Drug Study

Narcotan® - Concise Prescribing Information

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Manufacturer Troikaa Pharma

Distributor Pharmasan

Contents Naloxone HCl

Indications Used to reverse opioid central depression, including

resp depression, induced by natural or synthetic

opioids in the following situations: Treatment of

known or suspected opioid overdose. Post-op

following the use of opioids during surgery. In

neonates following the administration of opioid

analgesics to the mother during labor.

Dosage Opioid overdose Initially, 0.4-2 mg IV repeated at

intervals of 2-3 min if necessary. Childn 10 mcg/kg

body wt IV then up to 100 mcg/kg if necessary.

Doses may be administered via IM or SC. Post-op

100-200 mcg (1.5-3 mcg/kg) IV at 2-min intervals.

Opioid-induced depression Neonates 10 mcg/kg

IV, IM or SC inj then repeat at intervals of 2-3 min or

a single IM dose of 60 mcg/kg.

Special

Precautions

Physically-dependent or recipient of large doses of

opioids. Cardiac problems or patients receiving

cardiotoxic drugs.

Adverse

Drug

Reactions

Nausea, vomiting, hypotension, HTN, cardiac

arrhythmias, pulmonary edema, seizures.

View ADR Monitoring Form

Pregnancy

Category

(US FDA)Category B: Either animal-reproduction studies

have not demonstrated a foetal risk but there are no

OxyContin® - Concise Prescribing Information

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See related OxyContin PR tab informationAbbreviation Index

Manufacturer Mundipharma

Distributor Zuellig

Contents Oxycodone HCl

Indications Moderate to severe pain.

Click to view OxyContin detailed prescribing

infomation

Dosage Individualize treatment using a progressive plan

of pain management eg outlined by WHO. To

be swallowed whole & not to be broken,

chewed or crushed. Opioid-naive adult

Starting dose: 10 mg 12 hrly.

Click to view OxyContin detailed prescribing

infomation

Overdosage View OxyContin overdosage for action to be

taken in the event of an overdose.

Administration May be taken with or without food (Swallow

whole, do not break/chew/crush. Taking broken,

chewed or crushed tab leads to rapid release &

absorption of a potentially fatal dose of

oxycodone.).

Contraindications Significant resp depression, acute or severe

bronchial asthma or hypercarbia. Patient w/ or

suspected of having paralytic ileus. Lactation.

Click to view OxyContin detailed prescribing

infomation

Warnings For additional cautionary notes to warn of the

potential risk of using the medicine... click to

view OxyContin detailed prescribing infomation

Special

Precautions

The 80-mg tab is for opioid-tolerant patients

only. Acute alcoholism, adrenocortical

insufficiency, CNS depression or coma, delirium

tremens, debilitated patients, kyphoscoliosis

associated w/ resp depression, myxedema or

hypothyroidism, prostatic hypertrophy or

urethral stricture, severe hepatic, pulmonary or

renal impairment, toxic psychosis & patients

taking MAOIs. May obscure the diagnosis or

clinical course in patients w/ acute abdominal

conditions. May aggravate convulsions in

patients w/ convulsive disorders or seizures in

some clinical settings. Pregnancy & childn.

Click to view OxyContin detailed prescribing

infomation

Adverse Drug Resp depression & arrest, apnea, circulatory

Reactions depression, hypotension or shock. Constipation,

nausea, somnolence, dizziness, vomiting,

pruritus, headache, dry mouth, sweating,

asthenia.

View ADR Monitoring Website

Drug Interactions Additive effects w/ sedatives or hypnotics,

general anesth, phenothiazines, tranquilizers,

neuroleptics, antidepressants & alcohol.

Agonist/antagonist analgesics ie pentazocine,

nalbuphine, butorphanol, buprenorphine.

Silgram® - Concise Prescribing Information

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Manufacturer YSS

Distributor Cathay Drug

Contents Per 375 mg vial Ampicillin 250 mg, sulbactam

125 mg. Per 750 mg vial Ampicillin 500 mg,

sulbactam 250 mg. Per 1.5 g vial Ampicillin 1 g,

sulbactam 500 mg

Indications Treatment of upper & lower resp tract

infections, gynecological infections & as a

prophylaxis to reduce the risk of infections

following surgery caesarian & birth.

Dosage Adult 1.5-3 g 6 hrly. Acute pelvic

inflammatory disease 3 g 6 hrly in conjunction

w/ doxycycline (100 mg 12 hrly by oral or IV).

Parenteral regimen may be discontinued 24 hrs

after clinical improvement; oral doxycycline

should be continued to complete the 14 days of

therapy. Childn ≥1 yr 300 mg/kg daily by IV

infusion in equally divided doses 6 hrly; ≥1 mth

Mild to moderate infection 100-150 mg/kg

daily in 4 divided doses.

Contraindications Hypersensitivity.

Special

Precautions

Patients w/ mononucleosis. Superinfections

involving pseudomonas & candida (discontinue

the drug).

Adverse Drug Serious anaphylactoid reactions.

Reactions View ADR Monitoring Form

Drug Interactions Probenecid, allopurinol, aminoglycosides.

View more drug interactions with Silgram

Pregnancy

Category (US

FDA)Category B: Either animal-reproduction studies

have not demonstrated a foetal risk but there

are no controlled studies in pregnant women or

animal-reproduction studies have shown an

adverse effect (other than a decrease in fertility)

that was not confirmed in controlled studies in

women in the 1st trimester (and there is no

evidence of a risk in later trimesters).

MIMS Class Penicillins

ATC

Classification

J01CR04 - Sultamicillin ; Belongs to the class of

penicillin combinations, including beta-

lactamase inhibitors. Used in the

Delivery room

Comxytocin® - Concise Prescribing Information

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See related Comxytocin infusion informationAbbreviation Index

Manufacturer Rotexmedica

Distributor Commerz

Contents Oxytocin

Indications Induction or stimulation of labor in hypotonic

uterine inertia. Prevention & treatment of

postpartum uterine atony & hemorrhage. Early

stages of pregnancy as an adjunctive therapy

for the management of incomplete, inevitable or

missed abortion.

Dosage Induction or enhancement of labor IV drip

infusion 10 iu added to 1 L physiologic saline

electrolyte soln. For patients whom infusion of

NaCl must be avoided use 5% dextrose soln as

diluent. Initial infusion rate 1-4 mU/min (2-8

drops/min). Gradually increase at intervals not

<20 min, until a contraction pattern similar to

that of normal labor is established. Max rate: 20

mU/min (40 drops/min). Caesarean section 5

iu by slow IV inj immediately after delivery.

Prevention of post-partum uterine

hemorrhage 5 iu slow IV after delivery of the

placenta. Treatment of post-partum uterine

hemorrhage 5-10 iu IM or 5 iu slow IV followed

in severe cases by IV infusion of 5-20 iu of

oxytocin in 500 mL of non-hydrating diluent.

Missed abortion 5 iu IM or slowly IV. If

necessary, follow by IV infusion 20-40 mU/min.

Contraindications Hypertonic uterine contraction, mechanical

obstruction to delivery, fetal distress. Significant

cephalopelvic disproportion, fetal

malpresentation, placenta previa, placental

abruption, cord presentation or prolapse,

overdistension or impaired resistance of the

uterus to rupture as in multiple pregnancy,

polyhydramnios, grand multiparity & in uterine

scar. Do not use for prolonged period in

patients w/ oxytocin-resistant uterine inertia,

severe pre-eclamptic toxemia or severe CV

disorder.

Special

Precautions

Administration should only be under hospital

condition & qualified medical supervision. For

induction & enhancement of labor administer

only as an IV infusion. Carefully monitor fetal

heart rate & uterine motility. Caution use in

borderline cephalopelvic disproportion,

secondary uterine inertia, mild to moderate

degrees of pregnancy-induced HTN or cardiac

disease & patients >35 yr or w/ history of lower-

uterine-segment Caesarean section. Avoid

tumultous labor in fetal death in utero &/or

meconium-stained amniotic fluid. For the

prevention & treatment of uterine hemorrhage,

avoid rapid IV inj.

Adverse Drug

Reactions

Uterine spasm in low doses. High doses may

result in uterine overstimulation that may cause

fetal distress, asphyxia & death, or may lead to

hypertonicity, tetanic contractions, soft tissue

damage or rupture of the uterus. Rapid IV bolus

inj may cause short-lasting hypotension

accompanied w/ flushing & reflex tachycardia.

View ADR Monitoring Form

Drug Interactions prostaglandin, inhalation anesthetics eg

cyclopropane or halothane, sympathomimetic

vasoconstrictor agent.

View more drug interactions with Comxytocin

Medisyl® - Concise Prescribing Information

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Manufacturer Korea United Pharma

Distributor Scheeling Pharma Care Link

Contents Methylergometrine maleate

Click to view methylergometrine information

Indication &

Dosage

For details on therapeutic uses and relevant dosage

relating to the methylergometrine ... Click to view

methylergometrine

Pregnancy

Category

(US FDA)Category C: Either studies in animals have

revealed adverse effects on the foetus (teratogenic

or embryocidal or other) and there are no controlled

studies in women or studies in women and animals

are not available. Drugs should be given only if the

potential benefit justifies the potential risk to the

foetus.

MIMS Class Drugs Acting on the Uterus

ATC

Classification

G02AB01 - Methylergometrine ; Belongs to the

class of ergot alkaloids. Used to induce abortion or

augment labour and to minimize blood loss from the

placental site.

Poison

Schedule [?]Rx

Presentation/PackingForm Packing/Price Photo

Medisyl injection Medisyl 200 mcg/1 mL x 10's (P916.5)

Manufacturer: Korea United Pharma

Distributor: Scheeling Pharma Care Link

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Oxitone® - Concise Prescribing Information

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See related Oxitone infusion informationAbbreviation Index

Manufacturer Harson

Distributor Phil Pharmawealth

Contents Oxytocin

Indications Induction of labor, stimulation of labor in

hypotonic uterine inertia; management of

missed & incomplete abortion; postpartum

hemorrhage in patients who do not respond to

ergometrine.

Dosage IV drip infusion 1 u of oxytocin in 1 L 5%

dextrose soln delivers approx 1 milliunit/min

when infused at a rate of 1.5 drops/min.

Induction or stimulation of labor

Physiological oxytocin infusion: 2-5

milliunits/min. Pharmacological oxytocin

infusion: Initially 1.53 milliunits/min adjusted

gradually until contractions occur every 2-5 min;

infusion rate: Max 12 milliunits/min. Oxytocin

titration: Initially 1 milliunit/min, then double the

rate of flow every 20 min, until contractions last

40-50 sec occurring at intervals of 2-3 min.

Doses of oxytocin up to 128 milliunits/min have

been used. Missed abortion 10-20 u/500 mL of

5% dextrose soln increasing by 10-20 u/500 mL

every hr to a max of 100 u/500 mL if necessary.

Infusion rate: 10-30 drops/min.

Contraindications Hypertonic uterine inertia, mechanical

obstruction to delivery, failed trial labor, severe

toxemia, predisposition to amniotic fluid

embolism, fetal distress & placenta previa.

Special

Precautions

Caution should be exercised in patients with

parity & previous caesarian section. CV

disorders.

Adverse Drug

Reactions

Uterine spasm, very high dose may cause

violent uterine contractions leading to uterine

rupture, tissue damage & asphyxia of the fetus.

View ADR Monitoring Form

Drug Interactions Prostaglandins may potentiate the effects of

oxytocin.

View more drug interactions with Oxitone

Pregnancy

Category (US

FDA)Category X: Studies in animals or human

beings have demonstrated foetal abnormalities

or there is evidence of foetal risk based on

human experience or both, and the risk of the

use of the drug in pregnant women clearly

outweighs any possible benefit. The drug is

contraindicated in women who are or may

become pregnant.

MIMS Class Drugs Acting on the Uterus

ATC

Classification

H01BB02 - Oxytocin ; Belongs to the class of

oxytocin and analogues. Used in posterior

pituitary lobe hormone preparations.

Poison Schedule [?]

Rx

Presentation/Packing

Roxipan® - Concise Prescribing Information

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Manufacturer Panpharma-Meinz

Distributor Panpharma-Meinz

Contents Oxytocin

Indications Induction & augmentation of labor, to control

postpartum bleeding & uterine hypotonicity in

the 3rd stage of labor & to promote lactation in

cases of faulty milk ejection.

Click to view Roxipan detailed prescribing

infomation

Dosage Induction or enhancement of labor Drip

infusion Initially, 1-4 milliunits/min (2-8

drops/min). May be gradually increased at

intervals not <20 min, until a contraction pattern

similar to normal labor is established.

Caesarean section 5 iu by slow IV inj

immediately after delivery. Prevention of

postpartum uterine hemorrhage 5 iu by slow

IV after delivery of the placenta. Treatment of

postpartum uterine hemorrhage 5-10 iu IM or

5 iu slow IV, followed in severe cases by IV

infusion of 5-20 iu in 500 mL of non-hydrating

diluent at the rate necessary to control uterine

atony. Incomplete, inevitable or missed

abortion 5 iu IM or slow IV if necessary

followed by IV infusion at the rate of ≥20-40

milliunits/min.

Click to view Roxipan detailed prescribing

infomation

Overdosage View Roxipan overdosage for action to be taken

in the event of an overdose.

Contraindications Do not administer by IV bolus. Prolonged use in

patients w/ oxytocin-resistant uterine inertia,

severe preeclamptic toxemia or severe CV

disorders. Hypertonic uterine contractions,

mechanical obstruction to delivery, fetal

distress. Significant cephalopelvic disproportion,

fetal malpresentation, placenta praevia & vasa

praevia, placental abruption cord presentation

or prolapse, overdistention or impaired

resistance of the uterus to rupture as in multiple

pregnancy, polyhydramnios, grand multiparity &

presence of a uterine scar. Infusion via the

same apparatus as blood or plasma.

Click to view Roxipan detailed prescribing

infomation

Warnings For additional cautionary notes to warn of the

potential risk of using the medicine... click to

view Roxipan detailed prescribing infomation

Special

Precautions

Careful monitoring of fetal heart rate & uterine

motility. Caution in the presence of borderline

cephalopelvic disproportion, secondary uterine

inertia, mild to moderate degrees of pregnancy-

induced HTN or cardiac diseases, ≥35 yr or w/

a history of lower-uterine-segment cesarean

section. Water intoxication w/ prolonged

administration of high doses. Avoid rapid IV inj.

Careful monitoring in the concomitant

administration w/ prostaglandins.

Click to view Roxipan detailed prescribing

infomation

Adverse Drug

Reactions

Uterine spasm at low doses. Fetal distress,

asphyxia & death, hypertonicity, tetanic

contractions, soft tissue damage or rupture of

the uterus at high doses. Water intoxication

(headache, anorexia, nausea, vomiting &

abdominal pain), lethargy, drowsiness,

unconsciousness & grand mal type seizure, low

blood electrolyte conc. Acute short-lasting

hypotension w/ flushing & reflex tachycardia w/

rapid IV bolus inj.

View ADR Monitoring Website

Drug Interactions Prostaglandins. Inhalation anesth eg

cyclopropane or halothane. Sympathomimetic

vasoconstrictor agents. Soln containing Na

metabisulfite.

View more drug interactions with Roxipan

DRUG STUDY 1. Generic Name:Methylergonovine maleate Brand Name: Methergine Classification: Oxytocic

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:

CNS: Dizziness, headache, tinnitus, diaphoresisCV: Transient hypertension, palpitations, chest pains, dyspneaGI: Nausea and vomiting

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.

Generic Name:Dinoprostone (prostaglandin E2)Brand Name: Cervidil 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 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

Classification:Benzodiazepine (short-acting); CNS depressantTherapeutic actions:

- 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

adjunctive therapy- Avoid driving & operating machinery after parenteral administration.- Avoid strict heat