ergotrate


ergonovine

(er-goe-noe-veen) ergonovine,

ergometrine

(trade name),

Ergotrate

(trade name)

Classification

Therapeutic: none assigned
Pharmacologic: oxytocics
Pregnancy Category: UK

Indications

Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution.

Action

Directly stimulates uterine and vascular smooth muscle.

Therapeutic effects

Uterine contraction.

Pharmacokinetics

Absorption: Well absorbed after oral administration.Distribution: Unknown.Metabolism and Excretion: Unknown. Probably metabolized by the liver.Half-life: Unknown.

Time/action profile (uterine contractions)

ROUTEONSETPEAKDURATION
PO5–15 minunknown≥3 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Avoid chronic use; Should not be used to induce labor.Use Cautiously in: Hypertensive or eclamptic patients (increased susceptibility to hypertensive and arrhythmogenic side effects); Severe hepatic or renal disease; Sepsis; Third stage of labor.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Ear, Eye, Nose, Throat

  • tinnitus

Respiratory

  • dyspnea

Cardiovascular

  • arrhythmias
  • chest pain
  • hypertension
  • palpitations

Gastrointestinal

  • nausea (most frequent)
  • vomiting (most frequent)

Dermatologic

  • sweating

Miscellaneous

  • allergic reactions

Interactions

Drug-Drug interaction

Excessive vasoconstriction may result when used with other vasopressors, such as dopamine or nicotine.May ↑ the risk of adverse reactions with bromocriptine.

Route/Dosage

Oxytocic

Oral Sublingual (Adults) 0.2–0.4 mg q 6–12 hr (usual course is 48 hr).Intramuscular Intravenous (Adults) 200 mcg (0.2 mg) q 2–4 hr for up to 5 doses.

Availability (generic available)

Tablets: 0.2 mg Injection: 0.25 mg/mL

Nursing implications

Nursing assessment

  • Monitor BP, pulse, and respirations every 15–30 min until transfer to the postpartum unit, then every 1–2 hr. Report hypertension, chest pain, arrhythmias, headache, or change in neurologic status.
  • Monitor amount and type of vaginal discharge. Report symptoms of hemorrhage (increased bleeding, hypotension, pallor, tachycardia) immediately.
  • Palpate uterine fundus; note position and consistency. Notify health care professional if fundus fails to contract in response to ergonovine. Assess patient if cramping is severe; dose may be decreased.
  • Assess for signs of ergotism (cold, numb fingers and toes; nausea; vomiting; diarrhea; headache; muscle pain; weakness).
  • If patient fails to respond to ergonovine, check serum calcium level. Correction of hypocalcemia may restore responsiveness.
  • Lab Test Considerations: May cause ↓ serum prolactin level, which inhibits synthesis of breast milk.
    • Toxicity, initially manifested as ergotism, may cause seizures and gangrene. Seizures are treated with anticonvulsants. Vasodilators and heparin may be ordered to improve circulation to extremities.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)
Risk for injury (Side Effects)

Implementation

  • Do not administer solution that is discolored or contains a precipitate.
  • Oral: Administration is usually limited to 48 hr postpartum, by which time the danger of hemorrhage from uterine atony has passed.
    • Tablets may be administered SL.
  • Intramuscular: The preferred route is IM. Firm uterine contractions are produced within a few minutes. Dose may need to be repeated every 2–4 hr for full therapeutic effect.
  • Intravenous Administration
  • pH: 2.7–3.5.
  • The IV route is reserved for severe uterine bleeding. Diluent: Dilute with 5 mL of 0.9% NaCl.
  • Rate: Administer slow IV push over at least 1 min through Y-site injection of an IV of D5W or 0.9% NaCl.

Patient/Family Teaching

  • Review symptoms of toxicity with patient. Instruct the patient to report occurrence of these immediately.
  • Inform patient that uterine cramping demonstrates effectiveness of therapy.
  • Explain need for pad count to determine degree of bleeding. Instruct patient to report immediately an increase in degree of bleeding or passage of clots.
  • Instruct patient to report breastfeeding difficulties.
  • Caution patient not to smoke while receiving ergonovine; nicotine is also a vasoconstrictor.

Evaluation/Desired Outcomes

  • Uterine contraction and cramping in the prevention or cessation of uterine hemorrhage after delivery or abortion.

ergotrate

(ĕr′gō-trāt) An active principle isolated from ergot.

Ergotrate

A brand name for ERGOMETRINE.