Carboprost Tromethamine Medication Portfolio

1. Generic Name Carboprost Tromethamine Therapeutic Classification Oxytocics 2. Indications and mechanism of action Trade Name Hemabate Pharmacological Classification Prostaglandins Indications: Sterile Solution is indicated for aborting pregnancy between the 13th and 20th weeks of gestation as calculated from the first day of the last normal menstrual period and in the following conditions related to second trimester abortion: Mechanism of action: Carboprost tromethamine has stimulatory effects on uterine, gastrointestinal, and possibly other smooth muscle. Administration results in myometrial contractions in the gravid uterus similar to labor contractions at the end of a full term pregnancy. Carboprost tromethamineinduced uterine contractions will usually cause complete evacuation of the uterus; however, abortion may be incomplete in as many as 20 percent of patients receiving the drug. Postpartum, the resultant myometrial contractions provide hemostasis at the site of placentation. a. Safe dosage range (and route) For pregnancy termination between weeks 13—20 gestation dated from the first day of the last menstrual period. Intramuscular dosage Adults 100 mcg (0.4 mL) optional test dose may be administered initially; 250 mcg (1 mL) by deep IM injection repeated every 1.5—3.5 hours, depending on uterine response, is recommended. May increase the dose to 500 mcg (2 mL) IM if inadequate uterine contraction persists after several doses. Do not exceed the 12 mg (48 mL) Maximum Dosage Limit; administration for more than 48 hours is not recommended. 3. Adverse Effects (life threatening) and Common Side Effects fever, headache, anxiety, paresthesia, syncope, weakness, arrhythmias, chest pain, flushing, blurred vision, eye pain, vomiting, diarrhea, nausea, uterine rupture, endometritis, uterine or vaginal pain, retained placental fragments, excessive uterine bleeding, backache, leg cramps, cough, wheezing, rash, diaphoresis, breast tenderness, chills, hot flashes. 4. Contraindications -Contraindicated in patients hypersensitive to drug and in those with acute pelvic inflammatory disease or active cardiac, pulmonary, renal, or hepatic disease. -Use cautiously in patients with history of asthma, hypotension, HTN, anemia, jaundice, or diabetes and in those with seizure disorders, previous uterine surgery, or CV, renal, or hepatic disease. 5. Nursing administration guidelines: a. Nursing process – assessment (ex: lab values, VS) -Monitor frequency, duration, and force of contractions and uterine resting tone. Notify physician or other health care professional if contractions are absent or last more than 1 min. -Monitor temperature, pulse, and BP periodically throughout course of therapy. Large dose may cause hypertension. Temperature elevation beginning 1 to 16 hr after initiation of therapy and lasting for several hours is not unusual. -Auscultate breath sounds. Wheezing and sensation of chest tightness may indicate hypersensitivity reaction. -Assess for nausea, vomiting, and diarrhea. Vomiting and diarrhea occur in approximately twothirds of patients. Premedication with antiemetic and antidiarrheal is recommended. -Monitor amount and type of vaginal discharge. Notify physician or other health care professional immediately if symptoms of hemorrhage (increased bleeding, hypotension, pallor, tachycardia) occur. b. Nursing process – intervention (when to give, hold or not give, lab values, VS -Avoid contact with skin. -Thoroughly wash skin immediately after spillage. -Opioid analgesic may be given for uterine cramping. -Store in refrigerator. -check heart and lungs. c. Nursing process – evaluation (after administration of medication) -Complete abortion. 6. Nursing implications and considerations - include Lab value alterations caused by medication, and drug incompatibility or interactions with foods and other drugs. -Strictly adhere to recommended dosages. -Unlike other prostaglandin abortifacients, drug is given by IM injection. Injectable form avoids risk of expelling vaginal suppositories if patient has profuse vaginal bleeding. -Pretreating and giving with antiemetics and antidiarrheals decreases the risk of common GI effects. 7. Patient / family teaching -Explain use and administration of drug to patient and family. -Instruct patient to report all adverse reactions, including hypersensitivity reactions, promptly.