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Ed > OB Meds > Flashcards

OB Meds Flashcards

1
Q

oxytocin: classification

A

oxytoxic

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2
Q

oxytocin: indications

A
  • induction or augmentation of labor
    • must have a favorable cervix (soft, go from posterior–>anterior position, dilate and efface)
  • control of postpartum bleeding
  • inevitable or incomplete abortion
  • antepartum contraction stress test (CST): can help determine if the fetus can tolerate labor by getting 3 contractions in 10 min w/o any nonreassuring signs in FHR (negative–>continue pregnancy; positive–>deliver)
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3
Q

oxytocin: action

A
  • stimulates uterine smooth muscle resulting in inc strength, duration, and freq of uterine contractions
  • vasoactive
  • antidiuretic
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4
Q

oxytocin: contraindications

A
  • placenta previa
  • vasa previa
  • nonreassuring FHR
  • abnormal fetal presentation
  • prolapsed cord
  • presenting part above pelvic inlet
  • previous classic or fundal uterine incision
  • active genital herpes
  • pelvic structural deformities
  • invasive cervical CA
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5
Q

oxytocin: dosage for induction or augmentation of labor

A
  • starting doses of 0.5 to 6 milliunits/min
  • inc the dose to 1-2 milliunits/min every 15-40 min
    • high dose protocols may inc dose in increments of up to 6 milliunits/min
  • after adequate contraction pattern is established and cervix is dilated 5-6 cm, oxytocin may be reduced
  • actual dose based on uterine response and absence of ADRs
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6
Q

oxytocin: dosage for control of postpartum bleeding

A
  • IV: 10-40 units at a rate of 20-40 milliunits/min
    • inc or dec rate according to uterine response and rate of postpartum bleeding
  • IM: 10 units after delivery of placenta
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7
Q

oxytocin: dosage for inevitable or incomplete abortion

A
  • 10 units at a rate of 10-20 milliunits/min
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8
Q

oxytocin: ADRs

A
  • hypertonic uterine activity
  • impaired uterine bloodflow
  • uterine rupture
  • abruptio placentae
  • fetal asphyxia (r/t diminished uterine blood flow)
  • maternal fluid retention–>water intoxication
  • hypotension
  • tachycardia
  • cardiac dysrhythmias
  • subarachnoid hemorrhage
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9
Q

oxytocin: nursing implications intrapartum

A
  • assess fetal HR for at least 20 min before induction AND verify a cephalic fetal presentation w/ Leopold’s maneuver or a vaginal exam
    • if nonreassuring FHR or non-cephalic, then do not begin induction until U/S is done
  • observe uterine activity for establishment of effective labor pattern
    • contraction every 2-3 min, duration of 40-90 sec, intensity of 50-80 mmHg
    • watch for hypertonicity: contractions less than 2 min apart, rest interval shorter than 30 sec, duration longer than 90-120 sec, or resting tone greater than 20 mmHg
  • if hypertonicity or nonreassuring FHR occurs, stop infusion, inc rate of nonadditive soln, position woman in side-lying, and administer O2 at 8-10 L/min
  • given by pump
  • titrated according to contraction pattern
  • record BP, pulse, and RR every 30-60 min or with each dose inc
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10
Q

oxytocin: nursing implications postpartum

A
  • administer after delivery of the shoulders of the infant to help uterus contract
  • observe uterus for firmness, height, and deviation
  • massage until firm if uterus is boggy
  • observe lochia for color, quantity, and presence of clots
  • assess for cramping
  • assess V/S every 15 min
  • monitor I&O and breath sounds to identify fluid retention or bladder distention
  • notify provider if uterus fails to remain contracted or lochia is bright red or has clots
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11
Q

Misoprostol: Classification

A

prostaglandin E1 (PGE1) analog

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12
Q

Misoprostol: indications

A
  • cervical ripening
    • make the cervix more favorable so you can administer oxytocin
  • induction of labor
  • termination of pregnancy
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13
Q

Misoprostol: action

A
  • causes uterine contractions
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14
Q

Misoprostol: contraindications

A
  • if you have risk factors for uterine rupture:
    • late trimester pregnancy
    • previous CS or uterine surgery
    • >5 pregnancies
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15
Q

Misoprostol: dosage

A
  • 25 mcg vaginally
    • must be prepared by pharmacist–broken from a 100 or 200 mcg tablet
  • 100 mcg orally
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16
Q

Misoprostol: ADRs

A
  • uterine hyperstimulation
  • contraindicated in a womean with previous cesarean or other uterine surgery
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17
Q

Misoprostol: nursing implications

A
  • to reduce leakage, have woman lie flat for 15-20 min after the gel form of PG is inserted
  • FHR should be monitored for at least 30 min for changes
  • uterus should be assessed for excessive contractions
  • oxytocin induction can begin 4 hours after last dose
  • if uterine hypertonicity occurs, place woman in side lying position, provide O2 at 8-10 L/min, administer tocolytic drug (terbutaline or Mg Sulfate)
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18
Q

Dinoprostone: classification

A

cervical ripening agent

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19
Q

Dinoprostone: indications

A
  • cervical ripening
    • make the cervix more favorable so you can administer oxytocin
20
Q

Dinoprostone: action

A
  • Produces contractions
  • Initiates softening, effacement, and dilation of the cervix
21
Q

Dinoprostone: contraindications

A
  • PID
  • ROM
  • previous CS
  • asthma
  • HTN
  • glaucoma
  • severe renal or hepatic dysfunction
  • ischemic heart dz
22
Q

Dinoprostone: dosage

A
  • 10 mg in a time release vaginal insert left in place for up to 12 hours
    • remove w/ onset of active labor, membrane rupture, or uterine hyperstimulation
23
Q

Dinoprostone: ADRs

A
  • hypertonic contractions (uterine hypertonicity)
  • amniotic fluid embolism
  • uterine rupture
24
Q

Dinoprostone: nursing implications

A
  • remove after 12 hours or when active labor begins
  • ADRs can be reduced w/in 15 min after removal
  • if hypertonic uterine activity occurs, remove insert, place woman in side lying position, provide O2 at 8-10 L/min, and administer tocolytic (terbutaline or Mg sulfate)
    • may occur up to 9.5 hours after placement
  • to reduce leakage, have woman lie down for 2 hours after insertion
  • oxytocin induction may begin 30-60 min after removal of insert
25
Q

Butorphanol tartrate: classification

A

opioid analgesic

26
Q

butorphanol tartrate: indications

A
  • systemic pain relief during labor
27
Q

Butorphanol tartrate: action

A
  • MOA unknown
  • has agonist antagonist effects
28
Q

Butorphanol tartrate: contraindications

A
  • opiate dependence
  • use cautiously w/ preterm births
29
Q

butorphanol tartrate: dosage

A
  • IV: 1 mg every 3-4 hour
    • range 0.5-2 mg
30
Q

butorphanol tartrate: ADRs

A
  • respiratory depression or apnea (in woman or fetus)
  • anaphylaxis
  • dizziness, lightheadedness, sedation, lethargy, HA, euphoria, mental clouding, fainting, tremors, delirium, insomnia
  • n/v/constipation/anorexia
  • dry mouth
  • flushing
  • altered HR and BP
  • circulatory collapse
  • urinary retention
  • sensitivity to cold
31
Q

butorphanol tartrate: nursing implications

A
  • assess for allergies and opiate dependence
  • administer at the beginning or peak of contraction in order to prevent a lot of med going to baby
  • observe V/S and respiratory fcn in woman (at least 12 breaths/min) and newborn (at least 30 breaths/min)
    • have naloxone and resuscitation equipment available
  • report n/v for an order for antiemetic
    • may enhance respiratory depression
32
Q

Fentanyl: classification (p.291)

A
  • opioid analgesic
33
Q

Fentanyl: indications

A
  • intrapartum pain management
    • opioid analgesics
    • used as an adjunct to epidural analgesia
34
Q

Fentanyl: action

A
  • Binds to opiate receptors in the CNS, altering the response to and perception of pain.
  • Produces CNS depression.
35
Q

Fentanyl: contraindications

A
  • opiate dependence
36
Q

Fentanyl: dosage

A
  • 50-100 mcg
    • may be repeated every hour
    • may be given by PCA
37
Q

Fentanyl: ADRs

A
  • pruritis
  • n/v
  • delayed respiratory depression: for up to 12 hr after administration
38
Q

Fentanyl: nursing implications

A
  • record baseline maternal V/S and FHR
  • nurse should observe for signs of subarachnoid puncture or intravascular injection
  • assess maternal BP and FHR every 5 min furing first 15 min after administration
    • repeat at 30 min and at 1 hour after procedure
  • assess bladder every 2 hour
    • may need to obtain order for catheter placement
  • observe neonate for respiratory depression (esp if drug given w/in 4 hours of birth)
  • can use adjunctive therapy for nausea (promethazine)
  • have naloxone and respiratory resuscitation equipment ready
39
Q

Bupivicaine: classification

A
  • epidural local anesthetic
40
Q

Bupivicaine: indications

A
  • epidural block
    • for intrapartum pain management
  • local anesthetic: for episiotomy, to repair tear or laceration
41
Q

Bupivicaine: action

A
  • Local anesthetics inhibit initiation and conduction of sensory nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission.
42
Q

Bupivicaine: contraindications

A
  • coagulation defects
  • uncorrected hypovolemia
  • infection in area of insertion or systemic insertion
  • allergy
  • fetal condition that demands immediate birth
43
Q

Bupivicaine: dosage

A
  • 10-20 mL
    • administer in increments of 3-5 mL
    • do a test dose of 3 mL before full administration
44
Q

Bupivicaine: ADRs

A
  • maternal hypoTN
  • bladder distention
  • prolonged 2nd stage of labor
  • epidural catheter migration
  • cesarean births
  • maternal fever
  • can cause seizure if injected into vessel
45
Q

Bupivicaine: nursing implications

A
  • often times administered with epi to prevent bleeding
  • record baseline maternal V/S and FHR
  • nurse should observe for signs of subarachnoid puncture or intravascular injection
  • assess maternal BP and FHR every 5 min furing first 15 min after administration
    • repeat at 30 min and at 1 hour after procedure
  • assess bladder every 2 hour and encourage mom to void
    • may need to obtain order for catheter placement
  • prehydrate woman with LR or NS
  • displace uterus with wedge under woman’s side to enhance placental perfusion
    • assess FHR for signs of impaired placental perfusion
    • if impaired placental perfusion or hypoTN occur: administer nonadditive IV fluid, reposition woman on side, administer 8-10 L/min of O2

Ed (2 decks)

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