ATI Active Learning Template (Medication) - Misoprostol (Cytotec)

ATI Active Learning Template (Medication) - Misoprostol (Cytotec) Expected Pharmacological Action: Action: Acts as a prostaglandin analogue, decreasing gastric acid secretion (antisecretory effect) and increasing the production of protective mucus (cytoprotective effect). Causes uterine contractions. Therapeutic Effects: Prevention of gastric ulceration from NSAIDs. With mifepristone terminates pregnancy of less than 49 days. Therapeutic Use: Prevention of gastric mucosal injury from NSAIDs, including aspirin, in high-risk patients (geriatric patients, debilitated patients, or those with a history of ulcers). With mifepristone for termination of pregnancy. Unlabeled Use: Treatment of duodenal ulcers. Cervical ripening and labor induction. Complications: CNS: headache. GI: abdominal pain, diarrhea, constipation, dyspepsia, flatulence, nausea, vomiting. GU: miscarriage, menstrual disorders. Medication Administration: ● PO (Adults): Antiulcer—200 mcg 4 times daily with or after meals and at bedtime, or 400 mcg twice daily, with the last dose at bedtime. If intolerance occurs, the dose may be ↓ to 100 mcg 4 times daily. Termination of pregnancy—400 mcg single dose 2 days after mifepristone if abortion has not occurred. ● Intravaginally(Adults): 25 mcg (1/4 of 100– mcg tablet); may repeat q 3– 6 hr, if needed. Contraindications/Precautions: Contraindicated in: Hypersensitivity to prostaglandins; ● OB: Should not be used to prevent NSAID-induced gastric injury due to potential for fetal harm or death; ● Lactation: May cause severe diarrhea in the nursing infant. Use Cautiously in: ● OB: Patients with childbearing potential should be counseled to avoid pregnancy during misoprostol therapy for prevention of NSAID-induced gastric injury. Pregnancy status should be determined before initiating therapy; ● Pedi: Safety not established.Exercise Extreme Caution in: When used for cervical ripening (unlabeled use) may cause uterine rupture (risk factors are late trimester pregnancy, previous cesarean section or uterine surgery or 5 previous pregnancies). Nursing Interventions: Assessment: ● Assess patient routinely for epigastric or abdominal pain and for frank or occult blood in the stool, emesis, or gastric aspirate. ● Assess women of childbearing age for pregnancy. Misoprostol is usually begun on 2nd or 3rd day of menstrual period following a negative pregnancy test result. ● Termination of pregnancy: Monitor uterine cramping and bleeding during therapy. ● Cervical Ripening: Assess dilation of cervix periodically during therapy Implementation: ● Do not confuse Cytotec (misoprostol) with Mifeprex (mifepristone). ● Misoprostol therapy should be started at the onset of treatment with NSAIDs. ● PO: Administer medication with meals and at bedtime to reduce severity of diarrhea. ● Antacids may be administered before or after misoprostol for relief of pain. Avoid those containing magnesium, because of increased diarrhea with misoprostol. Interactions: ● Drug-Drug: ↑ risk of diarrhea with magnesium-containing antacids Client Education: ● Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as possible unless the next dose is due within 2 hr; do not double doses. Emphasize that sharing of this medication may be dangerous. ● Advise patient not to share misoprostol with others, even if they have similar symptoms; may be dangerous. ● 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 therapy. If pregnancy is suspected, the woman should stop taking misoprostol and immediately notify her health care professional. ● Inform patient that diarrhea may occur. Health care professional should be notified if diarrhea persists for more than 1 wk. Also advise patient to report onset of black, tarry stools or severe abdominal pain. ● Advise patient to avoid alcohol and foods that may cause an increase in GI irritation. Evaluation of Medication Effectiveness: The prevention of gastric ulcers in patients receiving chronic NSAID therapy. ● Termination of pregnancy. ● Cervical ripening and induction of labor.