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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
Magnesium Sulfate (PreE)
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
26
Hydrazine Hydrochloride
Use --> HTN crisis | Admin --> IV push every 20 minutes until max dose is reached or BP controlled
27
Methydopa
Use --> HTN crisis | Admin --> IV push, PO
28
Labetalol
Use --> HTN crisis | Admin --> IV push incrementally increased doses every 10 minutes until BP is controlled or max dose is reached
29
Prophylactic Antibiotic Therapy for GBS
Penicillin G & Ampicillin | Use --> prevention of GBS transmission to the fetus from maternal host during delivery through the vaginal canal
30
Prophylactic Antibiotic Therapy for C-Section
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
Cervical Ripening Agents
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
Prostaglandin E2
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
Misoprostol (Cytotec)
Admin --> pill given either PO, per vagina, or SL | Maternal side effects --> minimal, except uterine tachysystole
34
Cervical Ripening Nursing Care
- monitor maternal VS, uterine activity, cervical dilation & effacement - Monitor fetal status - Remove medication if tachysystole occurs
35
Uterotonics/Oxytocics
Meds used to enhance/stimulate uterine contractions
36
Oxytocin (Pitocin)
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
Oxytocin Side Effects
Hypertonic uterine dysfunction (uterine tachysystole, uterine hypertonus, placental abruption, uterine rupture)
38
Oxytocin Nursing Care
- 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
L&D Pain Control
- Patient preference/medical status - Non-pharm methods - Pharm methods (IV narcotic, NO, epidural anesthesia)
40
Opioid Agonists
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
Narcan Dosage
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
Opiod Agonists/Antagonist
Nalbuphine, Butorphanol - may precipitate withdrawal symptoms in opiate dependent women - less respiratory depression & N/V than opioid agonists
43
Nitrous Oxide
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
Nitrous Oxide Maternal Adverse Effects
- N/V in 5-36% of women - Vertigo - Dysphoria, anxiety, restlessness - Does not help pain (just makes them not care about it)
45
Nitrous Oxide Fetal/Neonate Effects
- crosses placenta | - doesn't cause respiratory depression or effect apgar scores because it clears quickly when the neonate breathes
46
Nitrous Oxide Contraindications
- 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
Nitrous Oxide Administration
- 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
Regional Anesthesia: Epidural
- 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
Epidural Risks
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
Epidural Side Effects
- 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
Epidural Nursing Care
- 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
Postpartum Medications
Used to increase uterine contractions to close off blood vessels & stop hemorrhage Oxytocin, Misoprostol, Carboprost, Methergine
53
Oxytocin (postpartum)
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
Misoprostol (Cytotec)
Prostaglandin Use --> treat PPH Dose --> 400-1000mcg administered PO, SL or rectally (much higher than cervical ripening dose)
55
Carboprost Tromethamine (Hemabate)
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
Carboprost Tromethamine (Hemabate) Side Effects
- N/V - Diarrhea (major diarrhea with multiple doses) - Fever - Headache - Weakness - Uterine or vaginal pain
57
Methylergonovine Maleate (Methergine)
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
Methylergonovine Maleate Adverse Reactions
- HYPERTENSTION (monitor BP) - Seizure activity - Headache - Cramping - N/V
59
TXA - Tranexamic Acid
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
Postpartum Pain Control
- 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
Breastfeeding & Meds
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
Rho(D) Immune Globulin (RhoGAM)
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
Common Newborn Meds
Indicated for - Opthalmic prophylaxis - Initiation of clotting Cascade - Hepatitis infection prevention
64
Ophthalmic prophylaxis
-Protects against gonorrhea & chlamydia -Most common: Erythromycin (other possible = silver nitrate or tetracycline)
65
Vitamin K
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
Hepatitis B Vaccine
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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