antepartum meds

Question 1

•Risk versus Benefit
- highest risk for baby is first trimester (1st 8 weeks)
•Consider risk of treating to not treating
•Discomforts vs Dangerous Medical Conditions
•Non pharmacologic, Adjunctive and Prescribed Medications (ex: vitamin C)

Answer 1

pharmacologic strategies

Question 2

A time of physical and psychologic preparation for birth and parenthood
that is divided into 3 trimesters

Answer 2

antepartum

Question 3

weeks 1-13

-most dangerous time for baby

Answer 3

first trimester

Question 4

weeks 14-26

-happiest time of pregnacy

Answer 4

2nd trimester

Question 5

weeks 27-40

-psychology separating from baby and increase in complications, like preeclampsia

Answer 5

3rd trimester

Question 6

Drug classification: Antacids
• basic compounds, which neutralize hydrochloric acid in the gastric secretions.
• H2 receptor antagonists:
-Famotidine (Pepcid or Pepcid Complete)
-Cimetidine (Tagament)
-Ranitidine (Zantac) - causes increase in peristalsis
• Metabolism: Hepatic
• Patient teaching:
-Recommended therapeutic doses are not to be exceeded
-Symptoms of overdose include nausea, vomiting, diarrhea, increased saliva
production, difficulty breathing, and a fast heartbeat

Answer 6

Heartburn

Question 7

a basic inorganic salt that acts by neutralizing hydrochloric acid in gastric
secretions
• Metabolism: Excreted mainly in the feces
• Patient teaching:
•take with meals or citrus juice
-Absorption reduced with fasting
-Adverse effects: constipation

Answer 7

Calcium carbonate (tums)

Question 8

occurs in 50-80% of pregnant women
• Symptoms usually first trimester but continue through entire
pregnancy
• Range from mild to severe hyperemesis gravidarum
• Treatment:
-First line is non pharmacological
–Ginger (up to 1 gram daily) increases tone & peristalsis in GI tract
–Carb snack at HS and crackers at bedside in AM
-Diet modification
-Antiemetic
-Severe – total parenteral nutrition and intravenous fluids

Answer 8

Nausea and vomiting

Question 9

Acts centrally – decreased sensitivity of the visceral nerves that transmit GI
impulses to the central emetic center and
• Peripherally – stimulating motility of the upper gastrointestinal tract and
increasing the lower esophageal sphincter basal tone.
-tricks brain that you aren’t nauseated
• Used to enhance GI motility
• Metabolism: Hepatic
• Adverse Effects:
-Extrapyramidal Symptoms (EPS),
-Tardive dyskinesia (permanent) and
-depression
• Patient Teaching:
-Can cause anxiety, diarrhea, drowsiness and restlessness
-Avoid alcohol, sleep remedies
-Report involuntary movement

Answer 9

metoclopramide (Reglan)
Drug classification: Antiemetic
Dopamine antagonist

Question 10

Prescribed for hyperemesis gravidarum (causing dehydration)
• Metabolism: Hepatic
• Adverse Effects:
-Extrapyramidal Symptoms (EPS)
-Tardive dyskinesia (permanent)
• Patient Teaching:
-Can cause dry mouth, dizziness, hypotension, drowsiness and
restlessness (use ice chips)
-Avoid alcohol, sleep remedies
-Report involuntary movement
-Avoid dehydration
-Avoid exposure to ultraviolet or sunlight to prevent photosensitivity

Answer 10

Phenothiazines: Prochloroperazine (Compazine)

Question 11

Binds to the serotonin receptors located on the vagal neurons lining the GI tract and blocks
impulses to the vomiting centers in the brain.
• Metabolism: Hepatic
• First trimester pregnancy: relative contraindication due to possible increased risk for
congenital heart defects and cleft palate
• Is prescribed when other anti-emetics fail
• Patient Teaching:
-Can cause weakness, dizziness, drowsiness
-Report chest pain, palpitations

Answer 11

Ondansetron (Zofran)
NVP treatment
Serotonic receptor antagonists

Question 12

Bulk-Forming agents (draws water in)
• Metabolism: Non-absorbable substances that draw in water and expands
resulting in increased peristalsis
• Adverse Effects: Bloating
• Patient Teaching:
-Instruct to use with >1.5 Liters/day non-caffeinated fluid
-Slowly increase fiber intake to minimize bloating
-Space Psyllium several hours apart from medications

Answer 12

Psyllium (Metamucil)

constipation

Question 13

Theoretically softens stool: Allows water and fat to penetrate the fecal mass
• Metabolism: GI tract
• Adverse Effects:
• May develop hepatotoxicity
• Increases the absorption of some medications
• Patient Teaching:
• For short term use only
• Take with full glass of water
• Discontinue if diarrhea, weakness or heart palpitations
• May cause bloating, gas and or stomach cramps

Answer 13

Docusate sodium (Colace)
constipation

Question 14

Glycerin protects the skin and creates a protective barrier over hemorrhoids, allowing them to heal. Glycerin also prevents drying of these tissues and reduces itching. (Cause swelling to decrease)
• Witch hazel is an astringent. It shrinks swollen tissue and provide relief
from itching and irritation
• Adverse Effects: May develop allergic reaction (rare)
• Patient teaching:
-Discontinue if bleeding or skin irritation develops
-To be used topically only

Answer 14

Witch hazel and glycerin topical (tucks)

Hemorrhoids

Question 15

Drug classification: Sedating Antihistamine
• A histamine H1 antagonist
-Metabolism: Hepatic and renal
• Adverse Effects:
-Dizziness
-Drowsiness
-Restless leg syndrome*
-Dry mouth
-Diarrhea or constipation
• Patient Teaching:
-Avoid operating heavy machinery or activities requiring mental alertness
-Avoid any alcohol
-Take with food/drink

Answer 15

Diphenhydramine hydrochloride (Benadryl) 
Sleep disturbances

Question 16

Drug classification: Sedative-hypnotic (non-barbiturate)
-Modulates GABA receptors to cause suppression of neurons leading to
sedation
• Metabolism: rapidly absorbed from the GI tract
• Adverse Effects:
-Dizziness
-Drowsiness
-Dry mouth
• Patient Teaching:
-It works quickly (usually within 15 minutes)
-Avoid operating heavy machinery or activities requiring mental
alertness
-Avoid any alcohol
-Avoid taking with food or immediately after a meal (slows absorption)
If you miss the window it won’t work as well

Answer 16

Zolpidem Tartate (Ambien)
sleep disturbances

Question 17

Drug classification: Iron Preparation (mineral)
-Elevates the serum iron concentration which can be converted to Hgb or
stored for later conversion
• Metabolism: unknown
• Adverse Effects:
-Gastrointestinal distress (so take in p.m.)
-Black stools
-Severe allergic reactions
• Patient Teaching:
-Take on empty stomach
-Avoid antacids or antibiotics (can interfere with absorption)
-Taking vitamin C and iron together helps the body absorb the iron

Answer 17

ferrous sulfate (Feosol)
iron deficiency anemia in pregnacy

Question 18

Drug classification: Vitamin and minerals
-Prophylactic administration of MVP is controversial because of balanced
diet should be sufficient and Vitamins A & D may be toxic in higher doses.
-Most have additional folate to prevent neural tube defects (folic acid is most crucial)
• Metabolism: Hepatic and Renal
• Adverse Effects:
-Nausea and Vomiting
-Overdose - teratogenic
• Patient teaching:
-Take only prescribed does
-Take in evening to minimize GI distress

Answer 18

Multivitamin preparation (PNV - prenatal vitamins)
dietary supplements

Question 19

Drug classification: Vitamin – one of the B vitamins
•At conception reduces neural tube defects (spina
bifida and anencephaly), cleft lip and palate and
conotruncal heart defects
•Recommended for all fertile women
Anyone who ovulates should take this

Answer 19

folic acid

dietary supplements

Question 20

Drug classification: immune globulin
-Sterilized solution made from human blood
-Prevention of Rh sensitization in Rh negative mother
-Suppresses the immune response
-Prevents hemolytic disease of the newborn in subsequent pregnancy
• Adverse Effects:
-Pain and soreness at injection site
-Anaphylaxis
• Patient teaching:
-Must be administered within 72 hours after Rh incompatible delivery,
miscarriage, abortion or trauma
-Notify HCP immediately with s/s of allergic reaction

Answer 20

Rho(D) immune globulin (RhoGAM)

Rh sensitivity prevention