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Flashcards in Sim: Postpartum Hemorrhage Drugs Deck (23)
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what is the trade name for oxytocin?



oxytocin: indications

  • induction or augmentation of labor
  • control of postpartum bleeding
  • inevitable or incomplete abortion


oxytocin: dosage for induction or augmentation of labor

  • starting doses of 0.5 to 6 milliunits/min
  • inc the dose to 1-2 milliunits/min every 15-40 min
    • high dose protocols may inc dose in increments of up to 6 milliunits/min
  • after adequate contraction pattern is established and cervix is dilated 5-6 cm, oxytocin may be reduced
  • actual dose based on uterine response and absence of ADRs


oxytocin: dosage for control of postpartum bleeding

  • IV: 10-40 units at a rate of 20-40 milliunits/min
    • inc or dec rate according to uterine response and rate of postpartum bleeding
  • IM: 10 units after delivery of placenta


oxytocin: dosage for inevitable or incomplete abortion

  • 10 units at a rate of 10-20 milliunits/min


oxytocin: ADRs

  • hypertonic uterine activity
  • impaired uterine bloodflow
  • uterine rupture
  • abruptio placentae
  • fetal asphyxia (r/t diminished uterine blood flow)
  • maternal fluid retention-->water intoxication
  • hypotension
  • tachycardia
  • cardiac dysrhythmias
  • subarachnoid hemorrhage


oxytocin: nursing implications intrapartum

  • assess fetal HR for at least 20 min before induction AND verify a cephalic fetal presentation w/ Leopold's maneuver or a vaginal exam
    • if nonreassuring FHR or non-cephalic, then do not begin induction until U/S is done
  • observe uterine activity for establishment of effective labor pattern
    • contraction every 2-3 min, duration of 40-90 sec, intensity of 50-80 mmHg
    • watch for hypertonicity: contractions less than 2 min apart, rest interval shorter than 30 sec, duration longer than 90-120 sec, or resting tone greater than 20 mmHg
  • if hypertonicity or nonreassuring FHR occurs, stop infusion, inc rate of nonadditive soln, position woman in side-lying, and administer O2 at 8-10 L/min
  • record BP, pulse, and RR every 30-60 min or with each dose inc


oxytocin: nursing implications postpartum

  • observe uterus for firmness, height, and deviation
  • massage until firm if uterus is boggy
  • observe lochia for color, quantity, and presence of clots
  • assess for cramping
  • assess V/S every 15 min
  • monitor I&O and breath sounds to identify fluid retention or bladder distention
  • notify provider if uterus fails to remain contracted or lochia is bright red or has clots


what is the trade name for misoprostol?



Misoprostol: indications

  • cervical ripening
  • induction of labor
  • termination of pregnancy


Misoprostol: dosage

  • 25 mcg vaginally
    • must be prepared by pharmacist--broken from a 100 or 200 mcg tablet
  • 100 mcg orally


Misoprostol: ADRs

  • uterine hyperstimulation
  • contraindicated in a womean with previous cesarean or other uterine surgery


Misoprostol: nursing implications

  • to reduce leakage, have woman lie flat for 15-20 min after the gel form of PG is inserted
  • FHR should be monitored for at least 30 min for changes
  • uterus should be assessed for excessive contractions
  • oxytocin induction can begin 4 hours after last dose
  • if uterine hypertonicity occurs, place woman in side lying position, provide O2 at 8-10 L/min, administer tocolytic drug (terbutaline or Mg Sulfate)


what is the trade name for Carboprost tromethamine?



Carboprost tromethamine: Indications

  • Used for tx of postpartum hemorrhage caused by uterine atony
  • Abortion


Carboprost tromethamine: dosage

  • Postpartum hemorrhage: 250 mcg IM
    • May repeat at 15-90 min intervals
    • Max dose: 2 mg


Carboprost Tromethamine: ADRs

  • Tetanic contraction and laceration
  • Uterine rupture
  • Uterine hypertonus if used w/ oxytocin
  • n/v/d
  • Fever
  • Flushing
  • HA
  • HTN or hypoTN
  • Tachycardia
  • Pulmonary edema


Carboprost tromethamine: Nursing implications

  • Refrigerate drug
  • Give via deep IM injection and aspirate carefully to avoid IV injection
  • Rotate sites if repeated
  • Monitor V/S
  • Administer antiemetics and antidiarrheals as ordered


Methylergonovine: trade name



Methylergonovine: indications

  • Used for prevention and tx of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution


Methylergonovine: dosage

  • 0.2 mg IM every 2-4 hours for max 5 doses
  • Change to oral route 0.2 mg every 6-8 hours for max 7 days
  • IV usage not recommended
    • Only in life threatening emergency
    • Give over 60 sec w/ close monitoring of BP and pulse


Methylergonovine: ADRs

  • n/v
  • Uterine cramping
  • HTN
  • Dizziness
  • HA
  • Dyspnea
  • Chest pain
  • Palpitations
  • Peripheral ischemia
  • Seizure
  • Uterine and GI cramping


Methylergonovine: Nursing implications

  • Before admin, assess BP
    • Withhold if hospital policy says you should at a certain level
  • Tell mother to avoid smoking b/c constricts vessels and will inc BP
  • Report any ADRs