CARBOPROST TROMETHAMINE

CARBOPROST TROMETHAMINe
(kar'boe-prost)
Hemabate
Classifications: hormone; oxytocic;
Therapeutic: oxytocic

Prototype: Oxytocin
Pregnancy Category: D

Availability

250 mcg/mL injection

Action

Synthetic analog of naturally occurring prostaglandin F2 alpha with longer duration of biologic activity. Stimulates myometrial contractions of gravid uterus; contractions are qualitatively similar to those occurring at term labor. Mean time to abortion 16 h; mean dose required 2.6 mL.

Therapeutic Effect

Effectively stimulates uterine contraction and is used to induce abortion. Useful in treatment of postpartum hemorrhage due to uterine atony unresponsive to usual measures.

Uses

To induce abortion between 13th and 20th week of pregnancy, as calculated from first day of last menstrual period. Also for refractory postpartum bleeding.

Unlabeled Uses

To reduce blood loss secondary to uterine atony; to induce labor in intrauterine fetal death and hydatidiform mole.

Contraindications

Acute pelvic inflammatory disease; active cardiac, pulmonary, renal, or hepatic disease; pregnancy (category D); lactation.

Cautious Use

History of asthma; adrenal disease; anemia; hypotension; hypertension; diabetes mellitus; epilepsy; history of uterine surgery; cervical stenosis; fibroids.

Route & Dosage

Abortion, Postpartum Bleeding
Adult: IM Initial: 250 mcg (1 mL) repeated at 1.5–3.5-h intervals if indicated by uterine response. Dosage may be increased to 500 mcg (2 mL) if uterine contractility is inadequate after several doses of 250 mcg (1 mL), not to exceed total dose of 12 mg or continuous administration for more than 2 d.

Administration

  • Because nausea and diarrhea occur in about 60% of patients, an antiemetic and an antidiarrheal agent may be prescribed before and during carboprost administration.
  • Give deep IM into a large muscle. Aspirate carefully before injecting drug to avoid inadvertent entry into blood vessel which can result in bronchospasm, tetanic contractions, and shock. Do not use same site for subsequent doses.
  • Store drug in refrigerator at 2°–4° C (36°–39° F) unless otherwise specified.

Adverse Effects (≥1%)

Body as a Whole: Fever, flushing, chills, cough, headache, pain (muscles, joints, lower abdomen, eyes), hiccups, breast tenderness. GI: Nausea, diarrhea, vomiting.

Pharmacokinetics

Peak: 30–90 min. Elimination: Renal within 24 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor uterine contractions and observe and report excessive vaginal bleeding and cramping pain. Save all clots and tissue for physician inspection and laboratory analysis.
  • Check vital signs at regular intervals. Carboprost-induced febrile reaction occurs in more than 10% of patients and must be differentiated from endometritis, which occurs around third day after abortion.

Patient & Family Education

  • Report promptly onset of bleeding, foul-smelling discharge, abdominal pain, or fever.
  • Since ovulation may reoccur as early as 2 wk post-abortion, you may wish to consider appropriate contraception.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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