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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
Q

Indomethacin Use

A

Premature labor (Tocolytic)

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26
Q

Indomethacin A/E Fetus

A

Closure of ductus arteriosus (cardiopulmonary problems)

Oligohydramnios (low amniotic fluid)

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27
Q

Indomethacin A/E Maternal

A

Nausea
Gastric upset
Kidney problems
Postpartum bleeding

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28
Q

Nitroglycerine MOA

A

Inhibits myometrial activity

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29
Q

Nitroglycerine Use

A

Tocolytic

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30
Q

Nitroglycerine Dose

A

10mg Patch Q12H for 48 Hr

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31
Q

Nitroglycerine A/E Maternal

A

Hypotension

HA

32
Q

Mag Sulfate MOA

A

Inhibits the release of acetylcholine at neuromuscular junctions

33
Q

Mag Sulfate Use

A

Neuroprotection for fetus (against cerebral palsy)
Does not stop labor
Seizure prevention in preeclampsia (decrease threshold of seizure)

34
Q

Preeclampsia effects

A

HTN, Kidney/ Liver damage

Seizures

35
Q

Mag Sulfate Dosing

A

IV infusion or single bolus only given for 24 hr (any longer it might be deadly to the baby)

36
Q

Mag Sulfate A/E Maternal Initial

A 
Flushing 
Hypotension 
HA
Dizziness
Lethargy 
Warm feeling
37
Q

Mag Sulfate A/E Maternal Late (too much Mag)

A

Respiratory depression

Sleepiness

38
Q

Mag Sulfate A/E Maternal Other

A

Pulmonary edema

39
Q

Mag Sulfate A/E Fetal

A

Muscle weakness → may need mechanical ventilation
Hypotonia → poor muscle tone
Poor feeding

40
Q

Mag Sulfate Contraindication

A

Myasthenia Gravis

Kidney impairment

41
Q

Mag Sulfate Monitoring

A 
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
Q

Group B Strep

A

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
Q

Glucocorticoids in premature labor

A

Betamethasone Q24H x2 doses (mostly given)
Dexamethasone Q12H x4 doses
For fetal lung maturity

44
Q

Dinoprostone MOA

A

Synthetic prostaglandin E2

Breaks down collagen chains in the cervix and stimulates contractions

45
Q

Dinoprostone Use

A

Soften cervix and cervical ripening

46
Q

Dinoprostone Route

A

Gel (Prepidil)

Pouch (Cervidil) placed in the fornix

47
Q

Dinoprostone A/E

A

N/V/D
fever
Uterine tachysystole and fetal distress (cut blood flow off form baby)
-Remove pouch if it happens

48
Q

Dinoprostone Nursing considerations

A

Mom needs to stay supine for:
-Gel: 30 min
-Pouch: 2 hr
Continuous fetal and maternal monitoring before insertion and after removal

49
Q

Dinoprostone Starting Oxytocin

A

6-12 hr after prepidil

30 min after Cervidil removed

50
Q

Misoprostol MOA

A

Synthetic prostaglandin

Promotes cervical ripening and uterine contractions

51
Q

Misoprostol Use

A

Off label use for cervical ripening
Postpartum hemorrhage
Works better than Dinoprostone

52
Q

Misoprostol Dose Cervical ripening

A

25mcg Placed in the posterior fornix of the vagina Q4H

53
Q

Misoprostol Dose Hemorrhage

A

600-1000mcg

54
Q

Misoprostol A/E Cervical ripening

A

increased risk for uterine tachysystole

55
Q

Misoprostol A/E Hemorrhage

A

Shivering

Fever

56
Q

Misoprostol Contraindications

A 
Uterine surgery (Previous C-section)
↳cause uterine rupture
57
Q

Misoprostol Nursing considerations

A

Can work fast (need to be monitoring)

Monitor contractions and fetal heart rate

58
Q

Oxytocin MOA

A

Synthetic form of posterior pituitary hormone

Stimulates the frequency, duration, and force of contractions

59
Q

Oxytocin Use

A

Augment labor
↳Induction
Postpartum hemorrhage 1st line

60
Q

Oxytocin Route Hemorrhage

A

IM

61
Q

Oxytocin Route Induction

A

IV

62
Q

Oxytocin A/E

A 
❊Water retention (monitor lungs)
Uterine tachysystole
Uterine rupture
Fetal distress and hypoxia
Increased pain in labor 
Cramping → hemorrhage
63
Q

Oxytocin Nursing considerations

A

Fetal lung maturity should be established and cervical ripening has occurred
Pain control
Always on a IV pump, frequently check pump

64
Q

Oxytocin Dosing Low dose

A

Start 0.5mu/min and increase by 1-2 mu/min Q15-40min

65
Q

Oxytocin Dosing High dose

A

Start 6mu/min and increase by 3-6 mu/min Q15-40 min

66
Q

Oxytocin Infusion monitoring

A

Needs to be on continuous fetal and uterine monitoring
Frequent vital signs
Monitor for uterine tachysystole: stop infusion

67
Q

Optimal uterine contraction pattern

A

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
Q

Carboprost Tromethamine MOA

A

15 methyl prostaglandin F2 alpha

Causes uterine contractions and vasoconstriction

69
Q

Carboprost Tromethamine Use

A

2nd line drug for postpartum hemorrhage

70
Q

Carboprost Tromethamine Route

A

IM

71
Q

Carboprost Tromethamine A/E

A

N/V/D
fever
HTN
Impaired respirations

72
Q

Carboprost Tromethamine Contraindications

A

PID
Disease of the heart, liver, kidneys, lungs
❊Asthma, HTN, Uterine scarring
Caution with diabetes

73
Q

Methylergonovine MOA

A

Ergonovine derivative

Stimulate uterine contractions and vasoconstriction

74
Q

Methylergonovine Use

A

2nd line postpartum hemorrhage

Late postpartum hemorrhage: PO

75
Q

Methylergonovine A/E

A

HTN
HA
N/V

76
Q

Methylergonovine Contraindications

A

❊Pre-existing HTN❊
↳Give other drug
Caution with liver, kidney disorders

Pharm Exam 3 (4 decks)

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