ANGELES UNIVERSITY FOUNDATION

Angeles City
College of Nursing
RELATED LEARNING EXPERIENCE (RLE) 0109
CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEM
(ACUTE AND CHRONIC)
Second Semester, Academic Year 2020 – 2021

MODULE 6:
DRUG STUDY

Submitted by:
JINGCO, Jashtine E.

BSN II – D

Submitted to:
Karen Cyril Cayanan, RN, LPT, MN

March 03, 2021

DRUG # 1
GENERIC NAME: Oxytocin

BRAND NAME: Pitocin, Syntocinon

DRUG CLASSIFICATION: Uterine smooth muscle stimulant

MECHANISM OF ACTION: Acts directly on myofibrils, thereby producing uterine

contraction; stimulates milk ejection by the breast; vasoactive antidiuretic effect

STOCK DOSAGE: 10 units/mL injection

INDICATION: Induction of labor in pts with medical indication (e.g., at or near term), to
stimulate reinforcement of labor, to produce uterine contractions during third stage of
labor and to control postpartum bleeding/hemorrhage

CONTRAINDICATIONS: 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.

SIDE EFFECTS/ADVERSE REACTIONS:

 Maternal: Hypertonicity may occur with tearing of uterus, increased bleeding,

abruptio placentae (i.e., placental abruption), cervical/vaginal lacerations.
 Fetal: Bradycardia, CNS/brain damage, trauma due to rapid propulsion, low
Apgar score at 5 min, retinal hemorrhage occurs rarely. Prolonged IV infusion of
oxytocin with excessive fluid volume has caused severe water intoxication with
seizures, coma, death.
NURSING INTERVENTIONS:

 Assess baselines for vital signs, B/P, fetal heart rate. Determine frequency,
duration, strength of contractions.
 Monitor fetal heart rate and maternal BP and pulse at least q15min during
infusion period. Report changes 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.
 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.

 Check fundus frequently during the first few postpartum hours and several times
daily thereafter.
 Educate the patient regarding the purpose and possible effects of the medication.
 Inform patient and family to report immediately if sudden, severe headache is
being experienced.

DRUG # 2

GENERIC NAME: Amyl Nitrite

BRAND NAME: Amyl Nitrite

DRUG CLASSIFICATION: Cardiovascular agent, nitrate vasodilator, antidote

MECHANISM OF ACTION: Short-acting vasodilator and smooth muscle relaxant with

actions similar to those of nitroglycerin

STOCK DOSAGE: 0.3 mL ampules

INDICATION: To facilitate uterine relaxation in difficult deliveries.

CONTRAINDICATIONS: Hypersensitivity to nitrites or nitrates; cerebral hemorrhage,

head trauma; hypotension; glaucoma; severe anemia; hyperthyroidism; recent MI; acute
alcoholism.

SIDE EFFECTS/ADVERSE REACTIONS:

 Body as a Whole: Transient flushing, weakness. 

 CV: Orthostatic hypotension, palpitation, cardiovascular collapse, tachycardia. 
 GI: nausea, vomiting. 
 Hematologic: Methemoglobinemia (large doses). 
 CNS: Headache, dizziness, syncope. 
 Respiratory: Respiratory depression.

NURSING INTERVENTIONS:

 Monitor vital signs until stable. Rapid pulse, which usually lasts for a brief period,
is an expected response to the fall in BP produced by the drug.
 Chart length of time required for pain to subside after administration of drug.
 Inform the client that the medication has a strongly fruity odor.

DRUG # 3

GENERIC NAME: Misoprostol

BRAND NAME: Cytotec

DRUG CLASSIFICATION: Prostaglandin

MECHANISM OF ACTION: Induces uterine contractions.

STOCK DOSAGE: 100 mcg, 200 mcg tablets

INDICATION: Cervical ripening, labor induction and treatment/prevention of postpartum

hemorrhage, treatment of incomplete or missed abortion.
CONTRAINDICATIONS: History of allergies to prostaglandins; pregnancy (category X),
lactation.

SIDE EFFECTS/ADVERSE REACTIONS:

 CNS: Headache. 
 GI: Diarrhea, abdominal pain, nausea, flatulence, dyspepsia, vomiting,
constipation. 
 Urogenital: Spotting, cramps, dysmenorrhea, uterine contractions.

NURSING INTERVENTIONS:

 Inform patient that misoprostol will cause spontaneous abortion. Women of

childbearing age must be informed of this effect through verbal and written
information and must use contraception throughout drug treatment. If pregnancy
is suspected, the woman should stop taking misoprostol and notify her health
care professional immediately.

 If used with mifepristone to terminate pregnancy, inform patient that vaginal

bleeding and uterine cramping will probably occur. Bleeding or spotting occurs
for an average of 9–16 days, but may continue for more than 30 days. Instruct
patient to report any severe or unusual cramping, bleeding, or pelvic pain that
extends beyond the expected time periods.

 Instruct patient to report bothersome side effects, including severe or prolonged

headache, menstrual irregularities, or GI problems (nausea, diarrhea, vomiting,
constipation, heartburn, flatulence, abdominal pain).

DRUG # 4

GENERIC NAME:

BRAND NAME: Dilapan-S

DRUG CLASSIFICATION: Non-pharmacologic, hygroscopic cervical dilator

MECHANISM OF ACTION: Controlled pressure on the cervical wall which dilates the
cervix. Partial and reversible osmotic cells dehydration which softens the tissue of the
cervix.

STOCK DOSAGE:

INDICATION: Cervical ripening, labor induction.

CONTRAINDICATIONS:

 Genital tract infection (signs of vaginal infection/sepsis; chorioamnionitis)

 Any contraindications to labor induction
 Refusal from the patient
 Pre-induction of labor ruptured membranes

SIDE EFFECTS/ADVERSE REACTIONS: Temporary status of weakness, paleness,

nausea, dizziness or loss of consciousness may be caused by cervical manipulation.

NURSING INTERVENTIONS:

 Inform the client to report immediately if there is presence of excessive bleeding,

pain or other concerns that occur during the ripening process
 Inform the client to avoid vaginal douching, sitting in a bath tub and having a
sexual intercourse while rods are in place.
 Educate the client that she can perform her normal daily activities.

DRUG # 5

GENERIC NAME: Progesterone

BRAND NAME: Utrogestan

DRUG CLASSIFICATION: Hormones and synthetic substitutes, Progestin

MECHANISM OF ACTION: Inhibits secretion of pituitary gonadotropins, which prevents
follicular maturation, ovulation. It stimulates growth of mammary tissue; relaxation of
uterine smooth muscle.

STOCK DOSAGE: 100 mg or 200 mg soft-gel capsules

INDICATION: Abnormal uterine bleeding, Corpus luteum insufficiency, early pregnancy

failure, PMS, fertility treatment, prevention of preterm birth in women with singleton
pregnancy who have a short cervix.

CONTRAINDICATIONS: Known missed abortions, ectopic pregnancy; hypersensitivity

to this product, peanuts, or peanut oil; thromboembolic disorders, reproductive cancer,
genital bleeding (abnormal, undiagnosed), cerebral hemorrhage, PID, STDs,
thrombophlebitis

SIDE EFFECTS/ADVERSE REACTIONS:

 CNS: Dizziness, headache, migraines, depression, fatigue, mood swings,

dementia, drowsiness
 CV: Hypotension, thrombophlebitis, edema, thromboembolism, stroke,
pulmonary embolism, MI
 EENT: Diplopia, retinal thrombosis
 GI: Nausea, vomiting, anorexia, cramps, increased weight, cholestatic jaundice,
constipation, abdominal pain
 GU: Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrhea,
vaginal candidiasis, nocturia, breast changes, gynecomastia, testicular atrophy,
impotence, endometriosis, spontaneous abortion, breast pain, ectopic pregnancy
 INTEG: Rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura,
melasma
 META: Hyperglycemia
 SYST: Angioedema, anaphylaxis

NURSING INTERVENTIONS:
  Record baseline data for comparative value about patient's weight, BP, and pulse
at onset of progestin therapy. Report deviations promptly.
 Inform physician promptly if any of the following occur: Sudden severe headache
or vomiting, dizziness or fainting, numbness in an arm or leg, pain in calves
accompanied by swelling, warmth, and redness; acute chest pain or dyspnea.
 Inform the client to use sunscreen, protective clothing to protect from sunlight,
ultraviolet light until tolerance determined.
 If using vaginal gel, avoid tasks that require alertness, motor skills until response
to drug is established.

DRUG # 6

GENERIC NAME: Dexamethasone

BRAND NAME: DexPak, Dexasone

DRUG CLASSIFICATION: Corticosteroid, Long-acting glucocorticoid

MECHANISM OF ACTION: Decreases inflammation and suppresses the normal

immune response

STOCK DOSAGE:

 4mg/mL, 10 mg/mL injection

 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg tablets

INDICATION: Short-term administration to high-risk mothers before delivery to prevent

respiratory distress syndrome in the newborn or accelerate fetal lung maturation.

CONTRAINDICATIONS: Systemic fungal infection, acute infections, active or resting

tuberculosis, vaccinia, varicella, administration of live virus vaccines (to patient, family
members), latent or active amebiasis.

SIDE EFFECTS/ADVERSE REACTIONS:

  CNS: Depression, flushing, sweating, headache, mood changes, euphoria,
psychosis, seizures, insomnia, pseudotumor cerebri
 CV: Hypertension, circulatory collapse, tachycardia, edema, cardiomyopathy,
thromboembolism, heart failure, dysrhythmias
 EENT: Fungal infections, increased intraocular pressure, blurred vision,
cataracts, glaucoma
 ENDO: HPA suppression, hyperglycemia, sodium, fluid retention
 GI: Diarrhea, nausea, abdominal distention, GI hemorrhage, increased appetite,
pancreatitis
 HEMA: Thrombocytopenia, transient leukocytosis, thromboembolism
 INTEG: Acne, poor wound healing, ecchymosis, petechiae, hirsutism,
angioedema
 META: Hypokalemia
 MS: Fractures, osteoporosis, weakness, arthralgia, myopathy

NURSING INTERVENTIONS:

 Monitor signs of allergic reactions including pulmonary symptoms or skin

reactions. Notify health care providers immediately.
 Monitor vital signs, I&O, daily weight and serum glucose.
 Be alert for signs of low potassium levels like fatigue, polyuria, dysrhythmias, and
weakness.
 Taper dose gradually to prevent adrenal insufficiency.
 For pregnancy, assess the gestational age of pregnant woman experiencing true
preterm labor pain.

DRUG # 7

GENERIC NAME: Magnesium Sulfate

BRAND NAME: Epsom salt

DRUG CLASSIFICATION: Gastrointestinal agent, saline cathartic, replacement agent,
anticonvulsant

MECHANISM OF ACTION: Acts as a CNS depressant and also as a depressant of

smooth, skeletal, and cardiac muscle function. Anticonvulsant properties thought to be
produced by CNS depression, principally by decreasing the amount of acetylcholine
liberated from motor nerve terminals, thus producing peripheral neuromuscular
blockade.

STOCK DOSAGE:

 10 mg/mL, 20 mg/mL, 40 mg/mL, 80 mg/mL infusion solution

 125 mg/mL, 500 mg/mL injection solution

INDICATION: Parenterally to control seizures in toxemia of pregnancy, epilepsy, and

acute nephritis and for prophylaxis and treatment of hypomagnesemia. Topically to
reduce edema, inflammation, and itching. To inhibit premature labor (tocolytic action)
and as adjunct in hyperalimentation.

CONTRAINDICATIONS: Myocardial damage; heart block; cardiac arrest except for

certain arrhythmias; IV administration during the 2 h preceding delivery

SIDE EFFECTS/ADVERSE REACTIONS:

 Body as a Whole: Flushing, sweating, extreme thirst, sedation, confusion,

depressed reflexes or no reflexes, muscle weakness, flaccid paralysis,
hypothermia. 
 CV: Hypotension, depressed cardiac function, complete heart block, circulatory
collapse. 
 Respiratory: Respiratory paralysis. 
 Metabolic: Hypermagnesemia, hypocalcemia, dehydration, electrolyte
imbalance including hypocalcemia with repeated laxative use.

NURSING INTERVENTIONS:
  Observe constantly when given IV. Check BP and pulse q10–15 min or more
often if indicated.
 Lab tests: Monitor plasma magnesium levels in patients receiving drug
parenterally (normal: 1.8–3.0 mEq/L). Plasma levels in excess of 4 mEq/L are
reflected in depressed deep tendon reflexes and other symptoms of magnesium
intoxication (see ADVERSE EFFECTS). Cardiac arrest occurs at levels in excess
of 25 mEq/L. Monitor calcium and phosphorus levels also.
 Monitor respiratory rate, urinary output and presence of deep tendon reflexes.
 Have calcium gluconate readily available in case of magnesium sulfate toxicity.
 Observe newborns of mothers who received parenteral magnesium sulfate within
a few hours of delivery for signs of toxicity, including respiratory and
neuromuscular depression.
 Do not breast feed while taking this drug without consulting physician.

DRUG # 8

GENERIC NAME: Azithromycin

BRAND NAME: Zithromax, Zmax

DRUG CLASSIFICATION: Anti-infective, Macrolide antibiotic

MECHANISM OF ACTION: Binds to ribosomal receptor sites of susceptible organisms,

inhibiting RNA-dependent protein synthesis

STOCK DOSAGE:

 250 mg, 500 mg, 600 mg tablets

 100 mg/5 mL, 200 mg/5 mL, 1 g/packet oral suspension
 500 mg injection
 Zmax extended release: 176 mg/5 mL oral suspension

INDICATION: Pneumonia, lower respiratory tract infections, pharyngitis/tonsillitis,

gonorrhea, nongonococcal urethritis, skin and skin structure infections due to
susceptible organisms, otitis media, Mycobacterium avium–intracellulare complex
infections, acute bacterial sinusitis.

CONTRAINDICATIONS: Hypersensitivity to azithromycin, erythromycin, or any of the

macrolide antibiotics.

SIDE EFFECTS/ADVERSE REACTIONS:

 CNS: Headache, dizziness. 
 GI: Nausea, vomiting, diarrhea, abdominal pain; hepatotoxicity, mild elevations in
liver function tests.

NURSING INTERVENTIONS:

 Check for GI discomfort, nausea, vomiting.

 Monitor daily pattern of bowel activity and stool consistency.
 Assess for signs of hepatotoxicity like malaise, fever, abdominal pain and GI
disturbances.
 Be alert for signs of superinfection including fever, vomiting, diarrhea,
anal/genital pruritus, oral mucosal changes (ulceration, pain, erythema).
 Educate patient to continue therapy for full length of treatment.
 Educate patient to use protective clothing or stay out of the sun since
photosensitivity may occur.

DRUG # 9

GENERIC NAME: Ritodrine

BRAND NAME: Yutopar

DRUG CLASSIFICATION: Beta-2 Adrenergic Agonist

MECHANISM OF ACTION: It stimulates beta-2 adrenergic receptor, increases cAMP

level and decreases intracellular calcium concentration leading to relaxation of uterine
smooth muscle and, therefore, a decrease in premature uterine contractions.
STOCK DOSAGE: 10 mg/mL, 15 mg/mL, 0.3 mg/mL injection

INDICATION: To manage premature labor in selected patients.

CONTRAINDICATIONS: Antepartum hemorrhage, eclampsia and severe

preeclampsia, intrauterine fetal death, cardiac disease. Threatened miscarriage,
placenta previa and cord compression.

SIDE EFFECTS/ADVERSE REACTIONS:

 Body as a Whole: erythema, nervousness, restlessness, anxiety,

malaise, anaphylactic shock, sweating, chills, drowsiness, weakness, myotonic
and muscular dystrophies. 
 CNS: Tremor, headache. 
 CV: Altered maternal and fetal heart rates and maternal BP (dose
related), palpitations, arrhythmias, chest pain, pulmonary edema. 
 Endocrine: Temporary hyperglycemia. 
 GI: Nausea, vomiting, epigastric distress, ileus, bloating, constipation, diarrhea. 
 Urogenital: Glycosuria. 
 Respiratory: Dyspnea, hyperventilation. 
 Skin: Rash.

NURSING INTERVENTIONS:

 Monitor continuously for pronounced dose-related adverse effects to maternal

and fetal heart rates and maternal BP while infusion is running.
 Be alert to S&S of pulmonary edema
 Report immediately any of the following: palpitations, chest pain, dizziness,
respiratory distress, weakness, tremors, sweating or chills.
 Do not breast feed while taking this drug.

DRUG # 10

GENERIC NAME: Terbutaline

BRAND NAME: Bricanyl

DRUG CLASSIFICATION: Beta-adrenergic agonist, bronchodilator

MECHANISM OF ACTION: Inhibits uterine contractions. Relieves bronchospasm,

reduces airway resistance.

STOCK DOSAGE:

 1 mg/mL injection solution

 2.5 mg, 5 mg tablets

INDICATION: Symptomatic relief of reversible bronchospasm due to bronchial asthma,

bronchitis, emphysema. Delays premature labor in pregnancies between 20 and 34
wks.

CONTRAINDICATIONS: Hypersensitivity to terbutaline. Cardiac arrhythmias

associated with tachycardia caused by digoxin toxicity.

SIDE EFFECTS/ADVERSE REACTIONS:

 CNS: Nervousness, tremor, headache, light-headedness, drowsiness, fatigue,

seizures. 
 CV: Tachycardia, hypotension or hypertension, palpitation, maternal and fetal
tachycardia. 
 GI: Nausea, vomiting. 
 Body as a Whole: Sweating, muscle cramps.

NURSING INTERVENTIONS:

 Assess vital signs: Baseline pulse and BP and before each dose. If significantly
altered from baseline level, consult physician.
 Monitor frequency, duration and strength of contractions.
 Diligently monitor fetal heart rate.
 Monitor for symptoms of hypoglycemia in neonates born of a mother who used
terbutaline during pregnancy.
  Monitor patient being treated for premature labor for CV S&S for 12 h after drug
is discontinued. Report tachycardia promptly.
 Monitor I&O ratio. Fluid restriction may be necessary. Consult physician.

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