Class: Penicillin; antibiotic

Action: Inhibits cell wall synthesis in susceptible microorganisims; bactericidal

Uses: Tx of susceptible infections d/t streptococci, S. pneumoniae, staphylococci, meningococci, Listeria, Klebsiella, E. coli, H. influenzae, Salmonella, Shigella

Dosage: po: adults 250-500mg, children 50-100mg/kg/day

IV, IM: adults 500mg-3g q4-6h, children 100-400mg/kg/day divided doses q6h, neonates 50-100 mg/kg/day divided doses q6-12h

Considerations: crosses placenta, appears in cord blood and amniotic fluid, distributed in breast milk in low concentrations; may lead to allergic sensitization, diarrhea, candidiasis, skin rash in infant, immature renal function in neonates/young infants

Side Effects: Pain at IM injection site, GI disturbances, oral or vaginal candidiasis

Adverse Effects: antibiotic associated colitis, hypersensitivity rx (anaphylaxis)

Class: Tricyclic glycopeptide antibiotic

Action: binds to bacterial cell walls altering cell membrane permeability, inhibiting RNA synthesis; Bactericidal

Uses: Tx of infections caused by staphylococcal, streptococcal spp.

Dosage: IV: 5mg/ml over 60 min or longer po: adults 10-19mg/kg/dose, child > 1mo 40mg/kg/day, neonates 15mg/kg/day

Considerations: crosses placenta

Side Effects: bitter/unpleasant taste, nausea, vomiting, mouth irritation; IV phlebitis, thrombophlebitis, pain at periph IV site, dizziness, vertigo, tinnitus, chills, fever, rash

Adverse Effects: nephrotoxicity, ototoxicity, RNS, cardiovascular toxicity 

Duramorph

(morphine)

Class: Narcotic agonist; opiate analgesic

Action: Binds with opioid receptors within CNS; alters pain perception, emotional response to pain

Uses: relief of moderate-severe, acute, or chronic pain; analgesia during labor

Precautions: acute or severe asthma, GI obstruction, paralytic ileus, severe hepatic/renal impair. severe respiratory depression

Considerations: crosses placenta, distributed in breast milk, may prolong labor if administered in latent phase of first stage of labor or before cervical dilation of 4-5cm, resp. depression may occur in neonate

Dosage: IV 0.1-1 mg/ml in D5W, administer very slowly

Side Effects: sedation, decreased BP, diaphoresis, facial flushing, constipation, dizziness, drowsiness, nausea, vomiting; overdose results in resp. depression, skeletal muscle flaccidity, cold clammy skin, cyanosis, extreme drowsiness progressing to seizures, stupor, coma

Class: Exogenous insulin; antidiabetic

Action: facilitates passage of glucose, potassium, magnesium across cellular membranes, controls storage and metabolism of carbs, protein, fats, promotes conversion of glucose to glycogen in liver; controls glucose levels in diabetic pts

Uses: tx of insulin-dependent type 1 diabetes mellitus

Considerations: insulin is drug of choice for diabetes in pregnancy but must be closely monitored, not distributed in breast milk, lactation may decrease insulin requirements

Dosage: adjusted to achieve premeal and bedtime serum glucose of 80-140mg/dl (children < 5yrs, 100-200mg/dl); Rapid acting (Aspart (Novolog)), Short acting (Regular (Humulin R)), Intermediate acting (NPH (Humulin N)), Long acting (Detemir (Levemir), Glargine (Lantus))

Adverse Effects: severe hypglycemia may occur with insulin overdose, decrease/delay of food intake, excessive exercise

naloxone 

(Narcan)

Class: narcotic antagonist; antidote

Action: displaces opioids at opioid-occupied receptor sites in CNS; reverses opioid-induced sleep/sedation, increases RR, raises BP to normal

Uses: complete or partial reversal of opioid depression including resp. depression

Dosage: IV push 0.4 mg/ml over 15 sec, adults also 1mg/ml inkection, neonates 0.02mg/ml

Adverse Effects: too rapid reversal may result in nausea, vomiting, tremors, increased BP, tachycardia

Class: anesthetic

Action: anesthetic that blocks nerve impulses that send pain signals to brain

Usage: local anesthetic for spinal block

Dosage: 12 mg injection

Side Effects: weak or shallow breathing, fast heart rate, slow heart rate, restless or anxious, probs with urination, nausea, vomiting, headache, back pain, dizziness

Considerations: distributed in breast milk

Class: opioid, narcotic agonist; analgesic

Action: binds to opioid receptors in CNS, reducing stimuli from sensory nerve endings, inhibits ascending pain pathways; alters pain reception, increases pain threshold

Uses: sedation, pain relief, preop medication, adjunct to general or regional anesthesia

Dosage: IM/IV adullts 50-100 mcg/dose (acute pain management, preop sedation)

IV adults 2-50mcg/kg (adjunct to general anesthesia)

Side effects: postop drowsiness, nausea, vomiting

Adverse Effects: overdose or too rapid IV admin. produces severe resp. depression, skeletal/thoracic muscle rigidity

Consideration: readily crosses placenta, may prolong labor or cause resp. depression in neonate if mother receives it during labor

carboprost tromethamine

(Hemabate)

Class: oxytocic, abortifacient, antihemorrhagic 

Action: acts on myometrium stimulating myometrial contractions to cause abortion

Usage: aborting midtrimester ans second trimester pregnancy; induction of labor in cases of intrauterine fetal death;  tx of postpartum hemorrhage to reduce blood loss and correct uterine atony

Dosage: intra-amniotic: 5 mg, intramuscular: 6-12 mg, antihemorrhagic: 2 mg

Side Effects: anaphylaxis, bradycardia, bronchoconstriction, hypertension, ileus adynamic, increased uterine pain accompanying abortion, inflammation and pain at injection site

furosemide 

(Lasix)

Class: loop; diuretic

action: enhances secretion of sodium, chloride, potassium by direct action at ascending limb of loop of Henle; produces diuresis, lowers BP

Usage: tx of edema associated with CHf, chronic renal failure, hepatic cirrhosis, acute pulmonary edema, tx of hypertension

Dosage: Injection: 10mg/ml, Oral Sol: 10mg/ml, 20mg/5ml, Tabl: 20mg, 40mg, 80mg

Side Effects: increased urinary frequency/volume, nausea, dyspepsia, abdominal cramps, diarrhea or constipation, electrolyte disturbances

considerations: crosses placenta, distributed in breast milk