Med Quiz II Flashcards
terbutaline sulfate: classification
tocolytic
Terbutaline sulfate: indications
- tocolytic: management of preterm labor–>inhibition of uterine contractions
Terbutaline sulfate: ADRs
- CV: maternal and fetal tachycardia, palpitations, cardiac dysrhythmias, chest pain, wide pulse pressure
- resp: dyspnea, chest discomfort
- CNS: tremors, restlessness, weakness, HA, dizziness
- metabolic: hypokalemia, hyperglycemia
- GI: n/v, reduced bowel motility
- skin: flushing, diaphoresis
Terbutaline sulfate: nursing implications
- not approved by the FDA for use as a tocolytic
- do not use for longer than 48-72 hour
- assess woman’s apical HR and lung sounds before administering each dose
- drug toxicity and d/c drug if: maternal HR over 120 bpm or respiratory findings such as “wet” lung sounds or more rapid rate
- report all non-reassuring maternal and fetal assessments to physician
- have propranolol ready as a reversal agent
nifedipine: classification
tocolytic; CCB
Nifedipine: indications
- CCB used for tocolysis
- reduce uterine contractions b/c Ca is essential for muscular contractions (for preterm labor)
nifedipine: contraindications
- AV heart block
- systolic BP <90
- coadministration with grapefruit juice
Nifedipine: ADRs
- flushing
- HA
- inc in maternal and fetal HR
- maternal postural hypotension
- hyperglycemia
- will cause the FHR to have reduced variability
Nifedipine: nursing implications
- observe for SEs
- report maternal pulse greater than 120 bpm
- educate on possible dizziness or faintness
- sit or stand slowly and call for assistance if needed
- never give with mag sulfate
Nifedipine: dosage
- Give 10-20 mg/3-6 hours until contractions become rare or stop
betamethasone: classification
glucocorticoids
Betamethasone: indications
- acceleration of fetal lung maturity to reduce the incidence and severity of respiratory distress syndrome (RDS)
- greatest benefits if at least 24 hrs elapse b/w initial dose and birth of preterm infant
- indicated if gestation b/w 24-34 wks
betamethasone: contraindications
- active infection, such as chorioamnionitis
Betamethasone: ADRs
- few b/c short term use of drug
- pulmonary edema possible secondary to sodium and fluid retention
- fever and elevated pulse rate secondary to infection
- UTI
- hyperglycemia
Betamethasone: nursing considerations
- educate woman on potential benefits, but tell her drug cannot prevent all complications of prematurity
- if woman has diabetes, more frequent blood glucose checks are needed
- WBCs greater than 20,000 may indicate infection
- but may have a temporary rise in platelets and WBCs for 72 hours that is expected
- assess lung sounds
- report chest pain, heaviness, or dyspnea
- report pain or burning with urination
- assess V/S for fever and elevated pulse
indomethacin: classification
ductus arteriosus patency adjunct
Indomethacin: indications
- tocolytic: to inhibit uterine contractions (for preterm labor)
- can be used to normalize volume of amniotic fluid if hydramnios is present
indomethacin: contraindications
- alcohol intolerance
- active GI bleed
- ulcer dz
- thrombocytopenia
- use of NSAIDs
Indomethacin: ADRs
- Maternal:
- GI: n/v/heartburn
- asthm ain aspirin sensitive women
- inc BP in hypertensive women
- Fetal:
- constriction of ductus arteriosus
- pulmonary HTN
- oligohydramnios (usually returns to normal when drug is d/c)
Indomethacin: nursing implications
- limit use to preterm labor before 32 weeks gestation
- use for no longer than 48-72 consecutive hours
- observe for GI SEs
- observe for abnormal bleeding (such as prolonged bleeding after injection and bruising with no apparent cause)
- watch for signs of infection, b/c drug may mask them
- check height of fundus at beginning of therapy and daily thereafter to identify reduced amniotic fluid
- observe for decreased fetal movements and absent FHR accelerations w/ fetal movement (may indicate fetal condition deteriorating)
- use U/S and fetal echocardiography to determine if drug having adverse effects on fetus
Carboprost tromethamine: classification
oxytoxics; prostaglandins
Carboprost tromethamine: Indications
- Used for tx of postpartum hemorrhage caused by uterine atony
- Abortion
carboprost tromethamine: contraindications
- acute PID
- asthma
- active pulmonary, hepatic, or renal dz
- use carefully if uterine scarring is present
Carboprost Tromethamine: ADRs
- Tetanic contraction and laceration
- Uterine rupture
- Uterine hypertonus if used w/ oxytocin
- n/v/d
- Fever
- Flushing
- HA
- HTN or hypoTN
- Tachycardia
- Pulmonary edema
Carboprost tromethamine: Nursing implications
- Refrigerate drug
- Give via deep IM injection and aspirate carefully to avoid IV injection
- Rotate sites if repeated
- Monitor V/S
- Administer antiemetics and antidiarrheals as ordered
Methylergonovine: classification
ergo-alkaloid and oxytoxic
Methylergonovine: indications
- Used for prevention and tx of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution
methylergonovine: contraindications
- should not be used to induce labor
- do not breastfeed during tx and for 12 hours after the last dose
- use cautiously in eclamptic patients
- exercise extreme caution in the 3rd stage of labor
Methylergonovine: ADRs
- n/v
- Uterine cramping
- HTN
- Dizziness
- HA
- Dyspnea
- Chest pain
- Palpitations
- Peripheral ischemia
- Seizure
- Uterine and GI cramping
Methylergonovine: Nursing implications
- Before admin, assess BP
- Withhold if hospital policy says you should at a certain level
- Tell mother to avoid smoking b/c constricts vessels and will inc BP
- Report any ADRs
magnesium sulfate: classification
tocolytic
magnesium sulfate: indications
- prevention and control of seizures in severe preeclampsia
- prevention of uterine contractions in preterm labor
magnesium sulfate: ADRs
- from magnesium overdose:
- flushing
- sweating
- hypoTN
- depressed DTRs
- CNS depression (including respiratory depression)
magnesium sulfate: nursing implications
- monitor BP closely during administration
- assess woman for respiratory rate above 12 breaths/minute, presence of DTRs, and urinary output greater than 30 mL/hour before administering
- place resuscitation equipment in room
- keep calcium gluconate (antidote) in room with syringes and needles
Mg Sulfate: loading dose
- 4-6 g/30 min
- then give 1-4 g for maintenance
calcium gluconate: indication
- antidote for magnesium toxicity
- prevent respiratory arrest if serum levels of magnesium get too high
why are magnesium levels less likely to become toxic in a woman who is in preterm labor?
b/c her renal function is usually normal
calcium gluconate: adverse reactions
- constipation
- phlebitis
- arrhythmias
- n/v
- HA
- tingling
- renal calciul/hypercalcemia
calcium gluconate: contraindications
- hypercalcemia
- renal calculi
- v. fib
calcium gluconate: nursing implications
- monitor for signs of hypocalcemia: numbness, tingling, Trousseau’s/Chvostek’s
- monitor BP, pulse, EKG
- administer with water and a meal
