Question

Ob/Newborn Med Lab Scenario

Mrs. Z is a 32 year old woman, G3 P2 at 38 weeks gestation who has been laboring and requests a natural delivery. At 4 cm dilation, the pain became very intense and she requested pain meds but did not want an epidural. The mother received Stadol 20 minutes ago, so the L&D team has called you to the delivery to attend to the infant.

What is stadol? Does stadol pass through the placenta?

What are your concerns about the infant if the medication passes through the placenta?

What will you anticipate happening and what supplies will you need to have available?

What medication can be given to the baby to reverse the effects of the medication given to the mother? What route is it administered through? How quickly should it act?

The doctor orders 0.36mg of Narcan IM Stat. The concentration of Narcan is 1mg/ml. How many ml’s will you draw up to administer to this patient?

Explain the steps to administer this medication to the infant

If the mother was a drug user during her pregnancy, would you give this medication to the baby? Why or why not? (Hint: reference neonatal abstinence syndrome)

Answer 1

STADOL

GENERIC NAME butorphanol

stadol is an opioid pain medication ,sometimes called a narcotics.it can be used during early labour if child birth is expected to be more than 4 hours away.stadol can pass placenta and can affect both mother and baby

infant conerns  

This medication can affect the baby's heartbeat.It is associated with an increased risk of a specific condition called a sinusoidal fetal heart rate pattern.In healthy baby side effects after birth are mild and without long term complications

such as -slow breathing in baby ,sleepiness,poor breast feeding ,apnea

side effects are more likely to occure in following conditions

if patient receive medication within two hours of delivery

if patient get multiple dose

if the delivery is premature

if take it along with other pain medication or sedatives

COMPLCATIONS FOR MOTHER

Nausea and vomitting

drowsiness or sedation

urinary retention

allergy -an allergic reaction such as itching,difficulty breathing

respiratory depression

withdrawal symptoms-in women who use drugs,butorphanol can cause sudden withdrawal in both mom and baby

addiction-opioid medication can be additing and lead to dependence and drug abuse

-keep ready- narcan[nalaoxone] is a medication that reverse the side effect of medication-in emergency narcan iv can administer as prescribed

keep ready oxygen ,oxygen mask tubings ,puise oxymeter ,connect the patient to monitors

-narcan can be given to reverse the effect of butorphanol

NEONATES DOSE

USUAL INITIAL DOSE IS 0.01mg/kg body weight -administered i.v.,i.m,ors.c

DOSEAGE OF MEDICATION

IFdoctor prescribed 0.36 mg of narcan stat

concentration of narcan is 1mg per ml

desired dose [divided by]amount in hand x quantity

0.36 mg divided by 1 mg X 1ml=0.36ml

If the mother is drug user -small doses every few miniutes can be given untill the desired effect is reached.naloxone is a non-selective and cometitive opioid receptor antagonist.it reverse the depression of center nervous system and respiratory system