Maternity and Newborn Medications Flashcards
1
Q
Tocolytics
A
- produce uterine relaxation and supress uterine activity, decreasing both frequency and intensity of contractions.
- used to delay birth and prevent preterm.
- Nifedipine, magnesium sulfate and terbutaline are other meds used for this effect.
- Adverse effects: pulmonary edema, hypotension, hyperglycemia, and tachycardia (mother). Tachycardia (fetus).
- Maternal contraind: severe preeclampsia and eclampsia, active vaginal bleeding, intrauterine infection, cardiac disease, placental abruption, or poorly controlled diabetes.
- Fetal contraind: estimated gestational age greater than 37 weeks, cervical dilation greater than 4cm, fetal demise, lethal fetal anomaly, chorioamnionitis, acute fetal distress, and chronic intrauterine growth restriction.
- Interventions: position the client on her side to enhance placental perfusion, monitor VS, fetal status, and labor status, daily weight, input and output and provide fluid and comfort.
- Dosing should stop after 48h and should be interrupted if the maternal HR exceeds 120 bpm.
2
Q
Magnesium Sulfate
A
- a CNS depressant and antiseizure med that causes smooth muscle relaxation.
- the antidote is calcium gluconate.
- used to stop preterm labor and birth (not usually used for this effect). Prevents and controls seizures in preeclamptic and eclamptic clients.
- can cause respiratory depression, depressed reflexes, flushing, hypotension, extreme muscle weakness, decreases urine output, pulmonary edema, and elevated mag level.
- IV infusion increases the risk for toxicity in the NB.
- is stopped for delivery only if the mother is having a c-section.
- may be prescribed for the first 24-48h postpartum if used for preeclampsia.
- high doses can cause loss of deep tendon reflexes, heart block, respiratory paralysis, and cardiac arrest.
- contraind: clients with heart block, myocardial damage, or kidney failure.
- Interventions: monitor VS every 30-60 min (specially RR, if <12 rpm notify OB). Assess renal function and ECG, monitor mag levels every 6h (target range is 4 to 7.5) if increases notify OB. Always adm by IV and keep calcium gluconate close. Monitor deep tendon reflexes and test patellar or knee reflex before adm another dose. Monitor intake and output hourly (should be 25-30ml/h because med is eliminated through the kidneys).
3
Q
Betamethasone and Dexamethasone
A
- corticosteroids that increase the production of surfactant to accelerate fetal lung maturity and reduce the incidence or severity of respiratory distress syndrome.
- used for clients in preterm labor between 28 and 32 weeks whose labor can be inhibited for 48h without jeopardizing the mother of fetus.
- may decrease mother’s resistence to infection, pulmonary edema secondary to sodium and flui retention can occur, and elevated blood glucose levels can occur in a client with DM.
- monitor maternal VS, lung sounds for edema, signs of infection, white blood cell count, blood glucose levels, and adm by deep IM injection.
4
Q
Opioid Analgesics
A
- used to relieve moderate to severe pain associated with labor, adm by IM or IV route.
- regular use of opioids during pregnancy may produce withdrawal symptoms in the NB. Can also cause withdrawal in opioid-dependent clients.
- Naloxone is the antidote of choice.
- monitor VS, (if RR < 12 rpm, withhold med and notify OB), FHR, characteristics of uterine contractions, maintain recumbent position (elevate the hip with a pillow), monitor bladder for distention and retention.
5
Q
Opioid Analgesics: Hydromorphone hydrochloride
A
- can cause dizziness, nausea, vomiting, sedation, decreased BP, decreased respirations, diaphoresis, flushed face, and urinary retention.
- high dosages may result in respiratory depression, skeletal muscle flaccidity, cold clammy skin, cyanosis, and extreme somnolence progressing to seizures, stupor, and coma.
- used with caution in clients delivering preterm.
- not adm in advanced labor.
6
Q
Opioid Analgesics: Fentanyl and Sufentanil
A
- can cause respiratory depression, dizziness, drowsiness, hypotension, urinary retention, and fetal narcosis and distress.
7
Q
Opioid Analgesics: Butorphanol tartrate and Nalbuphine
A
- can cause confusion, sedation, sweating, nausea, vomiting, hypotension, and sinusoidal-like fetal heart rhythm.
- used with caution in a client with preexisting opioid dependency because can precipitate withdrawal symptoms in the client and NB.
8
Q
Prostaglandins
A
- ripen the cervix, making it softer and causing it to begin to dilate and efface. Stimulate uterine contractions ans is adm vaginally.
- used for preinduction cervical ripening (bishop <4), induction of labor or abortion.
- adverse effects: diarrhea, nausea, vomiting, and stomach cramps. Fever, chills, flusing, headache, and hypotension. Uterine tachysystole (>12 uterine contractions in 20 min without an alteration in the FHR). Hyperstimulation of the uterus, fetal passage of meconium.
- Contraind: active cardiac, hepatic, pulmonary, or kidney disease, acute pelvic inflammatory disease, fetal malpresentation, history of c-section or major uterine surgery, history of difficult labor or traumatic labor, hypersensitivity to prostaglandins, maternal fever or infection, nonreassuring FHR pattern, placenta previa or unexplained vaginal bleeding, regular progressive uterine contractions, significant cephalopelvic disproportion.
- Interventions: monitor VS, FHR, status of pregnancy, have the client void before adm then have her maintain a supine with lateral tilt or side lying position for 30-60 min (gel) or up to 2h (insert) after adm. Treatment is discontinued when the bishop score is 8 or more or an effective contraction pattern is established (3 or more in 10 min).
- Oxytocin may be initiated if needed 6 to 12h after discontinuation of prostaglandin therapy.
9
Q
Uterine Stimulant: Oxytocin
A
- stimulates the smooth muscle of the uterus and increases the force, frequency, and duration of uterine contractions. Also promotes milk letdown.
- for induction of labor is adm IV (or IM) and magnesium sulfate should be readily accessible in case relaxation of the myometrium is necessary.
- uses: induces or augments labor, controls postpartum bleeding, manages an incomplete abortion.
- adverse effects: allergies, dysrhythmias, changes in BP, uterine rupture, and water intoxication. May produce uterine hypertonicity and high doses may cause hypotension with rebound hypertension. Postpartum hemorrhage can occur and should be monitored.
- Contraind: client who can not deliver vaginally or client with hypertonic uterine contractions or active genital herpes.
- Interventions: monitor maternal VS every 15 min, do not leave client unattended, adm oxygen of prescribed, monitor for hypertonic contractions or a nonreassuring FHR (notify OB, stop med, turn client to the side, increase IV rate of additive solution and adm oxygen by face mask), monitor signs of water intoxication.
10
Q
Medications used to manage postpartum hemorrhage
A
- Methylergonovine (ergot alkaloid)
- Oxytocin
- Prostaglandin F2a: carboprost tromethamine
11
Q
Ergot Alkaloid
A
- directly stimulates uterine muscle, increases the force and frequency of contractions, and produces a firm tetanic contraction of the uterus.
- can produce arterial vasoconstriction and vasospasm of the coronary arteries.
- adm postpartum and is not adm before the birth of placenta.
- used for portpartum or postabortal hemorrhage.
- adverse effects: can cause nausea, uterine cramping, bradycardia, dysrhythmias, myocardial infarction, and severe hypertension.
- high doses are associated with peripheral vasospasm or vasoconstriction, angina, miosis, confusion, respiratory depression, seizures, or unconsciousness; uterine tetany can occur.
- contraind: during pregnancy and in clients with significant cardiovascular disease, peripheral vascular disease, or hypertension.
- Interventions: monitor maternal VS, weight, intake and output, level of consciousness, lung sounds. Assess for chest pain, headache, shortness of breath, pale or cold hands or feet, nausea, itching, diarrhea, and dizziness. Assess extremities for color, warmth, movement, and pain. Assess vaginal bleeding.
12
Q
Prostaglandin F2a
A
- contracts the uterus
- used for postpartum hemorrhage.
- can cause headache, nausea, vomiting, diarrhea, fever, tachycardia, and hypertension.
- contraind: asthma
- interventions: monitor VS, vaginal bleeding and uterine tone.
13
Q
Rho(D) immuno globulin
A
- prevention of anti-Rho(D) antibody formation is most successful if adm twice, at 28 weeks of gestation and again within 72h after delivery.
- adverse effects: elevated temp, tenderness at the injection site.
- contraind: Rh-positive clients and history of alergic reaction to human immunoglobulins
- note: not adm to a NB.
- Interventions: adm IM (never IV!), monitor temp and site of injection.
14
Q
Rubella Vaccine
A
- given SC before hospital discharge to a nonimmune postpartum client (titer is less than 1:8).
- adverse effects: transient rash, hypersensitivity.
- contraind: clients with hypersensitivity to eggs.
- question adm of the client or other family members are immunocompromised.
- pregnancy should be avoided for 1-3m after vaccine.
15
Q
Lung Surfactants
A
- replenish surfactant and restore surface activity to the lungs to prevent and treat respiratory distress syndrome. Adm to the NB by the intratracheal route.
- adverse effects: transient bradycardia and oxygen desaturation, pulmonary hemorrhage, mucus plugging, and endotracheal tube reflux.
- adm with caution in NB at risk for circulatory overload.
- inteventions: avoid suctioning for at least 2h after adm. Monitor for bradycardia and decreased oxygen saturation, respiratory status and lung sounds.
