Obstetrics Flashcards
spontaneous abortion drugs
misprostol (cytotec)
this drug is used to prevent ulcers so make sure don’t give to woman of child bearing age to prevent ulcers
3 ways can evacuate spontaneous abortion
surgical
medical
expectant
preterm labor meds
tocolytics
steroids
Drug of choice for preterm labor between 24-32 weeks
Indomethacin
maternal side effects- nausea, gastric esophageal reflux, gastritis, emesis, platelet dysfunc
fetal side effects- closure of PDA, oligohydraminos
contraindications to indomethacin
Platelet dysfunction
Bleeding disorders
Hepatic dysfunction
GI ulcers
Renal dysfunction
Asthma if also sensitive to ASA (samters triad)
If give >48 hrs then need to monitor fetus w/ US to make sure PDA is open and oligohydraminos
Drug of choice for preterm labor between 32-34 weeks
Nifedipine
side effects- nausea, flushing, hypotension, HA, dizziness, palpitations
2nd line-terbutaline (beta agonist)
side effects-Tachycardia, palpitations, hypotension, tremor, shortness of breath, chest discomfort, hypokalemia, hyperglycemia
contraindications to nifedipine
hypotension, LV dysfunction or CHF, preload dependent cardiac lesion (right side of heart)
DO NOT use in conduction w/ magnesium sulfate cause work synergistically and can depress respiratory
what to monitor w/ nifedipine and terbutaline
I/O’s
Maternal symptoms of shortness of breath, CP, tachycardia
Stop drug if maternal HR > 120
Check blood glucose and K+ every 4-6 hours
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antenatal steroids
bethamethasone (preferred)
dexamethasone (2nd line non sulfite containing one)
indications for abx prophylaxis of Group B strep
positive culture had previous child w/ group b strep group b strep bacteriuria during current pregnancy or: maternal fever >100.4 preterm labor 18 hrs
do you need to give group b strep prophylaxis to woman who is having c section
no unless membranes rupture
abx prophylaxis for premature rupture of membranes
1 g Azithromycin at admission followed by ampicillin followed by amoxicillin OR if pcn allergy clindamyacin + gentamycin followed again by clindamycin
post partum hemorrhage
oxytocin- DOC
add misoprostol (stimulates uterine contractions)
add carboprost tromethamine (hemabate)
add methylergonovine maleate
contraindications for methylergonovine
HTN, raynauds, scleroderma (this drug is a vasoconstrictor)
contraindications of hemabate
asthma, HTN, renal failure, reduce cardiac output
severe HTN during labor
IV labetelol
or IV hydralazine
or PO nifedipine
seizure prophylaxis
magnesium sulfate
all cases of preeclampsia should be treated w/ this to prevent seizures
reversal of magnesium sulfate
calcium gluconate
how to check magnesium sulfate levels
plasma level 4- DTR decreased
level 8-10- DTR absent
10-15 respiratory paralysis
20-25 cardiac arrest
therapeutic level 4.8-8.4
contraindications to magnesium sulfate
heart block, myasthenia gravis, myocardial damage
induction of labor
pitocin (oxytocin)- stimulate uterine contractions
contraindications are things that you wouldn’t want to induce labor yet
tx of diarrhea
oral rehydration and diet changes is first line
can use loperamide ONLY if symptoms are disabling
constipation
1st line is increase dietary fiber and fluids
2nd line bulk forming agents- psyllium (metamucil), methyl cellulose (citrucel), fibercon, benefiber
refractory cases-lactulose or dulcolax; can use milk of magnesia too
gerd
lifestyle modifications (elevate bed, don’t eat late, antacids)
next line- sulcrafate
3rd line- h2 blockers- cimetidine (tagamet) or rantadine (zantac)
then ppi- omeprazole (prilosec), pantoprazole (protonix), lansoprazole (prevacid)
cold sxs
tylenol
saline spray
rhinorhea- ipratropium bromide (atrovent)
nasal congestion- pseudoephidrine (avoid in 1st trimester)
cough- robitussin or inhaled air, mucinex
