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Spring Pharm > OB Pharm > Flashcards

OB Pharm Flashcards

1
Q

Tocolytic Agents

A

Medications used to stop uterine contractions & delay preterm birth
Magnesium sulfate, Terbutaline, Indomethacin, Nifedipine

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2
Q

Criteria for Tocolytic Use

A

EGA between 20-34 weeks, documented preterm labor, maternal consent
Benefits: decreased neonatal M/M

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3
Q

Indications for Short Course Tocolytics

A
  • facilitate transport from a small to larger hospital
  • delay delivery for 24-48 hrs to allow use of corticosteroids to mature infant lungs
  • neuroprotection for fetal brain
  • fetal resuscitation in utero for a compromised fetus
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4
Q

Relative Contraindications for Tocolytic Therapy

A
  • cervical dilation > 4 cm (labor is inevitable)

- ruptured membranes (increased risk of infection)

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5
Q

Absolute Contraindications for Tocolytic Therapy

A
  • fetal death
  • fetal anomalies incompatible with life
  • fetal compromise warranting immediate delivery
  • chorioamnionitis
  • severe hemorrhage
  • severe chronic HTN and/or preeclampsia
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6
Q

Magnesium Sulfate (Toco)

A

MOA –> inhibits release of acetylcholine in neuromuscular junctions; thought to provide neuroprotective effect decreasing the incidence & severity of CP in preterm infants
Route –> IV
Excreted by kidney
Dosing –> large initial dose & smaller maintenance dose
Therapeutic Mag Level –> 4-7.5 mg/dL

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7
Q

Magnesium Sulfate Maternal Adverse Effects

A

Non-life threatening: flushing, N/V, diplopia, blurred vision, headache, lethargy, burns IV site
Serious effects: muscle weakness, loss of DTRs, pulmonary edema, respiratory arrest, ileum, hypocalcemia, cardiac arrest

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8
Q

Magnesium Sulfate Fetal/Neonatal Side Effects

A

Hypotonia –> floppy newborn, decreased body tone
Lethargy
Hypocalcemia

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9
Q

Calcium Gluconate

A

Given to reverse effects of magnesium sulfate

  • frequent monitoring of BP, P, R, LOC & DTRs until stable
  • may require more than one dose if renal function is slow to clear Mag
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10
Q

Magnesium Sulfate Nursing Care

A
  • Frequent VS (potential for decreased RR)
  • Auscultate breath sounds q2 hours (potential for atelectasis or pulmonary edema)
  • Continuous SaO2 monitoring
  • DTRs q1-2 hr
  • Continuous EFM (may depress fetal activity & decrease baseline FHR variability)
  • Labs
  • Bed rest (for patient safety)
  • I&O q hr (assess for decreased UOP)
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11
Q

Terbutaline

A

Beta-Agonist
MOA –> promotes binding of intracellular calcium, which inhibits actin & myosin chain which results in relaxation of smooth muscle
Use –> used for intrauterine fetal resuscitation due to FHR prolonged deceleration, titanic uterine contraction & increased uterine resting tone
Dose – recommended SQ
Contraindications: cardiac disease, hyperthyroidism, DM, convulsive disorders

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12
Q

Terbutaline Maternal Adverse Effects

A

Metabolic: hyperglycemia, hypokalemia
Other: nervousness, N/V
CV: tachycardia, palpitations, hypotension, chest pain/myocardial ischemia, SOB/Pulmonary edema

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13
Q

Terbutaline Fetal/Neonatal Adverse Effects

A

Fetal: tachycardia, hyperinsulinemia, hyperglycemia
Neonatal: hypoglycemia, hypocalcemia, hypotension, ileus

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14
Q

Terbutaline Nursing Care

A
  • Check VS (Hold if HR > 120 or BP < 90/60)
  • Monitor for S/S of pulmonary edema (osculate breath sounds q4 hrs - check for dyspnea, coughing, crackles, wheezing, decreased SaO2)
  • I&O (watch for oliguria)
  • Assess fetal response (tachycardia)
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15
Q

Indomethacin

A

Prostaglandin Synthase Inhibitor
MOA –> NSAID; blocks production of prostaglandins leading to smooth muscle relaxation
Admin –> loading dose via rectum & PO dose with food; given over 72 hrs
Use –> only used prior to 32 weeks EGA (has a risk of closing the ductus arterioles prematurely)

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16
Q

Indomethacin Maternal Adverse Effects

A
  • N/V
  • Dizziness
  • Skin rash
  • Decreased renal blood flow
  • Postpartum hemorrhage (if delivered close to time of delivery)
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17
Q

Indomethacin Neonatal Adverse Effects

A
  • ventricular hypertrophy
  • premature closure of the ductus arteriosus
  • oligohydramnios (too little amniotic fluid due to decreased blood flow to the fetus)
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18
Q

Indomethacin Nursing Care

A
  • I&O (potential for oliguria)

- Postpartum (be prepared for hemorrhage; medications, fundal massage)

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19
Q

Nifedipine

A

Calcium Channel Blocker

MOA –> relaxes smooth muscle by blocking calcium entry into the cell

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20
Q

Nifedipine Maternal Adverse Effects

A
  • Hypotension
  • Tachycardia
  • Facial flushing
  • Headache
  • Peripheral edema
  • Nausea
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21
Q

Nifedipine Neonatal Adverse Effects

A

No known adverse fetal effects

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22
Q

Betamethasone

A

Corticosteroid
MOA –> enhances fetal lung maturity by promoting increased synthesis & release of surfactant resulting in improved neonatal lung function & prevention of RDS
Admin –> injection into pregnant mom; 2 IM doses given 24 hours apart
Use –> recommended for women at 23-34 weeks EGA at risk for preterm delivery within 7 days

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23
Q

Surfactant

A

MOA –> synthetic lipoprotein used to decrease surface tension of the pulmonary fluids in the alveoli to decrease atelectasis
Admin –> given to preterm infant per ETT by NICU personnel to prevent/decrease RDS

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24
Q

Preeclampsia/Hypertension Medications

A

Anti-Seizure: Magnesium Sulfate

Antihypertensives: Hydrazine, Methyldopa, Labetalol

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25
Q

Magnesium Sulfate (PreE)

A

MOA –> unknown; thought to compete with intracellular calcium across cell membrane
Use –> prevent/treat eclamptic seizures in women with preeclampsia
Dosing –> large initial dose & smaller maintenance dose; different seizure dose treatment

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26
Q

Hydrazine Hydrochloride

A

Use –> HTN crisis

Admin –> IV push every 20 minutes until max dose is reached or BP controlled

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27
Q

Methydopa

A

Use –> HTN crisis

Admin –> IV push, PO

28
Q

Labetalol

A

Use –> HTN crisis

Admin –> IV push incrementally increased doses every 10 minutes until BP is controlled or max dose is reached

29
Q

Prophylactic Antibiotic Therapy for GBS

A

Penicillin G & Ampicillin

Use –> prevention of GBS transmission to the fetus from maternal host during delivery through the vaginal canal

30
Q

Prophylactic Antibiotic Therapy for C-Section

A

1st Gen Cephalosporin (Ancef)
If PCN allergy, give combo of clindamycin & gentamicin
Admin –> one time dose given within 60 minutes before start of delivery

31
Q

Cervical Ripening Agents

A

Medications used for softening & effacement of the cervix (rearrangement of collagen, elastin & smooth muscles cells to stretch cervix; degradation of collagen by proteolytic enzymes causes cervical dilation
Agents: Prostaglandin E2, Misoprostol, Dinoprostone

32
Q

Prostaglandin E2

A

MOA –> enzymatic dissolution of collagen fibrils, increased H2O content & chemical changes
Side effects –> (dose related) cramping, painful uterine contractions, N/V, diarrhea, fever/chills
Caution in patients with –> asthma, HTN, renal disease, liver disease, cardiac disease, seizure disorders, DM

33
Q

Misoprostol (Cytotec)

A

Admin –> pill given either PO, per vagina, or SL

Maternal side effects –> minimal, except uterine tachysystole

34
Q

Cervical Ripening Nursing Care

A
  • monitor maternal VS, uterine activity, cervical dilation & effacement
  • Monitor fetal status
  • Remove medication if tachysystole occurs
35
Q

Uterotonics/Oxytocics

A

Meds used to enhance/stimulate uterine contractions

36
Q

Oxytocin (Pitocin)

A

MOA –> synthetic of oxytocin synthesized by hypothalamus & transported to posterior pituitary; binds to myometrial (uterine) oxytocin binding sites to increase myometrial activity (contractions)
Use –> given to initiate or increase uterine contraction frequency and/or strength
Admin –> IV (piggy-backed into proximal IV port & titrated to uterine contractions & fetal response)

37
Q

Oxytocin Side Effects

A

Hypertonic uterine dysfunction (uterine tachysystole, uterine hypertonus, placental abruption, uterine rupture)

38
Q

Oxytocin Nursing Care

A
  • Monitor uterine activity (titrate dose)
  • Discontinue oxytocin with tachysystole or increased resting tone
  • EFM (FHR & UC q15 min; discontinue oxytocin with fetal compromise)
  • Assess maternal VS q15-30 min, progression of labor, pain, bladder distention
  • Notify provider of abnormal tracing, inadequate progress, cervical change & Document it
39
Q

L&D Pain Control

A
  • Patient preference/medical status
  • Non-pharm methods
  • Pharm methods (IV narcotic, NO, epidural anesthesia)
40
Q

Opioid Agonists

A

Demerol/Phenergan
Placental crossing –> readily cross fetal blood-brain barrier, respiratory depression at birth, slower clearance from neonate due to immature real & liver function
must always have maternal & neonatal Narcan available when used in labor

41
Q

Narcan Dosage

A

Neonatal dose: 01 mg/kg IV @ 2-3 minute intervals, may repeat up to 3 doses
Maternal dose: 0.4-2 mg IV @ 2-3 minutes, up to 10 mg

42
Q

Opiod Agonists/Antagonist

A

Nalbuphine, Butorphanol

  • may precipitate withdrawal symptoms in opiate dependent women
  • less respiratory depression & N/V than opioid agonists
43
Q

Nitrous Oxide

A

MOA –> simulates endogenous endorphin release
Pharm –> rapid onset of action & rapid clearance (30-60 seconds)
Benefits –> no fetal effects; mom maintains motor & sensory function
Limitations –> timing with contractions, doesn’t take all the pain away, not offered at many hospitals

44
Q

Nitrous Oxide Maternal Adverse Effects

A
  • N/V in 5-36% of women
  • Vertigo
  • Dysphoria, anxiety, restlessness
  • Does not help pain (just makes them not care about it)
45
Q

Nitrous Oxide Fetal/Neonate Effects

A
  • crosses placenta

- doesn’t cause respiratory depression or effect apgar scores because it clears quickly when the neonate breathes

46
Q

Nitrous Oxide Contraindications

A
  • hemodynamically unstable/or impaired oxygenation
  • acute drug or alcohol intoxication
  • hx of trauma, pneumothorax, increased ICP, surgery
  • inability to hold own face mask
  • Vitamin B12 deficiency (can cause megaloblastic anemia)
47
Q

Nitrous Oxide Administration

A
  • Education of patient & support person
  • Patient holds mask to face & inhales deeply for 30-60 seconds prior to contraction
  • Hand falls away if too much NO is inhaled
  • Only patient can hold mask
48
Q

Regional Anesthesia: Epidural

A
  • A thin catheter is passed into the epidural space at L3-L4 & infuse meds continuously or intermittent
  • MOA –> “Caine” meds stop axonal conduction by blocking sodium channels resulting in motor & sensory block
  • can have combined epidural/spinal infusion for wider nerve block
  • Benefits –> eliminates sharp pain so only pressure of contractions & delivery are felt, very little med crosses placenta to fetus, no respiratory depression for mom/baby, no change in LOC
49
Q

Epidural Risks

A

Common: doesn’t work/have a spotty block, hypotension (mild to severe; most common complication)
Unusual/Rare: “wet tap” resulting in severe spinal HA, “high level” resulting in paralyzing respiratory musculature, accidental IV injection can result in cardiovascular collapse

50
Q

Epidural Side Effects

A
  • Itching & nausea (increased with Duramorph use)
  • Urinary retention (place a urinary catheter or intermittent catheterization)
  • Longer labor (may decrease first stage of labor)
  • Longer second stage of labor (pushing - can’t feel the muscles you need to push)
  • Increased risk of oxytocin use
  • Increased forceps or vacuum assisted delivery
51
Q

Epidural Nursing Care

A
  • Assist with positioning for placement
  • Monitor maternal VS & EFM
  • Preload with 1000mL of IV fluid to prevent hypotension
  • Assess ongoing pain relief
  • Monitor bladder distention (Foley or I&O cath)
  • Assess for return of sensation & motor function after delivery
52
Q

Postpartum Medications

A

Used to increase uterine contractions to close off blood vessels & stop hemorrhage
Oxytocin, Misoprostol, Carboprost, Methergine

53
Q

Oxytocin (postpartum)

A

Use –> produce uterine contractions during the 3rd stage of labor & to control postpartum bleeding/treat hemorrhage
Admin –> after delivery of placenta; 2 bags for vaginal & 4 bags for cesarean; IV or IM
Dosing –> bag #1 rapid infusion & bag #2 125 mL/hr

54
Q

Misoprostol (Cytotec)

A

Prostaglandin
Use –> treat PPH
Dose –> 400-1000mcg administered PO, SL or rectally (much higher than cervical ripening dose)

55
Q

Carboprost Tromethamine (Hemabate)

A

Prostaglandin F2
Use –> treats postpartum uterine bleeding r/t uterine atony
MOA –> simulates uterine contractions
Admin –> IM; may repeat at 15-90 minute intervals until max dose reached or PPH resolved
Caution in patients with –> asthma, HTN, renal disease, liver disease, cardiac disease, seizure disorders, DM

56
Q

Carboprost Tromethamine (Hemabate) Side Effects

A
  • N/V
  • Diarrhea (major diarrhea with multiple doses)
  • Fever
  • Headache
  • Weakness
  • Uterine or vaginal pain
57
Q

Methylergonovine Maleate (Methergine)

A

Ergot Alkaloid
MOA –> alpha-adrenergic agonist that initiates contraction of vascular smooth muscle in both arteries & veins
Use –> prevention/control of PPH
Admin –> IM after placental delivery, IV route used for emergencies, PO
Contraindication –> HTN patients

58
Q

Methylergonovine Maleate Adverse Reactions

A
  • HYPERTENSTION (monitor BP)
  • Seizure activity
  • Headache
  • Cramping
  • N/V
59
Q

TXA - Tranexamic Acid

A

Antifibrinolytic
Use –> off-label for PPH
MOA –> decreases bleeding by inhibiting breakdown of fibrin clots
Admin –> 1 gram slow IV
Complications –> color vision changes, blood clots, allergic reactions

60
Q

Postpartum Pain Control

A
  • Epidural (for cesarean or 4th degree lac)
  • Opioids (for cesarean and > 2nd degree lac)
  • NSADS (used for almost all patients)
  • Occasionally use a PCA
61
Q

Breastfeeding & Meds

A

Most drugs cross from maternal plasma to breast milk, but are found in very small amounts in breast milk
-need to balance risks vs. benefits

62
Q

Rho(D) Immune Globulin (RhoGAM)

A

Use –> given to prevent Rh isoimmunization (concerned about mom making antibodies against Rh+ blood which could affect future pregnancies if the next babies have Rh+ blood)
MOA –> suppresses immune response by initiating antibody production, therefore preventing Rh hemolytic disease in the fetus of future pregnancies
Admin –> given to ALL Rh- moms at 26-28 weeks; given postpartum to Rh- mom with Rh+ baby

63
Q

Common Newborn Meds

A

Indicated for

  • Opthalmic prophylaxis
  • Initiation of clotting Cascade
  • Hepatitis infection prevention
64
Q

Ophthalmic prophylaxis

A

-Protects against gonorrhea & chlamydia
-Most common: Erythromycin
(other possible = silver nitrate or tetracycline)

65
Q

Vitamin K

A

Use –> newborn gut is sterile , so there’s not bacteria in the intestine that can make Vitamin K until they’re about 8 days old; given to protect from Vitamin K deficiency bleeding
Complications if not received –> intracranial hemorrhage, intrabdominal hemorrhage, overt bleeding, bruising and/or pallor, poor feeding & vomiting
Admin –> IM given within 1-2 hrs of delivery with syringe 25-27 gauge, 1/2 to 5/8 inch needle

66
Q

Hepatitis B Vaccine

A

Admin: 0.5mL IM (oposite vastus laterals from Vit. K)
MOA –> 1st of 3 doses; induces protective antibodies in 95-99% of healthy babies
-Requires informed consent

Spring Pharm (8 decks)

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