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- Used to relieve moderate to severe pain associated with labor
- Administered by intramuscular or intravenous route
- Regular use of opioids during pregnancy may produce withdrawal symptoms in the newborn (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, and seizures).
Antidotes for opioids
- Naloxone (Narcan) is usually the treatment of choice because it rapidly reverses opioid toxicity; the dose may need to be repeated every few hours until opioid concentrations have decreased to nontoxic levels.
- Nalmefene (Revex) is a long-acting opioid antagonist that does not require repeat doses.
- These medications can cause withdrawal in opioid-dependent clients.
Meperidine hydrochloride (Demerol) and hydromorphone hydrochloride (Dilaudid)
- Can cause dizziness, nausea, vomiting, sedation, decreased blood pressure, decreased respirations, diaphoresis, flushed face, urinary retention
- May be prescribed to be administered with an antiemetic such as promethazine (Phenergan) to prevent nausea
- High dosages may result in respiratory depression, skeletal muscle flaccidity, cold clammy skin, cyanosis, and extreme somnolence progressing to seizures, stupor, and coma.
- Used cautiously in clients delivering preterm infants
- Not administered in early labor because it may slow the labor process
- Not administered in advanced labor (within 1 hour of expected delivery); if the medication is not adequately removed from the fetal circulation, respiratory depression can occur. Fentanyl (Sublimaze) and sufentanil (Sufenta): Can cause respiratory depression, dizziness, drowsiness, hypotension, urinary retention, fetal narcosis and distress
Butorphanol tartrate (Stadol) and nalbuphine(Nubain)
- Can cause confusion, sedation, sweating, nausea, vomiting, hypotension, sinusoidal-like fetal heart rhythm
- Use with caution in a client with preexisting opioid dependency because these medications can precipitate withdrawal symptoms in the client and the newborn.
- signs, particularly respiratory status; if respirations are 12 breaths/min or less, withhold the medication and contact the health care provider.
- Monitor the fetal heart rate and characteristics of uterine contractions.
- Monitor for blood pressure changes (hypotension); maintain the client in a recumbent position (elevate the hip with a wedge pillow or other device).
- Record the client’s response and level of pain relief.
- Monitor the bladder for distention and retention.
- Have the antidote naloxone (Narcan) available, especially if delivery is expected to occur during peak drug absorption time.