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OB Clinical > Labor and Delivery Drugs > Flashcards

Labor and Delivery Drugs Flashcards

1
Q

Nalbuphine (Nubain) and Butorphanol (Stadol) Classification

A

Narcotic analgesic

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2
Q

Nalbuphine (Nubain) and Butorphanol (Stadol) Pharmacokinetics

A

Widely distributed in the body and can cross the placenta. Can be found in breast milk.

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3
Q

Nalbuphine (Nubain) and Butorphanol (Stadol) Location of Metabolism and Excretion

A

Metabolized by the liver and excreted by the kidneys in urine.

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4
Q

Trade Name of Nalbuphine

A

Nubain

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5
Q

Generic Name of Nubain

A

Nalbuphine

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6
Q

Trade Name of Butorphanol

A

Stadol

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7
Q

Generic Name of Stadol

A

Butorphanol

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8
Q

Nalbuphine (Nubain) and Butorphanol (Stadol) Pharmcodynamics

A

Bind with opiate receptors in CNS. Have been known to cause addiction and withdrawal.

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9
Q

Nalbuphine (Nubain) and Butorphanol (Stadol) Pharmacotherapeutics

A

Used to treat moderate to severe pain and provide sedation. Usually given during the active phase of labor of the first stage of labor.

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10
Q

Nalbupine (Nubain) may be given post delievery as …

A

and antidote for pruritus.

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11
Q

Nalbuphine (Nubain) and Butorphanol (Stadol) Adverse Reactions

A

Lightheadedness, sedation, N/V, respiratory depression, fetal depression and respiratory depression in the neonate.

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12
Q

Dosing for Nalbuphine (Nubain)

A

Dose: 5-10 mg, IV 1.5-2 hours PRN. May be given IM or Subq

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13
Q

Dosing for Butorphanol (Stadol)

A

Dose: 1-2 mg, IV q1-2 hours PRN. May also be given IM.

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14
Q

Nursing Implications for mother with Nalbuphine (Nubain) and Butorphanol (Stadol)

A

Use with extreme caution in women who are in premature labor. Teach patient to ask for assistance with ambulation. Avoid given medication in latent phase as it may arrest labor. Monitor maternal respirations, contraindication is respiration rate below 12. Monitor for N/V.

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15
Q

Nursing implications for neonate with Nalbuphine (Nubain) and Butorphanol (Stadol)

A

If given within 1 hour of delivery it may cause severe neonatal respiratory depression.

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16
Q

Antidote for Nalbuphine (Nubain) and Butorphanol (Stadol)

A

Naloxone (Narcan)

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17
Q

Fentanyl (Sublimaze) Classification

A

Narcotic analgesic (opioid)

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18
Q

Fentanyl (Sublimaze) Pharmacokinetics

A

IM onset 7-8 min, peak 30 min, duration 1-2 hr
IV onset 1 min, peak 3-5 min, duration 0.5-1 hr
Half life is 1.5-1 hr
Crosses the placenta and enters breast milk

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19
Q

Fentanyl (Sublimaze) Pharmacodynamics

A

Binds to opiate receptors in CNS, increase pain threshold and alters pain perception.

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20
Q

Fentanyl (Sublimaze) Pharmacotherapeutics

A

Relief of moderation to severe pain. Can be given during first stage of labor parentally, IV push, PCA or via epidural analgesia.

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21
Q

Generic name of Sublimaze

A

Fentanyl

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22
Q

Trade name of Fentanyl

A

Sublimaze

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23
Q

Adverse reactions for Fentanyl (Sublimaze)

A

Dizziness, N/V, hypotension, respiratory depression, urinary retention

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24
Q

Dosing and Nursing implications for Fentanyl (Sublimaze)

A

Dose: 50-100 mcg, IV may be repeated every hour. May be given by PCA. Give IV over 1-2 min.
Assist with ambulation, monitor respirations.

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25
Q

Antidote for Fentanyl (Sublimaze)

A

Naloxone (Narcan)

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26
Q

Promethazine (Phenergan) Classification

A

Tranquilizer, antihistamine, antiemetic, sedative/hypnotic

27
Q

Promethazine (Phenergan) Pharmacokinetics

A

Onset: 20 min for PO, IM or Rectal; 3-5 min for IV.
Duration: 2-8 hr (sedation), 6-12 (antihistamine)
Widely distributed, crosses placenta and blood-brain barrier.

28
Q

Promethazine (Phenergan) Pharmacodynamics

A

Depresses CNS and competes with histamine for H1 receptors to produce antihistaminic, sedative and antiemetic actions.

29
Q

Trade name for Phenergan

A

Promethazine

30
Q

Generic name for Promethazine

A

Phenergan

31
Q

Promethazine (Phenergan) Pharmacotherapeutics

A

Prevents or relieves nausea and vomiting, preanesthetic and obstetric sedation.

32
Q

Promethazine (Phenergan) Adverse Reactions for Mother

A

Sedation, drowsiness, dry mouth and possibly a paradoxical increase in pain and excitability, esp when given given during active labor.

33
Q

Promethazine (Phenergan) Adverse Reactions for Fetus

A

May cause decreased beat-to-beat variability in the FHR, and moderate CNS depression (more common with large doses).
May cause neonatal hypotonia, lethargy and hypothermia.

34
Q

Dosing and Nursing implications for Promethazine (Phenergan)

A

Dose: 25-50 mg IM or IV
Usually only given during the latent or early active phase of the first phase of the first stage of labor.
Will potentiate narcotic analgesics and dose will be reduced when given in conjunction with Phenergan.
Ice chips or hard candy may relieve dry mouth.
Due to the potential for vein irritation, should be dilute in normal saline before administration.

35
Q

Classification of Hydroxyzine (Vistaril)

A

Antihistamine, anti-anxiety, sedative/hypnotic

36
Q

Hydroxyzine (Vistaril) Pharmacokinetics

A

Well absorbed following oral or IM administration. Distribution is unknown, but does cross placenta. Onset: 15-30 min; Duration: 4-6 hrs

37
Q

Hydroxyzine (Vistaril) Pharmacodynamics

A

Depresses CNS at the limbic and subcortical levels of the brain.

38
Q

Hydroxyzine (Vistaril) Pharmacotherapeutics

A

Tx of anxiety, preoperative sedative, reduce narcotic dosage. Administered IM during latent or early active phase of first stage labor to decrease anxiety and/or prevent nausea.

39
Q

Hydroxyzine (Vistaril) Adverse reactions

A

Dry mouth, pain at injection site, drowsiness, dizziness

40
Q

Dosing and Nursing Implications for Hydroxyzine (Vistaril)

A

Dose: 25-100mg given deep IM, z-track, in large muscle; or PO. DO NOT GIVE subq or IV because of potential tissue irritation at site.
Observe for excessive sedation due to potentiation with other CNS depressants.
If patient is alert, the nurse may suggest sugarless candy or gum to relieve dry mouth.

41
Q

Trade name of Vistaril

A

Hydroxyzine

42
Q

Generic name of Hydroxyzine

A

Vistaril

43
Q

Terbutaline (Brethine) and Magnesium Sulfate Classification

A

Tocolytics, Sympathomimetics

Magnesium Sulfate: anti-seizure with tocolytic properties

44
Q

Terbutaline (Brethine) Pharmacokinestics

A

Readily cross the placenta and appear in breast milk. When administered IV, they have a rapid onset of action. They are absorbed orally and excreted in the urine.

45
Q

Terbutaline (Brethine) Pharmacodynamics

A

Ritodrine and terbutaline are beta-receptor agonists which cause na inhibition of uterine smooth muscle contractions with decreased intensity and frequency of receptor stimulation. Can cause bronchodilation, vasodilation, and muscle glycogenolysis.

46
Q

Terbutaline (Brethine) Pharmacotherapeutics

A

Used to prevent or arrest preterm labor.

47
Q

Terbutaline (Brethine) Adverse Effects

A

Tachycardia, palpitations, nervousness and tremors/jitteriness, hypotension, hyperglycemia, hypokalemia, headache, nausea, vomiting. Fetal tachycardia is common as well as neonatal tachycardia.

48
Q

Terbutaline (Brethine) Dosing

A

Dose: 2.5 mcg/minute to a max of 17.5 mcg/minute IV until contractions stop. Maybe be given subq in one or two doses of 0.125 or 0.25 mg q2-4 hrs or by subq infusion pumps. 2.5-5 mg PO q2-6 hrs.

49
Q

Nursing Implications for Terbutaline (Brethine)

A
  • Obtain baseline FHR and maternal VS before administration. Monitor and record contraction pattern and FHT throughout administration.
  • Position pt in left lateral position.
  • Assess respiratory stats for rate, rales, and ronchi due to possibility of pulmonary edema. Need accurate I&Os.
  • Notify doc if maternal pulse is above 140 BPM or if FHR is above 180 BPM.
  • Assess serum glucose and potassium levels (drawn 12-14hrs)
  • Notify doc if BP is below 100/60, record vital signs every time IV infusion rate is increased.
  • Record prior to every PO dose
50
Q

Contraindications for Terbutaline (Brethine) and Magnesium Sulfate

A
  • Any reason that the pregnancy should not be prolonged such as fetal death, severe preeclampsia or eclampsia, antepartum hemorrhage, chorioamnionitis
  • Maternal conditions such as cardia disease, uncontrolled HTN, etc.
  • Pulmonary edema occurs more often in patients being treated with steroids.
51
Q

Trade name of Terbutaline

A

Brethine

52
Q

Generic name of Brethine

A

Terbutaline

53
Q

Antidote for Terbutaline (Brethine) and Magnesium Sulfate

A

Beta blockers, Propanolol (Inderal)

54
Q

Nifedipine (Procardia) Classification

A

Calcium channel blocker

55
Q

Nifedipine (Procardia) Indications

A

Sometimes used as tocolytic medication during preterm labor to slow uterine contractions. This is an off-label use

56
Q

Nifedipine (Procardia) is used for the tx of preterm labor when …

A
  • regular contractions of the uterus have effaced the cervix and dilated it less than 4 cm, and the mother’s amniotic sac has not ruptured.
  • the mother is healthy
  • the fetus is alive and not in distress
  • labor needs to be delayed for 24-48 hrs. Typically needed with corticosteroid tx to help fetal lungs mature.
  • beta-sympathetic meds have not stopped uterine contractions.
  • the mother is at high risk of suffering the side effects of beta sympathetic meds due to such conditions as diabetes, heart disease, or lung disease
  • tx with other tocolytic meds was stopped because of side effects.
57
Q

Nifedipine (Procardia) MOA

A

potent vasodilator and works on smooth muscle tissue. Blocks the passage of calcium into the tissue, relaxing the uterine muscles and smooth muscles of blood vessels throughout the body.

58
Q

Trade name of Nifedipine

A

Procardia

59
Q

Generic name of Procardia

A

Nifedipine

60
Q

Nifedipine (Procardia) Dosage

A

10mg PO, q20 min for 2-3 doses

61
Q

Nifedipine (Procardia) Adverse Reactions

A

dizziness, lightheadedness, nervousness, skin flushing, headache, nausea, muscle cramps, hypotension in the mother and possible decrease in the blood supply to the fetus.

62
Q

Nursing implications for Nifedipine (Procardia)

A
  • carefully monitor mother’s BP.
  • Do not use if mother is on magnesium sulfate.
  • Pregnant women with liver disease should not take this medication.
63
Q

Oxytocin (Pitocin; Syntocinon) Pharmacokinestics

A
  • Absorbed, distributed and metabolized rapidly.
  • It is metabolized by the liver and the kidneys and excreted in the urine.
  • Oxytocin is not thought to cross the placenta
  • enzymes in GI tact can destroy all protein hormones, oral administration is ineffetive

OB Clinical (1 decks)

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