Policies Administration of Life-Saving Medications pursuant to A.O No.

2010-0014

Drug Indication Mecha Dose/Route Who What to Monitor

nism of will
Action adminis
ter
Oxytocin If heavy To Available Trained Continuously monitor contractions, fetal and maternal
postpartum induce Forms: nurse or heartrate, and maternal blood pressure and ECG.
bleeding or 10 units/ml in1ml midwives Discontinue infusion if uterine hyperactivity occurs.
stimulat ampule on Monitor patient extremely closely during first and second
e labor Initial Dose: BEmONC stages of labor because of risk of cervical laceration, uterine
IM/IV: 10 IU rupture and maternal and fetal death.
Continuing Assess fluid intake and output. Watch for signs and
Dose: symptoms of water intoxication
IM/IV: repeat 10 IU Observe the 10 rights of drug administration.
after 20 minutes if Do proper documentation
heavy bleeding
persist
Maximum Dose:
Not more than 3L
of IV fluids
containing
oxytocin
Ergometri If heavy bleeding Postpart Initial Dose: Trained This drug should be used extremely carefully because of its
ne in early um IM/IV: 0.2 mg nurse or potent vasoconstrictor action.
pregnancy or hemorrh slowly midwives I.V. use may induce sudden hypertension and
post-partum age and on cerebrovascular accidents. As a last resort, give I.V. slowly
bleeding (after uterine Continuing BEmONC over several minutes and monitor blood pressure closely
oxytocin) but DO atony, Dose: Observe the 10 rights of drug administration.
NOT give if subinvol IM: repeat 0.2 mg Do proper documentation
eclampsia, pre- ution IM after 15
eclampsia, minutes after
hypertension or heavy bleeding
retained persist
placenta
(placenta no Maximum Dose:
delivered) Not more than 5
 doses (total
1.0mg)
Magnesiu If severe pre- IV or IM: IV/IM combined Trained Before giving the next dose of MgSO4 ensure the following:
m Sulfate eclampsia and pre- dose (loading nurse or knee jerk is present, urine output >100ml/4hours,
eclampsia. eclamps dose) midwives respiratory rate >16/min.
ia or Insert IV line and on
eclamps give fluids slowly BEmONC Do not give the next dose if any of these signs: knee jerk
ia (normal saline or absent, urine output <100ml.4 hours, respiratory rate
Ringers lactate) <16/min.
To 1 litre in 6-8 hours
correct (3 ml/minute) Observe the 10 rights of drug administration.
or Give 4 g of
prevent magnesium Do proper documentation
hypoma sulphate (20 ml of
gnesemi 20% solution) IV
a in slowly over 20
patients minutes (woman
or may feel warm
parente during injection).
ral AND:
nutrition Give 10 g of
magnesium
sulphate IM: give
5 g (10 ml of 50%
solution) IM deep
in upper outer
quadrant of each
buttock with 1 ml
of 2% lignocaine
in the same
syringe.
If unable to give
IV, give IM only
(loading dose)
Give 10 g of
magnesium
sulphate IM: give
5 g (10 ml of 50%
solution) IM deep
in upper outer
quadrant of each
buttock with 1 ml
of 2% lignocaine
in the same
syringe.
If convulsions
recur
After 15 minutes,
give an additional
2 g of magnesium
sulphate (10 ml of
20% solution) IV
over 20 minutes.
If convulsions still
continue, give
diazepam
If referral delayed
for long, or the
woman is in late
labour, continue
treatment:
Give 5 g of 50%
magnesium
sulphate solution
IM with 1 ml of 2%
lignocaine every 4
hours in alternate
buttocks until 24
hours after birth
or after last
convulsion
(whichever is
later).
Diazepam If convulsions Depress Loading dose IV Trained Monitor BP, PR, RR prior to periodically throughout therapy
occur in early the Give diazepam 10 nurse or and frequently during IV therapy.
pregnancy or CNS, mg IV slowly over midwives Assess IV site frequently during administration, diazepam
probabl 2 minutes. on may cause phlebitis and venous thrombosis.
If magnesium y by If convulsions BEmONC Prolonged high-dose therapy may lead to psychological or
sulphate toxicity potentia recur, repeat 10 physical dependence. Restrict amount of drug available to
occurs or ting mg. patient.
magnesium GABA, Observe and record intensity, duration and location of
sulphate is not an Maintenance seizure activity. The initial dose of diazepam offers seizure
available. inhibitor dose control for 15-20 min after administration.
y Give diazepam 40 IM injections are painful and erratically absorbed. If IM route
neurotr mg in 500 ml IV is used, inject deeply into deltoid muscle for maximum
ansmitt fluids (normal absorption.
er. saline or Ringers Caution patient to avoid taking alcohol or other CNS
Produce lactate) titrated depressants concurrently with this medication.
s over 6-8 hours Effectiveness of therapy can be demonstrated by decrease
skeletal to keep the
anxiety level; control of seizures; decreased tremulousness.
muscle woman sedated
Observe the 10 rights of drug administration.
relaxati but rousable.
Do proper documentation
on by
inhibitin Loading dose
g spinal rectally
polysyn Give 20 mg (4 ml)
aptic in a 10 ml syringe
afferent (or urinary
pathwa catheter)
ys. If convulsions
Has recur, repeat 10
anticon mg.
vulsant
properti Maintenance
es due dose
to Give additional 10
enhanc mg (2 ml) every
ed hour during
presyna transport.
ptic
 inhibitio
n.

Therap
eutic
effects:
(1)
Relief of
Anxiety
(2)
Sedatio
n
(3)
Amnesi
a
(4)
Skeletal
muscle
relaxant
(5)
Decreas
ed
seizure
activity
Hydralazin General Acts If diastolic Trained Before
e Indications directly blood pressure nurse or Check blood pressure.
Hypertension on is > 110 mmHg: midwives Assess for contraindicated conditions.
Eclampsia vascular Give hydralazine on Observe the 10 rights of drug administration.
smooth 5 mg IV slowly (3- BEmONC Assess bowel sounds.
muscle 4 minutes). If IV Assess voiding pattern.
to cause not possible give
vasodila IM. During
tion, Give oral drug with food.
primaril If diastolic blood Use parenteral drug immediately after opening ampule.
y pressure remains
Discard discolored solutions.
arteriola > 90 mmHg,
Instruct to take drug exactly as prescribed.
r, repeat the dose at
 decreasi 30 minute After
ng intervals until Withdraw drug gradually.
peripher diastolic BP is Discontinue if blood dyscrasias occur.
al around 90 mmHg. Arrange for pyridoxine therapy if patient develops
resistan symptoms of peripheral neuritis.
ce; Do not give more Monitor for orthostatic hypotension.
maintai than 20 mg in Report persistent or severe constipation, unexplained fever
ns or total. or malaise, muscle or joint aching, chest pain, rash,
increase numbness, tingling.
s renal Do proper documentation.
and
cerebral
flow.
Antibiotics Give the first Used in Ampicillin: Trained Observe the 10 rights of drug administration.
dose of the Preparation: Vial nurse or Do proper documentation
antibiotic(s) treatme containing 500 midwives
before referral. If nt and mg as on
referral is preventi powder: to be BEmONC
delayed or not on of mixed with 2.5 ml
possible, bacteria sterile water
continue l Dosage and
antibiotics IM/IV infectio route: First 2 g
for 48 hours after ns. IV/IM then 1 g
woman is fever every 6 hours.
free. They Gentamicin
may Preparation: Vial
If signs persist or either containing 40
mother becomes kill or mg/ml in 2 ml
weak or has inhibit Dosage and
abdominal pain the route: 80 mg IM
postpartum, growth every 8 hours
refer urgently to of Cefazolin
hospital bacteria Preparation: Vial
. containing 1g
(powder for
injection / as
sodium salt).
Dosage and
route: First: 1 g
IV/IM every 6
hours
Clindamycin
Preparation: Vial
containing 150
mg for
injection (as
phosphate)/ml
Capsule: 150 mg
(as
hydrochloride).
Dosage and
route: 150 mg
IV/IM/PO every 6-8
hours.