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Pharm Exam 3 > OB > Flashcards

OB Flashcards

1
Q

Clomiphene (Clomid) MOA

A

Blocks estrogen receptors, causes the pituitary to increase secretion of LH and FSH and folicels

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2
Q

Clomiphene Use

A

Promote follicular maturation and ovulation in women with functioning pituitary and ovaries
1st line drug

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3
Q

Clomiphene Must have

A

functioning ovaries and hormones

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4
Q

Clomiphene Dose

A

Start 5 days after first day of menses

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5
Q

Clomiphene A/E

A 
Serious:
-Multiple gestations 
-Ovarian hyperstimulation 
Hot flashes
Nausea
Abdominal discomfort
Bloating
Breast engorgement 
Vision changes
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6
Q

Clomiphene Preg Cat

A

X

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7
Q

Clomiphene Pt edu

A

Risk for multiple pregnancies

Signs of ovarian hyperstimulation (might need to stop)

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8
Q

Signs of Ovarian hyperstimulation

A

Abdominal discomfort
Bloating
Gaining wt

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9
Q

Clomiphene Nursing considerations

A

Pt is going to have serial ultrasounds to show follicular enlargement
Make sure the pt isnt pregnant before starting

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10
Q

Beta 2 Adrenergic agonist

A

Terbutaline

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11
Q

Terbutaline MOA

A

Suppresses uterine muscle activity

-Stops contractions

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12
Q

Terbutaline Use

A

Tocolytic

1st line drug for stopping contractions

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13
Q

Tocolytic Definition

A

stops contractions

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14
Q

Terbutaline Dose

A

250mg SubQ Q20min/3hr for no more than 48hr

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15
Q

Terbutaline A/E Maternal

A

Pulmonary edema
Hypotension
Tachycardia

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16
Q

Terbutaline A/E Fetal

A

Fetal tachycardia

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17
Q

Terbutaline Nursing considerations

A 
Monitor for A/E
HOLD if maternal HR >120
Does not prevent preterm labor 
Must be on fetal monitoring
Need a baseline maternal heart rate
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18
Q

Babies born <37 wk are at increased risk for:

A

Infection
Cerebral palsy
Intracranial hemorrhage
Respiratory distress

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19
Q

Nifedipine MOA

A

Ca Channel blocker

Blocks Ca channels in the myometrium

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20
Q

Nifedipine Use

A

Tocolytic
Stops contractions
Safer than terbutaline (tachycardia)

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21
Q

Nifedipine Dose

A

Loading dose of 30mg then 10-20mg Q4-6H

Only used for 48Hr

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22
Q

Nifedipine A/E Maternal

A 
Tachycardia
Flushing
HA
Dizziness
Nausea
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23
Q

Nifedipine Nursing consideration

A

Hold in fetal distress

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24
Q

Indomethacin MOA

A

Suppresses prostaglandins, which increase contractions

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25
Indomethacin Use
Premature labor (Tocolytic)
26
Indomethacin A/E Fetus
Closure of ductus arteriosus (cardiopulmonary problems) | Oligohydramnios (low amniotic fluid)
27
Indomethacin A/E Maternal
Nausea Gastric upset Kidney problems Postpartum bleeding
28
Nitroglycerine MOA
Inhibits myometrial activity
29
Nitroglycerine Use
Tocolytic
30
Nitroglycerine Dose
10mg Patch Q12H for 48 Hr
31
Nitroglycerine A/E Maternal
Hypotension | HA
32
Mag Sulfate MOA
Inhibits the release of acetylcholine at neuromuscular junctions
33
Mag Sulfate Use
Neuroprotection for fetus (against cerebral palsy) Does not stop labor Seizure prevention in preeclampsia (decrease threshold of seizure)
34
Preeclampsia effects
HTN, Kidney/ Liver damage | Seizures
35
Mag Sulfate Dosing
IV infusion or single bolus only given for 24 hr (any longer it might be deadly to the baby)
36
Mag Sulfate A/E Maternal Initial
``` Flushing Hypotension HA Dizziness Lethargy Warm feeling ```
37
Mag Sulfate A/E Maternal Late (too much Mag)
Respiratory depression | Sleepiness
38
Mag Sulfate A/E Maternal Other
Pulmonary edema
39
Mag Sulfate A/E Fetal
Muscle weakness → may need mechanical ventilation Hypotonia → poor muscle tone Poor feeding
40
Mag Sulfate Contraindication
Myasthenia Gravis | Kidney impairment
41
Mag Sulfate Monitoring
``` Hourly vitals Intake and output DTRs (deep tendon reflex) Fetal heart tones Contraction pattern Mag serum level Q4H (5-7) Kidney function (depending on output) Mag toxicity cause decrease respirations ```
42
Group B Strep
PCN Ampicillin Normal flora on a women that can cause sepsis in baby and kill baby Any pregnant women who have urinary/genital infection needs to get abx
43
Glucocorticoids in premature labor
Betamethasone Q24H x2 doses (mostly given) Dexamethasone Q12H x4 doses For fetal lung maturity
44
Dinoprostone MOA
Synthetic prostaglandin E2 | Breaks down collagen chains in the cervix and stimulates contractions
45
Dinoprostone Use
Soften cervix and cervical ripening
46
Dinoprostone Route
Gel (Prepidil) | Pouch (Cervidil) placed in the fornix
47
Dinoprostone A/E
N/V/D fever Uterine tachysystole and fetal distress (cut blood flow off form baby) -Remove pouch if it happens
48
Dinoprostone Nursing considerations
Mom needs to stay supine for: -Gel: 30 min -Pouch: 2 hr Continuous fetal and maternal monitoring before insertion and after removal
49
Dinoprostone Starting Oxytocin
6-12 hr after prepidil | 30 min after Cervidil removed
50
Misoprostol MOA
Synthetic prostaglandin | Promotes cervical ripening and uterine contractions
51
Misoprostol Use
Off label use for cervical ripening Postpartum hemorrhage Works better than Dinoprostone
52
Misoprostol Dose Cervical ripening
25mcg Placed in the posterior fornix of the vagina Q4H
53
Misoprostol Dose Hemorrhage
600-1000mcg
54
Misoprostol A/E Cervical ripening
increased risk for uterine tachysystole
55
Misoprostol A/E Hemorrhage
Shivering | Fever
56
Misoprostol Contraindications
``` Uterine surgery (Previous C-section) ↳cause uterine rupture ```
57
Misoprostol Nursing considerations
Can work fast (need to be monitoring) | Monitor contractions and fetal heart rate
58
Oxytocin MOA
Synthetic form of posterior pituitary hormone | Stimulates the frequency, duration, and force of contractions
59
Oxytocin Use
Augment labor ↳Induction Postpartum hemorrhage 1st line
60
Oxytocin Route Hemorrhage
IM
61
Oxytocin Route Induction
IV
62
Oxytocin A/E
``` ❊Water retention (monitor lungs) Uterine tachysystole Uterine rupture Fetal distress and hypoxia Increased pain in labor Cramping → hemorrhage ```
63
Oxytocin Nursing considerations
Fetal lung maturity should be established and cervical ripening has occurred Pain control Always on a IV pump, frequently check pump
64
Oxytocin Dosing Low dose
Start 0.5mu/min and increase by 1-2 mu/min Q15-40min
65
Oxytocin Dosing High dose
Start 6mu/min and increase by 3-6 mu/min Q15-40 min
66
Oxytocin Infusion monitoring
Needs to be on continuous fetal and uterine monitoring Frequent vital signs Monitor for uterine tachysystole: stop infusion
67
Optimal uterine contraction pattern
No more than 5 contractions lasting 1 minute or less in a 10 min period No increased uterine resting tones Normal fetal heart tones
68
Carboprost Tromethamine MOA
15 methyl prostaglandin F2 alpha | Causes uterine contractions and vasoconstriction
69
Carboprost Tromethamine Use
2nd line drug for postpartum hemorrhage
70
Carboprost Tromethamine Route
IM
71
Carboprost Tromethamine A/E
N/V/D fever HTN Impaired respirations
72
Carboprost Tromethamine Contraindications
PID Disease of the heart, liver, kidneys, lungs ❊Asthma, HTN, Uterine scarring Caution with diabetes
73
Methylergonovine MOA
Ergonovine derivative | Stimulate uterine contractions and vasoconstriction
74
Methylergonovine Use
2nd line postpartum hemorrhage | Late postpartum hemorrhage: PO
75
Methylergonovine A/E
HTN HA N/V
76
Methylergonovine Contraindications
❊Pre-existing HTN❊ ↳Give other drug Caution with liver, kidney disorders

Pharm Exam 3 (4 decks)

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