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Tocolysis for Preterm Labor Patient Identification ZZ00495 (3/1/07) ORDERS Authorization for therapeutic substitution is given unless checked here STAT MEDICATION SCANNED TO PHARMACY Date: ________________ Time: ________________ Allergies: _______________________________________________________________________________________ Nifedipine If STAT check STAT MEDICATION on top of page. 1. Administer a loading dose of Nifedipine (immediate release caps) ______ mg PO (usual is 10, 20 or 30 mg). Then give Nifedipine ______ mg PO (usual is 10 or 20 mg) every ________ hours (usual is 4-6 hours). 2. Intake and output measure for 48 hours following first dose. 3. Hold dose and notify attending physician if maternal heart rate is greater than 120 bpm or BP is less than 90/60. 4. Notify attending physician if contractions do not decrease after 4 hours of treatment. Terbutaline If STAT check STAT MEDICATION on top of page. 1.
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