Oxytocin

Question 1

Stage 1 of Labor

Answer 1

onset of labor to full cervical dilation

the cervix relaxes, causing it to dilate and thin out

latent phase
active phase
descent phase

Question 2

Stage 2 of labor

Answer 2

time from full dilation to delivery

uterine contractions increase in strength and the infant is delivered

Question 3

Stage 3 of labor

Answer 3

time from delivery of infant to delivery of the placenta

the placenta is expelled

Question 4

Powers

Answer 4

inadequate/uncoordinated contractions; inadequate pushing

Question 5

Passenger

Answer 5

position, presentation or size of fetus

Question 6

Passage

Answer 6

maternal bony pelvis and soft tissues that can impede the process

Question 7

Induction of labor

Answer 7

stimulate contractions before onset of labor to achieve a vaginal delivery

oxytocin: main role in stages 2 and 3

Question 8

Maternal medical conditions

Answer 8

diabetes, renal disease, pulmonary disease, hypertension

preeclampsia

fetal compromise

fetal demise

Question 9

Oxytocin administration

Answer 9

IV infusions: NS OR LR

hypotension and uterine hyperstimulation

standing nurse driving protocols
low dose:1-2 milliunits/min
high dose: 4-6 milliunits/min

max dose: 40 milliunits/min

half life of 3 min when infused

Question 10

Oxytocin adverse effects

Answer 10

tachysystole: > 5 contractions/ 10 minutes; fetal heart rate changes

hyponatremia

hypotension

hyperbilirubinemia

Question 11

Oxytocin for postpartum hemorrhage

Answer 11

first-line for uterine atony to prevent excessive blood loss

20 units/L or NS over 1 hours
range 10-40 units/L

IM or intramyometrial- 10 units

Question 12

Oxytocin for medical termination

Answer 12

typically during 2nd trimester

admit to labor and delivery

higher dose than that at-term labor
50 units/500 mL NS over 3 hours + 1 hour rest

Question 13

Institute for safe medication practices

Answer 13

high-alert medication

significant harm to mother or fetus if incorrectly dose/administered

additional checks

limit access to infusion

use auxiliary labels

standardized concentrations/ordering

Question 14

Transfer from mother to infant

Answer 14

orally available to mother

absorbed into mother’s bloodstream

able to cross into breast milk

orally available to infant

absorbed into infants bloodstream

Question 15

Relative infant doses (RID)

Answer 15

can be used to calculate potential exposure
if range, use highest number

> 10% large amount transferred to milk risk of effects in infant exists

Question 16

HALE’S Lactation Risk category

Answer 16

L1: Safest (tylenol, amoxicillin)
L2: Safer (benadryl, fluoxetine)
L3: Moderately safe ( sudafed, narco)
L4: Possibly hazardous ( colchicine, dapsone)
L5: Contraindicated (amiodarone, chemo)

Question 17

Antidepressants and lactation

Answer 17

FIRST LINE SSRI

SERTRALINE AND PAROXETINE

Question 18

Drugs of abuse and lactation

Answer 18

alcohol
amphetamines
benzodiazepines
cocaine
heroin
marijuana

Question 19

Drugs for substance abuse

Answer 19

Methadone: lethargy, respiratory difficulties, poor weight gain

buprenorphine: same risks
decreased milk production

disulfiram and naltrexone
use discourages by FDA labeling

Question 20

Pain medications and lactation

Answer 20

preferred: tylenol or ibuprofen

aspirin: low dose may be acceptable

morphine is preferred because it is poorly orally available in infants