Medications

Medications
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Disclaimer: This is not a complete list of indications/contraindications/side effects/dosing/special
considerations/names/warnings of the following
medications.
Disclaimer: This section is to be utilized as a quick
reference guide only, and employees should refer to
the KU formulary for completeness of information.

Medications
Clindamycin
 Brand Name: Cleocin
 Drug class: antibiotic
 Indications: Tx/Prophylaxis for infection
 Dose: 900mg q8hrs
 Side Effects: diarrhea, cardiac arrest, hearing loss
 Black Box Warning: Pseudomembranous colitis

Medications
Codeine/Acetaminophen
 Brand name: “T3s”, Tylenol-Codeine #3, or Tylenol #3
 Drug class: Analgesic/Antipyretic
 Indications: Postpartum pain associated with perineal laceration/episiotomy, and uterine cramping
 Dose: 1-2 tab q 4 hrs po PRN
 Side Effects: Sever hepatotoxicity
Max Daily Dose of Acetaminophen is 4g

Medications
Ampicillin
 Brand name: Ampicillin
 Drug class: Antibiotic
 Indications: Tx/Prophylaxis for infection
(generally used for chorioamnionitis)
 Dose: 2g q 6 hrs
 May repeat in 20 min
 Contraindications: Allergy to penicillin
 Side Effects: Fever, rash, urticaria, diarrhea,
agranulocytosis, laryngeal stridor

Medications
Betamethasone
 Brand Name: Celestone Soluspan
 Drug class: Adrenal Glucocorticoid
 Indications: Assist fetal lung maturity; lasts about
1 week
 Dose: 2 doses of 12.5 mg deep IM injections, 24
hrs apart
 (6mg/mL = 2.08mL)
 Side Effects: site may burn, hyperglycemia, HTN,
depression
 Report any fever or illness
 Reduces risk for breathing problems in premature
babies
 Decreases risk for brain bleeding in premature babies

Medications
Butorphanol
 Brand name: Stadol
 Drug class: Narcotic, Agonist-Antagonist Analgesic
 Indications: Labor pain
 Dose: 1-2 mg q1-2hrs IV
 Side Effects: N/V, dizziness, insomnia, respiratory
depression, pseudo-sinusoidal fetal heart rate pattern
 Give at the peak of contraction because of vasoconstriction, so fetus gets least amount of med
 Do not give after 8 cm to prevent respiratory depression in baby at delivery.

Medications
Carboprost
 Brand name: Hemabate
 Drug class: Prostaglandin
 Indications: Postpartum hemorrhage; Abortion in
second trimester
 Dose: 250 mcg IM
 Repeat every 15-90 min PRN
 Do not exceed 2 mg
 Contraindications: Asthma; acute cardiac, pulmonary, renal or hepatic disease
 Side Effects: Diarrhea, fever, N/V,
shivering

NEVER GIVE TO ASTHMATICS!! ASK FOR LOMOTIL ASAP!!

Medications
Fentanyl
 Brand name: Fentanyl
 Drug class: Opioid/Analgesic
 Indications: Moderate pain
 Dose: 25-100 mcg IV
 Contraindications: asthma
 Side Effects: constipation, N/V, dizziness, confusion, urinary retention, respiratory depression, fatigue, anxiety, hallucinations
 Administration: Slow IV push over 1-2 min.
 Give at the peak of the contraction to decrease the
amount of medication that the fetus receives
 Muscular rigidity may occur w/ rapid IV administration
 Do not give after 8 cm to prevent respiratory depression in newborn at delivery

Medications
Gentamicin
 Brand Name: Garamycin
 Not in AcuDose
 Drug class: Antibiotic
 Indications: Tx/Prophylaxis for infection
(generally used for chorioamnionitis)
 Dose: 5 mg/kg/day
 Contraindications: preexisting renal disease, cystic fibrosis, hearing problems, low potassium, magnesium, or calcium levels. Myasthenia gravis, Parkinson’s Disease
 Side Effects: edema, dizziness, headache, proteinuria, hearing loss, tinitis

Medications
Hydralazine Hydrochloride Injection
 Brand name: Hydralazine
 Drug class: peripheral vasodilator
 Indications: Hypertension
 Dose: See physician order
 CHTN or Gestational Hypertension: 5mg IV
followed by 5-10mg q20-40 min prn for a total
of 30 mg/24 hours
 Preeclampsia: 5-10mg repeat in 20 min w/ 10
mg prn; if after an additional 20 min, BP still
exceeds threshold, consider asking physician
for labetalol
 Side Effects: chest pain, palpitations, tachycardia,
N/V, headache

Medications
Ibuprofen
 Brand name: Motrin
 Drug class: NSAID/Anti-inflammatory
 Indications: Fever, headache, general pain, pain
associated with postpartum uterine cramping
(common postpartum order)
 Dose: 600 mg po q 6 hrs
 Contraindications: Preeclampsia (decrease kidney function), asthma, CABG surgery
 Side Effects: dizziness, N/V, epigastric pain
 Black Box Warning: Increase risk for serious CV
thrombotic events, MI, and stroke

NEVER GIVE TO PRE-ECLAMPTICS OR PT’S W/
DECREASED KIDNEY
FUNCTION!!!

Medications
Indomethacin
 Brand name: Indocin
 Drug class: NSAID; Prostaglandin
 Indications: slow uterine contractions
 Dose: See Physician Order
 Contraindications: Imminent labor w/in 24 hrs,
poorly controlled HTN, asthma, renal disease, active peptic ulcer
 Side Effects: N/V, change in bleeding or clotting,
increased liver enzymes, dizziness, newborn renal
dysfunction, cardiac dysrhythmia, GI hemorrhage,
bruising, blood in stool
 May lower amniotic fluid levels
 Do not give in the 3rd Trimester (after 32 weeks
gestation)

Medications
Ketorolac
 Brand name: Toradol
 Drug class: NSAID/Anti-inflammatory/Analgesic
 Indications: Pain (commonly ordered post csection or GYN surgery)
 Dose: 30 mg IV (30mg/mL)
 Contraindications: Preeclampsia (decrease kidney function), asthma, CABG surgery
 Side Effects: HTN, MI, GI hemorrhage,
 Black Box Warning: Increase risk for serious CV
thrombotic events, MI, and stroke, and increase risk
of uterine hemorrhage

NEVER GIVE TO PRE-ECLAMPTICS!!!

Medications
Labetalol
 Brand name: Trandate/Normodyne
 Drug class: Antihypertensive; sympathetic blocker
 Indications: Hypertension
 Dose: See physician order
 Max IV Dose: 300 mg/24 hours
 Side Effects:
 No faster than 5mg/30 seconds or 20mg over 2
minutes.
 Check BP right before, 5 minutes after, 10 minutes
after

Medications
Methylergonovine
 Brand name: Methergine
 Drug class: Uterine stimulant
 Indications: PPH associated w/uterine
atony
 Dose: 0.2 mg/1mL IM q 2-4 hrs PRN
 Contraindications: HTN
 Side Effects: Diaphoresis, dizziness, N/V, HTN,
headache, MI

NEVER GIVE TO PT W/ HTN!!!

Medications
Misoprostol
 Brand name: Cytotec
 Drug class: Prostaglandin
 Indications: Cervical ripening; postpartum bleeding
 Dose:
 Cervical ripening—25 mcg vaginally q4hrs
(Max dose: 400 mcg)
 PP bleeding: 800-1000 mcg rectally
 Side Effects: fever, abdominal pain, diarrhea, cardiac dysrhythmia, GI hemorrhage, anemia, uterine
rupture
 Pt to remain in a recumbent position for 2 hours
after vaginal insertion
 Vaginal Cytotec to be placed by physicians

ONLY!!!
 Do not give to a VBAC!!!

Medications
Morphine Sulfate
 Brand name: Morphine
 Drug class: Opioid; Analgesic
 Indications: Moderate pain
 Dose: 2 mg IV PRN
 Contraindications: asthma, delirium, hypotension
 Side Effects: pruritus, constipation, N/V, dizziness,
headache, lightheadedness, cardiac arrest, dyspnea,
respiratory depression

Medications
Nifedipine
 Brand name: Procardia
 Drug class: Calcium channel blocker
 Indications: high BP, decrease contractions in preterm labor
 Dose: 40mg PO loading, then 20mg
q 6hrs PO
 Contraindications: receiving Mag, IU infection,
maternal HTN, or heart disease
 Side Effects: hypotension, palpitations, dizziness,
nervousness, MI, GI obstruction
 Notify physician of: swelling, weakness, severe
HA, very tired, chest pain, SOB

DO NOT GIVE W/ MAG!! CAN CAUSE CARDIAC
ARREST!!!

Medications
Oxytocin
 Brand name: Pitocin
 Drug class: Uterine Stimulant
 Indications: Induction of labor; PPH
 Dose:
 Titrate for induction (See Pit Protocol)
 PPH: 10 to 40 units of oxytocin added to running IV infusion (maximum 40 units to 1000
mL IV solution)
OR10 mg IM after delivery of placenta
 Side Effects: N/V, water intoxication, neonatal
jaundice, uterine rupture

Medications
Penicillin G
 Brand name: Penicillin G
 Drug class: Penicillins
 Indications: GBS + Mother; infection
 Dose: 5 million units (started at the time of labor or
rupture of membranes), then 2.5-3 million units IV
q4hrs until delivery
 Contraindications: Allergy to penicillin
 Side Effects: congestive heart failure, coma, seizure

Medications
Promethazine
 Brand name: Phenergan
 Indication: Nausea/vomiting
 Limit the dose
 Consider 6.25 mg or 12.5 mg as the starting
dose, especially for elderly
patients
 Smaller doses have proven quite
effecttive
 Administration: Dilute the 25 mg/mL strength in at
least 10 to 20 mL of NS
 Use large patent veins. Avoid the use of hand and
wrist veins unless no other alternatives are available!
 Administer slow IV push over at least 5 minutes
 Inspect site around catheter tip and extremity for
swelling, blanching, bleb formation, stretched and
firm skin or coolness
 Remain in continual contact with pt during administration and for 5 minutes following administration
to observe for adverse reactions and monitor injection site

Medications
(Promethazine Continued)
Educate and involve patient
 Question patient regarding pain, heat, stinging,
burning, and discomfort at insertion site and venous
pathway
 If patient complains of burning or pain at site, stop
the infusion immediately and assess the site
 Document all findings and interventions
If an extravasation is suspected:
 Discontinue infusion immediately
 Implement the Extravasation Management Protocol
 Report and Adverse Drug Reaction (ADR)
 Via Patient Safety Net (PSN) report or
 By calling extension 8-2328

Medications
Terbutaline
 Generic name: Terbutaline
 Drug class: Tocolytic; uterine relaxant
 Indications: Uterine tachysystole, fetal distress
 Dose: 0.25 mg sq q 20-60 min. until ctx stop. Not
to be given for >48-72 hrs
 Contraindications: Maternal Tachycardia
(HR>120),
 Side Effects: Maternal tachycardia (warn mother
before administration), palpitations, tachypnea, jittery, hot/flushed, nausea, constipation
 Long term use (>48-72 hrs) has caused maternal
cardiac complications and death

Medications
Vancomycin
 Brand name: Vancocin
 Drug class: Antibiotic
 Indications: Tx/Prophylaxis for infection Alternative tx of GBS (+) patient if allergic to penicillin
 Dose: See physician order
 Contraindications: Glycopeptide antibiotic allergy
 Side Effects: hypotension, rash, chills,
fever

Vaccinations During Pregnancy
Flu:
Why? To prevent infections in babies
Side Effects: flu like symptoms such as fever
or drowsiness, injection site burning, redness,
swelling, soreness
 Effects on Baby: L1 - Safest: Not found in
milk. It is not a live virus. Antibodies will help
protect infant
Varicella:
 Why? To prevent infections in babies
 Side Effects: flu like symptoms such as fever
or drowsiness, injection site burning, redness,
swelling, soreness
 Effects on Baby: L2 - Safer: Not found in milk
samples. Not contraindicated.
TDAP:
 Why? To maximize maternal response and
passive antibody transfer to the infant against
pertussis (whooping cough)
 Optimal timing: Administer during each pregnancy between 27-36 weeks
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Vaccinations Post Delivery
RH Immune Globulin:
 Why? Given to RH (-) women to prevent reaction
 Side Effects: Injection site burning, redness,
swelling, soreness,
 Effects on Baby: L2 - Safer: Traces found in
milk. Not contraindicated
MMR:
 Why? Rubella level not Immune
 Side Effects: flu like symptoms such as fever
or drowsiness
 Effects on Baby: L2 - Safer: May be found in
milk. Not contraindicated.
TDAP:
 Why? Protect against pertussis (whooping
cough) which can cause harm to infant
 Side Effects: Injection site burning, redness,
swelling, soreness
 Effects on Baby: L2 - Safer: Not found in milk
samples.

Vaccinations Post Delivery
Pneumococcal:
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Why? Pneumococcal disease can lead to severe health
problems; including pneumonia, blood infections, and
meningitis.
Who? Administer to POSTPARTUM PATIENTS
ONLY; anyone ages 2 through 64 years of age who has
a long-term health problem such as: heart disease, lung
disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of cerebrospinal fluid or cochlear implant or
has any disease that lowers the body’s resistance to infection, such as: Hodgkin’s disease; lymphoma or leukemia; kidney failure; multiple myeloma; nephrotic syndrome; HIV infection or AIDS; damaged spleen, or no
spleen; organ transplant.
Side Effects: Redness, swelling, or pain at injection site,
drowsiness, temporary loss of appetite, mild fever, fatigue, headache, chills, muscle pain
Effects on Baby: The CDC and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for
mothers or infants and that breastfeeding is not a contraindication to pneumococcal vaccine.