Trade Name DinoprostoneGeneric Name Prostin E, Prepidil, Cervidil

Dosage Intravaginal administration Cervidil = Intracervical gel Prostin E2 = Intravaginal suppository

The dosage of dinoprostone in the vaginal insert is 10 mg designed to be released at approximately 0.3 mg/hour over a 12 hour period. Cervidil should be removed upon onset of active labor or 12 hours after insertion.

Classification Uterine Stimulants, Abortifacient, ProstaglandinAction Prostaglandin E2

Uterine and gastrointestinal smooth muscle stimulation

Cervical softening and dilation Increases frequency and strength of uterine

contraction.Indication Cervidil Vaginal Insert (dinoprostone, 10 mg) is

indicated for the initiation and/or continuation of cervical ripening in patients at or near term in whom there is a medical or obstetrical indication for the induction of labor.

Contraindication Endocervically administered dinoprostone gel is not recommended for the following:

Patients in whom oxytocic drugs are generally contraindicated or where prolonged contractions of the uterus are considered inappropriate, such as:o Cases with a history of cesarean section or

major uterine surgery.o Cases in which cephalopelvic

disproportion is present.o Cases in which there is a history of

difficult labor and/or traumatic delivery.o Grand multiparae with 6 or more previous

term pregnancies cases with non-vertex presentation.

o Cases with hyperactive or hypertonic uterine patterns.

o Cases of fetal distress where delivery is not imminent.

o In obstetric emergencies where the benefit-to-risk ratio for either the fetus or the mother favors surgical intervention.

Patients with hypersensitivity to prostaglandins or constituents of the gel.

Patients with placenta previa or unexplained vaginal bleeding during this pregnancy.

Patients for whom vaginal delivery is not indicated, such as vasa previa or active herpes genitalia.

Vaginal Suppository Hypersensitivity to dinoprostone. Acute pelvic inflammatory disease. Patients with active cardiac, pulmonary, renal,

or hepatic disease.Adverse Reaction Nausea and vomiting; diarrhea

Fever Orthostatic hypotension Arrhythmia

Nursing Responsibilities Store suppositories in freezer and bring to room temperature before insertion.

Store cervical gel in freezer and bring to room temperature in room temperature, just prior to use. Do not force warming with external sources (ie, water bath, microwave)

Ensure adequate hydration throughout the procedure.

Monitor uterine tone and vaginal discharge throughout the procedure and several days after procedure.

Be prepared to support patient through labor (cervical ripening). Give oxytocin 6-12 hours after dinoprostone.

Trade Name Methergine, Methylergobasine, Methylergobrevin,Methylergonovine

Generic Name Methylergonovine maleateDosage PO = 0.2 mg q 6-8 H (max 1 week); IM = 0.2 mg q 2 –

4 H (max 5 doses)Classification Uterine Stimulants

Action Directly stimulate uterine contractionso Small doses = with normal resting muscle

toneo Intermediate doses = more forceful and

prolonged contractions with elevated resting muscle tone

o Large doses = severe, prolonged contractions

Not for induction of labor (intense uterine activity)

Indication Prevention and treatment of postpartum and postabortion hemorrhage caused by uterine atony or subinvolution

Contraindication contraindicated in patients hypersensitive to methylergonovine or any component of the formulation.

ergot alkaloids are contraindicated with potent inhibitors of CYP3A4 (includes protease inhibitors, azole antifungals, and some macrolide antibiotics);

hypertension; toxemia of pregnancy (PIH)Adverse Reaction Nausea, vomiting, abdominal cramping

HypertensionNursing Responsibilities Be alert for adverse reactions and drug

interactions. This drug should be used extremely carefully

because of its potent vasoconstrictor action. I.V. use may induce sudden hypertension and cerebrovascular accidents. As a last resort, give I.V. slowly over several minutes and monitor blood pressure closely.

Monitor Uterine Contractions

Trade Name Pitocin, SyntocinonGeneric Name Oxytocin

Dosage For stimulation of labor: 10 units (1ml) of drug infused in 1L D5LRS before deliver

For Reduction of Postpartum bleeding: 1 amp after delivery of placenta

Classification Uterine StimulantsAction Stimulates the smooth muscles of uterus, blood

vessels and mammary glands Third trimester = active labor

Indication Induction of labor at term; control of postpartum bleeding; adjunctive therapy in management of abortion

Contraindication Contraindicated in patients hypersensitive to the drug or any of its component.

Also contraindicated in cephalopelvic disproportion or delivery that requires conversion, as in tranverse lie; in fetal distress when delivery isn’t imminent; in prematurity and in severe toxemia, hypertonic uterine patterns, total placenta previa or vasa previa.

Also contraindicated in fetal distress.Adverse Reaction Cardiovascular: hypertension; increased heart

rate, systemic venous return, and cardiac output, and arrhytmias

CNS: seizures, coma from water intoxication

Gastrointestinal: Nausea, vomiting,

GU: titanic uterine contractions, abruption placentae, impaired uterine blood flow, pelvic hematoma

Hematologic: afibrinogenemia

Respiratory: anoxia, asphyxiaNursing Responsibilities Monitor and record uterine contractions, heart

rate, BP, intrauterine pressure, fetal heart rate, and blood loss q15.

Be alert for adverse reaction Monitor I/O. Antidiuretic effect may lead to

fluid overload, seizures, and coma Never give oxytocin simultaneously by more

than one route. Have 20% solution magnesium sulfate

available for relaxation of the myometrium. If contractions are less than 2 minutes apart, if

they’re above 50mm Hg ,or if they last 90sec. or longer, stop infusion, and turn patient on her side, and notify physician or midwife.

Trade Name ApresolineGeneric Name Hydralazine

Dosage 5 mg/dose then 5-10 mg every 20-30 minutes as needed. (TIV)

ClassificationAction Hydralazine

↓Directly relaxes arteriolar smooth muscle

↓Vasodilaion

↓Lowers Blood Pressure

Indication Pre-eclampsia /eclampsiaContraindication Contraindicated to pt.s hypersensitive to the

drug and any of its component and in those with coronary artery disease or mitral valvular rheumatic heart disease.

Use cautiously in patients with suspected cardiac disease, CVA, or severe renal impairment, and in those taking other antihytensives.

Adverse Reaction CNS: peripheral neuritis, headache, dizziness CV: orthostatic hypotension, tachycardia,

arrythmias, angina, palpitations. GI: n/v, diarrhea, anorexia Hematologic: neutropenia, leukopenia,

agranulocytopenia Metabolic: weight gain, sodium retention Skin: rash

Nursing Responsibilities Assess blood pressure before starting therapy and regularly thereafter.

Instruct client to take oral form with meals. Inform client that orthostatic hypotension can

be minimized by rising slowly and not changing position suddenly.

Tell pt. not to abruptly stop taking drug, but to call the one who prescribed it if adverse reaction occurs.

Tell client to limit sodium intake.

Trade Name Ferrous Sulfate Generic Name Ferrous Sulfate (FeSO4)

Dosage 200mg/day POClassification Antianemic, Iron

Action Males: 12-20mgFemales: 8-15mgIron is absorbed from the duodenum and upper jejunum by an active mechanism through the mucosal cells where it combines with the protein transferrin.

Indication Prophylaxis and treatment of iron deficiency and iron-deficiency anemias.

Dietary supplement for iron. Optimum therapeutic responses are usually noted within 2-4 weeks.

Contraindication Hemosiderosis, hemochromatosis, peptic ulcer, regional enteritis, and ulcerative colitis. Hemolytic anemia, pyridoxine-responsive anemia, and cirrhosis of the liver. Use in those with normal iron balance.

Adverse Reaction Constipation, gastric irritation, nausea, abdominal cramps, anorexia, diarrhea, dark colored stools.

Nursing Responsibilities Substitution of one iron salt for another without proper adjustment may result in serious over or under dosing.

Eggs, milk, coffee, or tea consumed with a meal or 1 hr after may significantly inhibit absorption of dietary iron.

Ingestion of calcium and iron supplements with food can decrease iron absorption by one-third; iron absorption is not decreased if calcium carbonate is used and taken between meals.

Do not crush or chew sustained-release products.

Trade Name Magnesium sulfateGeneric Name Magnesium sulfate

Dosage Anticonvulsant: o IM = loading dose (10 g of 50% solution

[20 mL] divided into 2 doses); maintenance dose (4 – 5 g of 50% solution [10 mL] q4H deep IM; alternate buttocks

o IV = loading does (4 g MgSO4 in 250 mL of D5W infuse at 10 mL per minute; maintenance dose (1 – 2 g per hour by continuous infusion)

Preterm labor: IV = loading dose (4 g of MgSO4 over 15 – 30 minutes; maintenance dose (1 – 3 g per hour by continuous infusion)

Classification CNS depressantAction CNS depressants = potentiate CNS depressant

effects of MgSO4 (barbiturates, analgesics, general anesthetics, tranquilizers, and alcohol

Neuromuscular blocking agents = concurrent use with MgSO4 will further depress muscular activity.

Indication Seizures of eclampsia (toxemia of pregnancy) Contraindication Conditions:Kidney Disease, Serious Kidney

Problems, High Amount of Magnesium in the Blood, Low Amount of Calcium in the Blood

Allergies:Magnesium Magnesium SulfateAdverse Reaction Deep tendon reflexes = absent

Decreased urine output Decreases respiratory rate, blood pressure, fetal

heart rate (fetal distress) Confusion Neonates = hypotension, hyporeflexia,

respiratory depressionNursing Responsibilities Pregnancy safety: Magnesium sulfate is administered

to treat toxemia of pregnancy. It is recommended that the drug not be administered in the 2 hours before delivery, if possible. IV calcium gluconate or calcium chloride should be available as an antagonist to magnesium if needed. Convulsions may occur up to 48 hr after delivery, necessitating continued therapy. The "cure" for toxemia is delivery of the baby. Magnesium

must be used with caution in patients with renal failure, since it is cleared by the kidneys and can reach toxic levels easily in those patients. Prophylactic administration of magnesium sulfate for patients with acute mvocardial infarction should be considered.

Trade Name PhenerganGeneric Name promethazine HCI

Dosage 25-50 mg (sedation); 10-25mg q 4hr as needed (anti-emetic) (1amp)

Classification anti-emetics, antihistamines, sedative/hypnoticsAction Selectively blocks H1 receptors, diminishing the

effects of histamine on cells of the upper respiratory tract and eyes and decreasing the sneezing, mucus production, itching and tearing that accompany allergic reactions. blocks cholinergic receptors in the vomiting center that are believed to mediate the nausea and vomitting caused by gastric irritation.

Indication Preoperative sedation, treatment and prevention of nausea and vomiting, adjunct to anesthesia and analgesia.

Contraindication Hypersensitivity, comatose patient, prostatic hypertrophy, bladder neck obstruction, narrow angle glaucoma

Adverse Reaction CNS: neuroleptic malignant syndrome, confusion, disorientation, sedation, dizziness, extrapyramidal reaction, fatigue, insomnia, nervousness;

EENT: blurred vision, diplopia, tinnitus; CV: bradycardia, hypertension, hypotension,

tachycardia; GI: constipation, drug-induced hepatitis, dry

mouth; Derm: photosensitivity, rashes; Hema: blood dyscrasias

Nursing Responsibilities Monitor BP, pulse and respiratory rate frequently.

Assess level of sedation after administration. Assess patient for nausea and vomiting before

and after administration. Administer each 25mg slowly over at least 1

hr. Do not give rectal supp or tabs to children

younger than 2 years old because of risk of fetal respiratory depressions

Give IM injections deep into muscle Do not administer SQ, tissue necrosis may

occur

Arteriospasms and gangrene of artery may occur when administered intra-arterially.

Reduce dosage of barbiturates given concurrently within promethazine by least half.

Trade Name XylocaineGeneric Name Lidocaine

Dosage For normal vaginal delivery: 50mg/ml of a 5% hyperbaric solution or 9mg-15mg (0.6ml-1ml) of a 1.5% solution.

For Cesarean Section: Up to 75 mg (1.5ml) of a 5% hyperbaric solution.

Classification Infiltration and Nerve BlockerAction Lidocaine

↓Stabilizes the neuronal membrane

↓Inhibits sodium ion movemnts

↓Conduction of impulses are inhibited

↓Local loss of pain sensation

Indication Injected prior to normal spontaneous delivery to anesthetize the area of the perineum to be used for episiotomy.

Used as a local anesthesia for Cesarean sectionContraindication Hypovolemia

Heartblock Other Conduction Disturbances

Adverse Reaction Dizziness Paresthesia Drowsiness Confusion Respiratory Depression Convulsions

Nursing Responsibilities Observe for untoward reactions such as drowsiness, depressed respiration, or seizures.

Trade Name BuscopanGeneric Name Hyoscine Butylbromide

Dosage Given via IV, 1mg/ml to promote cervical effacement.Classification

Action Hyoscine Butylbromide↓

Inhibits muscarinic actions of acetylcholine in the ANS

↓Affecting neural pathway

↓Relieves spasticity, nausea and vomitting; reduces

secretions; and blocks cardiac vagal reflexes.↓

Promotes cervical effacementIndication To reduce secretions perioperatively.

Contraindication Contraindicated in patients with angle-closure glaucoma, obstructive uropathy, asthma, COPD, myasthenia gravis, paralytic ileus, intestinal atony, & unstable CV.

Adverse Reaction CNS: dizziness, headache, restlessness, disorientation, irritability, fever

GI: constipation, dry mouth, nausea, vomiting CV: palpitations, tachycardia, flushing EENT: dilated pupils, blurred vision,

photophobia, dysphagia GU: urinary hesitancy, urinary retention Skin: rash, dryness

Nursing Responsibilities Be alert for adverse reactions and drug interactions.

Encourage pt. to void Monitor BP for possible hypotension. Monitor cervical effacement and dilatation.

Trade Name Fumide , Furomide , Lasix, Luramide Generic Name FUROSEMIDE

(fur-oh'se-mide)Dosage Edema

Adult: PO 20–80 mg in 1 or more divided doses up to 600 mg/d if needed IV/IM 20–40 mg in 1 or more divided doses up to 600 mg/d

HypertensionAdult: PO 10–40 mg b.i.d. (max: 480 mg/d)

Classification Electrolytic and water balance agent; loop diureticAction

Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow

IndicationTreatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.

ContraindicationHistory of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation.

Adverse Reaction CV: Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes, circulatory collapse.

Metabolic: Hypovolemia, dehydration, hyponatremia hypokalemia, hypochloremia metabolic alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia.

GI: Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal cramping, acute pancreatitis, jaundice.

Urogenital: Allergic interstitial nephritis, irreversible renal failure, urinary frequency.

Hematologic: Anemia, leukopenia, thrombocytopenic purpura; aplastic anemia, agranulocytosis (rare).

Special Senses: Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred vision.

Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde, necrotizing angiitis (vasculitis).

Body as a Whole: Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis, pain at IM injection site.

Nursing Responsibilities Assessment & Drug Effects Observe patients receiving parenteral drug

carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported.

Monitor BP during periods of diuresis and through period of dosage adjustment.

Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.

Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter.

Monitor for S&S of hypokalemia. Monitor I&O ratio and pattern. Report decrease

or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.

Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.

Trade Name Dormicum, Hypnovel, and VersedGeneric Name Midazolam

Dosage IV: inject 2.5 mg for 2 minutes (never as bolus)IM: 0.07-0.08 mg/kg

Classification Therapeutic: Anti-anxiety agents, sedative/hypnotics

Pharmacologic: benzodiazepinesAction Physiologic Mechanism:

Short-term sedation Postoperative amnesia

Pharmacologic Mechanism: Acts at many levels of the CNS to produce

generalized CNS depression. Effects may be mediated by GABA, an

inhibitory neurotransmitter.Indication Preprocedural sedation.

Aids in the induction of anesthesia and as part of balanced anesthesia.

Contraindication Hypersensitivity to benzodiazepines. Chronic respiratory insufficiency.

Adverse Reaction Rarely cardioresp adverse events, nausea, vomiting, headache, hiccoughs, laryngospasm, dyspnoea, hallucination, oversedation, drowsiness, ataxia, rash, paradoxical reactions, amnesic episodes.

Nursing Responsibilities Assess level of sedation and level of consciousness throughout and for 2-6 hr following administration.

Monitor BP, pulse and respiration continuously during IV administration. Oxygen and resuscitative equipment should be immediately available.

If overdose occurs, monitor pulse, respiration , and BP continuously. Maintain patent airway and assist ventilation as needed. If hypotension occurs, treatment includes IV fluids, repositioning and vasopressors.

The effects of midazolam can be reversed with flumazenil (Romazicon).

Trade Name Apo-Diazepam, Diastat, Diazemuls , E-Pam , Meval , Novodipam , Valium, Valrelease, Vivol 

Generic Name DIAZEPAM (dye-az'e-pam)

Dosage Status EpilepticusAdult: IV/IM 5–10 mg, repeat if needed at 10–15 min intervals up to 30 mg, then repeat if needed q2–4h

WithdrawalAdult: PO 2–10 mg b.i.d. to q.i.d. or 15–30 mg/d sustained release IV/IM 2–10 mg, repeat if needed in 3–4 hGeriatric: PO 1–2 mg 1–2 times/d (max: 10 mg/d)Child: PO >6 mo, 1–2.5 mg b.i.d. or t.i.d.

Classification Central nervous system agent; benzodiazepine anticonvulsant; anxiolytic

Action Psychotherapeutic agent related to chlordiazepoxide; reportedly superior in antianxiety and anticonvulsant activity, with somewhat shorter duration of action. Like chlordiazepoxide, it appears to act at both limbic and subcortical levels of CNS.

IndicationDrug of choice for status epilepticus. Management of anxiety disorders, for short-term relief of anxiety symptoms, to allay anxiety and tension prior to surgery, cardioversion and endoscopic procedures, as an amnesic, and treatment for restless legs. Also used to alleviate acute withdrawal symptoms of alcoholism, voiding problems in older adults, and adjunctively for relief of skeletal muscle spasm associated with cerebral palsy, paraplegia, athetosis, stiff-man syndrome, tetanus.

Contraindication Body as a Whole: Throat and chest pain. CNS: Drowsiness, fatigue, ataxia, confusion,

paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia.

CV: Hypotension, tachycardia, edema, cardiovascular collapse.

Special Senses: Blurred vision, diplopia, nystagmus.

GI: Xerostomia, nausea, constipation, hepatic dysfunction.

Urogenital: Incontinence, urinary retention, gynecomastia (prolonged use), menstrual irregularities, ovulation failure.

Respiratory: Hiccups, coughing, laryngospasm. Other: Pain, venous thrombosis, phlebitis at injection site.

Adverse ReactionInjectable form: Shock, coma, acute alcohol intoxication, depressed vital signs, obstetrical patients, infants <30 d of age. Tablet form: Infants <6 mo of age, acute narrow-angle glaucoma, untreated open-angle glaucoma; during or within 14 d of MAO inhibitor therapy. Safe use during pregnancy (category D) and lactation is not established.

Nursing Responsibilities Assessment & Drug Effects Monitor for adverse reactions. Most are dose

related. Physician will rely on accurate observation and reports of patient response to the drug to determine lowest effective maintenance dose.

Monitor for therapeutic effectiveness. Maximum effect may require 1–2 wk; patient tolerance to therapeutic effects may develop after 4 wk of treatment.

Observe necessary preventive precautions for suicidal tendencies that may be present in anxiety states accompanied by depression.

Observe patient closely and monitor vital signs when diazepam is given parenterally; hypotension, muscular weakness, tachycardia, and respiratory depression may occur.

Lab tests: Periodic CBC and liver function tests during prolonged therapy.

Supervise ambulation. Adverse reactions such as drowsiness and ataxia are more likely to occur in older adults and debilitated or those receiving larger doses. Dosage adjustment may be necessary.

Monitor I&O ratio, including urinary and bowel elimination.

Trade Name Plasil, Maxolon, ReglanGeneric Name Metoclopramide

DosageClassification Antiemetic, GI stimulant

ActionStimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit, little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin.

Indication relief of symptoms of acute and recurrent diabetic gastroparesis

-short- term therapy for adults with GERD parenteral: prevention of nausea and vomiting prophylaxis of postoperative nausea and

vomiting when nasogastric suction is undesirable

treatment of nausea and vomiting of a variety of etiologies

Contraindication contraindicated with allergy to metoclopramide, GI hemorrhage, mechanical obstruction or perforation, epilepsy.

use cautiously with previously detected breast cancer, lactation, pregnancy

Adverse Reaction CNS: restlessness, drowsiness, fatigue, insomnia, dizziness, anxiety

CV: transient hypertension GI: nausea, diarrhea

Nursing Responsibilities monitor BP carefully during IV administration keep diphenhydramine injection readily

available in case extrapyramidal reactions occur

have phenotolamine readily available in case of hypertensive crisis

take drug exactly as prescribed use of alcohol, sleep remedies, or sedatives can

cause serious sedation. report involuntary movement of the face, eyes,

and limbs

Trade Name NubainGeneric Name Nalbuphine Hydrochloride

Dosage Injection – 10 mg/ml, 20mg/mlClassification Narcotic agonist-antagonist analgesic

Action Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce analgesia,sedation but also acts to cause hallucinations and is an antagonist at µ receptors

Indication Relief of moderate to severe pain Preoperative analgesia, as a supplement to

surgical anesthesia, and for obstetric analgesia during labor and delivery

Contraindication Hypersensitivityto nalbuphine, sulfites; lactation.

Use cautiously with emotionally unstable clients or those with a history of narcotic abuse; pregnancy prior to labor, laboror delivery, bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery.

Adverse Reaction CNS: Sedation, clamminess, sweating, headache,nervousness, restlessness,depression crying, confusion, faintness, hostility, unusual dreams, hallucinations, euphoria, dysphoria, unreality, dizziness, vertigo,floating feeling, feeling of heaviness, numbness, tingling, flushing, warmth, blurred vision.

CV: Hypotension, Hypertension, bradycardia, tachycardia

DERMATOLOGIC: Itching, burning, urticaria

GI: Nausea,vomiting, cramps,dyspepsia, bitter taste, dry mouth

GU: Urinary urgency

RESPIRATORY: Respiratory depression, dyspnea, asthma

Nursing Responsibilities Monitor respiratory rate before and after giving nubain because it causes respiratorydepression

Monitor I and O todetermine if there isexcessive fluid loss

Monitor Bp before andafter administeringthe medication to prevent any complication

Trade Name Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin

Generic Name Tranexamic AcidDosage

Classification Anti-fibrinolytic, antihemorrhagicAction

Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis.

Indication Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas:

Treating heavy menstrual bleeding Hemorrhage following dental and/or oral

surgery in patients with hemophilia Management of hemophilic patients (those

having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction orother oral surgical procedures.

Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia.

Contraindication Allergic reaction to the drug or hypersensitivity Presence of blood clots (eg, in the leg, lung,

eye, brain), have a historyof blood clots, or are

at risk for blood clots Current administration of factor IX complex

concentrates or anti-inhibitorcoagulant concentrates

Adverse Reaction Severe allergic reactions such as rash, hives, itching, dyspnea, tightnessin the chest, swelling of the mouth, face, lips or tongue* Calf pain, swelling or tenderness* Chest pain* Confusion* Coughing up blood* Decreased urination* Severe or persistent headache* Severe or persistent body malaise* Shortness of breath* Slurred speech* Slurred speech* Vision changes

Nursing Responsibilities Unusual change in bleeding pattern should be immediately reported to the physician.

For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period.

Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed.

The medication can be taken with or without meals.

Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush,or chew before swallowing.

If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.