ARM 24.111.616. USE OF FORMULARY DRUGS

(1) Endorsed midwives may use the drugs in 37-27-302(2), MCA, according to the following protocol describing the indication for use, dosage, route of administration, and duration of treatment: Drug Indication Dose - in conformance ACOG guidelines Route of Administration Duration of Treatment Oxygen Maternal/Fetal Distress Neonatal Resuscitation 10-12 L/min. 10 L/min. 10-12 L/min. 10 L/min. Bag and mask Mask Bag and mask Mask Until maternal/fetal stabilization is achieved or transfer to hospital is complete Until stabilization is achieved or transfer to a hospital is complete Oxytocin (Pitocin) Postpartum hemorrhage only 10 Units/ml Intramuscularly only 1-2 doses Transport to hospital required if more than two doses are administered Lidocaine HCl 1% 2% Local anesthetic for use during postpartum repair of lacerations or episiotomy 20 cc 10 cc Percutaneous infiltration only Completion of repair Penicillin G (Recommended) Group B Strep Prophylaxis 5 million units initial dose, then 2.5 million units every 4 hours until birth IV in ≥ 100 ml LR, NS or D 5 LR Birth of baby Methegrine (Methylergonovine Postpartum hemorrhage only 0.2mg/ml Intramuscularly only 1 dose Transport to hospital required if single dose does not stop hemorrhage Ampicillin Sodium (Alternative) Group B Strep Prophylaxis 2 grams initial dose, then 1 gram every 4 hours until birth IV in ≥100 ml NS or LR Birth of baby Cefazolin Sodium (drug of choice for penicillin allergy with low risk for anaphylaxis) Group B Strep Prophylaxis 2 grams initial dose, then 1 gram every 8 hours IV in ≥ 100 ml LR, NS or D 5 LR Birth of Baby Clindamycin Phosphate (drug of choice for penicillin allergy with high risk for anaphylaxis) Group B Strep Prophylaxis 900 mg every 8 hours IV in ≥100 ml NS (not LR) Birth of Baby Epinephrine HCl 1:1000 Treatment or post-exposure prevention of severe allergic reactions 0.3 ml Subcutaneously or intramuscularly Every 20 minutes or until emergency medical services arrive Administer first dose then immediately request emergency services Lactated Ringer's (LR) 5% Dextrose in Lactated Ringer's solution (D 5 LR) 0.9% Sodium Chloride (NS) Sterile Water To achieve maternal stabilization Reconstitution of antibiotic powder I - 2 liter bags First liter run in at a wide-open rate, the second liter titrated to client's condition As directed Intravenously As directed Until maternal stabilization is achieved or transfer to a hospital is complete Birth of Baby Cytotec (Misoprostol) Postpartum hemorrhage only Up to 800 mcg Rectally is the preferred method Orally is allowed 1-2 doses Transport to hospital required if more than one dose is administered Rho(d) Immune Globulin Prevention of Rho (d) sensitization in Rho (d) negative women 300 mcg Intramuscularly Single dose at any gestation for Rho (d) negative, antibody negative women within 72 hours of spontaneous bleeding or abdominal trauma. Single dose at 26-28 weeks gestation for Rho (d) negative, antibody negative women Single dose for Rho (d) negative, antibody negative women within 72 hours of delivery of Rho (d) positive infant, or infant with unknown blood type Phytonadione Prophylaxis for Vitamin K Deficiency Bleeding 1 dose 0.5% Erythromycin Ophthalmic Ointment Prophylaxis of Neonatal Ophthalmia 1 cm ribbon in each eye Topical 1 dose Tranexamic acid Postpartum Hemorrhage 1000 mg over 10 minutes given within 3 hours of birth Intravenous Initiate transfer after administering first dose. If bleeding continues after 30 minutes or stops and restarts within 24 hours after the first dose, a second dose of 1000mg may be given. Terbutaline Stop or prevent premature labor As per direct order of a licensed physician As per direct order of a licensed physician As per direct order of a licensed physician