Smt.

RUKMANIBEN DEEPCHANDBHAI GARDI

NURSES TRAINING CENTRE, INDORE

TOPIC- OBSTETRICS DRUGS

SUBMITTED BY
SUBMITTED TO
RIYANA AHEIBAM
DR. SAPNA SINGH
BSc [4th] Year
Introduction
•The midwife should have a thorough knowledge of the

indications, actions, and side effects of drugs.

•Understanding nursing considerations is essential for

effective planning and implementation of the nursing

process.
Definition
Obstetrics drugs are medications used to treat a variety of conditions
during pregnancy, childbirth, and the postpartum period.

Drugs used in obstetrics:-

1. Oxytocic.
2. Antihypertensive therapy.
3. Diuretics.
4. Tocolytic Agents.
5. Anticonvulsants.
6. Anticoagulants
7. Analgesic and Anesthesia in obstetrics.
OXYTOCICS IN OBSTETRICS:-
• Oxytocic's are the drugs that have the power to excite contractions of the
uterine muscles.
• Among a large number of drugs belonging to this group, the ones that are
important and extensively used are:-
a) Oxytocin.
b) Ergot derivative.
c) Prostaglandins.

A) OXYTOCIN:-
• Oxytocin is a peptide, Nona peptide and octapeptide hormone secreted by
the posterior pituitary.
• It is released by stimuli such as parturition, suckling and coitus.
• The amount of secretion depends upon the nature of the stimuli.
# Preparation:-

Synthetic oxytocin available for parenteral use includes:

a) Syntocinon: 5 unit/mL in ampules of 1 mL

b) Pitocin: 10 unit/mL in ampules of 0.5 mL
c) Syntometrine: A combination of syntocinon 5 units and ergometrine 0.5 mg.
d) Oxytocin nasal solution 40 unit/ mL
e) Desamino oxytocin : *50IU buccal tablet to be repeated every 30 min upto a minimum of 10
tablet for induction of labor.
*25IU every 30min for uterine inertia.
*25-50 IU just before breast feeding for breast engorgement cases.

# Routes of administration:-

• Controlled intravenous (IV) infusion {10units of oxytocin in 1L of Ringer's lactate or 5%

dextrose in water}.
• 5-10units IV or IM after the birth of baby.
• Nasal spray for milk let-down takes 30-45 minutes to reach peak concentration levels and
stays in the body for 4-8 hours.

# Mechanism of action:-
• Syntocinon is a synthetic form of oxytocin works by mimicking the natural hormone oxytocin in the body.
• Binding to oxytocin receptors:
• *Oxytocin, whether naturally produced or administered as syntocinon, binds to specific receptors
located on the muscle cells of the uterus (myometrium). *These receptors are known as oxytocin
receptors.
• Activation of signal transduction:-
• *When oxytocin binds to it’s receptor, it triggers a series of events within the muscle cell.
• *This involves the activation of a signaling pathway that leads to an increase in the concentration of
calcium ions within the cell.
• Calcium release and muscle concentration:-
• *The increased calcium concentration causes the muscle fibers to contract.
• *This concentration is co-ordinated leading to rhythmic contraction of the uterus

• Positive feedback loop:-

• *The uterine contractions, in turn, stimulate the release of more oxytocin from the body’s own pituitary gland.
• *This creates a positive feedback loop, where concentration leads to more oxytocin release, which further
intensifies contraction.
B) Syntometrine is a combination drug containing two active ingredient:
1. Syntocinon (oxytocin) :-
*As explained earlier syntocin works by binding to oxytocin receptors in the uterus, leading to uterine
contractions.
2. Ergometrine:-
*This is a synthetic derivative of ergot alkaloids, it works by stimulating the release of calcium ions
within the muscles cell of the uterus, which also lead to uterine contraction.
*Additionally ergometrine causes constriction of blood vessels in the uterus, helping to reduce bleeding.
(Post partum bleeding)

# Indication:-
• The indication are grouped as follows:-a) Therapeutic. b) Diagnostic.
a) Therapeutic:- Pregnancy:
• To accelerate abortion (inevitable or missed).
• To expedite expulsion of hydatidiform mole.
• To stop bleeding following evacuation .
• To induce labor.
• To augment labor.
• In uterine inertia.
• To prevent and treat postpartum hemorrhage.
Postpartum:
• To initiate milk let-down in breast engorgement.

# Contraindications:-
• In late pregnancy:-
*Grand multipara.
*Contracted pelvis.
* History of cesarean section or hysterectomy.
*Malpresentation.
• During labor:-
*All contraindications mentioned in pregnancy.
*Obstructed labor.
*Incoordinate uterine action.
• Anytime:
*Hypovolemic state.
*Cardiac disease.
# Adverse Effects:-
• Hypertonic uterine activity.
• Fetal distress and fetal death.
• Uterine rupture.
• Hypotension.
• Neonatal jaundice.
• Water retention and water intoxication.

# Nursing Responsibility:- 1.Assess:

• Intake and output ratio.
• Uterine contractions and fetal heart rate (FHR).
• Blood pressure (BP), pulse and respiration.
2. Administer:
• By IV infusion.
• After having crash cart (emergency trolley) available in the ward.
3. Evaluate:
• Length and duration of contractions.
• Notify physician of contractions lasting over 1 minute or absence of con- tractions.
4. Teach client/family:
•To report increased blood loss, abdominal cramps or increased temperature.
B) ERGOT DERIVATIVE:-
• Ergot alkaloids are either natural or semi- synthetic.
• Ergot derivative are used in obstetrics to prevent postpartum hemorrhage after childbirth.
# Preparation:- Dosage and route:
• Ergometrine (ergonovine): 0.25 mg or 0.5 mg ampules (IV)and 0.5-1 mg tablets(orally)
• Methergine (methylergonovine): 0.2 mg ampules(IV) and 0.5-1 mg tablets (orally)
• Syntometrine with ergometrine: 0.5 mg + Syntocinon 5.0 units ampules (IM)

# Indications:
1.Therapeutic:
• To stop the atonic uterine bleeding
following delivery, abortion or
expulsion of hydatidiform mole.
# Mechanism of action:-
1. Vasoconstriction:-
•Ergot derivatives are potent
vasoconstriction they cause
blood vessels to narrow. This
further reduces blood flow to the
uterus contributing to
hemostasis (cessation of
bleeding).
2.Uterine contraction:-
• Ergot derivative stimulate the
uterine muscle, causing it to
contract more forcefully and
frequently. This help to compress
the blood vessels at the placental
site, reducing bleeding.
2.Prophylactic:
• As a prophylaxis against excessive hemorrhage; it may be administered after the delivery of the anterior
shoulder (active management of third stage) with crowning or following delivery of the baby.
# Contraindications:-
1. Suspected plural pregnancy:
*If given accidentally with the delivery of the first baby, the second twin is likely to be com- promised by
the titanic contractions of the uterus.
2.Organic cardiac disease:
• It may cause sudden squeezing of blood out of the uterine circulation into the general circulation causing
overloading of the right heart and precipitating failure.
3.Severe preeclampsia and eclampsia:
• There may be sudden rise of blood pressure.
4.Rhesus (Rh)-negative mother:
• There is more chance of fetomaternal micro- transfusion.
Note: For women with heart diseases or hypertension, oxytocin is a better substitute.
# Adverse effects:-
• A rise of blood pressure is precipitated be- cause of its vasoconstrictive action.
• Prolonged use in puerperium may interfere with lactation by decreasing the concentration of prolactin.
• Prolonged use may lead to gangrene of the toes due to its vasoconstrictive effect.
# Nursing Responsibility:-
1. Assess:
*Blood pressure, pulse and respiration.
*Watch for signs of hemorrhage.
2. Administer:
*Orally or intramuscular (IM) in deep muscle mass.
*Have emergency cart readily available.
3.Evaluate:
*Therapeutic effect: Decreased blood loss.
4.Teach client/family:
• To report increased blood loss, abdominal cramps, headache, sweating, nausea and vomiting or
dyspnea.
C) PROSTAGLANDINS:- Prostaglandins (PGs) are
synthesized from one of the essential fatty acids, arachidonic acid,
which is widely distributed throughout the body.
• In the female, these are identified in the menstrual fluid,
endometrium, decidua and amniotic membrane.
• Prostaglandins are 20 carbon carboxylic acids with a cyclopentane
ring which are formed from polyunsaturated fatty acid.
# Preparation:-
• PGE₂:-Prostin E₂ (dinoprostone).
• PGF2alpha:-Prostin F2alpha (dinoprost tromethamine).
• PGE1-misoprostol.
# Dosage and route of administration:-
• Tablets: Containing 0.5 mg Prostin E.
• Vaginal suppository: Containing 20 mg PGE², or 50 mg PGF2alpha.
• Vaginal pessary: Containing 3 mg PGE2.
• Injectable ampules or vials of Prostin E₂, 1 mg/mL Prostin F2alpha,
5 mg/ml.
• Misoprostol (PGE¹) 50 mg, given 4 hourly by oral, vaginal or rectal
route for induction of labor.
# Indication:-
• For induction of abortion during second trimester and expulsion of hydatidiform mole.
• For induction of labor in intrauterine death of fetus.
• In augmentation or acceleration of labor.
• To stop bleeding from the open uterine sinuses as in refractory cases of atonic PPH.
• Cervical priming.
# Contraindications:-
Hypersensitivity.
Uterine fibrosis.
Cervical stenosis.
Pelvic surgery .
Pelvic inflammatory disease.
Respiratory disease.
# Side Effects:-
• Headache.
• Dizziness.
• Hypotension.
• Leg cramps.
• Joint swelling.
• Blurred vision.
# Nurses Responsibility:-
1. Assess:
• Respiratory rate, rhythm and depth
• Vaginal discharge, itching or irritation indicative of infection.
2.Administer:
• Antiemetic or antidiarrheal preparations prior to giving this drug
• High in vagina (if vaginal preparations are used)
• After warming the suppository by running warm water over package.
3.Evaluate:
For length and duration of contractions, notify physician of contractions lasting over 1 minute or absence of
contractions
Fever and chills.
4.each client/family:
• To remain supine for 10-15 minutes after vaginal insertion.
ANTIHYPERTENSIVE DRUGS:-
*Antihypertensive drugs are used in hypertensive disorders of pregnancy.
*The commonly used drugs are:
A)Adrenergic inhibitors: Methyldopa
B)Adrenergic blocking agents: Labetalol, propranolol
C)Vasodilators: Hydralazine, Diazoxide, sodium nitroprusside
D)Calcium channel blockers: Nifedipine.
# Dosage and route of administration:-
• Methyldopa:-
*Orally:250mg twice a day (bid) to 1g three times a day (tid).
*Intravenous infusion :250-500mg.
• Labetalol:-
*Orally:100mg tid up to 800 mg daily.
*The IV infusion (hypertensive crisis) : 1-2 mg/min until desired effect.
• Propranolol:
*Orally: 80-240mg in divided doses.
 • Hydralazine:
*Orally: 100 mg/day in 4 divided doses.
*Intravenous/Intramuscular bolus 20-40 mg q4-6 h.
• Diazoxide:
*Intravenous-30-50 mg may be repeated every 10-15 minutes or continuous infusion.
• Sodium Nitroprusside:
*Intravenous infusion-0.5-10 mg/kg/min.
• Nifedipine:
*Orally:5-10mg tid.

A) ADRENERGIC INHIBITORS: (METHYLDOPA)

* Methyldopa is an adrenergic inhibitor that is a first line medication
for treating high blood pressure during pregnancy.
* It is a safe and effective medication that has been used during
pregnancy and breastfeeding.
* It has low risk of side effect and effective in lowering blood
pressure.
# Dosage and route of administration:-
*Orally: 250mg twice a day (bid) to 1g three times a day (tid).
* Intravenous infusion: 250-500 mg.
# Mechanism of action :-
*Methyldopa is converted to alpha – methyl norepinephrine in the body.
*Alpha – methyl norepinephrine binds to alpha-2 adrenergic receptors in the brain.
* This binding inhibits the release of norepinephrine from nerve endings.
*This leads to a decrease in the activity of the sympathetic nervous system. This results in a decrease in blood
pressure.
# Indication:-
• Hypertension.
# Contraindications:-
*Active hepatic disease.
* Congestive cardiac failure.
* Blood Dyscrasias.
* Psychiatric disorders.
# Adverse effects:-
*Nausea, vomiting, diarrhea, constipation.
*Bradycardia, orthostatic hypotension, angina, weight gain.
* Drowsiness, dizziness, headache, depression.
* Leukopenia, thrombocytopenia.
# Nursing Responsibility:-
1.Assess:
•Blood values: Neutrophils, platelets.
•Renal studies: Protein, blood urea nitrogen (BUN), creatinine.
•Liver function tests.
•Blood pressure before beginning treatment and periodically thereafter.
2.Perform/Provide:
•Storage of tablets in tight containers.
3.Evaluate:
•Decrease in blood pressure (therapeutic response).
• Allergic reaction: Rash, fever, pruritus, urticaria.
• Symptoms of congestive heart failure (edema, dyspnea, wet rales)
•Renal symptoms: Polyuria, oliguria, frequency.
4.Teach client/ family:
•To avoid hazardous activities.
•Administer 1 hour before meals.
• Not to discontinue drug abruptly or withdrawal symptoms may occur.
•Not to use over the counter (OTC) medications (nonprescription) for cough, cold or allergy,
unless directed by physician.
• Compliance with dosage schedule even if feeling better.
•To rise slowly to sitting or standing position to minimize orthostatic hypotension.
•Not to skip or stop drug unless directed by physician.
•Notify physician of untoward signs and symptoms.
B) CALCIUM CHANNEL BLOCKERS: (NIFEDIPINE)
*Nifedipine is effective in managing high blood pressure (hypertension)
during pregnancy, especially in case of pre eclampsia.
*It helps maintain blood pressure within a safe range, reducing the high
risk of complication for both the mother and the baby.
# Preparation:-
*Adalat.
*Procardia.
# Dosage and route of administration:-
*Orally: 5-10 mg (tid).

# Indication:-
• Hypertension.
• Angina pectoris.
# Contraindications:
• Simultaneous use of magnesium sulfate could be hazardous due to synergistic effect.
• Second or third degree heart block.
# Mechanism of action:-
1.Calcium channel blockers:
• Nifedipine binds to specific receptors on calcium
channel located in the cell membranes of smooth
muscle cells, particularly in blood vessels.
• This binding action blocks the channel,
preventing calcium ions from entering the cells.
2.Relaxation of smooth muscle:-
• Reduced calcium influx leads to a decrease in
intracellular calcium levels. This reduction in
calcium levels causes relaxation of smooth
muscle cells, especially in the blood vessels.
3.Vasodilation:-
• The relaxation of vascular smooth muscle results
in vasodilation Or widening of blood vessels. This
vasodilation lowers blood pressure by reducing
the resistance to blood flow.
# Adverse effects:-
• Flushing.
• Hypotension.
• Palpitations.
• Bradycardia.
• Inhibition of labor.
• Head- ache.
• Fatigue and drowsiness.
• Nausea, and vomiting.
# Nursing Responsibility:-
1.Assess:
•Blood levels of the drug, therapeutic levels 0.025-0.1 µg/mL.
2.Administer:
•Before meals and hs.
3.Evaluate:
•Therapeutic response, cardiac status, BP, pulse, respiration and electrocardiogram (ECG).
4.Teach client/family:
•To limit caffeine consumption.
•To avoid over-the-counter (OTC) drugs unless directed by the physician.
•Stress patient compliance to all aspects of drug use.
2.HYDROCHLOROTHIAZIDE:
• It is a medication commonly used to treat high blood pressure (hypertension) and fluid retention (edema).
• It belongs to a class of drugs called thiazide diuretics, also known as “water pills”.
#Preparation :-
• Esidex.
• Hydrodiuril.
• Hydrozide.
# Dosage and route:-
• 25-100 mg/day per orally.
# Mechanism of action:-
1.Sodium and chloride reabsorption:-
• Sodium and chloride are normally reabsorbed from the
distal convoluted tubules
of the kidneys back into the bloodstream.
• Hydrochlorothiazide blocks the reabsorption of these
electrolytes by inhibiting the sodium chloride cotransporter (NCC)).
• This prevents the sodium from being pumped back into the bloodstream, which also prevent water from
being reabsorbed.
2.Increased urine production:-
• With less sodium and water being reabsorbed, more of these substance are excreted in the urine.
• This leads to increased urine production (diuresis) and decreased blood volume.
3.Blood pressure reduction:-
• The decrease in blood volume reduce the amount of pressure exerted on the blood vessels walls, leading
to a decrease in blood pressure.
# Indication:-
• Edema.
• Hypertension.
# Contraindications:-
• Hypersensitivity to thiazides or sulfonamides.
# Adverse effects::-
1.Assess:
• Weight, intake and output to deter- mine fluid loss.
• Rate, depth and rhythm of respiration.
• Blood pressure: Lying and standing.
• Electrolytes: Potassium, sodium and chloride.
• Blood sugar, BUN, CBC, serum creatinine, blood pH and ABGS.
• Glucose in urine, if patient is diabetic.

2.Administer:
• In morning to avoid interference with sleep.
• Potassium replacement, if serum potassium is less than 3.0 mEq/L.
• With food, if nausea occurs.
3.Evaluate:
• Improvement in edema.
• Improvement in central venous pressure (CVP).
• Signs of metabolic acidosis, drowsiness and restlessness.
• Signs of hypokalemia, postural hypo- tension, malaise, fatigue, tachycardia, leg cramps and weakness.
• Rashes and temperature elevation.
4.each patient/family:
• To increase fluid intake to 2-3 L/day unless contraindicated.
• To notify physician of muscle weak- ness, cramps, nausea and dizziness.
• Drug may be taken with food or milk.
• To take early in day to avoid nocturia.
TOCOLYTIC AGENTS :-
• Tocolytic drugs can inhibit uterine contractions and used to prolong the pregnancy.
• In women who develop premature uterine con- tractions in addition to putting them to absolute bedrest
and sedating, tocolytic drugs are administered in an attempt to inhibit uterine contractions.
# Commonly used drugs are :-
a) Isoxsuprine (Duvadilan).
b) Ritodrine hydrochloride (Yutopar).
c) Magnesium sulfate.

A] ISOXSUPRINE (DUVADILAN) :-
• Isoxsuprine is a medication that is sometimes used in obstetrics to help prevent preterm labor.
• It works by relaxing the muscle in the uterus, which can help to reduce frequency and intensity of
contraction.
• Isoxsuprine is not a first line treatment for preterm labor, and it is generally only used if other treatment
has not been successful.

# Contraindications:-
• Hypersensitivity.
• Postpartum.
# Dosage and route of administration:-
1.Initial:-
• Intravenous drip 100 mg in 5% dextrose. Rate 0.2 µg/min. To continue for at least 2 hours after the contractions
cease.
2. Maintenance:
• Intramuscular 10 mg 6 hourly for 24 hours, tablet 10 mg 6-8 hourly.
# Mechanism of action:-
1.Vasodilation:-
*Direct smooth muscle relaxation:-
• Isoxsuprine directly relaxes the smooth muscle cells in the walls of blood vessels, particularly those supplying
skeletal muscles. This relaxation leads to vasodilation increasing blood flow to the affected areas.
2.Uterine Relaxation:-
*Beta adrenergic receptor stimulation:-
• While the exact mechanism is still debated , isoxsuprine is through to stimulate beta adrenergic receptor,
which can contribute to vasodilation, especially in the uterine smooth muscle.
• Isoxsuprine stimulation of beta adrenergic receptors in the uterine muscle can lead to relaxation of the
smooth muscle.
• This relaxation can help reduce the frequency and intensity of uterine contraction, making it useful in
managing preterm labor.
# Indication:-
• Premature labor: while not a first line treatment, isoxsuprine may be used to help relax the uterus and reduce
contraction.
• Menstrual cramps.
• Arteriosclerosis obliterans.
• Cerebrovascular insufficiency.

# Adverse effects:-
• Hypotension, tachycardia, nausea, vomiting, pulmonary edema, cardiac arrhythmias, adult respiratory
distress syndrome, hyperglycemia, hypokalemia, lactic acidosis.
# Nursing Responsibility:-
1.Assess:
Pulse and BP during treatment.
• Take BP, lying and standing-orthostatic hypotension is common.
• Intensity and length of uterine con- tractions.
• Fetal heart tones (FHT).
2.Administer:
• With meals to reduce GI upset.
3.Perform/Provide:
• Storage at room temperature.
4.Evaluate:
• Therapeutic response.
• Reduced uterine contractions.
• Absence of preterm labor and Increased pulse volume.

• 4.Teach patient/family:
• To avoid hazardous activities until stabilized on medication, dizziness may occur.
• To make position changes slowly or fainting may occur.
To notify physician if rash, palpitations or severe flushing develops
B) RITODRINE HYDROCHLORIDE ( YUTOPAR) :-
• Ritodrine hydrochloride is a medication primarily used to prevent preterm labor.
• It belongs to a class of drugs called beta – adrenergic agonist, which work by relaxing the smooth muscles
in the uterus.
• This relaxation helps to reduce the frequency and intensity of contraction, giving the fetus more time to
develop.
#Dosage and route of administration:
1.Initial:
• Intravenous drip 100 mg in 5% dextrose. Rate, 0.1 mg/min gradually in- creased by 0.05 mg/min q10min
until desired response. To continue for at least 2 hours after the contractions cease.
2.Maintenance:
• Tablet 10 mg 6-8 hourly.
• Per os 10 mg given half an hour be- fore termination of IV, then 10 mg q2h x 24 hours, then 10-20 mg q4h
not to exceed 120 mg/day.
# Mechanism of action:-
1.Beta-adrenergic Receptors activation:-
• Ritodrine primarily targets beta -2 adrenergic receptors present in the uterine smooth muscle cells.
• When ritodrine binds to these receptors, it activates a signaling pathway
ANTICONVULSANT:-
• Anticonvulsant drugs, also known as antiseizure medications or antiepileltic drugs (AEDs) are used to
prevent or treat seizures.
• Seizures occur when there is an abnormal electrical discharge in the brain.
• AEDs works by stabilizing the electrical activity in the brain and preventing these abnormal discharge.
# Commonly used anticonvulsant drugs are:-
1.Megnesium sulfate.
2.Diazepam.
3.Phenytoin.
4.Phenobarbitone.
 # Dosage and route of administration:-
1.Magnesium sulfate-
• For control of seizures, 20 mL of 20% solution IV slowly in 3-4 minutes; to be followed immediately by 10 mL
of 50% solution IM, and continued 4 hourly till 24 hours postpartum. Repeat injections are given only if the
knee jerks are present, urine output exceeds 100 mL in previous 4 hours and the respirations are more than
10 minutes. The therapeutic level of serum magnesium is 4-7 mEq/L.
• 4 g intravenous slowly over 10 minutes, followed by 2 g/h and then 1 g/h in drip of 5% dextrose for tocolytic
effect.
*Diazepam:-
• Per os, 2-10 mg tid-qid.
• Intravenous, 5-20 mg (bolus), 2 mg/min, may repeat q5-10 minutes, not to exceed 60 mg, may repeat in 30
minutes, if seizures reappear.
*Phenytoin (Dilantin) :-
• Eclampsia: 10 mg/kg IV at the rate not more than 50 mg/min, followed 2 hours later by 5 mg/kg.
• Epilepsy: 300-400 mg daily orally in di- vided doses.
*Phenobarbital (Luminal) :-
• About 120-240 mg/day in divided doses.
 *Magnesium sulfate-
• For control of seizures, 20 mL of 20% solution IV slowly in 3-4 minutes; to be followed immediately by 10 mL
of 50% solution IM, and continued 4 hourly till 24 hours postpartum. Repeat injections are given only if the
knee jerks are present, urine output exceeds 100 mL in previous 4 hours and the respirations are more than
10 minutes. The therapeutic level of serum magnesium is 4-7 mEq/L.
• 4 g intravenous slowly over 10 minutes, followed by 2 g/h and then 1 g/h in drip of 5% dextrose for tocolytic
effect.

*Diazepam:-
Per os, 2-10 mg tid-qid.
Intravenous, 5-20 mg (bolus), 2 mg/min, may repeat q5-10 minutes, not to exceed 60 mg, may repeat in 30
minutes, if seizures reappear.
*Phenytoin (Dilantin) :-
• Eclampsia: 10 mg/kg IV at the rate not more than 50 mg/min, followed 2 hours later by 5 mg/kg.
• Epilepsy: 300-400 mg daily orally in di- vided doses.
*Phenobarbital (Luminal) :-
• About 120-240 mg/day in divided doses.
1.MAGNESIUM SULFATE:-
• Magnesium sulfate is a medications that contains magnesium, a minerals that is naturally
present in the body.
# Dosage and route of administration:-
• For control of seizures, 20 mL of 20% solution IV slowly in 3-4 minutes; to be followed
immediately by 10 mL of 50% solution IM, and continued 4 hourly till 24 hours postpartum.
Repeat injections are given only if the knee jerks are present, urine output exceeds 100 mL in
previous 4 hours and the respirations are more than 10 minutes. The therapeutic level of serum
magnesium is 4-7 mEq/L.
• 4 g intravenous slowly over 10 minutes, followed by 2 g/h and then 1 g/h in drip of 5% dextrose
for tocolytic effect.

# Indication:-
• It is a valuable drug lowering seizure threshold in
women with pregnancy-induced hypertension.
• The drug is used in preterm labor to decrease uterine
activity.
# Mechanism of action:-
1.Anticonvulsant:-
• Magnesium sulfate acts as central nervous system depressant, by blocking the transmission of nerve impulses.
• It interfere with the release of acetylcholine , a neurotransmitters involved in muscle contraction and nerve
signaling.
• By reducing neuronal excitability, magnesium sulfate help prevent the hyper excitability that can lead to seizure
in eclampsia.
2. Muscle relaxant:-
• Magnesium sulfate can relax smooth muscle including the uterus.
• This effect can help to stop preterm labor by reducing uterine contractions.
3.Neuroprotection :-
Reduction of inflammation: magnesium sulfate can decrease the production of inflammatory mediators, which
can damage the developing brain.
Antioxidants effects: It may help to protect neurons from oxidative stress, which can contribute to brain damage.
Calcium channel blocked: magnesium sulfate can block calcium channel, which may help to reduce
excitotoxicity, a process that can damage neurons.
# Contraindications:-
• Hypersensitivity to magnesium sulfate.
• Myocardial damage.
• Significant renal impairment.
• Hypocalcemia.
• Hypermagnesemia.
# Adverse effects:-
1.Maternal:-
• Severe CNS depression (respiratory depression and circulatory collapse, evidence of
muscular paresis ( diminished knee jerks).
2.Fetal:-
• Tachycardia.
• Hypoglycemia.
# Nursing Responsibility:-
1. Assess:
• Maternal and FHT during infusion.
• Intensity and length of uterine con- tractions.
• Fluid intake to prevent fluid overload, discontinue if this occurs.
2.Administer:
• Only clear solutions.
• After dilution 150 mg in 500 mL 5%.
• Dextrose in water (D5W) or normal saline (NS), give at 0.3 mg/mL
• Using infusion pumps or monitor carefully.
3.Perform/Provide- Positioning of patient in left lateral recumbent position to decrease hypo- tension
and increase renal blood flow.
4.Evaluate:
Therapeutic response
Decreased intensity
Length of contraction
Absence of preterm labor
Decreased BP.
4.Teach patient/family: To remain in bed during infusion.
# Contraindications:-
Hypersensitivity.
Eclampsia.
Hypertension.
Dysrhythmias.

# Adverse effects:-
• Hyperglycemia, headache, restlessness, sweating,
chills and drowsiness.
• Nausea, vomiting, anorexia and malaise.
• Altered maternal and FHT and palpitations.
• Contraindications.
# Nursing responsibility:-
1.Assess:
• Vital signs q15min after IV dose. Do not exceed 150 mg/min.
• Monitor magnesium level.
• If using during labor, time contractions, determine intensity.
• Urine output should remain 30 mL/h or more, if less notify physician.
• Uterine contractions when used as tocolytic agent.
• Reflexes-knee jerk, patellar reflex.
2.Administer:
• Only after calcium gluconate is avail- able for treating magnesium toxicity.
• Using infusion pump or monitor care- fully; IV at less than 150 mg/min circulatory collapse may occur.
Only dilutions.
3.Perform/Provide:
• Seizure precautions: Place client in single room with decreased stimuli, padded side rails.
• Positioning of client in left lateral recumbent position to decrease hypo- tension and increase renal blood flow.
4.Evaluate:
• Mental status, sensorium, memory.
• Respiratory status: Respiratory depression, rate and rhythm, hold drug if respirations are less
than 12 minutes.
• Hypermagnesemia: Depressed patellar reflex, flushing, confusion, weak- ness, flaccid
paralysis, dyspnea.
• Respiratory rate, rhythm and reflexes of newborn if drug was given within 24-hours prior to
delivery.
• Reflexes: Knee jerk and patellar reflex decrease with magnesium toxicity.
• Discontinue infusion if respiration are below 12 minutes, reflexes severely hypotonic, urine
output below 30 mL/h or in the event of mental confusion or lethargy, or fetal distress.
5. Teach client/family:
• On all aspects of the drug: Action, side effects and symptoms of hypermagnesemia.
• To remain in bed during infusion.
2.DIAZEPAM:-
• Diazepam also known by the brand name Valium, is a medication belonging to the
benzodiazepine class of drugs.
• Benzodiazepine work by enhancing the effects of a neurotransmitters call gamma
aminobutyric acid (GABA) in the central nervous system.
• GABA is an inhibitory neurotransmitters, meaning it helps to calm down the activity of
nerve cells.
# Dosage and route of administration:-
• Per os, 2-10 mg tid-qid.
• Intravenous, 5-20 mg (bolus), 2 mg/min, may repeat q5-10 minutes, not to exceed 60
mg, may repeat in 30 minutes, if seizures reappear.
# Mechanism of action:-
Diazepam binds to receptors on GABA -A receptors, which are found throughout the
central nervous system.
This binding increase the flow of chloride ions into neurons, which makes it harder for
them to fire.
This results in a claiming effect on the brain and nervous system.
The increased GABA activity produced by diazepam has a number of effects, including –
reduced anxiety, sedation, muscle relaxation, anticonvulsant effects ( seizures
prevention).
# Indication:-
• Anxiety disorder.

• Muscle spasms.
• Seizures.
• Alcohol withdrawal.
• Insomnia.
• Eclampsia and preeclampsia.
• Tocolysis (relaxation of the uterus).
#Contraindications:-
• Hypersensitivity.
• Acute narrow-angle glaucoma.
• Severe respiratory insufficiency.
• Myasthenia gravid.
• Pregnancy and breastfeeding.
• Substance abuse.
# Adverse effects:-
• Mother: Hypotension, dizziness, drowsiness, headache.
• Fetus: Respiratory depressant effect, which may last for even 3 weeks after birth, hypotonea and
thermoregulatory problems in newborn.
# Nursing Responsibility:-
1.Assess:
• Blood pressure in lying and standing positions; if systolic pressure falls 20 mm Hg, hold drug and inform
physician.
• Blood studies: CBC.
• Hepatic studies.
2.Administer:
• Intravenous into large vein to de- crease chances of extravasation.
• Per os with milk or food to avoid Gl symptoms.
3.Provide:
• Assistance with ambulation during beginning therapy since drowsiness and dizziness may occur.
• Safety measures include side rails.
4.Evaluate:
• Therapeutic response.
• Mental status, sensorium, sleeping pattern.
• Physical dependence, headache, nausea, vomiting.
5.Teach patient/family:
• Drug may be taken with food.
• To avoid alcohol ingestion.
• Not to abruptly discontinue medication.
• To rise slowly as fainting may occur.
ANTICOAGULANTS:-
• Anticoagulants drugs also known as blood thinners,
are medications that prevent blood clots from
forming.
• They work by either preventing new clots from
forming or helping the body break down existing
clots.
# Anticoagulants drugs includes:
Heparin sodium.
Warfarin sodium ( Coumadin).

HEPARIN SODIUM:-
Heparin sodium is a type of anticoagulant
medications, also known as blood thinners.
Heparin sodium work by increasing the activity of
antithrombin , a protein in the blood that helps
prevent blood clotting.
# Dosage and route of
administration:-
• Administered parenterally; only
5,000- 7,000 IU to be
administered initially as IV push,
followed by 2,500 units
subcutaneously every 24 hours.
# Mechanism of action:-
1.Binding to antithrombin -3:
• Heparin sodium binds to a specific
pentasaccharide (a chain of five
sugar molecules) sequence on
antithrombin-3 .
• This binding induces a
conformational change in
antithrombin -3 , activating it. #
Indication:-
A) WARFARIN SODIUM (COUMADIN) :-
• Warfarin sodium is an anticoagulants medications, commonly known by the brand name coumadin.
• It works by interfering with vitamin k's role in blood clotting, making it more difficult for blood to clot.

# Dosage and route of administration:-

• Orally 10-15 mg daily for 2 days followed by 2-10 mg at the same time each day de- pending upon the
prothrombin time.
# Mechanism of action:-

• warfarin sodium acts as an anticoagulant by

inhibiting the vitamin k cycle, thereby
reducing the production of vitamin k
dependent clotting factors.

1.Vitamin k and blood clotting:-

• Vitamin k is essential for the synthesis of

several proteins involved in blood clotting
including factors II, VII, IX and X.
• These proteins require a specific
modifications called gamma- carboxylation to
become active. This modifications is
dependent on vitamin k.
2.Warfarin’s inhibitions of vitamin k cycle:-
• Warfarin interfere with the recycling of vitamin k in the liver.
• Specifically, it inhibits an enzyme called vitamin k epoxide
reductase, which is responsible for converting inactive
vitamin k epoxide back into its active from (vitamin k
hydroquinone).
• This disruption in the vitamin k cycle leads to a decrease in
the availability of active vitamin k.
3.Reduced clotting factor synthesis:-
With less active vitamin k available, the synthesis of vitamin k
dependent clotting factors is impaired.
As a result, the levels of these factors in the blood decrease,
leading to a reduced ability of the blood to clot.
4.Anticoagulant effects:-
• The overall effect of warfarin is to slow down blood clotting
thereby reducing the risk of blood clots forming in conditions
like arterial fibrillation, deep vein thrombosis or pulmonary
embolism.
# Indication:-
• Deep vein thrombosis, thromboembolism,
disseminated intravascular coagulation,
patients with prosthetic valves in the heart.

# Contraindications:-
• Active bleeding.
• Recent surgery.
• Severe uncontrolled hypertension.
• Severe thrombocytopenia ( low platelets
count)
• Hypersensitivity to heparin.

# Adverse effects:-
• Leukopenia, thrombocytopenia, osteoporosis,
hemorrhage, alopecia.
# Nursing responsibility:-
1.Assess:
• Blood studies: Hematocrit, platelets, occult blood in feces.
• Partial prothrombin time.
• Blood pressure: Signs of hypertension.
2.Administer:
At same time, each day to maintain steady blood levels.
Avoid all IM injections that may cause bleeding.
3.Evaluate:
Therapeutic response: Decrease of deep vein thrombosis.
Bleeding gums, petechiae, ecchymosis, black tarry feces, hematuria.
Fever, skin rash, urticaria.
4.Teach patient/family:
• To avoid use of drugs unless pre- scribed by physician.
• To use soft-bristled toothbrush to avoid bleeding gums.
• To comply with instructions.
• To recognize and to sign of bleeding- gums, under skin, urine, feces.
# Dosage and route of administration:-
• Administered parenterally; only 5,000- 7,000 IU to be administered initially as IV push,
followed by 2,500 units subcutaneously every 24 hours.
# Mechanism of action:-
1.Binding to antithrombin -3:
• Heparin sodium binds to a specific pentasaccharide (a chain of five sugar molecules)
sequence on antithrombin-3 .
• This binding induces a conformational change in antithrombin -3 , activating it.
# Indication:-
• Deep vein thrombosis, thromboembolism, disseminated intravascular coagulation, patients
with prosthetic valves in the heart.
# Contraindications:-
• Active bleeding.
• Recent surgery.
• Severe uncontrolled hypertension.
• Severe thrombocytopenia ( low platelets count)
• Hypersensitivity to heparin.
# Adverse effects:-
• Leukopenia, thrombocytopenia, osteoporosis, hemorrhage, alopecia.
# Nursing responsibility:-
1.Assess:
• Blood studies: Hematocrit, platelets, occult blood in feces.
• Partial prothrombin time.
• Blood pressure: Signs of hypertension.
2.Administer:
• At same time, each day to maintain steady blood levels.
• Avoid all IM injections that may cause bleeding.
3.Evaluate:
• Therapeutic response: Decrease of deep vein thrombosis.
• Bleeding gums, petechiae, ecchymosis, black tarry feces, hematuria.
• Fever, skin rash, urticaria.
4.each patient/family:
• To avoid use of drugs unless pre- scribed by physician.
• To use soft-bristled toothbrush to avoid bleeding gums.
• To comply with instructions.
• To recognize and to sign of bleeding- gums, under skin, urine, feces.
# Indication:-
• Deep vein thrombosis.
• Pulmonary embolism.
• Atrial fibrillation.
• Myocardial infractions.

# Contraindications:-
• Active bleeding.
• Recent major surgery.
• Severe liver disease.
• Pregnancy.
• Breastfeeding.
• Hypersensitivity.
# Adverse effects:-
*Maternal:- Hemorrhage.
*Fetal:- skeletal and facial deformities, optic atrophy, microcephaly.
# Nursing responsibility:-
1.Assess:
• Blood studies:- hematocrit, platelets, occult blood in feces.
• Prothrombin time.
• Blood pressure:- watch for signs of hypertension.
2.Administer:-
• At same time each day to maintain steady blood levels.
• Alone do not give with food.
• Avoid all I’M injection that may cause bleeding.
3.Evaluate:-
• Therapeutic response:- Decrease of deep vein thrombosis.
• Bleeding gums, Petechiae, ecchymosis, black tarry feces, hematuria.
• Fever, skin rash, urticaria.
4.Teach patient/ family:-
• To avoid OTC preparation unless prescribed by physician.
• Drug may be held during menstruation.
• To use soft bristled tooth brush.
• Stress client compliance.
 ANALGESICS:-
• Analgesic are medications used to relieve pain.
• They work by either reducing inflammation at the source of the pain or by changing the way the brain
perceive pain.
# Analgesic drugs includes :--
A) Pethidine (Meperidine).
B) Fentanyl.
C) Promethazine (Phenergan).
# Dosage and route of administration:-
• Pethidine:- Injectable preparation contains 50 mg/ mL, can be administered subcutaneous (SC), IM, IV. Its
dose is 50-100 mg IM combined with promethazine 25 mg.
• Fentanyl :- Intramuscular: 0.05-0.1 mg q 1-2 hours as needed (prn), available in injectable form, 0.05
mg/mL.
• Promethazine :- Available for oral use as 12.5 mg, 24 mg and 50 mg tablets and for parenteral use as 25-
50 mg/mL solutions. The dose is 25 mg, 8 hourly orally and 25 mg intramuscularly to be repeated as
necessary.
PETHIDINE (MEPERIDINE) :-
• Pethidine is synthetic narcotic analgesic agent, well absorbed
by all routes of administration.
• Pethidine also known as meperidine and sold under brand
name demerol.

# Dosage and route of administration:-

• Injectable preparation contains 50 mg/ mL, can be
administered subcutaneous (SC), IM, IV. Its dose is 50-100 mg
IM combined with promethazine 25 mg.
# Indications:-
Moderate to severe pain in labor.
Postoperative pain.
Abruption placenta.
Pulmonary edema.
# Mechanism of action:-
• Pethidine works in a similar way
to other opioids pain
medications, by binding to
opioid receptors in the central
nervous system.
• This binding can prevent the
release of neurotransmitters that
are involved in the transmission
of pain signals.
• Pethidine also has a local
anesthesia effects, which may
contribute to it’s pain relieving
properties.
 # Contraindications:-
Pethidine should not be used intravenously within 2 hours and intramuscularly within 3 hours of the
expected time of delivery of the baby for fear of birth asphyxia.
It should not be used in cases of preterm labor and when the respiratory reserve of the mother is reduced.
# Adverse effects:-
1.Mother:
• Drowsiness, dizziness, confusion, headache, sedation, euphoria, nausea and vomiting.
2.Fetus:
• Respiratory depression, asphyxia.
# Nursing responsibility:-
1.Assess:
• Urinary output: May cause urinary retention.
2.Administer:
• With antiemetic (promethazine) to prevent nausea and vomiting.
• When pain is beginning to return- determine dosage interval by patient response.
3.Perform/Provide:
• Storage in light-resistant container at room temperature.
• Assistance with ambulation.
• Safety measures: Side rails, night light, call bell within easy reach.
4.Evaluate:
• Therapeutic response: Decrease in pain.
• Changes in CNS: Dizziness, drowsiness, euphoria.
• Allergic reactions: Rash, urticaria.
• Respiratory depression, notify physician if respirations are less than 12 minutes.
5.Teach patient/family:
• To report symptoms of CNS changes, allergic reactions.
FENTANYL:-
• Fentanyl is a synthetic narcotic analgesic.
• Fentanyl is commonly used to treat moderate to severe pain, especially who have developed tolerance
to other opioids.
# Dosage and route of administration:-
Intramuscular: 0.05-0.1 mg q 1-2 hours as needed (prn), available in injectable form, 0.05 mg/mL.
# Mechanism of action:-
Fentanyl is a potent synthetic opioid analgesic that binds to opioid receptors in the central nervous system
(CNS), primarily the mu (μ) receptors.
This binding activates a cascade of events that ultimately inhibit the transmission of pain signals.

1.Binding to Opioid Receptors:

Fentanyl binds to µ-opioid receptors in
the spinal cord and brain.
2. Inhibition of Neurotransmitter
Release:
• This binding activates G-protein-
coupled receptors, which leads to the
inhibition of the release of
neurotransmitters, such as substance
P and glutamate, that are involved in
the transmission of pain signals.
3.ltered Pain Perception:
• The inhibition of neurotransmitter
release results in a decrease in the
perception of pain.
4.Other Effects:
• In addition to its analgesic effects, fentanyl can also cause other effects, such as
sedation, euphoria, and respiratory depression.
# Indication:-
• Moderate to severe pain in labor, postoperative pain and as adjunct to general
an- esthetic.
# Contraindications:-
• Hypersensitivity to opiates.
# Adverse effects:-
• Dizziness.
• Delirium.
• Euphoria.
• Nausea.
• Vomiting.
• Muscle rigidity.
• Blurred vision.
# Nursing responsibility:-
1.Assess:
Vital signs.
Note muscle rigidity.
2.Administer:
By injection (IM or IV), give slowly to prevent rigidity.
Only with resuscitative equipment available.

3.Perform/Provide:
• Storage in light-resistant container at room temperature.
• Coughing, turning and deep breathing for postoperative patients.
• Safety measures: Side rails, night light, call bell within reach.
4.Evaluate:
Changes in CNS: Dizziness, drowsiness, hallucination, euphoria, level of consciousness (LOC), pupil
reaction.
Allergic reaction: Rash, urticaria.
Respiratory dysfunction, respiratory depression: Notify physician if respirations are more than 12
minutes.
5.each patient/family:
• To report any symptoms of CNS changes, allergic reactions.
ANAESTHESIA:-
• Anesthetic drugs, also known as anesthetics, are substances that cause a loss of feeling or
awareness.
• They are used in a variety of medical procedures, including tests, surgeries, and childbirth.
# There are three types of anesthetics:
1.Local anesthetics:
These drugs cause a loss of feeling in a small area of the body, such as a tooth or a small wound.
The patient remains awake and alert during local anesthesia.
2.Regional anesthetics:
These drugs cause a loss of feeling in a larger part of the body, such as an arm, leg, or everything
below the waist.
The patient may be awake or given sedation.
General anesthetics
These drugs cause a loss of feeling and a complete loss of
awareness, similar to a deep sleep.
General anesthetics can be administered by injection, inhalation,
or a combination of both.
# commonly used anesthetic drug are:-
1.Lignocaine.
2.Bupivacaine.
1. LIGNOCAINE
• Lidocaine, also known by the brand name Xylocaine, is a local
anesthetic that prevents pain by blocking nerve endings in the
skin.
• It’s used in many medical specialties and can be administered
via injection, inhalation, or topically.
# Dosage and route of administration:-
Lignocaine:- 7mg/kg onset – rapid / duration (min) -60-90 min.
# Mechanism of action:-
Lignocaine is a local anesthetic commonly
used in obstetrics and gynecology
(OBGYN).
Its mechanism of action involves temporarily
blocking the transmission of nerve
impulses, thereby providing pain relief.
1.Nerve Blockade:
Lignocaine works by binding to sodium channels in the nerve cell membrane. These channels
are responsible for the influx of sodium ions, which is essential for the propagation of nerve
impulses.
2.Inhibition of Nerve Impulses:
• By binding to the sodium channels, lignocaine prevents them from opening.
• This blocks the influx of sodium ions, preventing the nerve cell from depolarizing and
generating an action potential.
• As a result, the nerve impulse is unable to travel along the nerve fiber, leading to a loss of
sensation in the affected area.
3.Reversible Effect:
The effect of lignocaine is typically reversible. Once the drug concentration at the nerve site
decreases, the sodium channels can resume their normal function, and nerve conduction is
restored.
# Indication:-
Epidural anesthesia: Lignocaine can be used as part of an epidural anesthetic mixture
to provide pain relief during labor and delivery.
Paracervical block: This involves injecting lignocaine around the cervix to provide pain
relief during labor and delivery.
Local infiltration: Lignocaine can be injected directly into the tissues to provide local
anesthesia for minor procedures, such as suturing lacerations or performing
biopsies.
Episiotomy and perineal repair: Lidocaine is injected into the perineum to numb the
area before an episiotomy is performed or to repair a tear after vaginal delivery.
Local anesthesia: Lidocaine blocks nerve signals, causing numbness in a specific
area of the body. This is used for a variety of medical procedures, such as:
• Minor surgeries
• Dental procedures
•Skin biopsies
• Pain management
# Contraindications:-.
• Known hypersensitivity: Lidocaine should not be used in patients with a known allergy or hypersensitivity to
lidocaine or other amide-type local anesthetics.
• Severe hypotension and hypovolemia: Using lidocaine in patients with severe hypotension or hypovolemia can
worsen their condition.
• Paracervical block: While lidocaine is sometimes used in paracervical blocks, it is important to note that this
procedure can cause fetal bradycardia and should be performed with caution.
• Caution in certain conditions: Lidocaine should be used with caution in patients with liver disease, epilepsy,
impaired cardiovascular function, and respiratory impairment.
# Adverse effects:-
• Maternal toxicity: High doses or accidental intravenous injection of lidocaine can cause serious side effects in
the mother, including hypotension, bradycardia, arrhythmias, seizures, and cardiac arrest.
• Fetal toxicity: While lidocaine crosses the

• Placenta, the amount that reaches the fetus is usually minimal and does not cause significant harm. However,
in rare cases, high doses can lead to fetal bradycardia, acidosis, and hypoxia.
• Neonatal toxicity: Neonates born to mothers who have received lidocaine may experience transient
neurological effects such as tremors, jitteriness, and hypotonia.
# Nursing responsibility:-
1.Assessment:-
Patient history: Gather information about the patient’s allergies, medications, and medical conditions.
Vital signs: Monitor the patient’s blood pressure, heart rate, respiratory rate, and oxygen saturation before and
after the injection.
Injection site: Choose an appropriate injection site based on the intended use of the lignocaine.
2.Preparation:
• Gather equipment: Prepare the necessary supplies, including the lignocaine vial, syringe, alcohol swabs,
gloves, and a sharps container.
• Calculate dosage: Ensure the correct dosage is calculated and double-checked by another qualified
healthcare professional.
• Prepare medication: Draw up the medication aseptically into the syringe.
3.Administration:
Hand hygiene: Wash hands thoroughly with soap and water or use hand sanitizer.
Wear gloves: Put on clean gloves.
Clean injection site: Clean the injection site with an alcohol swab.
Inject medication: Inject the lignocaine slowly and smoothly at the prescribed rate.
Observe patient: Monitor the patient for any adverse reactions, such as dizziness, lightheadedness, or allergic
reactions.
4.Post-injection care:
• Dispose of supplies: Dispose of needles and other sharps in a designated sharps container.
• Document: Document the administration of the lignocaine injection, including the date, time,
dosage, route of administration, and patient’s response.
• Monitor patient: Continue to monitor the patient’s vital signs and overall condition.
5.Patient education:
Inform patient: Inform the patient about potential side effects of lignocaine and what to do if they
experience any adverse reactions.

• Provide instructions: Provide the patient with any necessary post-injection instructions, such as
avoiding strenuous activity or applying ice to the injection site.
2.BUPIVACAINE:-
• Bupivacaine is a commonly used local anesthetic in obstetrics, primarily for epidural analgesia during
labor and delivery.
# Dosage and route of administration:-
• Bupivacaine: 3mg/kg /onset- slow / duration- 90-150 min.
# Mechanism of action:-
• Bupivacaine’s mechanism of action in obstetrics revolves
around its ability to block nerve impulses, preventing the
transmission of pain signals from the uterus and birth canal to
the brain.
1.Sodium Channel Blockade:
• Bupivacaine, like other local anesthetics, primarily works by
interacting with voltage-gated sodium channels in the nerve
cell membranes.
• These sodium channels are crucial for the generation and
propagation of nerve impulses. When a nerve cell is
stimulated, sodium ions rush into the cell through these
channels, causing a rapid change in electrical charge
(depolarization).
• Bupivacaine molecules bind to specific receptor sites within
the sodium channels, effectively blocking the influx of sodium
ions.
2.Prevention of Action Potential: with the influx of sodium ions
inhibited, the nerve cell cannot reach the threshold for generating
an action potential.
• The action potential is the electrical signal that travels along the nerve fiber, transmitting the
sensation of pain to the brain.
• By preventing the action potential, bupivacaine interrupts the pain pathway.
3. Sensory and Motor Block:
• Bupivacaine can block both sensory and motor nerves.
• Sensory nerves transmit sensations like pain, temperature, and touch.
• Motor nerves control muscle movement.
• In obstetric epidurals, the goal is to primarily block sensory nerves while minimizing motor
block to allow the mother to actively participate in the birthing process.
4.Reversible Effect:
• The binding of bupivacaine to sodium channels is reversible.
• As the local anesthetic concentration decreases at the nerve site, the drug molecules
gradually unbind from the channels, allowing nerve function to return.
# Indication:-
• Epidural anesthesia for labor and delivery: Bupivacaine is a popular choice for epidural anesthesia during
labor as it provides effective pain relief with a relatively long duration of action. It can be used as a continuous
infusion or given as bolus doses as needed.
• Cesarean section: Bupivacaine can be used for spinal or epidural anesthesia during cesarean sections.
• Postoperative pain management: Bupivacaine can be used as part of a multimodal pain management
approach after cesarean section to help manage pain and improve recovery.
# Contraindications:-
• Hypersensitivity: Bupivacaine is contraindicated in patients with a known hypersensitivity to it or to other local
anesthetics of the amide type.
• Obstetrical paracervical block: This technique has been associated with fetal bradycardia and death, making
bupivacaine contraindicated for this use.
• High concentrations (0.75%): Higher concentrations of bupivacaine are not recommended for obstetrical
anesthesia due to an increased risk of serious side effects.
• Sepsis: Bupivacaine should be used with caution in patients with sepsis due to the potential for increased risk
of cardiovascular side effects.
• Hypovolemia: Patients with hypovolemia (low blood volume) may be more susceptible to the hypotensive
effects of bupivacaine.
# Adverse effects:-
• Hypotension: Bupivacaine can cause a significant drop in blood
pressure, especially when used for epidural anesthesia.
• Fetal heart rate changes: Bupivacaine can slow down the fetal heart
rate. Continuous fetal monitoring is essential during its use.
• Nausea and vomiting: These are common side effects of epidural
anesthesia in general.
• Shivering and chills: These are often experienced after the epidural
wears off.
• Back pain: This can occur at the epidural site.
• Urinary retention: Bupivacaine can temporarily make it difficult to
urinate.
• Cardiotoxicity: In rare cases, bupivacaine can cause serious heart
problems, including heart block and cardiac arrest.
• Neurotoxicity: High doses or accidental intravenous injection can lead
to seiz1.
• Respiratory depression: Bupivacaine can depress breathing,
especially when used in combination with other medications.
• Allergic reactions: Although rare, allergic reactions to bupivacaine can
occur.
# Nursing responsibility :-
1.Patient Assessment:
• Obtain a thorough medical history, including allergies, medications, and any contraindications to
regional anesthesia.
• Assess the patient’s understanding of the procedure and obtain informed consent.
• Monitor vital signs (blood pressure, heart rate, respiratory rate, temperature, oxygen saturation) and
fetal heart rate (FHR) before, during, and after administration.
• Assess the patient’s level of pain and response to the medication.
2. Medication Preparation and Administration:
• Ensure the correct medication, dosage, and concentration are prepared and labeled according to
hospital protocol.
• Assist the anesthesiologist with the administration of the epidural or spinal block.
• Monitor the patient closely for signs of local anesthetic toxicity, such as numbness, tingling, dizziness,
or seizures.
3.Post-Procedure Care:
• Continue to monitor vital signs and FHR.
• Assess the patient’s level of pain and response to the medication.
• Monitor the patient for any side effects, such as hypotension, nausea, vomiting, or urinary retention.
• Assist the patient with ambulation and positioning as needed.
• Educate the patient about potential side effects and the importance of reporting any concerns to the
healthcare provider.
4.Documentation:
• Document all relevant information, including the type and dose of medication administered, the time
of administration, the patient’s response to the medication, and any adverse events.
5.Safety Measures:
• Ensure that emergency equipment, such as resuscitation drugs and equipment, is readily available.
• Monitor the patient closely for any signs of complications and intervene promptly as needed.
• Adhere to all hospital policies and procedures related to the use of regional anesthesia.