Exam 2: Meds/newborn reflexes & tests Flashcards
Pitocin
prevents/treats hemorrhage; Pitocin 10-40 units in 500-1,000 mL LR IV bolus; can do 10 units IM without IV access
Methergine
treats hemorrhage, 0.2 mg IM
Contraindications: hypertension
TXA
1 g in 100 ml NS IV over 10 minutes, repeat in 30 minutes if not effective
Given during first 3 hours after birth
Cytotec
give 800-1000 mcg SL, buccal, or rectally
Hemabate
treats hemorrhage, give 250 mcg IM, intracervical, or intrauterine
Contraindications: primary = asthma; can cause diarrhea, so have an order for imodium
Ephedrine
5-10 mg IV for maternal hypotension (epidural)
Narcan
0.1mg/kg Q5min PRN for neonates with confirmed opioid exposure and struggling to transition
don’t use often, typically intubate
ambien
5-10 mg PO sedative for prodromal
Benefits: decreases anxiety, allows for rest, inhibits UC (therefore good for prodromal labor)
Risks: neonatal CNS depression, maternal response can vary
benadryl
20-50 mg PO
Benefits: induces relaxation and sleepiness (good for early labor when mom is exhausted)
promethazine (phenergan)
12.5-25 mg IM or PO antiemetic
Benefits: relieves nausea, vomiting; decreases anxiety; does not relieve pain, but potentiates narcotic
fentanyl
50-100 mcg IVP Q10-15 minutes x 5 doses
Onset: rapid; crosses placenta and is in fetal circulation within a minute of admin
Half life: 2-4 hours
** used often bc of it’s fast onset, short half life, and lack of metabolite; downside is short duration, so needs more frequent doses
morphine sulphate
2 mg IV + 10 mg IM with PO phenergan for prodromal labor (false contractions)
Onset: 10-30 min
Half life: 2-4 hours
Duration: 4-5 hours
nalbuphine
5-10 mg IVP partial opioid agonist
Onset: 2-3 min
Half-life: 3.5-5 hours
Since it’s a partial agonist, provides good analgesia without causing significant respiratory depression in the mother or neonate
Ceiling effect, so additional doses after 30 mg don’t increase respiratory depression
ADRS: drowsiness, dizziness, decreased FHR; less likely to cause n/v, but sedative effects may be greater
opioid benefits/risks
pain blunting effect → increased relaxation between UCs; neonatal CNS/respiratory depression, absent/minimal variability during labor; risk of maternal respiratory depression, bradycardia, hypotension, decreased GI motility
Opioids inhibit uterine contractions, which can prolong labor; should not be administered until later in labor unless they are used to help mom rest during a prolonged latent phase of labor
nitrous oxide
MOA: unknown… may stimulate endogenous endorphin, corticotropins, and dopamine release; dulls perception of pain
fast on/off (30 secs), self-admin (must hold mask), no effect on fetus, can be used in all stages, fall precautions
epidural
continuous injection of pain medication (narcotic +/- “-caine”) into epidural space between L2 and L4 vertebrae t/o labor; has a T8-S5 blocking effect. takes longer to take effect
(walking epidural is without the “-caine”)
Contraindications: allergy to agent, clotting disorders, hx of spinal injury or abnormality
Advantages: good pain relief, assists with coping, mom’s awake, dose can be continuously adjusted, avoids general anesthesia if end up having unplanned c/s, results in vasodilation, which increases placental perfusion and decreases maternal HTN for a time
spinal
Onset: immediate, lasts 1-3 hours
Mostly used for c/s, but can be used for vaginal delivery
Lower risk of failure, smaller drug volumes
Complications:
Inadequate block: “hot spot,” one sided, block failure
Breakthrough pain: full bladder, complete dilation, uterine rupture
Procedure related events: nerve root injury, accidental dura puncture, intravascular injection
Sympathetic nerve blockade:
Maternal hypotension leads to late decelerations: tx with ephedrine 5-10 mg IV and fluid bolus, side-lying position, face mask
Urinary retention- foley placement
Fever: possible similar to spinal cord injury
Itching: treat with Nubain or benadryl
