OBI Flashcards
Clomiphene citrate (Clomid)
DOC Female ovulation
Mechanism of action: Binds to estrogen receptors in the pituitary gland, blocking them from detecting estrogen
Dosage: Variable; PO; Start on fifth day of menses with 50mg/day for five days; can increase dosage with next cycle if ovulation doesn’t occur
Side Effects: Vasomotor flushes, abdominal discomfort, N/V, breast tenderness, ovarian enlargement
Facts about Infertility
If cause of ailment is known, goal of treatment is to address that cause
Increase correlated with increase in age
Female infertility
Anovulatory (including intermittent) Clomiphene citrate (Clomid): stimulates ovulation; first-line; can lead to hyperstimulation and increased chance of multifetal pregnancy
Treatment for PCOS (r/t infertility)
Clomid- Infertility
Metformin- Insulin resistance
Unresponsive to Clomid (r/t infertility)
• Human menopausal gonadotropic (HMG), FSH, and rFSH for follicle stimulation
• HCG to induce ovulation
Others: Gonadotropin-releasing hormone (GnRH)-more aggressive therapy, progesterone, bromocriptine
GnRH- Daily estrogen monitoring and U.S.
Pregnancy Category
- Drugs are tested with specific criteria.
- A being the best and X the worst.
- X- lost of human studies have shown fetal abnormalities
Preterm Labor Meds
Antibiotics Decrease Uterine Contractility (Tocolytics) Terbutaline Nifedipine Indomethacin Magnesium Sulfate Betamethasone
Terbutaline
(IM) Preterm; Stimulates beta-2 adrenergic blockers, relaxing smooth muscle—stopping contractions; Monitor maternal and fetal HR)
Nifedipine
(PO) Preterm; Ca channel blocker; blocks calcium flow into smooth muscle; Monitor for s/sx of hypotension
Indomethacin
(PO) Preterm; blocks prostaglandin synthesis; Caution against long-term use due to fetal closing of Ductus arteriosus which could lead to pulmonary hypotension
a/e: gastric irritation, interstitial nephritis
Magnesium Sulfate
(IV) Preterm; Probably competes with calcium to decrease contractions; Not the most effective method of tocolysis; Monitor for s/sx of toxicity)
Helps stabilize blood flow in the baby to prevent complications if baby was to be born
Protect fetal development
Neuroprotective; protects against cerebral palsy
Maternal s/e: transient hypotension, flushing, head ache, dry mouth, feeling of lethargy
Contraindicated in: myasthenia gravis, hypocalcemia, renal failure
Monitor deep tendon reflexes-hypermagnesmia
Betamethasone
(IM) Preterm; Promotes fetal surfactant development; 23-34 weeks EGA
Nitro Patch TD Preterm; could cause headache and hypotension
Cervical Ripening
Intrapartum; Goal is to soften cervix to prepare it for dilation and delivery
-Prostaglandin synthesis by:
Dinoprostone- E2-
Endocervical gel (Prepidil)
Vaginal suppository (Cervidil)
Misoprostol-E1 (Cytotec)-Dinoprostone- E2-
Intrapartum; Vaginal suppository (Cervidil)-10mg suppository q12 hours on until onset of labor; Endocervical gel (Prepidil)-1mg in the posterior fornix, can repeat once in 6hrs; Pts need to be monitored after placement, lay supine for approx. 30 min Gel is applied intracervically via catheter
Misoprostol-E1 (Cytotec)-
Intrapartum; PO or vaginal-25-50mcgs vaginally; GI Drug-off-label use- induce cervical ripening also for abortions
Stored at room temp; more convenient, less expensive
-Not recommended for those with prior uterine surgery
Oxytocin (Pitocin)-Action, Route
DOC induction of labor
Used to establish an adequate labor pattern
titrated IV; Stimulates contractions by activating G-protein-coupled receptors that trigger increases in intracellular calcium levels in uterine myofibrils –promotes contractions and milk ejection
Oxytocin (Pitocin)- Warnings and cautions
One of the WHO’s most dangerous medications;
can cause tachysystole or uterine rupture if not carefully monitored and managed
In large doses could cause water intoxication due to antidiuretic effect
During infusion- constant monitoring
Maternal: BP, HR, Uterine Contraction (frequency)
Fetal: HR, Rythum- Stop infusion if fetal distress
Narcotics (IV)-
usually short-acting, can enhance with synergistic meds like Phenegran, caution giving close to delivery, b/c it could go to baby; nalbuphine (Nubain), butorphanol (Stadol), morphine
Epidural/Spinal -
long-acting for labor/surgery; local anesthetic combined with another opioid to increase effectiveness without prolonging motor function recovery; example: bupivacaine and fentanyl.
bed-bound
Spinal is more invasive/deeper that epidural
General Anesthesia-
Only used in emergent situations where time is a factor or if epidural/spinal is contraindicated like clotting disorder, or spinal surgery, or rods in the spine/back
Magnesium sulfate
- Other Use: (IV); Used to treat pre-eclampsia by decreasing calcium activity and minimizing risk of seizures
Antibiotics-Penicillin G
(IV; GBS 5 million units loading, 2.5 million units q4 until delivery), gentamicin, ampicillin, clindamycin
Bacteria found in 10-15% women can harm baby- go septic; test done towards end of pregnancy, and abx administered if present.
Antiemetics-
Ondansetron (IV, Zofran), metoclopramide (IV, Reglan), sodium citrate/citric acid (PO, Bicitra)
Oxytocin (Pitocin)-
Postpartum IV (bolus depending on hospital policy) or IM (10 units); MOA-increase uterine contractility
Misoprostol (Cytotec)
-Postpartum Rectal 600-1000 mcg once- MOA-increase uterine contractility
S/e: shivering, Increase in temp
Carboprost tromethamine (Hemabate)-
Postpartum Deep IM 250mcg every 15-90 minutes PRN, max 8 doses; MOA-increase uterine contractility; caution in pts with asthma d/t bronchoconstriction or HTN- causes vasoconstriction and bronchospasm
s/e: Monitor for SEVERE GI UPSET- diarrhea
GI reactions common; admin antiemetic and antidiarrheal prophylactically
Contraindicated in PID(Pelvic Inflammatory disease)- acute disease of heart, lungs, kidneys liver; asthma, HTN, DM, uterine scarring
Methylergonovine (Methergine)-
Postpartum IM 0.2mg q2-4hrs PRN; MOA-increase uterine contractility; caution in pts with HTN and CAD d/t increased risk of vasospasm
Postpartum Pain Management
Depends on route of delivery, surgical anesthesia, degree of laceration, etc. Witch hazel pads (Tucks)- comfort pads are good for moms who have hemorrhoids benzocaine spray (Dermoplast)- laccerations
C-Section: Pain Management
Ketorolac (Toradol) 30mg IV q6hrs and oxycodone/acetaminophen (Percocet)1-2 tabs PO q4-6 for the first 24 hours; following 24 hours, switch to ibuprofen and Norco(hydrocodone/acetaminophen) or Tylenol #3 (codeine/acetaminophen) protocol. b/c can’t send them home an IV, need PO meds
Vaginal delivery: Pain Management
Ibuprofen 600mg PO q6hrs for most, can also have opioids PO depending on situation (hydrocodone/acetaminophen (Norco) or codeine/acetaminophen (Tylenol #3); 1-2 tabs PO q4-6hrs PRN
b/c can’t send them home an IV, need PO meds
