and patients with
decompensated hepatic cirrhosis. Drug may cause hyperglycemia.
 Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce or
prevent potassium depletion.
 Make position changes slowly because high doses of antihypertensive drugs taken
concurrently may produce episodes of dizziness or imbalance.
 Avoid replacing fluid losses with large amounts of water.
 Avoid prolonged exposure to direct sun.
 Do not breast feed while taking this drug.

HYDRALAZINE

Generic name: Hydralazine hydrochloride

Brand name: Alazine, Apresoline

Classifications: Cardiovascular Agent; Nonnitrate Vasodilator; Antihypertensive

Availability:
— Vial: 20 mg/mL
— Tablets: 10 mg, 25 mg, 50 mg, 100 mg

Action: Reduces BP mainly by direct effect on vascular smooth muscles of arterial-

resistance vessels, resulting in vasodilation. Has little effect on venous-capacitance vessels.
Hypotensive effect may be limited by sympathetic reflexes, which increase heart rate, stroke volume,
and cardiac output.
Uses: Most commonly in stepped-care approach to treat moderate to severe
hypertension. Also in early malignant hypertension and resistant hypertension that persists after
sympathectomy.

Contraindication: Coronary artery disease, mitral valvular rheumatic heart disease, MI, tachycardia,
SLE. Safe use during pregnancy (category C) or lactation is established.

Route and Dosage:

— Oral
 Give with food; bioavailability is increased by taking it with food.
 Discontinue gradually to avoid sudden rise in BP and acute heart failure.
 Inform patients of the dangers of abrupt withdrawal.
*Hypertension: 10–50 mg q.i.d. IM 10–50 mg q4–6h IV 10–20 mg q4–6h
— Intramuscular
 Give deep into a large muscle.
— Intravenous
 PREPARE: Direct: Give undiluted. Use immediately after being drawn into syringe. Do not
add to IV solutions.
 ADMINISTER: Direct: Give each 10 mg or fraction thereof over 1 min.

Adverse effects:
 Body as a Whole: Hypersensitivity (rash, urticaria, pruritus, fever, chills, arthralgia,
eosinophilia, cholangitis, hepatitis, obstructive jaundice)
 CNS: Headache, dizziness, tremors. CV: Palpitation, angina, tachycardia,flushing, paradoxical
pressor response
 Overdose: arrhythmia, shock
 Special Senses: Lacrimation, conjunctivitis
 GI: Anorexia, nausea, vomiting, diarrhea, constipation, abdominal pain, paralytic ileus
 Urogenital: Difficulty in urination, glomerulonephritis
 Hematologic: Decreased hematocrit and hemoglobin, anemia, agranulocytosis (rare)
 Other: Nasal congestion, muscle cramps, SLE-like syndrome, fixed drug eruption, edema.

Nursing considerations:
 Make baseline and periodic determinations of BUN, creatinine clearance, uric acid, serum
potassium, blood glucose, and ECG.
 Monitor for S&S of SLE, especially with prolonged therapy.
 Monitor BP and HR closely. Check every 5 min until it is stabilized at desired level, then every
15 min thereafter throughout hypertensive crisis.
 Monitor I&O when drug is given parenterally and in those with renal dysfunction.
 Monitor weight, check for edema, and report weight gain to physician.
 Note: Some patients experience headache and palpitations within 2–4 h after first PO dose;
symptoms usually subside spontaneously.
 Make position changes slowly and avoid standing still, hot baths/showers, strenuous exercise,
and excessive alcohol intake.
 Do not breast feed while taking this drug without consulting physician.

MEFENAMIC ACID

Generic name: Mefenamic acid

Brand name: Ponstan, Ponstel

Classifications: Central Nervous System Agent; Analgesic; Antipyretic

Availability:
— Tablets: 250 mg

Action: Anthranilic acid derivative. Like ibuprofen inhibits prostaglandin synthesis and
affects platelet function. No evidence that it is superior to aspirin.

Uses: Short-term relief of mild to moderate pain including primary dysmenorrhea.

Contraindication: Hypersensitivity to drug; GI inflammation, or ulceration. Safety in children <14 y,

during pregnancy (category C), or lactation is not established.

Route and Dosage:

— Oral
 Give with meals, food, or milk to minimize GI adverse effects.
 Do not use drug for a period exceeding 1 wk (manufacturer's warning).
* Mild to Moderate Pain: Loading Dose - 500 mg PO Maintenance Dose - 250 mg q6h prn

Adverse effects:
 CNS: Drowsiness, insomnia, dizziness, nervousness, confusion, headache
 GI: Severe diarrhea, ulceration, and bleeding; nausea, vomiting, abdominal cramps, flatus,
constipation, hepatic toxicity
 Hematologic: Prolonged prothrombin time, severe autoimmune hemolytic anemia (long-term
use), leukopenia, eosinophilia, agranulocytosis, thrombocytopenic purpura, megaloblastic
anemia, pancytopenia, bone marrow hypoplasia
 Urogenital: Nephrotoxicity, dysuria, albuminuria, hematuria, elevation of BUN
 Skin: Urticaria, rash, facial edema
 Special Senses: Eye irritation, loss of color vision (reversible), blurred vision, ear pain
 Body as a Whole: Perspiration
 CV: Palpitation
 Respiratory: Dyspnea; acute exacerbation of asthma; bronchoconstriction (sensitive to aspirin).

Nursing considerations:
 Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte
imbalance.
 Discontinue drug promptly if diarrhea, dark stools, hematemesis, ecchymoses, epistaxis, or
rash occur and do not use again. Contact physician.
 Notify physician if persistent GI discomfort, sore throat, fever, or malaise occur.
 Do not drive or engage in potentially hazardous activities until response to drug is known. It
may cause dizziness and drowsiness.
 Monitor blood glucose for loss of glycemic control if diabetic.
 Do not breast feed while taking this drug without consulting physician.

METHERGINE

Generic name: Methylergonovine maleate

Brand name: Methergine

Classifications: Autonomic Nervous System Agent; Adrenergic Antagonist (Sympatholytic); Ergot
Alkaloid; Oxytocic

Availability:
— Injection: 0.2 mg/mL
— Tablets: 0.2 mg

Action: Ergot alkaloid that induces rapid, sustained tetanic uterine contraction that
shortens third stage of labor and reduces blood loss.

Uses: 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.

Contraindication: Hypersensitivity to ergot preparations; to induce labor; use prior to delivery of

placenta; threatened spontaneous abortion; prolonged use; uterine sepsis; hypertension; toxemia;
lactation.

Route and Dosage:

— Oral
 Note: Dosing should not exceed 1 wk.
*Postpartum Hemorrhage: 0.2–0.4 mg q6–12h until danger of atony passes (2–7 d)
— Intravenous:
 PREPARE: Direct: Give undiluted or diluted in 5 mL of NS.
 ADMINISTER: Direct: Give 0.2 mg or fraction thereof over 60 sec.
*Postpartum Hemorrhage: 0.2 mg q2–4h (max: 5 doses)

Adverse effects:
 GI: Nausea, vomiting (especially with IV doses)
 CV: Severe hypertensive episodes, bradycardia
 Body as a Whole: Allergic phenomena including shock, ergotism

Nursing considerations:
 Monitor vital signs (particularly BP) and uterine response during and after parenteral
administration of methylergonovine until partum period is stabilized (about 1–2 h).
 Notify physician if BP suddenly increases or if there are frequent periods of uterine relaxation.
 Report severe cramping for increased bleeding.
 Report any of the following: Cold or numb fingers or toes, nausea or vomiting, chest or muscle
pain.
 Do not breast feed while taking this drug.

SYNTOCINON

Generic name: Oxytocin injection

Brand name: Pitocin, Syntocinon

Classifications: Hormones And Synthetic Substitutes; Oxytocic

Availability:
— Injection: 10 units/mL

Action: Synthetic, water-soluble polypeptide consisting of eight amino acids, identical

pharmacologically to the oxytocic principle of posterior pituitary.

Uses: 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.

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.

Route and Dosage:

— Intravenous:
 PREPARE: IV Infusion: When diluting oxytocin for IV infusion, rotate bottle gently to
distribute medicine throughout solution. For inducing labor: Add 10 U (1 mL) of oxytocin to
1 L of D5W or NS to yield 10 mU/mL. For postpartum bleeding: Add 10–40 U (1–4 mL) of
oxytocin to 1 L of D5W or NS to yield 10–40 mU/mL.
 ADMINISTER: IV Infusion: See ROUTE & DOSAGE for recommended rates (mU/min).
*Antepartum: Start at 1 mU/min, may increase by 1 mU/min q15min (max: 20 mU/min)
*Postpartum: Infuse a total of 10 U at a rate of 20–40 mU/min after delivery

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

Nursing considerations:
 Start flow charts to record maternal BP and other vital signs, I&O ratio, weight, strength,
duration, and frequency of contractions, as well as fetal heart tone and rate, before instituting
treatment.
  Monitor fetal heart rate and maternal BP and pulse at least q15min during infusion period;
evaluate tonus of myometrium during and between contractions and record on flow chart.
Report change in rate and rhythm immediately.
 Stop infusion to prevent fetal anoxia, turn patient on her side, and notify physician if
contractions are prolonged (occurring at less than 2-min intervals) and if monitor records
contractions about 50 mm Hg or if contractions last 90 seconds or longer. Stimulation will wane
rapidly within 2–3 min. Oxygen administration may be necessary.
 If local or regional (caudal, spinal) anesthesia is being given to the patient receiving oxytocin,
be alert to the possibility of hypertensive crisis (sudden intense occipital headache, palpitation,
marked hypertension, stiff neck, nausea, vomiting, sweating, fever, photophobia, dilated pupils,
bradycardia or tachycardia, constricting chest pain).
 Monitor I&O during labor. If patient is receiving drug by prolonged IV infusion, watch for
symptoms of water intoxication (drowsiness, listlessness, headache, confusion, anuria, weight
gain). Report changes in alertness and orientation and changes in I&O ratio (i.e., marked
decrease in output with excessive intake).
 Check fundus frequently during the first few postpartum hours and several times daily
thereafter.
 Be aware of purpose and anticipated effect of oxytocin.
 Report sudden, severe headache immediately to healthcare providers.

TRANEXAMIC ACID

Generic name: Tranexamic acid

Brand name: Lysteda, Cyklokapron

Classifications: Hemostatic agents, Antifibrinolytics

Availability:
— Injection: 100 mg/mL
— Tablet: 650 mg

Action: Inhibits activation of plasminogen thereby reducing conversion of plasminogen to

plasmin (fibrinolysin). Also, inhibits the formation and activity of plasmin by tranexamic acid may
prevent attacks of angioedema by decreasing plasmin-induced activation of the first complement
protein (C1)

Uses: To treat heavy bleeding during your menstrual period. Also, works by slowing the
breakdown of blood clots, which helps to prevent prolonged bleeding.

Contraindication: Hypersensitivity to tranexamic acid or any of the ingredients; Acquired defective

color vision, since this prohibits measuring one endpoint that should be followed as a measure of
toxicity; Subarachnoid hemorrhage; Active intravascular clotting

Route and Dosage:

— Oral
* Hemorrhage, hyperfibrinolysis-induced–epistaxis: 1 to 1.5 grams three or four times a day for
10 days
*Angioedema: 1 to 1.5 grams two or three times a day.
— Intravenous:
*Hemorrhage, hyperfibrinolysis-induced–epistaxis: 15 mg per kg of body weight or 1 gram
every six to eight hours
Adverse effects:
 GI: nausea, vomiting, diarrhea, abdominal pain
 NS: giddiness, dizziness, headache, tension headache, and migraine
 Hematologic: thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism,
cerebral thrombosis, acute renal cortical necrosis, and central retinal artery and vein
obstruction) and anemia
 Hypersensitivity: included allergic skin reactions, anaphylactic shock and anaphylactoid
reactions
 Senses: disturbances of color vision (rare) and retinal artery occlusion
 Musculoskeletal: back pain, musculoskeletal pain, muscle cramps and spasms, myalgia, and
arthralgia including joint stiffness and swelling
 Respiratory: nasal and sinus symptoms including nasal, respiratory tract and sinus congestion,
sinusitis, acute sinusitis, sinus headache, and allergic sinusitis and sinus pain
 CV: hypotension when intravenous administration exceeded 1 mL per minute
 GU: ureteral obstruction due to clot formation in patients with upper urinary tract bleeding

Nursing considerations:
 Monitor blood pressure, pulse, and respiratory status as indicated by severity of bleeding.
 Monitor for overt bleeding every 15–30 min.
 Monitor neurologic status (pupils, level of consciousness, motor activity) in patients with
subarachnoid hemorrhage.
 Assess for thromboembolic complications.(especially in patients with history). Notify physician
of positive Homans’ sign, leg pain hemorrhage, edema, hemoptysis, dyspnea, or chest pain.
 Monitor platelet count and clotting factors prior to and periodically throughout therapy in
patients with systemic fibrinolysis.
 Stabilize IV catheter to minimize thrombophlebitis. Monitor site closely.
 Instruct patient to notify the nurse immediately if bleeding recurs or if thromboembolic
symptoms develop.
 Caution patient to make position changes slowly to avoid orthostatic hypotension.