DRUGS Flashcards
1
Q
Oxytocin - Class and indication
A
Oxytocics
Induction, post hem bleed after placenta, threatened abortion
2
Q
Methylergonovine - Class and indication
A
Oxytocics
Prevent/treat PP hemorrhage caused by uterine atony or subinvolution
abnormal uterine bleed
3
Q
Dinoprostone - Class and indication
A
Oxytocic + Cervical ripening
Induction and cervical ripening
PP hemorrhage
4
Q
Misoprostol - Class and indication
A
Abortificants + prostaglandin
Termination of preg less than 45 days
Induction and cervical ripening
PP hemorrhage
*prevent NSAID induced ulcers
5
Q
Nifedipine - Class and indication
A
Tocolytic + HTN
Stop labor before 37 weeks
HTN
6
Q
Magnesium Sulfate - Class and indication
A
Tocolytic
Stop preterm labor
Prevent seizures in pre and eclampsia
Neuroprotection to fetus
7
Q
Transexamic acid - Class and indication
A
Increase clotting factors
Prevent/stop PP hemorrhage by increasing clotting factors
heavy menstural
8
Q
Carboprost - Class and indication
A
Oxytocic + abortificant
Labor induction
Term preg 13-20 weeks
PP hemorrhage from uterine atony not managed by other methods
9
Q
Terbutaline - Class and indication
A
Tocolytic / beta 2 agonists
Prevent preterm labor / decrease contractions
10
Q
Hydralazine - Class and indication
A
HTN
HTN emergencies - preeclampsia and eclampsia
11
Q
Labetalol - Class and indication
A
HTN
HTN emergencies - preeclampsia and eclampsia
12
Q
Ketorolac - Class and indication
A
Pain control
Short term management of pain control post c-section
NSAID
13
Q
Calcium gluconate - Class and indication
A
Antidote
Reversale med for mag toxicity
Hypocalcemia
Hyperkalemia
Reduce pre-eclampisa
Stop preterm birth
14
Q
Medroxyprogesterone - Class and indication
A
Birth control / decrease bleeding by hormone imbalance
15
Q
Phytonadione - Class and indication
A
Antidote / vitamin K
Treat and prevent bleeding in neonate / increase coagulation
16
Q
Oxytocin - Route and Dose
A
IV & IM
Induce: IV - 0.5-1mu/min, ^ 1-2mu/min
Post hemm: IV 10-40U, IM 10u
Abortion: IV 10u @10-20mu/min
17
Q
Methylergonovine - Roust and Dose
A
PO, IM, IV
0.2mg
*After delivery of shoulder, placenta or puerperium - IM q 2-4hrs as needed
*Life threatening = IV over 1 min + PO 3-4X a day for 7 days
18
Q
Dinoprostone - Route and Dose
A
Vag gel or insert / intraamniotic
Gel 0.5mg X2 q 6hr
Insert 10mg
MAX 1.5mg/24hr
19
Q
Misoprostol - Route and Dose
A
PO, Vag, Rectally
Abortion - 800 PO, buccally, sublingual + 400mcg PO, buccally or rectally after 24-48hrs
Induction - 25mcg q3-6hrs vag/rec
PP hemorrhage - 600-1000 mcg rectally
20
Q
Nifedipine - Route and Dose
A
PO
HTN- 30mg
Preterm - 10-20mg q 4-6hrs
21
Q
Magnesium sulfate - Route and Dose
A
IV
Eclampsia - loading 4-6g over 15-20mins + maintenance 1-3g/hr
Preterm - loading 4-6g over 20-30mins + maintenance 1-3g/hr
22
Q
Tranexamic acid - Route and Dose
A
IV
1g IV over 10 mins
Heavy menses - 1-1.5g 3x day up to four days prior or period
23
Q
Phytonadione - Route and Dose
A
IM SubQ
0.5-1mg w/in 1 hr of birth - left vastus lateralis
May repeat in 6-8hrs if needed
24
Q
Ketorolac - Route and Dose
A
IV
15-30mg IV q 6 hrs
Not to exceed 5 days!
25
Calcium gluconate - Route and Dose
IV
7-9g(5-10ml) of 10% over 5-10mins
**(MAX 3g)**
26
Medroxyprogesterone - Route and Dose
IM
150mg Q 3 months - given with in 5 days PP or after 6 weeks if breastfeeding
27
Labetalol - Route and Dose
PO, IV
PO -100mg twice daily, can increase q 2-3days (maintence dose 200-800/day in divided doses)
IV - 20mg over 2 min, additional dose q 10 min
**(max 300mg)**
28
Hydralazine - Route and Dose
PO, IV
5-10mg q 4-6 hrs
5-10mg IV admin slow over 2-5mins additional dose in 20-30mins
**(max 25mg)**
29
Carboprost - Route and Dose
IM
**Abortion** - 800mcg PO, buccally, sublingual + 400mcg PO, buccually, anally after 24-48hrs
**Induce/ripen **- 25mcg q 3-6 hours vaginally
**PPhem** - 600-1000mcg rectally
**Max 12mg or continous 2 days**
30
Terbutaline - Route and Dose
IV
2.5-10mcg, can increase by 5 q 10 mins until contractions stop
31
Oxytocin - Adverse effects
Water intox (coma, seizure, death), Uterine rupture, uterine tachysystole, Placental abrupto
Fetus - Asphyxia, intracranial hemorrhage, arrthymias
32
Methylergonovine - Adverse effects
Dyspnea
(Seizure, stroke with IV, MI HTN, cramp, nausea, vomit, decreased BP and increased RR - parethesia)
33
Dinoprostone - Adverse effects
Maternal?
Fetal?
**Amniotic fluid embolism, uterine hyperstimulation, uterine rupture**
(Fever, GI, Warm vagina)
FETUS: **HR abnormality **
34
Misoprostol - Adverse effects
Maternal?
Fetal?
**Uterine rupture, hemorrhage, uterine hyperstimulation, hypotension**
(nausea, vomit, diarrhea, diaphoresis)
**FETAL**: Abnormal FHR by restricting placental blood flow
35
Nifedipine - Adverse effects
**Hypotension and decreased blood flow to fetus**
(headache, dizzy)
gingival hyperplasia, constipation, flank pain
36
Ketorolac - Adverse effects
Maternal?
FEtal?
Gi Bleed
Renal, Cardiovascular, CNS, hematologic effects
FETUS - increased risk of miscarriage, premature closure of ductus arterious, harm to developing kidneys. AVOID In preg esp after 30 weeks
37
Calcium gluconate - Adverse effects
**Cardiac arrest, bradycardia**
Hypercalcemia, bradycardia, hypotension
38
Medroxyprogesterone - Adverse effects
DVT, PE, Breast cancer
Weight/mood changes
bone density loss
39
Magnesium Sulfate - Adverse effects
**Toxicity**! Loss of deep tendon reflexes, respiratory depression, cardiac arrest, neurological effects, muscle weakness
FETUS - hyptonia and respiratory depression
**Can cause fetal abnormalities if given beyond 5-7 days
40
Tranexamic acid - Adverse effects
Seizures, imparied color vision, GI upset,
Rare - excessive clotting, DVT, PE
Skin rash, diff breathing
41
Hydralazine - Adverse effects
Increased ICP, orthostatic hypotension, headaches, tachycardia
Maternal/fetal lupus like syndrome, hypospasias in boy fetus, thrombocytopenia
May cause fetal toxicity
42
Labetalol - Adverse effects
**Arrhythmias, HF, bradycardia, pulmomary edema
FETUS: Fetal growth restriction, hypoglycemia, bradycardia, hypotension, respiratory depression**
43
Oxytocin - Contraindications
Dino - wait 30min vag, 6-12hrs gel
Miso - do not use
X - when vag is contraindicated: fetal distress, prematurity, ob emergency, hypertonic uterus, fetal malpresentation, unripe cervix, history of uterine surgery
Vasopressors = severe HTN
44
Methylergonovine - Contraindications
HTN (vasocontricts), CAD, PAD (smoking, obesity, DM), MI, sepsis, liver disease
Grapefruit increases vasospasm
45
Dinoprostone - Contraindications
Hypersensitivty to prostaglandin
Active cardiac, pulmonary, renal or hepatic disease
Pelvic inflammatory disease
When prolonged uterine contract is inappropriate - placent previa, herpes, multipara, fetal distress
Do not use with other oxytocics
CAUTION: Asthma, kidney/liver dysfunction, ruptured membranes, glucoma
46
Misoprostol - Contraindications
Pelvic infection, sepsis
Inflammatory bowel disease (chrons disease or ulcerative colitis)
Active cardiovascular disease (HF or CAD) - bc of changes in bp and hr
Chronic renal failure
When vag delivery is contra - Placent previa, OB emergency, past csection, multiparity
*Avoid use with other oxytocic
47
Nifedipine - Contraindications
Hypotension, hemodynamical unstable
Avoid in HF pts
Breastfeeding
48
Ketorolac - Contraindications
Do not take more than 5 days
Increased bleeding with garlic, ginger, ginko
Not used during labor = inhibit contractions and affect fetal circulation
NSAIDS can cause fetal renal dysfunction
Avoid w/ peptic ulcer, severe renal impairment, asthma, urticaria and w/ other NSAIDS
49
Calcium gluconate - Contraindications
Cacrdiac arrest, bradycardia
hypercalcemia, hypotension
50
Medroxyprogesterone - Contraindications
DVT, PE, Breast cancer, pregnancy
Thromembolitic disease, breast/genital cancer, cerebral vascular disease, depression
51
Magnesium sulfate - Contraindications
When prolonging preg poses a risk
Before 20wks or after 34 wks
Heart block
Hypocalcemia, respiratory depression
Premature rupture of membranes
**Myasthenia gravis**
Caution: MI, renal disease
52
Tranexamic acid - contraindications
Clotting disorder, CAD, DVT, PE, thromoembolism, impaired color vision, concurrent use of hormonal contraceptives
Severe renal dyfunction
52
Hydralazine - Contraindications
CAD, rheumatic heart disease, hypersensitive to aspirin, hypotension, acute MI, glucoma, breastfeeding
Monitor slow position changes, HR
53
Labetalol - Contraindications
Asthma, heart disease, CHF, Severe bradycardia, HF, pulmonary edema, cardiogenic shock
54
What to monitor with Oxycotin?
I&O!!
If max dose 20mu/min - internal monitoring REQ
Discontinue if 3 conq decels or 1-2 min contractions
55
What to monitor with Methylergonovine?
Bp, pulse, contractions may continue up to 45mins after IV and 3 hours after PO, IM
Check Ca level prior to admin, low Ca decrease effectiveness
56
What to monitor with Dinoprostone?
Uterine activity, fetal status, cervix
*remove at onset of labor
57
What to monitor with Misoprostol?
Remove after 12 hours or onset of labor
58
What to monitor with Nifedipine?
**Look for decrease in FHR variability and decels!!**
Fall risk
Watch for signs of HF, monitor BP and pulse
59
What to monitor with Calcium gluconate?
| not checked
Monitor electrolyte levels, signs of hypercalcemia (confusion, coma)
60
What to monitor with Medroxyprogesterone
| not checked
BP, I&O,
May decrease glucose in DM
DO not use more than 2 years can cause osteroporosis
61
What to monitor with Magnesium sulfate
I&O. Output should be 100ml during 4 hr period
Monitor renal function, RR, EKG, mag levels
Calcium gluconate is antidote for mag toxicity
62
What to monitor with Tranexamic acid
| not checked
Monitor renal function
63
What to monitor with hydralazine
| not checked
Slow position changes
Monitor BP, HR, weight
64
What to monitor with labetalol
| not checked
pulse,BP I&o weight
65
Hep B - Class and indication?
Vaccine
Hep B prevention
66
Tdap - Class and indication?
Vaccine
Prevention of tetanus, pertussis and diptheria
67
Phytonadione - Class and indication?
| not checked
Antidote
Prevent bleeding in neonates (increase coagulation)
68
Hep B - Route and Dose
IM
Pregnancy - 20mcg/dose X3 IM deltoid
Neonate - 5mcg X 3 IM in vastus lateralus(series of 3)
69
TDAP - - Route and Dose
IM
0.5ML
Given to mom at 27-36wks or PP
70
Phytonadione - Route and Dose
IM, SUBQ
0.5-1mg w/in 1 hour of birth, may repeat in 6-8hrs if needed
71
What to monitor with hep b?
If mom is hep + - give neonate a bath then Hep B PLUS H bIG
If mom is hep B - = just give hep b
72
TDAP - contraindications
Some contain latex, confirm allergies
73
Carboprost - Adverse
Uterine rupture, excessive bleeding, respiratory distress, septic shock, bronchospasms, hypotension, bradycardia
74
Carboprost - contraindications
ASTHMA, hypersensitivity, acute pelvic inflammatory disease, active pulmonary, renal, hepatic or cardiovascualr disease
75
Terbutaline - adverse effects
Tachycardia, arrhythmias, hypotension, hypokalemia, hyperglycemia, pulmonary edema, chest tightness, seizures
Fetal - tachycardia
76
What 4 symptoms do you hold terbutaline for?
FHR greater than 180
RR greater than 30
Sp02 less than 95%
Maternal RH greater than 120
77
What to monitor with Carbopost
pretreat with antiemetics and antidiarrheals
monitor BP
78
Terbutaline - contraindications
Known cardiac disease
unmanaged DM
Hyperthyroid
TO delay preg = risk: preeclampsia, intrauterine infection, active vag bleeding,
Before 20wks after 34wks
Premature rupture of membrane
FEtal = abnormal FHR, fetal death, leathal amonalies
79
WHat to monitor with terbutaline?
Maternal respiratory status, hypoglycemia, hypokalemia
*increased RR, crackles, frothy sputumn, anxiety, chills, drowieness, weakness, U wave arrhythmias
80
Phytonadione - adverse
hypotension, thromboembolic events, skin changes
81
Phytonadione - contraindications
Severe liver disease, thromboembolic disorder, hemolytic anemia
82
Tdap - Class and indication
Vaccine
Tetanus (stiff muscle,spasm), Pertussis (Whooping cough), diptheria (thick coat in throat = decreased breathing)
83
Tdap - Route and dose
IM
0.5ML
Given to mom at 27-36 weeks or PP
84
TDAP - contraindications
Some contain laxtex - confirm allergies
85
Hep B - Class and indication
Vaccine
Hep B prevention
86
Hep B - Route and Dose
Pregnany women - IM deltoid, 20mcg/ dose X3
Neonate - IM vastus lateralus 5 mcg/dose X3
87
Hep B - what to monitor
If mom is hep B + = give baby a bath and give hep B and H big
If mom is Hep B - = just give Hep b
88
RhoGam - - Class and indication
Vaccine
Given to mom who is Rh negative who has Rh + baby or exposure to Rh+ blood
89
RhoGam - Route and dose
IM
Before delivery - 300mcg @26-28weeks and again following delivery 300mcg w/in 72hrs
Termination of preg with rh+ = IM 300mcg w/in 72hrs
90
RhoGam - adverse
Disseminated vascular coagulation (DIC)
Intravascular hemolysis
Back pain, shaking, fever, hemogloburiria
91
RhoGAM - Contraindication
Do not give to infant!
Do not give to Rh+ or people already previously sensitized to antigen
Hemolytic anemia, igA deficiency with antibodies against, acute thrombocytopenia
92
Rubella - - Class and indication
Vaccine
Prevent MMR
93
Rubella - Route and dose
Subq
0.5ml
94
Rubella - Contraindications
AFter vaccine do not conceive for 3 months causes birth defects
Can breastfeed
95
Betamethosone - Class and indication
Corticosteroid
Fetal lung maturation
Prevention of intraventricular hemorrhage (bleeding in brain)
Prevention of necrotizing enterocolitis (lifethreatening GI)
96
Betamethosone - Route and Dose
IM
12mg daily for 2-3 days before delivery
97
Betamethosone - adverse
Maternal - Hyperglycemia, hypertension, fluid retention, mood changes
FETAL - Growth restriction, adrenal suppression, immunomodulation (increasing infection), hypoglycemia
98
Betamethosone - contraindications
Maternal -Active infections, uncontrolled DM
Fetal - FEtal distress,, known fetal anomalies,
99
Betamethosone - what to monitor
Give to mom gestational 24-34wks
Monitor I&O, dyspnea
100
Penicillin - G - Class and indication
Antibiotic
Intrapartum for GBS prophylaxis
treatment of syphillis
101
Penicillin G - Route and dose
GBS - IV 5MU followed by 2.5MU q 4hrs until delivery or 4 doses
Syphillus - IM 2.4MU
102
Penicillin - adverse
Superinfection, renal and neurotoxicity
May alter normal colon flora and more susceptible to Cdiff
103
Penicillin G - contra
Cannot give to women with cephalosporin sensitivities
Renal, GI or neurologic disorders
104
Erythromycin - Class and indication
Antibiotics
to prevent ophthalmia neonatorum (blindness) caused by maternal STD
105
105
Erythromycin - Route and dose
Topical
0.5-1cm in length w/in 1st hour of delivery
federally required
