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Obstetric Medication List
Labor & Delivery Medications:
Generic Name: Oxytocin
Brand Name: Pitocin
Classification: Oxytocic hormones
Oxytocin binds to receptors on uterine smooth muscle cells. This binding causes the release of calcium
Mechanism of Action: ions from the sarcoplasmic reticulum. The increase in calcium causes the muscle to contract more
forcefully and frequently. The contractions cause the pituitary gland to release more oxytocin
Used to induce labor, it increases the frequency and intensity of uterine contractions and postpartum
Indications:
hemorrhage.
Route: IV
Stimulation of Labor: 1 TO 20 MU/MIN and then titrate up
Dosage Range:
Postpartum hemorrhage: 10-40 units in 1000 mL non hydrating diluent infused at 20-40 mU/min
Possible maternal adverse effects include uterine tachysystole, placental abruption, and uterine rupture.
Side Effects: Possible fetal adverse effects include fetal compromise, a progressive decrease in fetal oxygen status,
and neonatal acidemia.
Nursing Considerations:
● Oxytocin is considered a high-alert medication because it has a heightened risk for causing significant client harm when
used in error.
● Client and partner teaching and support:
○ Reasons for use of oxytocin (e.g., start or improve labor)
○ Reactions to expect concerning the nature of contractions: intensity of the contraction increases more rapidly,
holds the peak longer, and ends more quickly; contractions come regularly and more often
○ Monitoring to anticipate
● Continue to keep the woman and her partner informed regarding progress.
● Remember that women vary greatly in their response to oxytocin; some require only very small amounts of medication to
produce adequate contractions, whereas others need larger doses.
● Uterine response typically takes only 3–5 min after IV administration of oxytocin is started.
● Assessment:
○ Record uterine activity and FHR continuously using EFM. Evaluate the tracing at least every 15 min during the
first stage of labor and during the passive fetal descent phase of the second stage of labor. Evaluate the tracing
every 5 min during the active pushing phase of the second stage of labor.
○ Contractions should not occur more frequently than every 2 min.
○ Use a standard definition for uterine tachysystole that does not include an abnormal FHR and pattern or the
woman’s perception of pain (see Emergency Treatment box: Uterine Tachysystole with Oxytocin [Pitocin]
Infusion).
○ Continually titrate the rate of oxytocin infusion to the lowest dose that achieves acceptable labor progress.
Usually the oxytocin dose can be decreased or discontinued after rupture of membranes and in the active phase
of first-stage labor.
○ Perform a vaginal examination as indicated.
○ Observe emotional responses of the woman and her partner.
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Generic Name: Methylergometrine
Brand Name: Methergine
Classification: Oxytocic
Mechanism of Action: Systemic vascular constriction
Indications: Prevention, treatment of hemorrhage postpartum, uterine contractions
Route: IM/IV
Dosage Range: 0.2 mg after delivery of shoulder, placenta, or puerperium, then q2-4hr × 1-5 doses
CNS: Headache, dizziness, seizures, hallucinations; stroke (IV)
CV: Hypotension, chest pain, palpitation, hypertension, dysrhythmias, CVA (IV)
EENT: Tinnitus
GI: Nausea, vomiting
Side Effects:
GU: Cramping
INTEG: Sweating, rash, allergic reactions
MS: Leg cramps
RESP: Dyspnea
Nursing Considerations
Assess:
● B/P, pulse, character and amount of vaginal bleeding; watch for indications of hemorrhage
● Uterine relaxation; observe for severe cramping
● Ergot toxicity: tinnitus, hypertension, palpitations, chest pain, nausea, vomiting, weakness; cold, numb extremities
● Pregnancy/breastfeeding: do not use in pregnancy except following obstetric delivery or abortion to reduce
postpartum hemorrhagic risk; may breastfeed 1 wk postpartum
● Education:
● To report increased blood loss, severe abdominal cramps, fever, or foul-smelling lochia
● 🚨DO NOT GIVE IF PATIENT IS HYPERTENSIVE
Generic Name: Butorphanol
Brand Name: Stadol
Classification: Opioid (narcotic) agonist-antagonist analgesic
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors.
μ-Opioid Receptor (MOR): Butorphanol acts as a partial agonist and antagonist at MORs. It can
activate these receptors to a lesser extent than full agonists like morphine, providing analgesic
Mechanism of Action:
effects while potentially reducing the risk of respiratory depression and euphoria.
κ-Opioid Receptor (KOR): It serves as a full agonist at KORs, contributing significantly to its
analgesic properties.
Indications: Moderate to severe labor pain and postoperative pain after cesarean birth.
Route: IV/IM/INTRANASAL
Dosage Range: Moderate to Severe Pain:
IM: 1-4 mg q3-4 hr prn
IV: 0.5-2 mg q3-4 hr prn
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INTRANASAL: 1 spray in 1 nostril, may give another dose 1-1.5 hrs later; repeat if needed 3-4 hr
s/p last dose.
CNS: Drowsiness, dizziness, confusion, headache, sedation, euphoria, weakness, hallucinations,
insomnia (nasal)
CV: Palpitations, bradycardia, hypotension
EENT: Tinnitus, blurred vision, miosis (pupil constriction), diplopia (double vision), nasal
Side Effects: congestion, unpleasant taste
GI: Nausea, vomiting, anorexia, constipation, cramps
GU: Urinary retention
INTEG: Rash, urticaria, bruising, flushing, diaphoresis, pruritus
RESP: Respiratory depression
Nursing Considerations
Assess:
● Decreasing urine output
● Maternal vital signs, degree of pain, FHR, and uterine activity before and after administration.
● CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
● Allergic reactions: rash, urticaria
● Need for pain medication, physical dependence
● Safety measures: night-light, call bell within reach
Observe for:
● Maternal respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min
● Withdrawal symptoms in opioid-dependent patients and newborns (pulmonary embolism, vascular occlusion,
abscesses, ulcerations).
Evaluate: Therapeutic response in pain
Actions:
● Implement safety measures as appropriate (raise side rails; help with walking)
● Continue use of nonpharmacologic pain relief measures
Avoid:
● Prior or present substance abuse (including alcoholism)
● Concurrent use of CNS depressants or benzodiazepines
● Pregnancy/breastfeeding: use only if benefits outweigh risks; usually compatible with breastfeeding
Contraindications: Patients with hypertension or preeclampsia because can increase blood pressure.
Patient/Family Teaching:
● Report any symptoms of CNS changes and to seek emergent medical care for stupor, slow breathing, severe
sleepiness
● Accidental exposure and overdose (intranasal): May be fatal, keep out of reach of children
● To report all products taken (OTC, Rx, herbs, supplements)
● Physical dependency over prolonged time periods
● Withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
● How to use nasal product
● To avoid hazardous activities, to have help getting out of bed or walking
Treatment of Overdose: Naloxone (Narcan) 0.2-0.8 mg IV, IM/SUBCUT/O2, IV fluids, vasopressors
Generic Name: Nalbuphine
Brand Name: Nubain
Classification: Opioid (narcotic) agonist-antagonist analgesic
Mechanism of Action: Depressed pain impulse transmission by interacting with opioid receptors.
Indications: Moderate to severe labor pain and postoperative pain after cesarean birth.
Route: SUBCUTANEOUS/IM/IV
Obstetric Medication List
Labor & Delivery Medications:
Generic Name: Oxytocin
Brand Name: Pitocin
Classification: Oxytocic hormones
Oxytocin binds to receptors on uterine smooth muscle cells. This binding causes the release of calcium
Mechanism of Action: ions from the sarcoplasmic reticulum. The increase in calcium causes the muscle to contract more
forcefully and frequently. The contractions cause the pituitary gland to release more oxytocin
Used to induce labor, it increases the frequency and intensity of uterine contractions and postpartum
Indications:
hemorrhage.
Route: IV
Stimulation of Labor: 1 TO 20 MU/MIN and then titrate up
Dosage Range:
Postpartum hemorrhage: 10-40 units in 1000 mL non hydrating diluent infused at 20-40 mU/min
Possible maternal adverse effects include uterine tachysystole, placental abruption, and uterine rupture.
Side Effects: Possible fetal adverse effects include fetal compromise, a progressive decrease in fetal oxygen status,
and neonatal acidemia.
Nursing Considerations:
● Oxytocin is considered a high-alert medication because it has a heightened risk for causing significant client harm when
used in error.
● Client and partner teaching and support:
○ Reasons for use of oxytocin (e.g., start or improve labor)
○ Reactions to expect concerning the nature of contractions: intensity of the contraction increases more rapidly,
holds the peak longer, and ends more quickly; contractions come regularly and more often
○ Monitoring to anticipate
● Continue to keep the woman and her partner informed regarding progress.
● Remember that women vary greatly in their response to oxytocin; some require only very small amounts of medication to
produce adequate contractions, whereas others need larger doses.
● Uterine response typically takes only 3–5 min after IV administration of oxytocin is started.
● Assessment:
○ Record uterine activity and FHR continuously using EFM. Evaluate the tracing at least every 15 min during the
first stage of labor and during the passive fetal descent phase of the second stage of labor. Evaluate the tracing
every 5 min during the active pushing phase of the second stage of labor.
○ Contractions should not occur more frequently than every 2 min.
○ Use a standard definition for uterine tachysystole that does not include an abnormal FHR and pattern or the
woman’s perception of pain (see Emergency Treatment box: Uterine Tachysystole with Oxytocin [Pitocin]
Infusion).
○ Continually titrate the rate of oxytocin infusion to the lowest dose that achieves acceptable labor progress.
Usually the oxytocin dose can be decreased or discontinued after rupture of membranes and in the active phase
of first-stage labor.
○ Perform a vaginal examination as indicated.
○ Observe emotional responses of the woman and her partner.
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Generic Name: Methylergometrine
Brand Name: Methergine
Classification: Oxytocic
Mechanism of Action: Systemic vascular constriction
Indications: Prevention, treatment of hemorrhage postpartum, uterine contractions
Route: IM/IV
Dosage Range: 0.2 mg after delivery of shoulder, placenta, or puerperium, then q2-4hr × 1-5 doses
CNS: Headache, dizziness, seizures, hallucinations; stroke (IV)
CV: Hypotension, chest pain, palpitation, hypertension, dysrhythmias, CVA (IV)
EENT: Tinnitus
GI: Nausea, vomiting
Side Effects:
GU: Cramping
INTEG: Sweating, rash, allergic reactions
MS: Leg cramps
RESP: Dyspnea
Nursing Considerations
Assess:
● B/P, pulse, character and amount of vaginal bleeding; watch for indications of hemorrhage
● Uterine relaxation; observe for severe cramping
● Ergot toxicity: tinnitus, hypertension, palpitations, chest pain, nausea, vomiting, weakness; cold, numb extremities
● Pregnancy/breastfeeding: do not use in pregnancy except following obstetric delivery or abortion to reduce
postpartum hemorrhagic risk; may breastfeed 1 wk postpartum
● Education:
● To report increased blood loss, severe abdominal cramps, fever, or foul-smelling lochia
● 🚨DO NOT GIVE IF PATIENT IS HYPERTENSIVE
Generic Name: Butorphanol
Brand Name: Stadol
Classification: Opioid (narcotic) agonist-antagonist analgesic
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors.
μ-Opioid Receptor (MOR): Butorphanol acts as a partial agonist and antagonist at MORs. It can
activate these receptors to a lesser extent than full agonists like morphine, providing analgesic
Mechanism of Action:
effects while potentially reducing the risk of respiratory depression and euphoria.
κ-Opioid Receptor (KOR): It serves as a full agonist at KORs, contributing significantly to its
analgesic properties.
Indications: Moderate to severe labor pain and postoperative pain after cesarean birth.
Route: IV/IM/INTRANASAL
Dosage Range: Moderate to Severe Pain:
IM: 1-4 mg q3-4 hr prn
IV: 0.5-2 mg q3-4 hr prn
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INTRANASAL: 1 spray in 1 nostril, may give another dose 1-1.5 hrs later; repeat if needed 3-4 hr
s/p last dose.
CNS: Drowsiness, dizziness, confusion, headache, sedation, euphoria, weakness, hallucinations,
insomnia (nasal)
CV: Palpitations, bradycardia, hypotension
EENT: Tinnitus, blurred vision, miosis (pupil constriction), diplopia (double vision), nasal
Side Effects: congestion, unpleasant taste
GI: Nausea, vomiting, anorexia, constipation, cramps
GU: Urinary retention
INTEG: Rash, urticaria, bruising, flushing, diaphoresis, pruritus
RESP: Respiratory depression
Nursing Considerations
Assess:
● Decreasing urine output
● Maternal vital signs, degree of pain, FHR, and uterine activity before and after administration.
● CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
● Allergic reactions: rash, urticaria
● Need for pain medication, physical dependence
● Safety measures: night-light, call bell within reach
Observe for:
● Maternal respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min
● Withdrawal symptoms in opioid-dependent patients and newborns (pulmonary embolism, vascular occlusion,
abscesses, ulcerations).
Evaluate: Therapeutic response in pain
Actions:
● Implement safety measures as appropriate (raise side rails; help with walking)
● Continue use of nonpharmacologic pain relief measures
Avoid:
● Prior or present substance abuse (including alcoholism)
● Concurrent use of CNS depressants or benzodiazepines
● Pregnancy/breastfeeding: use only if benefits outweigh risks; usually compatible with breastfeeding
Contraindications: Patients with hypertension or preeclampsia because can increase blood pressure.
Patient/Family Teaching:
● Report any symptoms of CNS changes and to seek emergent medical care for stupor, slow breathing, severe
sleepiness
● Accidental exposure and overdose (intranasal): May be fatal, keep out of reach of children
● To report all products taken (OTC, Rx, herbs, supplements)
● Physical dependency over prolonged time periods
● Withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
● How to use nasal product
● To avoid hazardous activities, to have help getting out of bed or walking
Treatment of Overdose: Naloxone (Narcan) 0.2-0.8 mg IV, IM/SUBCUT/O2, IV fluids, vasopressors
Generic Name: Nalbuphine
Brand Name: Nubain
Classification: Opioid (narcotic) agonist-antagonist analgesic
Mechanism of Action: Depressed pain impulse transmission by interacting with opioid receptors.
Indications: Moderate to severe labor pain and postoperative pain after cesarean birth.
Route: SUBCUTANEOUS/IM/IV
