Pharm 2 Exam #4 (Chpt. 49-54, 32-34) Flashcards
Explain potential health-promoting and detrimental effects of substances ingested during pregnancy
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Chapter 49, objective #1
WHAT TO AVOID:
— EtOH, smoking, heavy caffeine use
— Rubella exposure: it is a live vaccination therefore cannot give to mom b/c at risk for miscarriages, stillbirths, and defects for fetus = lower birth weight for baby (intrauterine growth restrictions); will have to give after baby is born
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NEEDED FOR/DURING PREGNANCY:
— Folic acid deficiency = neural tube defects |start 1-month prior to conception and continued 2-3 months post conception; S/Eff: urine = dark yellow
— Iron = 2x the normal amount is needed for pregnant women (60mg elemental, given until twos postpartum) | best absorbed on empty stomach/OJ aids absorption; may inhibit the absorption of the other meds
— Teratogenic period = 2-12 weeks after conception
— Multivitamins = preventing congenital defects (not proven); take 2 children’s chewable MVIs w/ Fe
Non-pharmacological methods of treating constipation during pregnancy
pg. 647
— Increase fluids; increase fiber; increase exercise – best to walk p.c.
— Castor oil should be avoided during pregnancy as it can induce labor.
— Mineral oil should be avoided because it can reduce the absorption of fat soluble vitamins…moms and babies especially need vitamin K
— Aspirin causes irreversible antiplatelet action – meaning aspirin effects last until mom and baby make new platelets
— Tylenol safest – has weak prostaglandin inhibition activity (which is why it is not a strong anti-inflammatory!) Remember max 4 grams per day, manufacturer recommends 3 G/day
Drugs that Decrease Uterine Muscle Contractility
Tocolytic therapy (pre-term labor):
Beta2-adrenergic receptor agonists:
— Terbutaline
Calcium antagonists:
— MgSO4
CCBs:
— Nifedipine (Procardia)
Prostaglandin inhibitor:
— Indomethacin (Indocin) prostaglandin inhibitors
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Oxytocic (labor + hemorrhage):
— Prostaglandin
— Oxytocin (Pitocin)
— Ergot (Methergie) = for DIRE situations —> Elsa guíñate to death
Preterm labor (PTL) is common in moms that are
<18 years old & >40 years old
What are the 2 drugs categories that alter uterine function? What are their purpose?
1) Oxytocic drugs — uterotonic drugs, stimulate contractions
2) Tocolytic drugs — stimulate uterine relaxation; used to treat PTL
Goals of treatment of preterm labor (PTL)
- Interrupt or inhibit uterine contractions to create more time for in utero fetal development
- Delay delivery by 48-72 hours so antenatal corticosteroids can be given
- Delay delivery to allow transport to appropriate facility if required
Effectiveness of tocolytic drug – less than 6 uterine contractions per hour
RN Interventions During Tocolytic Therapy
Perform maternal and fetal assessment and record daily weight
Monitor intake and output, breath/bowel sounds.
Assess deep tendon reflexes (DTR).
Assess pain and uterine contractions.
Monitor serum magnesium levels as ordered (therapeutic level is 4 to 7 mg/dL).
Have calcium gluconate (1 g given IV over 3 min) available as an antidote.
Observe newborn for 24 to 48 h for magnesium effects if drug is given to mother before delivery.
Describe the drugs that alter uterine muscle contractility
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Chapter 49, objective #2
_Uterotropic (uterine stimulant/enhancer):
— Oxytocic, ergot alkaloids, some prostaglandins
For inducing labor
— Mechanical methods = Foley catheter in undulated cervix | extra-amniotic saline infusion | membrane “stripping” | amniotomy (“breaking water”)
Prostaglandins
— Dinoprostone cervical gel (Prepidil gel)
— Dinoprostone vaginal inserts (Cervidil)
Discuss drug therapy used during preterm labor to decrease the incidence or severity of neonatal respiratory dysfunction
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Chapter 49, objective #3
**Given for PTL before the 32nd week of gestation **
Betamethasone (Celestone)
— given IM q 24 hours x 2 (48 hrs)
— inject into large muscle (avoid deltoid)
— watch for HYPERglycemia
Can also use Dexamethasone (babies seem to do better with Betamethasone
— given IM q 12 hours x 4 (48 hrs)
Tocolytics
— used to treat pre-term labor
— stimulates uterine relaxation
— used when there is less than 6 uterine contractions per hour
Compare systemic and regional medications for pain control during labor
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Chapter 49, objective #4
Describe the drugs used in gestational hypertension
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Chapter 49, objective #5
Gestational HTN
— Most common serious complication of pregnancy
_Preeclampsia:
— Gestational HTN w/ proteinuria
— A severe sequela of preeclampsia is known as HELLP syndrome (defined by Hemolysis, Elevated Liver enzymes, and Low Platelet count)
KTR: Preeclampsia SBP >140 and/or DBP <90
Eclampsia
— New-onset grand mal seizures in a patient with preeclampsia
Nonpharmacologic treatments for preeclampsia:
— Bedrest; lying on left side; increased dietary protein; psychosocial therapy; biofeedback
Pharmacological tx:
— Delivery of infant and POC (products of conception or placenta) is the only known cure for preeclampsia
— In the case of seizure delivery is postponed 1 to 3 hours if fetal status allows since mom can become acidotic from the hypoxia
— 1st line (mild) preeclampsia = Methyldopa, hydralazine, labetalol
— 2nd/Additional therapy : Prazosin, nifedipine, clonidine
— Severe preeclampsia: Magnesium sulfate
Adverse effects of preeclampsia:
Methyldopa: peripheral edema, anxiety, nightmares, fever | Drowsiness, headache, dry mouth, mental depression
Hydralazine: H/A/Di, nasal congestion, angina | Nausea, vomiting, tachycardia, hypotension, palpitations
Magnesium sulfate: lethargy, flushing, warmth, perspiration, thirst, sedation | Heavy eyelids, slurred speech, hypotension, DTR, decreased muscle tone
ACE-Is should NOT be used in pregnancy due to the risk of fetal renal toxicity
Describe the nursing process, including patient teaching, associated with the drugs used during pregnancy and preterm labor
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Chapter 49, objective #6
PHYSIOLOGICAL
1) Changes in liver metabolism – some drugs are cleared faster (ABOs, barbiturates) however during labor drugs may clear slower
2) Reduced GI motility and increased gastric pH – changes absorption; can add to heartburn
3) Increased glomerular filtration rate and increased renal perfusion – unless patient has diabetes or gestational hypertension
4) Expanded maternal circulating blood volume – results in dilution of drugs
5) Alteration in drug clearance in later pregnancy causing decrease in drug concentrations
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NAUSEA
Nonpharmacological
— BRAT diet; crackers before getting OOB; avoiding high fat, spicy foods; small meals; liquids between meals instead of with meals; flat soda; ginger; high-protein hs snack; iron supplement at bedtime; ginger (up to 1,000 mg/day) – can increase bleeding risk
Pharmacological tx
— Antacids – first line therapy if nonpharm methods fail to prevent heartburn
— H2 receptor antagonists: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) – category B
HEARTBURN
Nonpharmacologic tx
— Avoid spicy, greasy foods; limit caffeine; discourage smoking and alcohol; limit size of meals; avoid gas-forming foods (cabbage, onions, etc); eat slow and chew well; avoid citrus juice; avoid drinking with meal; avoid reclining after eating
CONSTIPATION
Nonpharmacological tx
— Increase fluids; increase fiber; increase exercise – best to walk p.c.
— Avoid castor oil should be avoided during pregnancy as it can induce labor.
— Mineral oil should be avoided because it can reduce the absorption of fat soluble vitamins…moms and babies especially need vitamin K
Pharmacological tx
— Aspirin causes irreversible antiplatelet action – meaning aspirin effects last until mom and baby make new platelets
— Tylenol safest – has weak prostaglandin inhibition activity (which is why it is not a strong anti-inflammatory!) Remember max 4 grams per day, manufacturer recommends 3 G/day
Critique systemic and regional medications for pain control during labor, their action, side effects, and nursing implications
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Chapter 50, objective #1
(2 Types: local anesthetics and regional blocks)
LOCAL ANESTHETIC
— For local infiltrations e.g. episiotomy)
— Injected local anesthetic agents that temporarily block conduction of painful impulses along sensory nerve pathway to the brain | will feel numb
— When epinephrine is given = less bleeding during episiotomy
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REGIONAL ANESTHESIA (spinal, epidural, pudenal, local infiltration)
(makes a specific part of the body numb to relieve pain or allow surgical procedures to be done (e.g. epidural, spinal))
— Goal: achieves pain relief during labor and delivery without loss of consciousness |Assess dehydration status prior
Interventions
— Assess hydration status before regional anesthesia is given.
— Position and support patient on her left side or as instructed by anesthesia provider
— Monitor labor progress for any decrease in frequency or intensity of uterine contractions.
— Monitor maternal vital signs and FHR.
— Assess uterine contractions.
— Assess for bladder distention.
— Watch out for Systemic HoTN (most frequent) | positioned/supported on LEFT side; hydration status assessed before regional anesthetic given
— ER drugs readily available: ephedrine, antihistamines, O2, resuscitation equipment
Some of these drugs wear off relatively quickly…within a few hours; others can last; i.e. Duramorph lasts 18 to 24 hours…so continue to watch for hypotension and side effects the entire time
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SYSTEMIC ANALGESICS
— given @ onset of uterine contractions b/c parenteral administration decreases neonatal drug exposure
— blood flow moves towards the fetus and uterus, causing increase pain, excitability, lethargy, and decreased BP
Describe the nursing process, including patient teaching, associated with the drugs used during labor and delivery
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Chapter 50, objective #2
— Advise patient reason and purpose of IV drug administration
— Discuss expected side effects regarding mother and fetus with IV drug administration
— Most pain meds are not given PO d/t GI upset, tx f(x) slower during labor b/c absorption decreases
— Position accordingly with use of side rails
Compare and contrast drugs used to enhance uterine contractility during labor and following placental expulsion, their action, side effects, and nursing implications
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Chapter 50, objective #3
Slide 12. Table 50.4
Side effects of pain control drugs during labor
Hypotension; decreased fetal heart rate (FHR); respiratory depression – mom and baby; decreased sucking response; euphoria; pruritus and nausea; constipation; lower Apgar scores for baby; confusion; orthostatic hypotension
RN Implications for Pain Control Drugs during Labor
Screen for prior analgesic use; monitor mom’s vitals and FHR; best not to administer opioids within 2 hours of delivery due to risk of neonatal respiratory depression; have narcan available; do not give opioids if respirations < 12/minute; safety precautions; can have narcotic withdrawal symptoms if mixed opioid agonist-antagonist given to narcotic dependent patient
Discuss the purpose, action, side effects, and nursing implications of the drugs commonly administered during the postpartum period
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Chapter 50, objective #4
Lactation suppression = Slide #13
RhoGam = slide 16
Tx pain, hemorrhoids, constipation, wound care — table 50.4 (non pharm)
Describe the nursing process related to drugs used during the postpartum period immediately after delivery and include patient teaching
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Chapters 50, objective #5
Nonpharmacologic agents
Pain relief for uterine contractions
NSAIDs
Opioids
Pain relief for perineal wounds and hemorrhoids
Topical and local agents
Witch hazel and dibucaine ointment
Discuss the purposes, actions, side effects, and nursing implications of the drugs administered to the newborn
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Chapter 51, objective #1
Describe the nursing process, including parent teaching for medications and immunizations administered to the newborn
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Chapters 51, objective #2
Recognize that successful contraception is essential to the health and well-being of women
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Chapter 52, objective #1
Describe methods of contraception (hormonal and nonhormonal) commonly prescribed, patient selection, mechanisms of action, and possible side effects
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Chapter 52, objective #2
Identify specific nursing actions that will enhance successful contraception for women and their partners
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Chapter 52, objective #3
Describe the nursing process, including health teaching and risk-benefit–alternative education associated with medications used for contraception and family planning
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Chapter 52, objective #4
Explain the pathophysiology of women’s health conditions, pharmacologic therapies, and expected outcomes of pharmacologic therapies
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Chapter 52, objective #5
What are the 2 most common hormones involved in women’s health related to reproduction? What are their purposes?
1) Progestins (progesterones)
— after ovulation serum levels begin to rise and if ovum is impregnated and fertilized, progestin levels continue to fertilize; progestin will drop (weaning) resulting in menstrual cycle
— Absence of progesterone, one starting to rise and then withdraw, (once levels drop), that completes luminal phase —> having a period
— Acts to prepare the uterus for implantation of a fertilized ovum. There are many types of progestins – eight different forms in oral contraceptives.
2) Estrogens (estradiols)
— Estrogen = hormone that prepares female tract for pregnancy; RISES during follicular phase until ovulation and then will drop
Methods of Contraceptions
— Spermicides
— Barrier methods (condoms (17%), diaphragms)
— Intrauterine contraception (IUD)
— Sterilization
— EC (emergency contraception): medical or surgical abortion
Oral (account for 28%):
— CHC (combined hormonal contraceptives)
— POC (progestin only contraceptives)
What are the 3 most common methods of contraceptions?
1) Barriers methods: condoms, diaphragms
2) Oral: whether combined hormonal (CHC) or progestin only contraceptives (POC)
3) Sterilization = the most common
Understand pharmacologic interventions used in the treatment of female infertility
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Chapter 52, objective #6
Describe the mechanism of action for ovulatory stimulation therapy
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Chapter 52, objective #7
Identify drug therapies used for common gynecologic conditions, such as dysfunctional uterine bleeding endometriosis, dysmenorrhea, and premenstrual syndrome
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Chapter 52, objective #8
Describe the nursing process, including teaching, related to drugs used in women’s health and infertility
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Chapter 52, objective #9
Provide information for nonpharmacologic and pharmacologic interventions for women experiencing menopausal symptoms
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Chapter 52, objective #10
Differentiate between the types of medications used for osteoporosis – bisphosphonates and SERMs
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Chapter 52, objective #11
Describe the nursing process, including health teaching and risk-benefit–alternative education associated with medications used for menopausal symptoms
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Chapter 52, objective #12
Describe the effects of gonadal hormone supplementation on the hypothalamic, anterior pituitary feedback loop
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Chapter 53, objective #1
Describe the role of testosterone therapy in managing developmental problems related to primary and secondary male sex characteristics and in spermatogenesis
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Chapter 53, objective #2
Differentiate between cell cycle–specific and cell cycle–nonspecific anticancer drugs
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Chapter 32, objective #2
Cell cycle – Major phases
G1 Cell prepares to make DNA
S DNA synthesis takes place
G2 Prepares for cell division
M Cell division takes place (mitosis)
After mitosis
Cells can enter G1 or G0
G0 – dormant
Cell-cycle–nonspecific
Alkylating agents
Antitumor antibiotics
Hormones
Cell-cycle–specific
Antimetabolites
Mitotic inhibitors
Vinca alkaloids
