[2] PRELIMS | REPRODUCTIVE AND GENDER RELATED DRUGS

Question 1

INDICATIONS

• Nutritional supplementation e.g. ____
• Treatment of ____

Answer 1

• Nutritional supplementation e.g. iron, vitamins, and minerals
• Treatment of nausea and vomiting, gastric acidity, and mild discomforts

Question 2

THERAPEUTIC DRUGS AND USE OF HERBS

• ____
• ____
• ____

Answer 2

• Iron Supplements
• Folic Acid
• Multiple Vitamins

Question 3

IRON SUPPLEMENT

• Used as ____
• ____ the normal amount of iron is needed to meet fetal and maternal daily requirements.
• RDA of Iron: ____ (non-pregnant); ____ (pregnancy)
• Supplemental: ____/ day (at risk)
• Needed only during the ____, the time when fetus begins to store iron.
• Greatest iron demand is during the ____.

Answer 3

• Used as hematinic
• Twice the normal amount of iron is needed to meet fetal and maternal daily requirements.
• RDA of Iron: 18 mg (non-pregnant); 27 mg (pregnancy)
• Supplemental: 60-120mg/ day (at risk)
• Needed only during the second trimester, the time when fetus begins to store iron.
• Greatest iron demand is during the third trimester.

Question 3

SAMPLE OF IRON PRODUCTS

• ____ (Fer-ln-Sol, Feosol, Fero-Gradumet. MoMron, Fer-lron)
• ____ (Fergon)
• ____ (Fumasorb, Femiron, Feostat, Fumerin)

Answer 3

• Ferrous sulfate (Fer-ln-Sol, Feosol, Fero-Gradumet. MoMron, Fer-lron)
• Ferrous Gluconate (Fergon)
• Ferrous fumarate (Fumasorb, Femiron, Feostat, Fumerin)

Question 4

IRON PHARMACOKINETICS

• Absorption ____ is ____ in intestines
• Increased absorption with ____
• Decreased absorption with ____.

Answer 4

• Absorption PO is 5%-30% in intestines
• Increased absorption with ascorbic acid
• Decreased absorption with eggs, milk, coffee, and tea.

Question 5

IRON PHARMACODYNAMICS

• Peak ____ is ____.
• Hemoglobin values ____ in ____.

Answer 5

• Peak reticulocytosis is 5-10 days.
• Hemoglobin values increase in 2-4 weeks.

Question 6

SIDE EFFECTS OF IRON SUPPLEMENT

• N____
• V____
• C____
• B____
• E____
• D____
• G____
• D____

Answer 6

• Nausea
• VomitinG
• Constipation
• Black or red tarry stools
• Epigastric pain
• Diarrhea
• GI irritation
• Discoloration of urine

Question 7

IRON NURSING IMPLICATIONS

• Absorption is promoted when taken with ____.
• Administer with food if ____ occurs.
• Use ____ when taking the liquid form (e.g. elixir)
• ____ after dose to decrease reflux.
• Administer ____ with drugs like antacids, methyldopa, penicillins, quinolons and tetracyclines.
• Do not administer with ____.

Answer 7

• Absorption is promoted when taken with orange juice or other sources of vitamin C
• Administer with food if gastric irritation occurs.
• Use straw when taking the liquid form (e.g. elixir)
• Sit upright 30 min after dose to decrease reflux.
• Administer separately with drugs like antacids, methyldopa, penicillins, quinolons and tetracyclines.
• Do not administer with milk, cereal, tea, coffee or eggs

Question 8

• Also known as Vitamin B9 or Folate
• Improves outcome of pregnancy

Answer 8

Folic Acid

Question 9

FOLIC ACID

• Prevents ____ or ____ (e.g., neural tube defects), ____, ____, and premature separation of the placenta (____).
• RDA: ____ and must be acquired from food sources.
• Supplementation: ____ a month before pregnancy and ____ of pregnancy.

Answer 9

• Prevents spontaneous abortion or birth defects (e.g., neural tube defects), premature birth, low birth weight, and premature separation of the placenta (abruptio placenta).
• RDA: 180 mcg and must be acquired from food sources.
• Supplementation: 0.4-0.8 mg a month before pregnancy and 2-3 months of pregnancy.

Question 10

FOLIC ACID SIDE EFFECTS

• ____
• Includes: ____, rash, ____, ____, general malaise
• May cause urine to turn ____

Answer 10

• Uncommon
• Includes: allergic bronchospasm, rash, pruritus, erythema, general malaise
• May cause urine to turn intense yellow

Question 11

MULTIPLE VITAMINS

• ____ recommended.
• Preparations generally supply vitamins ____, ____, ____, and other minerals.
• Most effective when ____.
• Some can be ____ when taken in large amounts.

Answer 11

• Routinely recommended.
• Preparations generally supply vitamins A, D, E, C, B complex (B1, B2, B3, B5, B6, B12), Iron, calcium, and other minerals.
• Most effective when taken with meals.
• Some can be teratogenic or toxic when taken in large amounts.

Question 12

NAUSEA AND VOMITING

• Severe occurrence: ____ (____ occurrence)
• Cause: Increased level of ____, ____, and ____

Answer 12

• Severe occurrence: hyperemesis gravidarum (1-3% occurrence)
• Cause: Increased level of hCG, Estrogen and progesterone

Question 13

Also known as morning sickness (88% occurence).

Answer 13

Nausea & Vomiting

Question 14

NON-PHARMACOLOGIC MEASURES FOR NVP

• Eating ____ or ____.
• Avoid ____ foods
• ____ (SFF)
• ____ in bet. meals rather than with meals
• Drinking ____ bet. meals
• Eating ____ bedtime snack
• Cessation of ____
• Taking ____ at bedtime

Answer 14

• Eating crackers or dry toast.
• Avoid high-fat / highly seasoned foods
• Small Frequent Feeding (SFF)
• Drinking fluids in bet. meals rather than with meals
• Drinking apple juice or flat carbonated drinks bet meals
• Eating high protein bedtime snack
• Cessation of smoking
• Taking iron supplement at bedtime

Question 15

PHARMACOLOGIC TX FOR NAVP

____ (Antivert, Bonamine)
* Blocks ____ which acts on vomiting center.
* Common SE is ____
* Patients should avoid alcoholic beverages, ____, ____.

____ (Phenargan)
* Blocks ____ receptors in the brain.
* SE: ____, ____, ____

Answer 15

Meclizine (Antivert, Bonamine)
* Blocks CTZ which acts on vomiting center.
* Common SE is drowsiness
* Patients should avoid alcoholic beverages, tranquilizers, sedatives and narcotics.

Promethazine (Phenargan)
* Blocks post synaptic mesolimbic dopaminergic receptors in the brain.
* SE: Dizziness, drowsiness, excitation

Question 16

PHARMACOLOGIC TX FOR NAVP

____ (Plasil, Nausil)
* Blocks dopamine receptor in ____ of the CNS
* AR- ____, ____, ____

____ and ____
* Safe and well-tolerated by patients

____ (severe cases)
* Administered only in patients with

Answer 16

Metoclopramide (Plasil, Nausil)
* Blocks dopamine receptor in CTZ of the CNS
* AR- Restlessness, drowsiness, diarrhea

Doxylamine Succinate and Pyridoxine HCl
* Safe and well-tolerated by patients

Phenothiazine (severe cases)
* Administered only in patients with hyperemesis gravidarum

Question 16

NON-PHARMACOLOGUC MEASURES FOR HEARTBURN

• Limiting ____
• Avoid ____ foods
• Avoiding ____ foods
• Eating ____
• Avoiding ____
• Drinking ____ but not with meals
• Avoid ____ immediately after meal

Answer 16

• Limiting size of meals
• Avoid highly seasoned or greasy foods
• Avoiding gas forming foods
• Eating slowly and chewing thoroughly
• Avoiding citrus juices
• Drinking adequate fluids but not with meals
• Avoid reclining immediately after meal

Question 17

Also known as pyrosis

Answer 17

HEARTBURN

Question 18

HEARTBURN

• A burning sensation in the ____ with reflux of acidic contents.
• Common in ____.
• Causes: Increased ____; Decreased ____ time; ____ down after meal

Answer 18

• A burning sensation in the epigastric and sternal regions with reflux of acidic contents.
• Common in 2nd & 3rd trimester.
• Causes: Increased progesterone; Decreased gastric emptying time; Sitting or lying down after meal

Question 19

PHARMACOLOGIC TX FOR HEARTBURN

____.
* Neutralization of ____.
* S/E – Constipation
* AR – Dehydration

____ and ____
* Neutralization of gastric acidity and ____
* AR – constipation/diarrhea

____ is the most commonly used

Answer 19

Aluminum hydroxide
* Neutralization of gastric acidity.
* S/E – Constipation
* AR – Dehydration

Magnesium HCl and Aluminum hydroxide
* Neutralization of gastric acidity and antiflatulence
* AR – constipation/diarrhea

Liquid form is the most commonly used

Question 20

• Frequent occurrence in pregnancy.
• Cause: hormonal changes causing decrease GI motility.
• Non-pharmacologic Mgt:
  
  • Increased fluid intake
  • Increase dietary fiber intake
  • Moderate physical activity
• Pharmacologic tx: bulk-forming preparations
  ex. Docusate Na

Answer 20

CONSTIPATION

Question 21

CONSTIPATION

• Frequent occurrence in pregnancy.
• Cause: ____ causing decrease ____.
• Non-pharmacologic Mgt:
  
  • Increased ____
  • Increase ____
  • Moderate ____
• Pharmacologic tx: ____ preparations
  ex. ____

Answer 21

• Frequent occurrence in pregnancy.
• Cause: hormonal changes causing decrease GI motility.
• Non-pharmacologic Mgt:
  
  • Increased fluid intake
  • Increase dietary fiber intake
  • Moderate physical activity
• Pharmacologic tx: bulk-forming preparations
  ex. Docusate Na

Question 22

REMINDERS FOR CONSTIPATION

Use occasionally:
- Milk of ___
- ____
- L____
- S____
- B____
- S____

Should be avoided:
- ____

Answer 22

Use occasionally:
- Milk of magnesia
- Magnesium citrate
- Lactulose
- Sorbitol
- Bisacodyl
- Senna

Should be avoided:
- Mineral oil

Question 23

Due to headache, sinus congestion, eye strain, backache, joint pain and round ligament pain

Answer 23

PAIN

Question 24

# PAIN * Due to headache, ____, eye strain, backache, ____. * Non-pharmacologic tx: - ____ techniques - promote ____ - use of ____ - use of ____ * Pharmacologic tx: ____

Answer 24

* Due to headache, **sinus congestion**, eye strain, backache, **joint pain and round ligament pain**. * Non-pharmacologic tx: - **rest and relaxation** techniques - promote **calming environment** - use of **ice packs or warm compress** - use of **proper body mechanics** * Pharmacologic tx: **Acetaminophen** ## Footnote Acetaminophen is the same as Paracetamol

Question 25

Drug therapy to decrease uterine muscle contraction

Answer 25

TOCOLYTIC THERAPY

Question 26

# TOCOLYTIC THERAPY * Drug therapy to ____ * Goal: - inhibit ____ - ____ delivery - allow ____ of patient to an appropriate facility if needed * Includes: - ____ (terbutaline) - ____ (magnesium sulfate) - ____ or NSAIDs (indomethacin)

Answer 26

* Drug therapy to **decrease uterine muscle contraction** * Goal: - inhibit **uterine contraction** - **delay** delivery - allow **safe transport** of patient to an appropriate facility if needed * Includes: - **betasympatho-mimetics** (terbutaline) - **calcium antagonist** (magnesium sulfate) - **non-steroidal anti-inflammatory drugs** or NSAIDs (indomethacin)

Question 27

# BETASYMPATHOMIMETIC DRUGS * ____ (Brethine, Bricanyl) * Stimulates ____ in the uterine smooth muscle to ____ * Route – ____ * AR: ____, malaise, weakness. ____, ____, increase SBP (mother) ____ and ____ (fetus) * ____ and ____. Relaxes smooth muscles of the uterus.

Answer 27

* **Terbutaline** (Brethine, Bricanyl) * Stimulates **beta2 receptors** in the uterine smooth muscle to **relax** * Route – **SQ/PO** * AR: **Tremors**, malaise, weakness. **Dyspnea**, **tachycardia**, increase SBP (mother) **Tachycardia** and **Hypoglycemia** (fetus) * **Calcium antagonist and CNS depressant**. Relaxes smooth muscles of the uterus.

Question 28

# BETASYMPATHOMIMETIC DRUGS * ____ (Magneon, Magwell) * Route : ____ * CI : MG, ____, MI * AR : ____, feeling of increase ____, perspiration, dizziness, headache, ____ * AR : ____, Inc. ____, * S/E Fetus – ____, ____ 24 – 48 hours.

Answer 28

* **Magnesium Sulfate** (Magneon, Magwell) * Route : **IV/IM** * CI : MG, **renal impairment**, MI * AR : **Flushing**, feeling of increase **warmth**, perspiration, dizziness, headache, **lethargy** * AR : **Heavy eyelids**, Inc **HR**, * S/E Fetus – **hypotonia**, **lethargy** 24 – 48 hours.

Question 28

# BETASYMPATHIOMIMETIC DRUGS: NURSING CONSIDERATIONS * Monitor VS, ____ and ____ * Monitor ____. * Assess ____ and ____ before initiation of treatment. * Monitor ____ * Antidote: ____ (Calgonate, Kalcinate, Cal-G, Cal_Glu)- It plays a role in normal cardiac function, renal function, respiration, blood coagulation, and cell membrane and capillary permeability. * AR – ____ *Nursing Alert – always check your IVF*

Answer 28

* Monitor VS, **FHR** and **uterine activity** * Monitor **I and O**. * Assess **deep tendon reflexes** and **clonus** before initiation of treatment. * Monitor Respiration * Antidote: **Calcium Gluconate** (Calgonate, Kalcinate, Cal-G, Cal_Glu)- It plays a role in normal cardiac function, renal function, respiration, blood coagulation, and cell membrane and capillary permeability. * AR – **Phlebitis** *Nursing Alert – always check your IVF*

Question 29

Prevention and cessation of Pre-Term Labor (PTL)

Answer 29

CORTICOSTEROIDS

Question 29

# BIOSYMPATHOMIMETIC DRUGS Non-steroidal anti-inflammatory drugs or NSAIDs (for example, ____) * During that period, doctors can administer other drugs to help ensure the baby is born as healthy as possible. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a type of ____ and indomethacin (Indocin). Indomethacin is the most frequently used NSAID for preterm labor. * CI: ____, increased risk of ____ due to clotting disorder. AR: heart attack, stroke, skin changes

Answer 29

Non-steroidal anti-inflammatory drugs or NSAIDs (for example, **indomethacin**) * During that period, doctors can administer other drugs to help ensure the baby is born as healthy as possible. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a type of **tocolytic**. NSAIDs include ibuprofen (Motrin) and indomethacin (Indocin). Indomethacin is the most frequently used NSAID for preterm labor. * CI: **systemic mastocytosis**, increased risk of **bleeding** due to clotting disorder. AR: heart attack, stroke, skin changes

Question 30

# CORTICOSTEROIDS * Prevention and cessation of ____. * Client at risk for PTL (____ gestation) - ____ maturation - ____ development * ____ ( ‎Decadron, ‎Dexasone, Cordex 5, Dabrin, Decan,Dexavit, Dexicort, Doxam) * AR – ____, ____, increased ____, headache, ____.

Answer 30

* Prevention and cessation of **PTL**. * Client at risk for PTL (**24 – 34 weeks** gestation) - **Fetal lung** maturation - **Surfactant** development * **Dexamethasone** ( ‎Decadron, ‎Dexasone, Cordex 5, Dabrin, Decan,Dexavit, Dexicort, Doxam) * AR – **Insomia**, **Nervousness**, increased **appetite**, headache, **hypersensitivity reaction**.

Question 31

# GESTATIONAL HYPERTENSION * ____ ( Aldomet ) * MOA – stimulate ____ receptors * Route - ____ * CI- ____ * AR- ____, NV, nasal congestion, ____ * ____ (Apresoline) apparently lowers ____ by exerting a peripheral ____ effect through a direct _____. * ____ SO4 (Magneon, Magwell)

Answer 31

* **Methyldopa** ( Aldomet ) * MOA – stimulate central **alpha-adrenegic** receptors * Route - **PO** * CI- **MAOI’s** * AR- **peripheral edema**, NV, nasal congestion, **dry mouth drug fever** * **Hydralazine** (Apresoline) apparently lowers **blood pressure** by exerting a peripheral **vasodilating** effect through a direct **relaxation of vascular smooth muscle**. * **Magnesium** SO4 (Magneon, Magwell)