Narcotan® - Concise Prescribing Information > Manufactur er > Distributo r > Contents > Indication s > Dosage > Special Precaution s > Adverse Drug Reactions > Pregnancy Category (US FDA) > MIMS Class > ATC Classification > Poison Schedule > Presentation/Pac king Related Information See related Narcotan inj informationAbbreviation Index Manufactu rer Troikaa Pharma Distribut or Pharmasan Contents Naloxone HCl Indicatio ns Used to reverse opioid central depression, including resp depression, induced by natural or synthetic
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Therapeutic Actions: • A partial agonist or antagonist at alpha receptors; as a result, it increases the strength, duration, and frequency of uterine contractions. Indications: • Routine management after delivery of the placenta. • Treatment of postpartum atony and hemorrhage; subinvolution of the uterus. • Uterine stimulation during the second stage of labor following the delivery of the anterior shoulder, under strict medical supervision. Contraindications • Contraindicated with allergy to methylergonovine, hypertension, toxemia, lactation, pregnancy. Adverse Effects:
Nursing Considerations: • Assess history of allergy to the drug. • Administer by IM injection or orally unless emergency requires IV use. Complications are more frequent with IV use. • Monitor postpartum women for BP changes and amount and character of vaginal bleeding. • Avoid prolonged use of the drug. • Teach client to report difficulty breathing, headache, numb or cold extremities, severe abdominal cramping.
Stimulates the myometrium of the pregnant uterus to contract; similar to thecontractions of the uterus during labor, thus evacuating the contents of theuterus.Indications: • Termination of pregnancy 12-20 wks from the first day of the LMP. • Evacuation of the uterus in the management of missed abortion or intrauterine fetal death up to 28 wk gestational stage • Initiation of cervical ripening before induction of labor Contraindications: • Contraindicated with allergy to prostaglandins; acute PID; active cardiachepatic; pulmonary, renal disease; women in whom prolonged uterinecontractions are inappropriate.Adverse Effects: CNS: Headache, paresthesias, anxiety, weakness, syncope, dizzinessCV: Hypotension, arrthymias, chest painFetal: Abnormal heart ratesGI: vomiting, diarrhea, nauseaRespiratory: Coughing, dyspneaNursing Considerations: • Monitor uterine tone and vaginal discharge throughout the procedure and several days after the procedure. • Ensure adequate hydration throughout the procedure. Be prepared to support patient through labor. Give oxytocin infusion 6- 12 hr after dinoprostone. • Teach client to report severe pain, difficulty breathing, palpitations, eye pain, rash.
3. Generic Name:OxytocinBrand Name: Pitocin Classification: Oxytocic; hormone Therapeutic Actions: • Synthetic form of an endogenous hormone produced in the hypothalamusand stored in the posterior pituitary; stimulates the uterus, especially thegravid uterus just before parturition, and causes myoepithelium of the lactealglands to contract, which results in milk ejection in lactating women.Indications: • Antepartum: to initiate or improve uterine contractions to achieve earlyvaginal delivery; stimulation or reinforcement of labor in selected cases ofuterine inertia; management of inevitable or incomplete abortion; 2nd
trimester abortion• Postpartum: to produce uterine contractions during the third stage of labor to control postpartum bleeding or hemorrhage • Lactation defieciency Contraindications: • Significant cephalopelvic disproportion, unfavorable fetal positions orpresentations, 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 cesarian section.Adverse Effects: CV: cardiac arrhythmias, PVCs, hypertension, subarachnoid hemorrhageFetal effects: fetal bradycardia, neonatal jaundice, low Apgar scoresGI: nauseas, vomiting
GU: postpartum hemorrhage, uterine rupture, pelvic hematoma, uterinehypertonicity, spasmNursing Considerations: • Ensure fetal position and size and absence of complications that are contraindicated with oxytocin therapy • Ensure continuous observation for induction of labor; fetal monitoring is preferred. • Regulate rate of oxytocin delivery; monitor rate and strength of contractions • Monitor BP during administration 4. Generic Name:Lidocaine hydrochlorideBrand Name: Dilocaine Classification: Local anesthetic Therapeutic Actions: • Blocks the generation and conduction of action potentials in sensory nervesby reducing sodium permeability, reducing height and rate of rise of theaction potential, increasing excitation threshold, and slowing conductionvelocityIndications: • Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia Contraindications: • Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF cardiogenic shock, 2nd or 3rd degree AV blocks Adverse Effects:
CNS: headache, backache, septic meningitis, persistent sensoryCV: hypotensionDermatologic: urticaria, pruritus, erythema, edemaGU: urinary retention, urinary or fecal incontinenceNursing Considerations: • Check drug concentrations carefully • Establish safety precautions if CNS changes occur • Teach client to report difficulty speaking, thick tongue, numbness, tingling, difficulty breathing, pain or numbness at site, swelling or pain at site 5. Generic Name:Terbutaline SulfateBrand Name:Brethine Classification: Tocolytic Therapeutic Actions:
- In low doses, acts relatively selectively at beta 2-adrenergic receptors tocause bronchodilation and relax the pregnant uterus; at higher doses, beta 1selectivity is lost and the drug acts at beta 2 receptors to cause typicalsympathomimetic cardiac effectsIndications: - Tocolytic to prevent preterm labor Contraindications: - Contraindicated with hypersensitivity to terbutaline, tachyarrythmias, tachycardia, hypertension, lactation. Adverse Effects: CNS: restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesias,insomnia, tremorsCV: cardiac arrhythmias, palpitations, angina pain, changes in BP and ECGGI: Nausea, vomiting, heartburn, unusual or bad tasteRespiratory: Respiratory difficulties, pulmonary edema, coughing,
bronchospasmNursing Considerations:- Use minimal doses for minimal periods of time; drug tolerance can occur - Maintain a beta-adrenergic blocker on standby in case cardiac arrhythmias occur - Teach client to report chest pain, dizziness, insomnia, weakness, tremor 6. Generic Name:Carboprost tromethamineBrand Name:Hemabate Classification: Prostaglandin; Abortifacient Therapeutic Actions: Stimulates the myometrium of the pregnant uterus to contract; similar to thecontractions of the uterus during labor, thus evacuating the contents of theuterus.Indications: - Termination of pregnancy 13-20 wk from the first day of the LMP - Evacuation of the uterus in instance of missed abortion or intrauterine fetal death in the 2nd trimester - Postpartum hemorrhage due to uterine atony unresponsive to conventional methods Contraindications: - Contraindicated with allergy to prostaglandin preparations, acute PID; active cardiac,hepatic, pulmonary, renal disease Adverse Effects: CNS: headache, paersthesias, flushing, anxiety, weakness, syncope, dizziness
CV: hypotension, arrhythmias, chest painGI: vomiting, diarrhes, nauseaNursing Considerations: - Assess allergy to the drug - Monitor uterine tone and vaginal discharge during procedure and several days after to assess drug effects and recovery - Ensure adequate hydration Generic Name:Nalbuphine hydrochlorideBrand Name: Nubain Classification: Narcotic agonisy-antagonist analgesic Therapeutic Actions:
- Nalbuphine acts as an agonist at specific opioid receptors in the Cns toproduce analgesia, sedation but also acts to cause hallucinations and is anantagonist at mu receptorsIndications: - Relief of moderate to severe pain - For obstetric analgesia during labor and delivery Contraindications: - Contraindicated with hypersensitivity to nalbuphine, sulfites; lactation Adverse Effects: CNS: sedation, clamminess, sweating, headache, nervousness, restlessness,depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations,euphoria, blurred visionCV: hypotension, hypertension, bradycardia, tachycardiaDermatologic: itching, burning, urticariaGI: N/V, cramps, dyspepsia, bitter taste, dry mouthGU: Urinary urgencyRespiratory: Respiratory depression, dyspnea, asthmaNursing Considerations: - Assess hypersensitivity to the drug
- Provide narcotic antagonist, facilitates for assisted or controlled respiration on standby in case of respiratory depression - Reassure patient about addiction liability; most patients who receive opiates for medical reasons do not develop dependence syndrome - Inform clients about these side effects: dizziness, sedation, drowsiness, impaired visual acuity, nausea, loss of appetite 8. Generic Name:Magnesium sulfateBrand Name: Epsom salt Classification: electrolyte; anticonvulsant; laxarive Therapeutic Actions: - Cofactor of many enzyme systems involved in neuromuscular transmission and muscular excitability Indications: - Preeclampsia/eclampsia - Inhibition of premature labor Contraindications:
- Contraindicated with allergy to magnesium product; heart block, myocardialdamage, abdominal pain, N/V, acute surgical abdomen, fecal impaction,hepatitis. DO NOT GIVE 2 HR PRECEEDING DELIVERY BECAUSE OF RISK OFMAGNESIUM TOXICITY IN THE NEONATE.Adverse Effects: CNS: weakness, dizziness, fainting, sweatingCV: palpitationsGI: excessive bowel activity, perianal irritationMetabolic: Magnesium intoxication, hypocalcemia with tetanyNursing Considerations: - Assess history of allergy to the drug and other contraindications- Reserve IV use in eclampsia for immediate life- threatening situations
- Monitor magnesium levels during parenteral therapy- Monitor knee-jerk reflex before repeated parenteral administration, ifhappens, do not administer because respiratory failure may occur
- Do not give orally with abdominal pain, N/V Generic Name:Butorphanol tartrate Brand Name: stadol Classification: Narcotic agonist- antagonist analgesic Therapeutic Actions: - Acts as an agonist at opioid receptors in the CNS to produce analgesia, sedation, but also acts to produce hallucinations; has low abuse potential Indications: - Relief of moderate to severe pain - To supplement balances anesthesia and to relieve prepartum pain Contraindications: - Contraindicated with hypersensitivity to butorphanol, physical dependence on a narcotic analgesic, pregnancy lactation Adverse Effects: CNS: sedation, clamminess, sweating, headache, vertigo, dizziness, lethargy,confusion, unusual dreams, agitation, euphoria, hallucinationsCV: Palpitations, increase or decrease in blood pressureDermatologic: Ras, hives, pruritus, flushing, warmth, sensitivity to coldEENT: diplopia, blurred visionGI: N/VRespiratory: slow, shallow respirationNursing Considerations: - Assess history of allergy to butorphanol , depression DM, lactation, and dependence
- Monitor diet for presence of caffeine- containing foods that may contribute to overdose - Inform patients that these side effects may occur: diuresis, restlessness, insomnia, muscular tremors, light- headedness, nausea, abdominal pain - Remind patient to report abnormal heart rate, dizziness, palpitations 10.Generic Name:MisoprostolBrand Name: Cytotec Classification: Prostaglandin Therapeutic Actions:
- A synthetic prostaglandin E1 analog; inhibits gastric acid secretion andincreases bicarbonate and mucus production, protecting the lining of thestomachIndications: - With mifepristone as an abortifacient - Cervical ripening and labor induction Contraindications: - History of allergy to prostaglandins; pregnancy; lactation Adverse Effects: GI: nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, constipation GU: Miscarriage, excessive bleeding, spotting, cramping, menstrual disorders Nursing Considerations: - Assess history of allergy to the drug - Report severe diarrhea, spotting, or menstrual pain, severe menstrual bleeding Generic Name: Midazolam hydrochlorideBrand Name: Versed
- Exact mechanisms of action not understood; acts mainly at the limbicsystem and reticular formation; potentiates the effects of GABA, aninhibitory neurotransmitter; anxiolytic and amnesia effects occur atdoses below those needed to cause sedation, ataxia; has little effect oncortical function.Indications - IV or IM: Sedation, anxiolysis, and amnesia prior to diagnostic,therapeutic, or endoscopic procedures or surgery - Induction of general anesthesia - Continuous sedation of intubated and mechanically ventilated patientsas a component of anesthesia or during treatment in the critical care setting - Unlabeled uses: Treatment of epileptic seizure or refractory status epilepticus Contraindications and cautions - Contraindicated with hypersensitivity to benzodiazepines; psychoses,acute narrow-angle glaucoma, shock, coma, acute alcoholicintoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiacdefects, microcephaly, pyloric stenosis have been reported when usedin first trimester; neonatal withdrawal syndrome reported in
infants);neonates.- Use cautiously in elderly or debilitated patients; with impaired liver or kidney function, lactation. Adverse effects CNS: Transient, mild drowsiness (initially); sedation, depression, lethargy,apathy, fatigue, light-headedness, disorientation, restlessness, confusion,crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity,tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration,vivid dreams, psychomotor retardation, extrapyramidal symptoms; mildparadoxical excitatory reactions (during first 2 wk of treatment), visual andauditory disturbances, diplopia, nystagmus, depressed hearing, nasalcongestionCV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension,palpitations, edemaDermatologic: Urticaria, pruritus, skin rash, dermatitisGI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting,difficulty in swallowing, gastric disorders, elevations of blood enzymes: LDH,alkaline phosphatase, AST, ALT, hepatic dysfunction, jaundiceGU: Incontinence, urinary retention, changes in libido, menstrualirregularitiesHematologic: Decreased Hct, blood dyscrasiasOther: Phlebitis and thrombosis at IV injection sites, hiccups, fever,
diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain,burning, and redness after IM injectionDependence: Drug dependence with withdrawal syndrome when drug isdiscontinued (more common with abrupt discontinuation of higher dosageused for longer than 4 mo)Nursing considerations - History: Hypersensitivity to benzodiazepines; psychoses, acutenarrow-angle glaucoma, shock, coma, acute alcoholic intoxication withdepression of vital signs; elderly or debilitated patients; impaired liveror kidney function; pregnancy, lactation
Generic Name:FresofolBrand Name: Propofol Classification:sedative hypnotic; anesthetic agentTherapeutic Actions: - Propofol is a short-acting hypnotic. Its mechanism of action has not been well-defined. Indications: - induction of general anesthesia in adults and in pediatric patients greater than 3 years of age
- maintenance of anesthesia utilizing balanced techniques with otherappropriate agents such as opioids and inhalation anesthetics in adultsand pediatric patients greater than 2 months of age- produce sedation or amnesia as a supplement to local or regional anesthetics Contraindications:
- Contraindicated in pediatric patients for monitored anesthesia care(MAC) sedation or for sedation in intensive care; epileptics; usecautiously in lactationAdverse Effects: CV: Arterial hypotension; decreased systemic vascular resistance,myocardial blood flow, and oxygen consumption, palpitations, tachycardiaRespiratory: apnea, hyperventilation, bradypnea, dyspnea, wheezing,swelling of throat
CNS: increased ICP, lethargy, drowsiness, euphoria, hallucinations, blurredvision, anxiety, tension, seizure, lightheadedness, faintingDERM: skin rash, flushing, urticariaNursing Considerations: - Assess history of allergy to the components of the drug.- Use safety precautions after administration.- Advise patient that mental alertness, coordination, and physicaldexterity may be impaired for some time after administration. - For IV, do not mix with other therapeutic agents prior to administration. Avoid mixing blood or plasma in same IV catheter. - Minimize pain associated with administration by infusing into larger veins. - Should be administered only by personnel who are trained in administration of general anesthesia and familiar with drug. - Shake well before use. Do not use if there is evidence of separation of phases of emulsion.
Generic Name:Hyoscine-N-butylbromideBrand Name: Buscopan Classification:Antispasmodic; AnticholinergicTherapeutic Actions: - acts by interfering with the transmission of nerve impulses by acetylcholine in the parasympathetic nervous system. Indications:
- Buscopan Tablets are indicated for the relief of spasm of the genito-urinary tract or gastro- intestinal tract and for the symptomatic relief ofIrritable Bowel SyndromeContraindications:
- Buscopan Tablets should not be administered to patients withmyasthenia gravis, megacolon and narrow angle glaucoma. Inaddition, they should not be given to patients with a knownhypersensitivity to hyoscine-N-butylbromide or any other component ofthe product.Adverse Effects: CNS: dizziness, anaphylactic reactions, anaphylactic shock, increased ICP, disorientation,restlessness, irritability, dizziness, drowsiness, headache, confusion,hallucination, delirium, impairedmemoryCV: hypotension, tachycardia, palpitations, flushingGI: Dry mouth, constipation, nausea, epigastric distressDERM: flushing, dyshidrosisGU: Urinary retention, urinary hesitancyResp: dyspnea, bronchial plugging, depressed respirationEENT: mydriasis, dilated pupils, blurred vision, photopobia, increased
intraocular pressure,difficulty of swallowing.Nursing Considerations: - Drug compatibility should be monitored closely in patients requiring