This document provides information on several medications including their mechanism of action, route of administration, common side effects, and relevant nursing responsibilities. It lists Misoprostol, Bicitra, Methergine, Magnesium Sulfate, and Oxytocin, describing their uses in pregnancy, labor and delivery, as well as important factors for nurses to monitor when administering each medication.

1. MEDICATION MOA RT LABS TO SIDE EFFECTS NURSING
REVIEW RESPONSIBILITIES
Misoprostol Action PO BUN, Frequent Baseline assessment
Replaces protective Hematocrit, Abdominal pain Question for possibility of
(Cytotec)
prostaglandins consumed CBC Diarrhea pregnancy before initiating
with prostaglandin- ALT, AST, Occasional therapy (Pregnancy Category X)
inhibiting therapies (e.g., Hgb, Nausea,
Stage 3
NSAIDs). Creatinine Flatulence
(Also used in
Therapeutic Effect: Dyspepsia
first trimester to
Reduces acid secretion Headache
terminate
from gastric parietal cells,
pregnancy)
stimulates bicarbonate
production from
gastric/duodenal mucosa.
Uses
Prevention of NSAID-
induced gastric ulcers and
in pts at high risk for
developing gastric
ulcer/gastric ulcer
complications
Chemical termination of
pregnancy (in conjunction
with mifepristone)
Bicitra Action PO sodium levels Nausea, During pregnancy, this
This medication is used to pH (acidity) vomiting, medication should be used only
(Cytra-2,
make the urine less acidic. of your urine diarrhea, and when clearly needed. This
Liqui-Dual
Citra,
This medication can also blood stomach pain medication may worsen high
Oracit) prevent and treat certain electrolyte blood pressure during pregnancy
GI System metabolic problems bicarbonate (toxemia of pregnancy).
(electrolyte (acidosis) caused by kidney levels
modifier) disease.
Citric acid and citrate salts
Stage 1 (which
(prior to contain potassium and
epidural) sodium)
Methergine Action PO calcium Nausea, uterine Baseline assessment
Stimulates alpha- levels cramping, Determine baseline serum
(Methylergonovine)
adrenergic, serotonin vomiting calcium level, B/P, pulse. Assess
Stage 2 receptors, producing for any evidence of bleeding
(, given after arterial vasoconstriction before administration.
delivery, Causes vasospasm of Intervention/evaluation
rd
shortens 3 coronary arteries Monitor uterine tone, bleeding,
stage of labor) Directly stimulates uterine B/P, pulse q15min until stable
muscle. (about 1–2 hrs)
Assess extremities for color,
warmth, movement, pain.
Report chest pain promptly
Provide support with ambulation
if dizziness occurs.

2. Magnesium Action IV Mg, Common Baseline assessment
Essential for enzyme IM electrolytes Assess if pt is sensitive to
Sulfate Muscle
activity, nerve conduction, PO magnesium.
(Epsom Salt) muscle contraction Weakness Antacid: Assess GI pain (duration,
Stage 1 Maintains and restores Lack of Energy location, quality, time of
magnesium levels. Blurry Vision occurrence, relief with food,
Anticonvulsant: Slurred Speech causative/excacerbative factors).
Blocks neuromuscular Headache Laxative: Assess for weight loss,
transmission, amount of Nausea and nausea, vomiting, and history of
acetylcholine released at Vomiting recent abdominal surgery.
motor end plate. Flushing Systemic: Assess renal function,
Produces seizure control serum magnesium.
Uses Intervention/evaluation
Treatment/prevention of Antacid: Assess for relief of
hypomagnesemia gastric distress. Monitor renal
Prevention and treatment function (esp. if dosing is long
of seizures in eclampsia; term or frequent).
Torsade de pointes Laxative: Monitor daily pattern of
(atypical ventricular bowel activity, stool consistency.
tachycardia); Maintain adequate fluid intake.
Treatment of arrhythmias Systemic: Monitor renal function,
due to hypomagnesemia magnesium levels, EKG for
(ventricular cardiac function.
tachycardia/ventricular Test patellar reflexes (knee jerk
fibrillation) reflexes) before giving repeat
parenteral doses (used as
indication of CNS depression;
suppressed reflexes may be sign
of impending respiratory arrest).
Patellar reflex must be present,
respiratory rate should be 16/min
or over before each parenteral
dose. Initiate seizure precautions.
Oxytocin Uses IV electrolytes Occasional: Baseline assessment Assess
Induction of labor at term, Tachycardia, baselines for vital signs, B/P, fetal
(Pitocin,
control of post-partum premature heart rate. Determine frequency,
Syntocinon) bleeding. Adjunct in ventricular duration, strength of
Endocrine management of abortion. contractions, contractions.
system hypotension, Intervention/evaluation
(pituitary drug) nausea, Monitor B/P, pulse, respirations,
vomiting. Rare: fetal heart rate, intrauterine
(Stage 1 & 3) Nasal: pressure, contractions (duration,
Lacrimation/tea strength, frequency) q15min.
ring, nasal Notify physician of contractions
irritation, that last longer than 1 min, occur
rhinorrhea, more frequently than every 2
unexpected min, or stop. Maintain careful
uterine I&O; be alert to potential water
bleeding/contra intoxication. Check for blood loss.
ctions.

3. Terbutaline Action IV Frequent (38%– Baseline assessment
(Brethine) Stimulates beta2- PO 23%): Bronchospasm: Offer emotional
(Bricanyl) adrenergic receptors, Tremor, anxiety support (high incidence of
resulting in relaxation of Occasional anxiety due to difficulty in
uterine, bronchial smooth (11%–10%): breathing, Sympathomimetics
(CNS system.
muscle Drowsiness, response to drug). Preterm labor:
Stimulant)
Therapeutic Effect: headache, Assess baseline maternal pulse,
Inhibits uterine nausea, B/P, frequency and duration of
(Stage 2)
contractions heartburn, contractions, fetal heart rate.
Relieves bronchospasm, dizziness Intervention/evaluation
reduces airway resistance. Bronchospasm: Monitor rate,
Uses depth, rhythm, type of
Symptomatic relief of respiration; quality, rate of pulse.
reversible bronchospasm Assess lung sounds for rhonchi,
due to bronchial asthma, wheezing, and rales. Monitor
bronchitis, emphysema ABGs. Observe lips, fingernails for
Delays premature labor in cyanosis (blue or dusky color in
pregnancies between 20 light-skinned pts; gray in dark-
and 34 wks skinned pts). Observe for
clavicular retractions, hand
tremor. Evaluate for clinical
improvement (quieter, slower
respirations, relaxed facial
expression, and cessation of
clavicular retractions). Preterm
labor: Monitor for frequency,
duration, strength of
contractions. Diligently monitor
fetal heart rate.
Penicillin Action IM CBC, Occasional: Baseline assessment
Inhibits bacterial cell wall urinalysis, Lethargy, fever, Question for history of allergies,
G benzathine
synthesis by binding to one renal dizziness, rash, particularly penicillins,
or more of the penicillin- function pain at injection cephalosporins.
(Stage 2) binding proteins of tests. site. Rare:
bacteria. Therapeutic Seizures,
Effect: interstitial
Bactericidal. Uses nephritis.
Treatment of mild to
moderate severe
infections caused by
organisms susceptible to
low concentrations of
penicillin including
streptococcal (Group A)
upper respiratory
infections, syphilis, yaws.
Prophylaxis of infections
caused by susceptible
organisms (e.g., rheumatic
fever prophylaxis).

4. Penicillin G Action IV CBC, Occasional: Baseline assessment
Inhibits bacterial cell wall urinalysis, Lethargy, fever, Question for history of allergies,
potassium
synthesis by binding to one renal dizziness, rash, particularly penicillins,
or more of the penicillin- function pain at injection cephalosporins.
(Stage 2) binding proteins of tests. site. Rare:
bacteria. Seizures,
Therapeutic Effect: interstitial
Bactericidal. nephritis.
Uses
Treatment of susceptible
infections due to gram-
positive organisms, gram-
negative organisms,
actinomycosis, clostridium,
diphtheria, Listeria, N.
meningitidis, pasteurella
including anthrax,
endocarditis, respiratory
tract infections,
meningitis, neurosyphilis,
skin/skin structure
infections.
Penicillin V Action PO Hgb levels Frequent: Baseline assessment
Inhibits cell wall synthesis Mild Question for history of allergies,
potassium
by binding to bacterial cell hypersensitivity particularly penicillins,
membranes. reaction (chills, cephalosporins.
(Stage 3) Therapeutic Effect: fever, rash), Intervention/evaluation
Bactericidal. nausea, Hold medication, promptly report
Uses vomiting, rash (hypersensitivity), diarrhea
Treatment of mild to diarrhea. (with fever, abdominal pain,
moderate infections of Rare: mucus or blood in stool may
respiratory tract, skin/skin Bleeding, indicate antibiotic-associated
structure, otitis media, allergic colitis). Monitor I&O, urinalysis,
necrotizing ulcerative reaction. renal function tests for
gingivitis; prophylaxis for nephrotoxicity. Be alert for
rheumatic fever, dental superinfection: fever, vomiting,
procedures. diarrhea, anal/genital pruritus,
oral mucosal change (ulceration,
pain, and erythema). Review Hgb
levels; check for bleeding (overt
bleeding, ecchymosis, swelling of
tissue).

5. Betamethasone Action: IM Calcium Frequent: Baseline assessment
Controls rate of protein PO levels, Systemic: Question for hypersensitivity to
(Celestone,
synthesis, depresses TOPICAL Hematocrit, Increased any corticosteroid, sulfite.
Celestone migration of Hgb, RBC, PT, appetite, Obtain baseline values for height,
Phosphate, polymorphonuclear PTT abdominal weight, B/P, serum glucose,
leukocytes/fibroblasts, distention, electrolytes.
Celestone
reverses capillary nervousness, Obtain baseline results of initial
Soluspan) permeability, prevents or insomnia, false tests (tuberculosis [TB] skin test,
(Stage 3) controls inflammation. sense of well- X-rays, EKG).
Therapeutic Effect: being. Intervention/evaluation
Decreases tissue response Topical: Monitor B/P, blood glucose,
to inflammatory process. Burning, electrolytes.
Uses stinging, Apply topical preparation
Systemic: pruritus. sparingly. Do not use on broken
Anti-inflammatory, skin or in areas of infection.
immunosuppressant, Do not apply to wet skin, face,
corticosteroid replacement and inguinal areas.
therapy.
Topical:
Relief of inflammatory and
pruritic dermatoses. Foam:
Relief of inflammation,
itching associated with
dermatosis.
Ropivacaine Action Nerve Hypotension, Baseline assessment
Most local anesthetics fall block bradycardia, Pt should be in recumbent
(Naropin,
into one of two groups: headache, position before drug is
Naropin esters or amides. Both pruritus, administered by parenteral
Polyamp, provide anesthesia and nausea, route. Assess onset, type,
Naropin SDV, analgesia by reversibly vomiting, location, duration of pain. Obtain
binding to and blocking dizziness, vital signs before giving
Naropin sodium (Na) channels. This anxiety, medication. If respirations are
Novaplus) slows the rate of tinnitus, 12/min or less (20/min or less in
depolarization of the nerve dyspnea, children), withhold medication,
action potential; thus, cardiac arrest, contact physician. Effect of
propagation of the arrhythmias, medication is reduced if full pain
electrical impulses needed seizures, recurs before next dose.
for nerve conduction is syncope, chills Intervention/evaluation
prevented. Monitor vital signs 15–30 min
Uses after subcutaneous/IM dose, 5–
Local anesthetics suppress 10 min after IV dose (monitor for
pain by blocking impulses hypotension, change in
along axons. Suppression rate/quality of pulse). Monitor
of pain does not cause pain level, sedation response.
generalized depression of Monitor daily pattern of bowel
the entire nervous system. activity, stool consistency; avoid
Local anesthetics may be constipation. Check for adequate
given topically and by voiding. Initiate deep breathing,
injection (local infiltration, coughing exercises, particularly in
peripheral nerve block pts with pulmonary impairment.
[axillary], IV regional [Bier Therapeutic serum level: 100–550
block], epidural, and spinal). ng/ml; toxic serum level: greater
than 1,000 ng/ml.

6. Demerol Action IV plasma Frequent: Baseline assessment
Binds to opioid receptors IM amylase & Sedation, Pt should be in recumbent
(meperidine)
within CNS. Therapeutic PO lipase hypotension position before drug is
(Isonipecaine) Effect: Alters pain concentration (including administered by parenteral
(Pethidine)
perception, emotional orthostatic route. Assess onset, type,
(Neperdine)
response to pain. hypotension), location, duration of pain. Obtain
Uses diaphoresis, vital signs before giving
Analgesic
Relief of moderate to facial flushing, medication. If respirations are
severe pain. dizziness, 12/min or less (20/min or less in
NARCAN
nausea, children), withhold medication,
is vomiting, contact physician. Effect of
antidote
constipation. medication is reduced if full pain
recurs before next dose.
Intervention/evaluation
Monitor vital signs 15–30 min
after subcutaneous/IM dose, 5–
10 min after IV dose (monitor for
hypotension, change in
rate/quality of pulse). Monitor
pain level, sedation response.
Monitor daily pattern of bowel
activity, stool consistency; avoid
constipation. Check for adequate
voiding. Initiate deep breathing,
coughing exercises, particularly in
pts with pulmonary impairment.
Therapeutic serum level: 100–
550 ng/ml; toxic serum level:
greater than 1,000 ng/ml.
Morphine Action IV plasma Ambulatory pts, Baseline assessment
Binds with opioid amylase & that not in Pt should be in recumbent
sulfate
receptors within CNS lipase severe pain position before drug is given by
(Avinza, Kadian, Therapeutic Effect: concentration may experience parenteral route. Assess onset,
Morphine IR, MS Alters pain perception, nausea, type, location, duration of pain.
Contin, MSIR, emotional response to vomiting more Obtain vital signs before giving
pain frequently than medication. If respirations are
Oramorph SR, Uses those in supine 12/min or less (20/min or less in
Roxanol) Relief of moderate to position or who children), withhold medication,
NARCAN severe, acute, or chronic have severe contact physician. Effect of
is pain; analgesia during pain. medication is reduced if full pain
antidote labor Frequent: recurs before next dose.
Drug of choice for pain due Sedation, Intervention/evaluation
to MI, dyspnea from decreased B/P Monitor vital signs 5–10 min after
pulmonary edema not (including IV administration, 15–30 min
resulting from chemical orthostatic after subcutaneous, IM. Be alert
respiratory irritant hypotension), for decreased respirations, B/P.
DepoDur: Epidural diaphoresis, Check for adequate voiding.
(lumbar) single dose facial flushing, Monitor daily pattern of bowel
management of surgical constipation, activity and stool consistency.
pain. Infumorph: Use in dizziness,
devices for managing drowsiness,
intractable chronic pain nausea,
vomiting..

7. ketorolac Action IV Frequent (17%– Baseline assessment
Inhibits prostaglandin IM BUN, serum 12%): Assess onset, type, location,
(Toradol) synthesis, reduces PO creatine, CBC Headache, duration of pain. Obtain baseline
prostaglandin levels in with diff, nausea, renal/hepatic function tests.
Immune system aqueous humor. electrolytes, abdominal Intervention/evaluation
drug, Anti- Therapeutic Effect: bleeding cramps/pain, Monitor renal/hepatic function
inflammatory & Reduces intensity of pain time, & liver dyspepsia tests, urinary output. Monitor
Disease- stimulus, reduces function (heartburn, daily pattern of bowel activity,
modulating intraocular inflammation. tests indigestion, stool consistency. Observe for
Agent Uses epigastric pain). occult blood loss. Assess for
PO, injection: Short-term therapeutic response: relief of
(5 days or less) relief of pain, stiffness, swelling;
mild to moderate pain. increased joint mobility, reduced
Ophthalmic: Relief of joint tenderness, improved grip
ocular itching due to strength. Be alert to signs of
seasonal allergic bleeding (may also occur with
conjunctivitis. Treatment ophthalmic route due to systemic
postop for inflammation absorption).
following cataract
extraction, pain following
incisional refractive
surgery.
Hydralazine Action PO None Frequent: Baseline assessment
Competes with histamine IM significant Drowsiness, dry Anxiety: Offer emotional support
(Apresoline)
for receptor sites in GI mouth, marked to anxious pt. Assess motor
tract, blood vessels, discomfort with responses (agitation, trembling,
respiratory tract IM injection. tension), autonomic responses
Diminishes vestibular Occasional: (cold/clammy hands,
stimulation, depresses Dizziness, diaphoresis). Antiemetic: Assess
labyrinthine function. ataxia, asthenia for dehydration (poor skin turgor,
Therapeutic Effect: (loss of dry mucous membranes, and
Produces anxiolytic, strength, longitudinal furrows in tongue).
anticholinergic, energy), slurred Intervention/evaluation
antihistaminic, analgesic speech, For those on long-term therapy,
effects; relaxes skeletal headache, hepatic/renal function tests,
muscle; controls nausea, agitation, blood counts should be
vomiting. increased performed periodically. Monitor
Uses anxiety. lung sounds for signs of
Treatment of anxiety, hypersensitivity reaction.
preop sedation, antipruitic Monitor serum electrolytes in pts
with severe vomiting. Assess for
paradoxical reaction, particularly
during early therapy. Assist with
ambulation if drowsiness, light-
headedness occur.

8. Nubain Action IV plasma Frequent Baseline assessment
Binds with opioid IM amylase & Sedation. Obtain vital signs before giving
(Nalbuphine )
receptors within CNS. May lipase Occasional medication. If respirations are
Short acting displace opioid agonists, concentration Diaphoresis, 12/min or less (20/min or less in
competitively inhibiting cold/clammy children), withhold medication,
their action; may skin, nausea, contact physician. Assess onset,
precipitate withdrawal vomiting, type, location, duration of pain.
symptoms. Therapeutic dizziness, Effect of medication is reduced if
Effect: Alters pain vertigo, dry full pain recurs before next dose.
perception, emotional mouth, Low abuse potential.
response to pain. headache. Intervention/evaluation
Uses Monitor for change in
Relief of moderate to respirations, B/P, rate/quality of
severe pain, preop pulse. Monitor daily pattern of
analgesia, obstetric bowel activity and stool
analgesia, adjunct to consistency. Initiate deep
anesthesia. OFF-LABEL: breathing, coughing exercises,
Opioid-induced pruritus. particularly in pts with pulmonary
impairment. Assess for clinical
improvement, record onset of
relief of pain. Consult physician if
pain relief is not adequate.
Ritodrine Action PO Frequent: Baseline assessment
Inhibits HIV-1 and HIV-2 GI disturbances Pts beginning combination
proteases, rendering these (abdominal therapy with ritonavir and
enzymes incapable of pain, anorexia, nucleosides may promote GI
used to stop processing polypeptide diarrhea, tolerance by beginning ritonavir
premature labor precursors leading to nausea, alone and subsequently adding
production of vomiting), nucleosides before completing 2
noninfectious, immature circumoral and wks of ritonavir monotherapy.
HIV particles. Therapeutic peripheral Obtain baseline laboratory
Effect: Slows HIV paresthesias, testing, esp. serum hepatic
replication, reducing altered taste, function tests, triglycerides
progression of HIV headache, before beginning ritonavir
infection. dizziness, therapy and at periodic intervals
Uses Treatment of HIV fatigue, during therapy. Offer emotional
infection in combination asthenia (loss support to pt/family.
with other antiretroviral of strength, Intervention/evaluation
agents. energy). Closely monitor for evidence of
GI disturbances, neurologic
abnormalities (particularly
paresthesias). Monitor serum
hepatic function tests, serum
glucose, CD4 cell count, plasma
levels of HIV RNA.

9. Calcium Action: IV electrolytes, Frequent: Baseline assessment Assess
Essential for function, serum Mg, PO: Chalky B/P, EKG and cardiac rhythm,
Gluconate
integrity of nervous, Ph, & K taste. renal function, serum
(Tums) muscular, skeletal systems. concentratio Parenteral: magnesium, phosphate,
Plays an important role in ns Pain, rash, potassium concentrations.
GI Drug, normal cardiac/renal redness, Intervention/evaluation
electrolyte function, respiration, burning at Monitor B/P, EKG, cardiac
modifier blood coagulation, cell injection site, rhythm, serum magnesium,
membrane and capillary flushing, feeling phosphate, potassium, renal
permeability. Assists in of warmth, function. Monitor serum, urine
Therapeutic regulating release/storage nausea, calcium concentrations. Monitor
Effect: of vomiting, for signs of hypercalcemia.
Replaces calcium neurotransmitters/hormo diaphoresis,
in deficiency nes. Neutralizes/reduces hypotension
states; controls gastric acid (increases pH).
hyperphosphate Calcium acetate: Combines
mia in end-stage with dietary phosphate,
renal disease, forming insoluble calcium
relieves phosphate.
heartburn, Uses:
indigestion. Parenteral: Acute
hypocalcemia (e.g.,
neonatal hypocalcemia
tetany, alkalosis),
electrolyte depletion,
cardiac arrest (strengthens
myocardial contractions),
hyperkalemia (reverses
cardiac depression),
Hypermagnesemia (aids in
reversing CNS depression).
Stadol Action IV plasma Frequent: Baseline assessment
Binds to opiate receptor Nasal amylase & Parenteral: Obtain vital signs before giving
(Butorphanol)
sites in CNS. Reduces Spray lipase Drowsiness, medication. If respirations are
Short acting intensity of pain stimuli (Stadol concentration dizziness. 12/min or less (20/min or less in
incoming from sensory NS): Nasal: children), withhold medication,
nerve endings. Therapeutic 10 mg/ml. Nasal contact physician. Assess onset,
Effect: Alters pain congestion type, location, duration of pain.
perception, emotional . Effect of medication is reduced if
response to pain full pain recurs before next dose.
Uses Protect from falls. During labor,
Management of pain assess fetal heart tones, uterine
(including postop pain). contractions.
Nasal: Management of Intervention/evaluation
moderate to severe pain, Monitor for change in
including migraine respirations, B/P, rate/quality of
headache pain. Parenteral: pulse. Initiate deep breathing,
Preop, preanesthetic coughing exercises, particularly in
medication, supplement those with pulmonary
balanced anesthesia, relief impairment. Change pt’s position
of pain during labor. q2–4h. Assess for clinical
improvement, record onset of relief
of pain.

10. Phytonadione Action IM PT Occasional: Intervention/evaluation
Promotes hepatic IV IR Pain, soreness, Monitor PT, international
Aqua
formation of coagulation PO swelling at IM normalized ratio (INR) routinely
(Vitamin K 1) factors II, VII, IX, X. injection site, in those taking anticoagulants.
stage 2 Therapeutic Effect: pruritic Assess skin for ecchymoses,
First hour after Essential for normal erythema (with petechiae. Assess gums for
clotting of blood. repeated gingival bleeding, erythema.
birth Uses injections), Assess urine for hematuria.
Prevention, treatment of facial flushing, Assess Hct, platelet count,
Cardiovascular hemorrhagic states in altered taste. urine/stool culture for occult
Drug, Affecting neonates; antidote for blood. Assess for decrease in B/P,
coagulation hemorrhage induced by increase in pulse rate, complaint
oral anticoagulants, of abdominal/back pain, severe
Antidote hypoprothrombinemic headache (may be evidence of
for states due to vitamin K hemorrhage). Question for
WARFARIN deficiency. Will not increase in amount of discharge
counteract anticoagulation during menses. Assess peripheral
effect of heparin. pulses. Check for excessive
bleeding from minor cuts,
scratches.
PNV Prenatal vitamins are used PO None Upset stomach; Avoid taking any other
to provide the additional significant headache; or multivitamin product within 2
vitamins needed Unusual or hours before or after you take
during pregnancy. unpleasant your prenatal vitamins. Taking
Minerals may also be taste in your similar vitamin products together
contained in prenatal mouth. at the same time can result in a
multivitamins. vitamin overdose or serious side
effects.
Avoid the regular use of salt
substitutes in your diet if your
multivitamin contains potassium.
If you are on a low-salt diet, ask
your doctor before taking a
vitamin or mineral supplement.
Do not take this medication with
milk, other dairy products,
calcium supplements, or antacids
that contain calcium. Calcium
may make it harder for your body
to absorb certain ingredients of
the prenatal vitamin.

11. Iron Sulfate Uses PO Serum iron, Constipation Although symptoms of iron
Ferrous sulfate provides total iron- Stomach Upset deficiency usually improve within
(ferrous sulfate)
the iron needed by the binding a few days, you may have to take
body to produce red blood capacity, ferrous sulfate for 6 months if
cells. reticulocyte you have severe iron deficiency.
count, Hgb, This medication should be taken
It is used to treat or ferritin. on an empty stomach, at least 1
prevent iron-deficiency hour before or 2 hours after
anemia, a condition that eating.
occurs when the body has Ferrous sulfate drops come with
too few red blood cells a special dropper for measuring
because of pregnancy, the dose. Ask your pharmacist to
poor diet, excess bleeding, show you how to use it. The
or other medical problems. drops may be placed directly in
the mouth or mixed with water
or fruit juice (not with milk).
Ducolax Action PO electrolytes Frequent: Some Intervention/evaluation
Direct effect on colonic degree of Encourage adequate fluid intake.
smooth musculature by abdominal Assess bowel sounds for
stimulating intramural discomfort, peristalsis. Monitor daily pattern
GI system, nerve plexi. Therapeutic nausea, mild of bowel activity and stool
Laxative/ bowel Effect: Promotes fluid and cramps, consistency; record time of
preps/ ion accumulation in colon faintness. evacuation. Assess for abdominal
Anitflatulents increasing peristalsis, Occasional: disturbances. Monitor serum
producing laxative effect. Rectal electrolytes in those exposed to
Uses administration: prolonged, frequent, or excessive
Treatment of constipation, burning of use of medication.
colonic evacuation before rectal mucosa,
examinations or mild proctitis.
procedures.
(Reglan Action IV ◀ ALERT ▶ Baseline assessment
(Metoclopramide) Stimulates motility of upper GI PO Doses of 2 Antiemetic: Assess for
tract
Routes mg/kg or dehydration (poor skin turgor,
Decreases reflux into
esophagus. Raises threshold greater, or dry mucous membranes, and
activity in chemoreceptor increased longitudinal furrows in tongue).
trigger zone length of Assess for nausea, vomiting,
Therapeutic Effect: therapy, may abdominal distention, and bowel
Accelerates intestinal transit, sounds.
result in a
gastric emptying. Relieves
nausea, vomiting. greater Intervention/evaluation
Uses incidence of Monitor for anxiety, restlessness,
Facilitates placement of enteral side effects. extrapyramidal symptoms (EPS)
feeding tubes; stimulates Frequent (10%): during IV administration. Monitor
gastric emptying, intestinal Drowsiness, daily pattern of bowel activity
transit in conjunction with
restlessness, and stool consistency. Assess skin
radiography; treatment of
gastroparesis, fatigue, for rash. Evaluate for therapeutic
gastroesophogeal reflux lethargy response from gastroparesis
disease (GERD); prevents or (nausea, vomiting, bloating).
treats cancer chemotherapy- Monitor renal function, B/P,
induced nausea, vomiting; heart rate.
prevents or treats postop
nausea, vomiting. Orally-
Disintegrating Tablets:
Treatment of gastroparesis,
GERD.

12. Methyldopa Lowers blood pressure by ORAL slow heart rate; You should not take
decreasing the levels of pale or this medication if you are allergic
(Aldomet)
certain chemicals in your yellowed skin, to methyldopa, or if you have
blood. This allows your fever, confusion liver disease (especially cirrhosis),
blood vessels (veins and or weakness; or a history of liver problems
arteries) to relax (widen) nausea, upper caused by taking methyldopa. Do
and your heart to beat stomach pain, not use methyldopa if you have
more slowly and easily. itching, loss of used an MAO inhibitor such as
appetite, dark furazolidone (Furoxone),
Methyldopa is used to urine, clay- isocarboxazid (Marplan),
treat hypertension (high colored stools, phenelzine (Nardil), rasagiline
blood pressure). jaundice (Azilect), selegiline (Eldepryl,
(yellowing of Emsam, Zelapar), or
the skin tranylcypromine (Parnate) in the
or eyes); last 14 days. A dangerous drug
skin rash, interaction could occur, leading
bruising, severe to serious side effects.
tingling,
numbness,
pain, muscle
weakness;
feeling short of
breath, even
with mild
exertion;
swelling in your
hands, ankles,
or feet;
easy bruising,
unusual
bleeding (nose,
mouth, vagina,
or rectum),
purple or red
pinpoint spots
under your
skin; or
Muscle
movements you
cannot control.

13. Procardia Action PO LFT, RFT, Frequent Baseline assessment
Inhibits calcium ion SUB CBC, serum Peripheral Concurrent therapy of sublingual
(Nifedipine)
movement across cell LINGUAL glucose, K edema, nitroglycerin may be used for
Cardiovascular membranes, depressing headache, relief of anginal pain
system, contraction of cardiac, flushed skin, Record onset, type (sharp, dull,
Affecting vascular smooth muscle dizziness. squeezing), radiation, location,
contractility/ Therapeutic Effect: Occasional intensity, duration of anginal
rhythm/ Increases heart rate, Nausea, pain; precipitating factors
circulating cardiac output shakiness, (exertion, emotional stress)
blood volume Decreases systemic muscle Check B/P for hypotension
vascular resistance, B/P cramps/pain, immediately before giving
Uses drowsiness, medication.
Treatment of angina due palpitations, Intervention/evaluation
to coronary artery spasm nasal Assist with ambulation if light-
(Prinzmetal’s variant congestion, headedness, dizziness occurs
angina), chronic stable cough, Assess for peripheral edema.
angina (effort-associated dyspnea, Assess skin for flushing. Monitor
angina) wheezing. serum hepatic enzymes,
Extended-release signs/symptoms of CHF.
Treatment of essential
hypertension
Bupivacaine Inducing spinal anesthesia Nerve Mild dizziness Baseline assessment
(Marcaine HCl, for certain medical or block or drowsiness. Pt should be in recumbent
Marcaine Spinal, surgical procedures. position before drug is
Sensorcaine, administered by parenteral
Sensorcaine- Bupivacaine Solution is an route. Assess onset, type,
MPF, anesthetic. It works by location, duration of pain. Obtain
Sensorcaine- blocking the generation vital signs before giving
MPF Spinal) and conduction of nerve medication. If respirations are
impulses. 12/min or less (20/min or less in
children), withhold medication,
contact physician. Effect of
medication is reduced if full pain
recurs before next dose.
Intervention/evaluation
Monitor vital signs 15–30 min
after subcutaneous/IM dose, 5–
10 min after IV dose (monitor for
hypotension, change in
rate/quality of pulse). Monitor
pain level, sedation response.
Monitor daily pattern of bowel
activity, stool consistency; avoid
constipation. Check for adequate
voiding. Initiate deep breathing,
coughing exercises, particularly in
pts with pulmonary impairment.
Therapeutic serum level: 100–
550 ng/ml; toxic serum level:
greater than 1,000 ng/ml.

14. Action IV plasma amylase Frequent: Baseline assessment Resuscitative
Fentanyl
Binds to opioid receptors in CNS, IM BUCAL & lipase IV: Postop equipment, opiate antagonist (naloxone
( Fentora, reducing stimuli from sensory drowsiness, nausea, 0.5 mcg/kg) must be available. Establish
nerve endings, inhibits ascending vomiting. baseline B/P, respirations. Assess type,
Onsolis) pain pathways. Therapeutic Transdermal (10%– location, intensity, duration of pain.
CNS, Analgesics Effect: Alters pain reception, 3%): Headache, Intervention/evaluation
increases pain threshold. pruritus, nausea, Assist with ambulation. Encourage post-
NARCAN is antidote Uses vomiting, op pt to turn, cough, deep breathe q2h.
For sedation, pain relief, preop diaphoresis, Monitor respiratory rate, B/P, heart rate,
medication; adjunct to general or dyspnea, confusion, oxygen saturation. Assess for relief of
regional anesthesia. Duragesic: dizziness, pain.
Management of chronic pain drowsiness,
(transdermal). Actiq: Treatment diarrhea,
of breakthrough pain in chronic constipation,
cancer or AIDS-related pain. decreased appetite.
Fentora: Breakthrough pain in pts Occasional: IV:
on chronic opioids. Onsolis: Postop confusion,
Breakthrough pain in pts with blurred vision,
cancer currently receiving opioids chills, orthostatic
and tolerant to opioid therapy. hypotension,
constipation,
difficulty urinating.
Transdermal (3%–
1%): Chest pain,
arrhythmias,
erythema, pruritus,
syncope, agitation,
skin irritations.
Action PO Serum Expected: Baseline assessment
Phenergan
Antihistamine: Inhibits histamine IV electrolytes, Drowsiness, Assess allergy symptoms. Assess B/P,
(Promethazine) at histamine receptor sites. serum bilirubin, disorientation; pulse for bradycardia, tachycardia if pt is
GI System, Antiemetic: AST, ALT hypotension, given parenteral form. If used as
Antiemetics/ Diminishes vestibular stimulation confusion, syncope antiemetic, assess for dehydration (poor
Antihistamine Depresses labyrinthine function in elderly skin turgor, dry mucous membranes, and
Acts on chemoreceptor trigger Frequent: longitudinal furrows in tongue).
zone Dry mouth, nose, Intervention/evaluation
Sedative-hypnotic: throat; urinary Monitor serum electrolytes in pts with
Produces CNS depression by retention; severe vomiting. Assist with ambulation if
decreasing stimulation to brain thickening of drowsiness, light-headedness occurs.
stem reticular formation bronchial secretions Monitor for relief of nausea, vomiting,
Therapeutic Effect: allergic symptoms
Prevents allergic responses
mediated by histamine (urticaria,
pruritus). Prevents, relieves
nausea/vomiting
Produces mild sedative effect
Uses
Treatment of allergic conditions,
Motion sickness,
Nausea
Vomiting
May be used as mild sedative

15. RhoGAM Action IV CNS: dizziness, Assessment
Prevent production of anti-Rh(D) IM headache. IV: Assess vital signs periodically during
antibodies in Rh(D)-negative CV: hypertension, therapy in patients receiving IV Rh(D)
patients who were exposed to hypotension. immune globulin .ITP: Monitor patient for
Rh(D)-positive blood. Increase Derm: rash. signs and symptoms of intravascular
(RHo (D)
platelet counts in patients with GI: diarrhea, hemolysis (IVH) (back pain, shaking chills,
immune ITP. Therapeutic Effects: nausea, vomiting. fever, hemoglobinuria), anemia, and renal
globulin) Prevention of antibody response Hemat: ITP: insufficiency. If transfusions are required,
and hemolytic disease of the anemia, use Rh(D) negative packed red blood cells
newborn (erythroblastosis fetalis) intravascular to prevent exacerbation of IVH.
in future pregnancies of women hemolysis. Lab Test Considerations: Pregnancy: Type
who have conceived a Rh (D)- MS: arthralgia, and crossmatch of mother and newborns
positive fetus. Prevention of myalgia. Local: pain cord blood must be performed to
Rh(D) sensitization following at injection site. determine need for medication. Mother
transfusion accident. Decreased Misc: fever. must be Rh (D)-negative and Du-negative.
bleeding in patients with ITP. Infant must be Rh(D)-positive. If there is
doubt regarding infants blood type or if
father is Rh(D)-positive, medication
should be given. An infant born to a
woman treated with Rh(D) immune
globulin antepartum may have a weakly
positive direct Coombs test result on cord
or infant blood.ITP: Monitor platelet
counts, RBC counts, hemoglobin, and
reticulocyte levels to determine
effectiveness of therapy .
Zofran Action IV Serum Frequent Baseline assessment
(Ondansetron) Blocks serotonin, both PO electrolytes, (13%–5%): Assess degree of nausea,
peripherally on vagal nerve serum Anxiety, vomiting. Assess for dehydration
terminals and centrally in bilirubin, dizziness, if excessive vomiting occurs (poor
GI System, chemoreceptor trigger AST, ALT drowsiness, skin turgor, dry mucous
Antiemetics/ zone headache, membranes, and longitudinal
Antihistamine Therapeutic Effect: fatigue, furrows in tongue). Provide
Prevents nausea/vomiting constipation, emotional support.
Uses diarrhea, Intervention/evaluation
Prevention/treatment of hypoxia, urinary Monitor pt in environment.
nausea/vomiting due to retention. Assess bowel sounds for
cancer chemotherapy Occasional peristalsis. Provide supportive
(including high-dose (4%–2%): measures. Assess mental status.
cisplatin) Abdominal Monitor daily pattern of bowel
Prevention of postop pain, activity and stool consistency.
nausea, vomiting. xerostomia, Record time of evacuation
Prevention of radiation- fever, feeling of
induced nausea, vomiting. cold,
Treatment of postop redness/pain at
nausea, vomiting. injection site,
OFF-LABEL: paresthesia,
Postanesthetic shivering, asthenia (lack
vomiting due to viral of strength,
illness energy)
Treatment of early-onset Rare (1%):
alcoholism, Hyperemesis Hypersensitivity
gravidarum reaction (rash,
pruritus),
blurred vision

16. Motrin Action PO Serum, Occasional: Baseline assessment
(Diphenhydramine Inhibits prostaglandin plasma, Nausea with or Assess onset, type, location,
Ibuprofen ) synthesis. Produces URINE without duration of pain, inflammation.
vasodilation acting on vomiting, Inspect appearance of affected
heat-regulating center of dyspepsia, joints for immobility, deformities,
hypothalamus. dizziness, rash. skin condition. Assess
Therapeutic Effect: Rare (less than temperature.
Produces analgesic, anti- 3%): Diarrhea Intervention/evaluation
inflammation effects, or constipation, Monitor for evidence of nausea,
decreases fever. flatulence, dyspepsia. Monitor CBC,
Uses abdominal hepatic/renal function tests,
Treatment of fever, cramps or pain, occult blood loss. Monitor daily
juvenile rheumatoid pruritus. pattern of bowel activity and
arthritis (JRA), stool consistency. Assess skin for
osteoarthritis, minor pain, rash. Observe for bleeding,
mild to moderate pain, bruising. Evaluate for therapeutic
primary dysmenorrheal. response: relief of pain, stiffness,
NeoProfen: Closes swelling; increased joint mobility;
clinically significant patent reduced joint tenderness;
ductus arteriosus (PDA) in improved grip strength. Monitor
premature infants temperature for fever.
weighing between 500 and
1,500 g who are no more
than 32 wks gestational
age when usual medical
management is ineffective.
Zantac Action PO serum AST, Occasional Baseline assessment
Inhibits histamine action at IM ALT levels, (2%): Diarrhea. Obtain history of
(ranitidine) histamine 2 receptors of IV creatinine, Rare (1%): epigastric/abdominal pain.
gastric parietal cells.
BUN Constipation, Obtain baseline hepatic/renal
Therapeutic Effect: Inhibits
headache (may function tests.
gastric acid secretion (fasting,
nocturnal, when stimulated be severe). Intervention/evaluation
by food, caffeine, insulin). Monitor. Assess mental status in
Reduces volume, hydrogen . elderly. Question present
ion concentration of gastric abdominal pain, GI distress
juice.
Uses
Short-term treatment of
active duodenal ulcer.
Prevention of duodenal ulcer
recurrence. Treatment of
active benign gastric ulcer,
pathologic GI hypersecretory
conditions, acute
gastroesophageal reflux
disease (GERD), includes
erosive esophagitis.
Maintenance of healed
erosive esophagitis. Part of
regimen for H. pylori
eradication to reduce risk of
duodenal ulcer recurrence.
OTC: Relieve heartburn, acid
indigestion, sour stomach.

17. Pepcid Action PO Occasional Baseline assessment
Inhibits histamine action IM (5%): Assess epigastric/abdominal pain.
H2 receptors of parietal IV Headache. Intervention/evaluation
(Famotidine, cells. Therapeutic Effect: Monitor daily pattern of bowel
calcium, and Inhibits gastric acid activity and stool consistency.
magnesium) secretion (fasting, Monitor for diarrhea,
nocturnal, or stimulated by constipation, and headache.
food, caffeine, insulin). Assess confusion in elderly.
Uses
Short-term treatment of
active duodenal ulcer.
Prevention, maintenance
of duodenal ulcer
recurrence. Treatment of
active benign gastric ulcer,
pathologic GI
hypersecretory conditions.
Short-term treatment of
gastroesophageal reflux
disease (GERD), including
erosive esophagitis. OTC
formulation for relief of
heartburn, acid
indigestion, sour stomach.
Beractant Action Intra Frequent: Baseline assessment
Lowers alveolar surface tracheal Transient Drug must be administered in
(Survanta)
tension during respiration, bradycardia, highly supervised setting.
stabilizing alveoli. oxygen (O2) Clinicians caring for neonate
Therapeutic Effect: desaturation, must be experienced with
Improves lung compliance, increased intubation, ventilator
respiratory gas exchange. carbon dioxide management. Offer emotional
Uses (CO2) support to parents.
Prevention and treatment retention. Intervention/evaluation
(rescue therapy) of Monitor infant with arterial or
respiratory distress Occasional: transcutaneous measurement of
syndrome (RDS—hyaline Endotracheal systemic O2, CO2. Assess for
membrane disease) in tube reflux. adventitious breath sounds
premature infants. (rales, rhonchi).
Prevention: Body weight
less than 1,250 g in infants
at risk for developing or
with evidence of
surfactant deficiency (give
within 15 min of birth).
Rescue Therapy:
Treatment of infants with
RDS confirmed by X-ray,
requiring mechanical
ventilation (give within 8
hrs of birth).

18. Erythromycin 1% Action PO Frequent: Baseline assessment
Penetrates bacterial cell TOPICAL IV: Abdominal Question for history of allergies
stage 2
membranes, reversibly cramping/disco (particularly erythromycins),
First hour after
binds to bacterial mfort, hepatitis.
birth
ribosomes, inhibiting phlebitis/throm Intervention/evaluation
protein synthesis. bophlebitis. Monitor daily pattern of bowel
Therapeutic Effect: Topical: Dry activity and stool consistency.
Bacteriostatic. skin (50%). Assess skin for rash. Assess for
Uses Occasional: hepatotoxicity (malaise, fever,
Treatment of susceptible Nausea, abdominal pain, GI disturbances).
infections due to S. vomiting, Be alert for superinfection: fever,
pyogenes, S. pneumoniae, diarrhea, rash, vomiting, diarrhea, anal/genital
S. aureus, M. pneumoniae, urticaria. pruritus, oral mucosal changes
Legionella, diphtheria, Rare: (ulceration, pain, erythema).
pertussis, chancroid, Ophthalmic: Check for phlebitis (heat, pain,
Chlamydia, N. gonorrheae, Sensitivity red streaking over vein). Monitor
E. histolytica, syphilis, reaction with for high-dose hearing loss.
nongonococcal urethritis, increased
Campylobacter irritation, .
gastroenteritis. Topical: burning,
Treatment of acne itching,
vulgaris. Ophthalmic: inflammation.
Prevention of gonococcal Topical:
ophthalmia neonatorum, Urticaria.
superficial ocular
infections.
OFF-LABEL:
Systemic: Treatment of
acne vulgaris, chancroid,
Campylobacter enteritis,
gastroparesis, Lyme
disease, preoperative gut
sterilization. Topical:
Treatment of minor
bacterial skin infections.
Ophthalmic: Treatment of
blepharitis, conjunctivitis,
keratitis, chlamydial
trachoma.
Narcan Action IV None known; Baseline assessment
Displaces opioids at opioid- IM little or no Maintain clear airway. Obtain weight
(Naloxone) occupied receptor sites in pharmacologic of children to calculate drug dosage.
CNS Drug, CNS. Therapeutic Effect: effect in absence Intervention/evaluation
Reverses opioid-induced of narcotics. Monitor vital signs, esp. rate, depth,
Opioid Reversal sleep/sedation, increases rhythm of respiration, during and
Agent respiratory rate, raises B/P to frequently following administration.
normal range. Carefully observe pt after satisfactory
Uses response (duration of opiate may
Complete or partial reversal of exceed duration of naloxone,
opioid depression including resulting in recurrence of respiratory
respiratory depression. Diagnosis
depression). Assess for increased
of suspected opioid tolerance or
acute opioid overdose. Neonatal pain with reversal of opiate.
opiate depression. Coma of
unknown origin

19. Benadryl Action IV Frequent: Baseline assessment
Competitively blocks IM Drowsiness, If pt is having acute allergic
(Diphenhydramine)
effects of histamine at PO dizziness, reaction, obtain history of
Respiratory
peripheral H1 receptor muscle recently ingested foods, drugs,
System, Anti-
sites. Therapeutic Effect: weakness, environmental exposure, and
allergy/ Anti-
Produces anticholinergic, hypotension, emotional stress. Monitor B/P
inflammatory
antipruritic, antitussive, urinary rate, depth, rhythm, type of
Agent
antiemetic, antidyskinetic, retention, respiration; quality, rate of pulse.
sedative effects. thickening of Assess lung sounds for rhonchi,
Uses bronchial wheezing, and rales.
Treatment of allergic secretions, dry Intervention/evaluation
reactions, parkinsonism; mouth, nose, Monitor B/P, esp. in elderly
prevention/treatment of throat, lips; in (increased risk of hypotension).
nausea, vomiting, vertigo elderly: Monitor children closely for
due to motion sickness; sedation, paradoxical reaction.
antitussive; short-term dizziness,
management of insomnia. hypotension.
Topical form used for relief Occasional:
of pruritus, insect bites, Epigastric
skin irritations. distress,
flushing,
visual/hearing
disturbances,
paresthesia,
diaphoresis,
chills.
Percocet Action PO May increase ◀ ALERT ▶ Baseline assessment
Binds with opioid serum Effects are Assess onset, type, location,
receptors within CNS. amylase, dependent on duration of pain. Effect of
(Acetaminophen/ Therapeutic Effect: Alters lipase. dosage amount. medication is reduced if full pain
Oxycodone) perception of and Ambulatory pts, recurs before next dose. Obtain
emotional response to those not in vital signs before giving
pain. severe pains medication. If respirations are
may experience 12/min or less (20/min or less in
Uses dizziness, children), withhold medication,
Relief of mild to nausea, contact physician.
moderately severe pain. vomiting, and Intervention/evaluation
hypotension Palpate bladder for urinary
more retention. Monitor daily pattern
frequently than of bowel activity and stool
those in supine consistency. Initiate deep
position or breathing, coughing exercises,
having severe esp. in pts with pulmonary
pain. Frequent: impairment. Monitor pain relief,
Drowsiness, respiratory rate, mental status,
dizziness, B/P.
hypotension
(including
orthostatic
hypotension),
anorexia.