DRUG STUDY DRUG CLASSIFICATI ON THERAPEUTIC ACTION INDICATION CONTRAINDICATI ON & CAUTION Contraindicated with history of allergy to prostaglandins;

; pregnancy (abortifacient; advise women of childbearing age in written and oral form of use, have a negative serum pregnancy test within 2 wk prior to therapy, provide contraceptives, and begin therapy on the second or third day of the next normal menstrual period); lactation. Use cautiously in the elderly, and with renal impairment, duodenal ulcers. ADVERSE EFFECTS NURSING RESPONSIBILITY

misoprostol (mye soe prost ole) Brand Name: Cytotec Pregnancy category x

Prostaglandin

A synthetic prostaglandin E1 analogue; inhibits gastric acid secretion and increases bicarbonate and mucus production, protecting the lining of the stomach.

Prevention of NSAID (including aspirin)induced gastric ulcers in patients at high risk of complications from a gastric ulcer (the elderly; patients with concomitant debilitating disease, history of ulcers) With mifepristone as an abortifacient (see mifepristone) Unlabeled use: Appears effective in treating but not preventing duodenal ulcers in patients unresponsive to histamine-2 antagonists; cervical ripening and labor induction; postpartum hemorrhage; chronic idiopathic constipation

GI: Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, constipation GU: Miscarriage, excessive bleeding, spotting, cramping, hypermenorrhea, menstrual disorders, dysmenorrhea Other: Headache

Give to patients at high risk for developing NSAID-induced gastric ulcers; give for the full term of the NSAID use.

Arrange for oral and written explanation of the risks to pregnancy; appropriate contraceptive measures must be taken; begin therapy on the second or third day of a normal menstrual period.

DRUG STUDY DRUG CLASSIFICATI ON THERAPEUTIC ACTION INDICATION CONTRAINDICATI ON & CAUTION Contraindicated with significant cephalopelvic disproportion, unfavorable fetal positions or presentations, obstetric emergencies that favor surgical intervention, prolonged use in severe toxemia, uterine inertia, hypertonic uterine patterns, induction or augmentation of labor when vaginal delivery is contraindicated, previous cesarean section, pregnancy. Use cautiously with renal impairment. ADVERSE EFFECTS NURSING RESPONSIBILITY

Oxytocin (ox i toe sin) Brand Name: Pitocin pregnancy category x

Hormone Oxytocic

Synthetic form of an endogenous hormone produced in the hypothalamus and stored in the posterior pituitary; stimulates the uterus, especially the gravid uterus just before parturition, and causes myoepithelium of the lacteal glands to contract, which results in milk ejection in lactating women.

Antepartum: To initiate or improve uterine contractions to achieve early vaginal delivery; stimulation or reinforcement of labor in selected cases of uterine inertia; management of inevitable or incomplete abortion; second trimester abortion. Postpartum: To produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage Lactation deficiency Unlabeled uses: To evaluate fetal distress (oxytocin challenge test), treatment of breast engorgement

CV: Cardiac arrhythmias, PVCs, hypertension, subarachnoid hemorrhage Fetal effects: Fetal bradycardia, neonatal jaundice, low Apgar scores GI: Nausea, vomiting GU: Postpartum hemorrhage, uterine rupture, pelvic hematoma, uterine hypertonicity, spasm, tetanic contraction, rupture of the uterus with excessive dosage or hypersensitivity Hypersensitivity: Anaphylactic reaction Other: Maternal and fetal deaths when used to induce labor or in first or second stages of labor; afibrinogenemia; severe

Ensure fetal position and size and absence of complications that are contraindicated with oxytocin before therapy. Ensure continuous observation of patient receiving IV oxytocin for induction or stimulation of labor; fetal monitoring is preferred. A physician should be immediately available to deal with complications if they arise. Regulate rate of oxytocin delivery to establish uterine contractions that are similar to normal labor; monitor rate and strength of contractions; discontinue drug and notify physician at any sign of uterine hyperactivity or spasm.

water intoxication with seizures and coma, maternal death (associated with slow oxytocin infusion over 24 hr; oxytocin has antidiuretic effects)

DRUG STUDY

Nomenclature

Mechanism of action

Contraindication

Indication

Adverse Effect

Nursing Responsibilities Assess for the pt. history: liver and kidney dysfunction, lactation, pregnancy Physical: skin, status, liver and kidney function test, culture of affected area sensitivity teeest

Generic Name: Ceftriaxone

Bacterial: inhibits synthesis of bacterial cell wall, causing cell death.

Allergy to cephalosporins or penicilins, renal failure, lactation and pregnancy

Brand Name: Rocephin

Lower respiratory tract infections cause S.pneumonia, S.ureas,Klebsiella,H.influenza, E. coli,P. mirabilis, E.aerogens ,Seratia marcessens, Haemophilus parainfluenza, streptococcus (excluding enterococci)

CNS: headache, dizziness, lethargy, paresthesias . GI: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, liver toxicity GU: nephrotoxicity

Classification: Third- generation Cephalosporin Hematologic: bone marrow depression; decrease WBC, decrase platelets, decrease HCT Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum,sickess,reaction