Antepartum: Prenatal Medications

Question 1

Acyclovir use during pregnancy

Answer 1

Safety has not be established during pregnancy

Question 2

Acyclovir is used to TX which STI’s?

Answer 2

Virus infections? Check

Question 3

Betamethasone (Celestone)glucocorticoids(London 444)

Answer 3

Given to promote lung maturity if deliver is anticipated e.g. 32 weeks gestation, marginal abrupt placenta

Question 4

Methotrexate (MTX)

Answer 4

Inhibits cell division and embryo enlargement, dissolving the pregnancy

Question 5

Methotrexate (MTX)Instruct pt to avoid (2) to prevent a toxic response to medication

Answer 5

1) Alcohol consumption 2) Vitamins containing folic acid

Question 6

Methotrexate (MTX)Advise pt to protect herself against?

Answer 6

sun exposure (photosensitivity)

Question 7

Methotrexate (MTX): Route: DosageFrequency

Answer 7

Route: Intramuscular injectionsDosageFrequency

Question 8

Betamethasone (Celestone Soluspan)Purpose: (2)

Answer 8

1) Capable of inducing pulmonary maturation2) Decreasing incidence of respiratory distress syndrome(London 444)

Question 9

Betamethasone (Celestone Soluspan)1) Route2) Dosage3) Frequency4) Birth should be delayed for at least?5) Risk to mother?6) If fetus is younger than 34 completed weeks, delivery route?

Answer 9

1) Route: IM, deep GM avoid deltoid2) Dosage: 12 mg3) Frequency: Once daily for 2 dayscan be administered with Dexamethasone to enhance effect: 6 mg q 12hrs for 4 doses (2 days)4) Birth should be delayed for at least 24 hrs after completing the first round of TX.5) Increase risk for infection6) Likely C-section due to strain of labor and immature lungs. Prepare parents for this possibility.

Question 10

Betamethasone (Celestone Soluspan)Contraindications: (5)

Answer 10

1) Inability to delay birth2) adequate L/S ratio3) Presence of a condition that necessitates immediate birth ( e.g. maternal bleeding)4) Presence of maternal infection, DM (relative contradiction)5) Gestational age greater that 34 completed weeks

Question 11

Betamethasone (Celestone Soluspan)1) Birth should be delayed for at least?

Answer 11

1) Birth should be delayed for at least 24 hrs after completing the first round of TX.

Question 12

Betamethasone (Celestone Soluspan)Effects of Fetus/Newborn: (3)

Answer 12

1) Lower cortisol levels at birth but with rebound by 2 hours2) Hypoglycemia3) Increase risk of neo sepsis

Question 13

Glucose: 1 day old

Answer 13

40-60mg/dL

Question 14

Neonate s/s of hypoglycemia:

Answer 14

Infants with low blood sugar may not have symptoms. If your baby has one of the risk factors for low blood sugar, nurses in the hospital will check your baby’s blood sugar level, even if there are no symptoms.Bluish-colored or pale skinBreathing problems, such as pauses in breathing (apnea), rapid breathing, or a grunting soundIrritability or listlessnessLoose or floppy musclesPoor feeding or vomitingProblems keeping the body warmTremors, shakiness, sweating, or seizures(MedlinePlus)

Question 15

Neonate at risk for hypoglycemia if?

Answer 15

Low blood sugar level is more likely in infants with one or more of these risk factors:Born early, have a serious infection, or needed oxygen right after deliveryMother has diabetes (these infants are often larger than normal)Have slower than usual growth in the womb during pregnancyAre smaller in size than normal for their gestational age(MedlinePlus)

Question 16

Neonate needs glucose for?

Answer 16

Babies need blood sugar (glucose) for energy. Most of that glucose is used by the brain.

Question 17

Tocolytic Medications

Answer 17

Tocolytics are medicines that attempt to stop labor. They are used if labor begins before term. Tocolytics can stop labor or delay labor to give the baby’s lungs time to mature. If started early in premature labor, they may be effective. They are not as successful later in labor, if the membranes have broken, or if your cervix is already dilated beyond 2 centimeters. When taking this medication, you may need hospitalization or home therapy.Terbutaline, ritodrine, nifedipine and magnesium sulfate are all used as tocolytic drugs. Tocolytics are not used if the mother has chorioamnionitis (an infection in the membranes around the baby), abruptio placenta, severe preeclampsia or eclampsia, cardiac disease, or other severe medical illnesses. Tocolytics are also not used if the fetus has died in the uterus, or if the fetus is in acute distress. Some of these drugs are used in combination with other medications.

Question 18

TerbutalineTocolytic Medications

Answer 18

Terbutaline: This medicine is used to stop preterm labor. It is also known as Brethine. It can be taken as a pill, through an IV (through a catheter directly into your vein), as an injection, or through a controlled infusion pump. A pump is used to give a continuous low dose of the terbutaline. Additional amounts of the medication can be administered if uterine activity increases. A subcutaneous (the medicine is injected under your skin but not directly into a vein) infusion pump may be used with home uterine monitoring. Some of the side effects can include nervousness, restlessness, insomnia, headache, rapid heart rate, nausea, hyperglycemia (high blood sugar) and hypokalemia (low blood potassium). A rare but serious side effect is pulmonary edema. The baby may also experience a fast heart rate and high or low blood sugar after birth. The mother and baby should be monitored while taking this drug. Your doctor should be informed if you have shortness of breath or chest pain while taking this medicine, or if the contractions begin again while you are on this medicine.

Question 19

NifedipineTocolytic Medications

Answer 19

Nifedipine: This medicine is used to stop contractions. It is also called Adalat or Procardia and is taken as a pill. It is used to stop contractions and delay labor, and may also be used for occasional uterine irritability. Some of the side effects that may occur include facial flushing, headache, nausea, palpitations, and lightheadedness. No serious newborn side effects have been noted.

Question 20

Magnesium sulfate:Tocolytic Medications

Answer 20

Magnesium sulfate: This medicine can be used to stop contractions as well as in the treatment and prevention of seizures in a patient with preeclampsia. It can be taken as a pill or through an IV. Side effects may include feelings of extreme warmth, perspiration, flushing, nausea, vomiting, blurred vision, lightheadedness, lethargy, nasal stuffiness and constipation. Magnesium sulfate can affect your reflexes and slow your breathing. Some women report chest pain, especially if they are taking this medicine with another of the tocolytics. Women who have myasthenia gravis, a history of renal impairment (kidney problems), heart block, or a history of a myocardial infarction (heart attack) should discuss this with your doctor before using magnesium sulfate. Side effects usually go away within a few days. The fetus may show a decreased baseline heart rate. A newborn who has been exposed to magnesium sulfate may seem drowsy, have a weak cry and a decreased sucking rate in the early postpartum period. The mother and fetus should be monitored while on this medication.

Question 21

Indomethacin:Tocolytic Medications

Answer 21

Indomethacin: This medicine is used to try to stop preterm labor, and is also called Indocin. It can be taken as a pill or as a suppository (in the rectum). Side effects include abdominal discomfort, nausea, vomiting, depression and dizzy spells for the mother. Indocin can also have serious effects on the fetus if used long term or if the gestational age is greater than 32-34 weeks. This drug may also be dangerous for the mother is she has a history of bleeding disorders, aspirin sensitivity, or kidney problems.

Question 22

Dexamethasone

Answer 22

Often administered with Betamethasone to obtain max results of fetal lung maturity

Question 23

Ceftriaxone IM: Used to Tx bacteria?Pregnancy Class B

Answer 23

1) Gonorrhea safe during pregnancy

Question 24

DoxycyclinePregnancy Class D/ not safe during pregnancy

Answer 24

1) Used to treat Gonorrhea