antepartum meds Flashcards
•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)
pharmacologic strategies
A time of physical and psychologic preparation for birth and parenthood
that is divided into 3 trimesters
antepartum
weeks 1-13
-most dangerous time for baby
first trimester
weeks 14-26
-happiest time of pregnacy
2nd trimester
weeks 27-40
-psychology separating from baby and increase in complications, like preeclampsia
3rd trimester
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
Heartburn
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
Calcium carbonate (tums)
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
Nausea and vomiting
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
metoclopramide (Reglan)
Drug classification: Antiemetic
Dopamine antagonist
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
Phenothiazines: Prochloroperazine (Compazine)
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
Ondansetron (Zofran)
NVP treatment
Serotonic receptor antagonists
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
Psyllium (Metamucil)
constipation
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
Docusate sodium (Colace) constipation
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
Witch hazel and glycerin topical (tucks)
Hemorrhoids
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
Diphenhydramine hydrochloride (Benadryl) Sleep disturbances
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
Zolpidem Tartate (Ambien) sleep disturbances
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
ferrous sulfate (Feosol) iron deficiency anemia in pregnacy
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
Multivitamin preparation (PNV - prenatal vitamins) dietary supplements
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
folic acid
dietary supplements
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
Rho(D) immune globulin (RhoGAM)
Rh sensitivity prevention
