Pharm 2 Exam #4 (Chpt. 49-54, 32-34) Flashcards

1
Q

Explain potential health-promoting and detrimental effects of substances ingested during pregnancy
________
Chapter 49, objective #1

A

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

____________________________________________________________
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

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2
Q

Non-pharmacological methods of treating constipation during pregnancy

A

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

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3
Q

Drugs that Decrease Uterine Muscle Contractility

A

Tocolytic therapy (pre-term labor):
Beta2-adrenergic receptor agonists:
— Terbutaline
Calcium antagonists:
— MgSO4
CCBs:
— Nifedipine (Procardia)
Prostaglandin inhibitor:
— Indomethacin (Indocin) prostaglandin inhibitors
_______________________________________________________
Oxytocic (labor + hemorrhage):
— Prostaglandin
— Oxytocin (Pitocin)
— Ergot (Methergie) = for DIRE situations —> Elsa guíñate to death

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4
Q

Preterm labor (PTL) is common in moms that are

A

<18 years old & >40 years old

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5
Q

What are the 2 drugs categories that alter uterine function? What are their purpose?

A

1) Oxytocic drugs — uterotonic drugs, stimulate contractions
2) Tocolytic drugs — stimulate uterine relaxation; used to treat PTL

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6
Q

Goals of treatment of preterm labor (PTL)

A
  1. Interrupt or inhibit uterine contractions to create more time for in utero fetal development
  2. Delay delivery by 48-72 hours so antenatal corticosteroids can be given
  3. Delay delivery to allow transport to appropriate facility if required

Effectiveness of tocolytic drug – less than 6 uterine contractions per hour

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7
Q

RN Interventions During Tocolytic Therapy

A

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.

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8
Q

Describe the drugs that alter uterine muscle contractility
_________
Chapter 49, objective #2

A

_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)

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9
Q

Discuss drug therapy used during preterm labor to decrease the incidence or severity of neonatal respiratory dysfunction
__________
Chapter 49, objective #3

A

**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

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10
Q

Compare systemic and regional medications for pain control during labor
________
Chapter 49, objective #4

A
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11
Q

Describe the drugs used in gestational hypertension
__________
Chapter 49, objective #5

A

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

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12
Q

Describe the nursing process, including patient teaching, associated with the drugs used during pregnancy and preterm labor
________
Chapter 49, objective #6

A

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
_______________
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

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13
Q

Critique systemic and regional medications for pain control during labor, their action, side effects, and nursing implications
__________
Chapter 50, objective #1

A

(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
______________
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
____________
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

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14
Q

Describe the nursing process, including patient teaching, associated with the drugs used during labor and delivery
________
Chapter 50, objective #2

A

— 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

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15
Q

Compare and contrast drugs used to enhance uterine contractility during labor and following placental expulsion, their action, side effects, and nursing implications
______________
Chapter 50, objective #3

A

Slide 12. Table 50.4

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16
Q

Side effects of pain control drugs during labor

A

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

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17
Q

RN Implications for Pain Control Drugs during Labor

A

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

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18
Q

Discuss the purpose, action, side effects, and nursing implications of the drugs commonly administered during the postpartum period
__________
Chapter 50, objective #4

A

Lactation suppression = Slide #13
RhoGam = slide 16
Tx pain, hemorrhoids, constipation, wound care — table 50.4 (non pharm)

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19
Q

Describe the nursing process related to drugs used during the postpartum period immediately after delivery and include patient teaching
________
Chapters 50, objective #5

A

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

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20
Q

Discuss the purposes, actions, side effects, and nursing implications of the drugs administered to the newborn
_________
Chapter 51, objective #1

A
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21
Q

Describe the nursing process, including parent teaching for medications and immunizations administered to the newborn
__________
Chapters 51, objective #2

A
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22
Q

Recognize that successful contraception is essential to the health and well-being of women
_________
Chapter 52, objective #1

A
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23
Q

Describe methods of contraception (hormonal and nonhormonal) commonly prescribed, patient selection, mechanisms of action, and possible side effects
_______
Chapter 52, objective #2

A
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24
Q

Identify specific nursing actions that will enhance successful contraception for women and their partners
______
Chapter 52, objective #3

A
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25
Q

Describe the nursing process, including health teaching and risk-benefit–alternative education associated with medications used for contraception and family planning
_______
Chapter 52, objective #4

A
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26
Q

Explain the pathophysiology of women’s health conditions, pharmacologic therapies, and expected outcomes of pharmacologic therapies
_______
Chapter 52, objective #5

A
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27
Q

What are the 2 most common hormones involved in women’s health related to reproduction? What are their purposes?

A

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

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28
Q

Methods of Contraceptions

A

— 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)

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29
Q

What are the 3 most common methods of contraceptions?

A

1) Barriers methods: condoms, diaphragms
2) Oral: whether combined hormonal (CHC) or progestin only contraceptives (POC)
3) Sterilization = the most common

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30
Q

Understand pharmacologic interventions used in the treatment of female infertility
________
Chapter 52, objective #6

A
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31
Q

Describe the mechanism of action for ovulatory stimulation therapy
_________
Chapter 52, objective #7

A
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32
Q

Identify drug therapies used for common gynecologic conditions, such as dysfunctional uterine bleeding endometriosis, dysmenorrhea, and premenstrual syndrome
___________
Chapter 52, objective #8

A
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33
Q

Describe the nursing process, including teaching, related to drugs used in women’s health and infertility
_______
Chapter 52, objective #9

A
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34
Q

Provide information for nonpharmacologic and pharmacologic interventions for women experiencing menopausal symptoms
_________
Chapter 52, objective #10

A
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35
Q

Differentiate between the types of medications used for osteoporosis – bisphosphonates and SERMs
________
Chapter 52, objective #11

A
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36
Q

Describe the nursing process, including health teaching and risk-benefit–alternative education associated with medications used for menopausal symptoms
______
Chapter 52, objective #12

A
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37
Q

Describe the effects of gonadal hormone supplementation on the hypothalamic, anterior pituitary feedback loop
______
Chapter 53, objective #1

A
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38
Q

Describe the role of testosterone therapy in managing developmental problems related to primary and secondary male sex characteristics and in spermatogenesis
_________
Chapter 53, objective #2

A
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39
Q

Differentiate common conditions for which androgen therapy and antiandrogen therapy are indicated
________
Chapter 53, objective #3

A
40
Q

Describe patients for whom androgen therapy is particularly risky
________
Chapter 53, objective #4

A
41
Q

Assess patients for therapeutic and adverse effects of androgen therapy
________
Chapter 53, objective #5

A
42
Q

Categorize commonly prescribed medications that can impair male sexual function
________
Chapter 53, objective #6

A
43
Q

Explain the nursing process, including patient teaching, related to drugs used to treat male reproductive disorders
________
Chapter 53, objective #7

A
44
Q

Describe the pharmacologic intervention for sexually transmitted infections (STIs) caused by bacterial agents, viral agents, parasites, and other pathogens
________
Chapter 54, objective #1

A

Bacterial: vaginitis’s, chlamydia, gonorrhea, syphilis
— Tx: ABOs
Viral pathogens: herpes simplex, human immunodeficiency virus (HIV), human papillomavirus (HPV) | Tx: antivirals (not curable, but tx by decreasing viral load and transmission)
Fungal: yeast (white, curd-like d/c) | Tx: antifungals
Trichomoniasis: protozoan infection (yellow greenish d/c)
Scabies: burrowing mite | Tx: topical
Lice: parasite “crabs” | Tx: topical

45
Q

Describe the nursing process, including teaching, related to drugs used in women’s health, infertility and in the treatment of STIs
______
Chapter 54, objective #2

A
46
Q

Discuss ways the nurse can avoid exposure to anticancer drugs
_______
Chapter 32, objective #1

A

— Avoid skin contact
— Always wear TWO pairs of gloves
— Use non-absorbant gown + close front with fitted cuffs

47
Q

Differentiate between cell cycle–specific and cell cycle–nonspecific anticancer drugs
_________
Chapter 32, objective #2

A

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

48
Q

Compare the uses and considerations for alkylating compounds, antimetabolites, antitumor antibiotics, hormones, and biotherapy agents
__________
Chapter 32, objective #3

A
49
Q

Prioritize appropriate nursing interventions to use while patients receive anticancer drugs
___________
Chapter 32, objective #4

A
50
Q

Develop a focused teaching plan on the uses and side effects of anticancer drugs
___________
Chapter 32, objective #5

A
51
Q

Compare the mechanisms of action of targeted therapies (topoisomerase I and II inhibitors, small-molecule tyrosine kinase inhibitors, multikinase inhibitors (MKIs), angiogenesis inhibitors, and monoclonal antibodies) for cancer with those of standard chemotherapy drugs
_____________
Chapter 33, objective #1

A
52
Q

Explain the pharmacokinetics and pharmacodynamics for the different types of targeted therapy
_________
Chapter 33, objective #2

A
53
Q

Incorporate the nursing process related to the needs of patients receiving targeted therapies for cancer
___________
Chapter 33, objective #3

A
54
Q

Evaluate a focused teaching plan for patients, family, and caregivers for the different types of targeted therapies for cancer
__________
Chapter 33, objective #4

A
55
Q

Compare the mechanisms of action of drugs classified as biologic response modifiers with those of standard chemotherapy drugs
__________
Chapter 34, objective #1

A
56
Q

Distinguish among the different types of biologic response modifiers with regard to indications, common side effects and adverse effects, route of administration, and nursing responsibilities
_________
Chapters 34, objective #2

A
57
Q

Discuss three common side effects of interferons, colony-stimulating factors, and interleukin-2
_________
Chapters 34, objective #3

A
58
Q

Incorporate the nursing process related to the needs of patients receiving biologic response modifiers
_________
Chapters 34, objective #4

A
59
Q

Different menstrual disorders

A

Menorrhagia: heavy periods
Metrorrhagia: irregular bleeding b/w periods, usually heavy
endometriosis:
dysmenorrhea:
premenstrual syndrome (PMS):

NOTE: may benefit from continuous-cycle COC products because of their ability to suppress ovarian function and limit uterine bleeding

60
Q

Combined Oral Contraceptive Products (COC)

A

Types: pills, rings, transdermal patches
— Estrogen (inhibits FSH from pitiuitary) & progestin (suppresses LH surge midcycle, which usually triggers ovulation)
— Most commonly used methods of reversible contraception in the world b/c of their ease of use, high degree of effectiveness, and relative safety
— Can be non-phasic, monophasic, biphasic, triphasic or quadphasic – all equally effective and none advantageous over the other.

61
Q

Ortho-Evra Transdermal Patch Interventions

A

— Patch that is placed once a week for 3 weeks in a row
— Fourth week is patch-free to allow for withdrawal bleeding.
— Patch works in a similar manner to COC pills by inhibiting ovulation, thickening cervical mucus to prevent sperm penetration, and preventing a fertilized egg from implanting in the uterus.

Instruction: Hold patches in place for about 10 seconds…the warmth of your hand will adhere it better to skin. Avoid placement near the breast area

62
Q

Ortho-Evra Transdermal Patch MOA

A

MOA: inhibits ovulation, thickens cervical mucus to prevent sperm penetration, & prevents fertilized egg implantation in uterus

63
Q

NuvaRing Transvaginal Contraception Administration

A

Initiating tx: ring is inserted during first five days of menstrual cycle; back-up contraception is recommended during first seven days after ring is placed
— It can be removed rinsed with lukewarm water and reinserted.

KTR: can be removed, rinsed, and replaced, but if out >3hrs, MAKE SURE NEED TO USE ADDITIONAL CONTRACEPTION FOR THE NEXT 7 DAYS TO PREVENT PREGNANCY

64
Q

Progestin-ONLY Contraception

A

also known as POP, minipill

— Taken continuously, w/o break for w/drawal bleeding
— Alters cervical mucous and lining, inhibits ovulation

KTR: Must be taken at the same time every day| if >3hrs late, additional contraception is required for the next 48 HOURS

65
Q

Pros + Cons for Progestin-Only Contraception Productions (POP)

A

PRO: of not using estrogen for women who have CV risks than combined products that contain estrogen; good for moms that are breastfeeding (does not interfere w/ milk production unlike the combined hormonal products)

CON: have higher incidences of other side effects that women (breakthrough bleeding, depression, mood changes, decreased libido, fatigue, weight gain)

66
Q

Methods of administration of Progestin Products

A

Injected (IM) or implanted immediately postpartum
POPs can be started 4-6 weeks postpartum
Mirena can be placed 6 weeks postpartum

67
Q

Who are the Progestin Contraceptive Products best for

A

Women who does not have the schedule to remember to take pill at the same time everyday
After having children
Breastfeeding
Don’t want to be pregnant with another child immediately postpartum

68
Q

Problem with having an excess of estrogen

A

— Nausea, vomiting, dizziness
— Fluid retention, edema, bloating
— Breast enlargement, breast tenderness
— Chloasma (“mask of pregnancy”)
— Leg cramps
— Decreased tearing, corneal curvature alteration, visual changes
— Vascular headache
— Hypertension

69
Q

What do we teach patients with regarding S/Sx for excessive estrogen levels

A

Excessive estrogen levels pose a threat to dangerous CV side effects = notify HCP if you have:

Abdonminal pain (severe)
Chest pain | SOB
Headaches (severe)| dizziness/weakness/numbness/speech difficulties
Eye disorders | blurring, loss of vision
Severe leg pain | swelling

70
Q

What will we see if there is an estrogen deficiency?

A

Vaginal bleeding (breakthrough bleeding, especially in the first few cycles after starting therapy) that lasts several days (usually during days 1 to 14)
Oligomenorrhea (very scant periods) especially after long-term use
Nervousness
Dyspareunia (painful sexual intercourse) secondary to atrophic vaginitis

71
Q

When Progestin/Estrogen hormonal levels incline/decline, pregnancy will occur

A

Progestin, decline

72
Q

Bacterial vaginosis S/Sx? Tx?

A

KTR: If person has contracted one bacterial pathogen, will test for ALL STIs

bacterial infection
— healthy bacteria replaced w/ anaerobic bacteria
S/Sx: thin white d/c w/ fishy odor
Tx: Metronidazole (Flagyl); Tinidazole; Clindamycin

73
Q

Chlamydia S/Sx + Tx?

A

bacterial infection
most common STI in the US, RVA = the capital

S/Sx: usually asymptomatic, but can have bad complications (pelvic inflammatory disease, ectopic pregnancies, infertility)
**Tx: Azithromycin, erythromycin, ethylsuccinate, levofloxacin, ofloxacin, doxycycline, amoxicillin| abstain from sex for 7 days after single-dose therapy or until 7-day regimen completed **

74
Q

Gonhorrea S/Sx + Tx?

A

bacterial infection
2nd most common in US
S/Sx:
— Males = greenish-yellow or white d/c from penis, burning upon urination, testicular pain
— Females = frequently asymptomatic or low belly pain
— Oral infections = sore throat, difficulty swallowing

Tx: Ceftriaxone, azithromycin (single dose), cefixime, gemifloxacin, gentamicin

75
Q

Difference b/w primary, secondary, tertiary Syphilis + treatment

A

caused by bacterium Treponemia pallidum (spirochete)
will also test for HIV

Primary
— painless chancre (ulcer) at entrance site
Secondary
— skin rash, mucocutaneous lesions, fever
— fatigue, sore throat, lymphadenopathy; latent stage = asymptomatic, lasts 1-20 years
Tertiary
— large sores on skin or inside body
— cardiovascular and ocular syphilis, neurosyphilis
__________
Treatment —> Benzathine penicillin

76
Q

Viral Pathogens

A

Types:
— Herpes = genital herpes is lifelong infection
— HSV-1 = “cold sores”
— HSV-2 = “genitals”
only way to Dx correctly is to test b/c can obtain either d/t oral sex

S/Sx:
— lesions which crust over and scab, H/A
— fever

Tx: Acyclovir, valacyclovir, famciclovir
— antiviral medications can reduce reocurrences by ~70-80%
— 30-50% of babies of pregnant women will obtain this pathogen therefore receive suppression therapy w/in the last 4 weeks of pregnancy

77
Q

HIV

A

Chronic illness that progressively depletes CD4 T lymphocytes developing into AIDS (d/t complications)

S/Sx:
— fever, fatigue, rash, pharyngitis, lymphadenopathy

Tx: antiretroviral therapy (ART) or highly-active (HART)
— Suppression therapy that can reduce viral load and increase CD4 T count
— Concern = transmission form mother to baby is ~45% so teach mother that medication can reduce transmission to <2%

78
Q

Human papillomavirus

A

S/Sx:
— asymptomatic, genital warts
— recurrent respiratory papillomatosis

Complications: cancer
— Vaccines for the prevention of viral infection (transmitted sexually)
— Males should receive vaccine to prevent other types of cancers
Tx: removal of genital warts and precancerous lesions

79
Q

Other pathogens transmitted sexually

A

— Pediculosis pubis
— Scabies
— Trichomoniasis
— Vulvovaginal candidiasis

80
Q

Other pathogens transmitted through sexual contact

A

— Pediculosis pubis
— Scabies
— Trichomoniasis
— Vulvovaginal candidiasis

81
Q

Pediculosis virus

A

S/Sx:
— extreme pruritos
— lice or nits on pubic hair

Tx:
— permethrin, malathion, ivermectin
— pyrethrums w/ piperonyl butoxide

make sure to treat bed linen and clothes; HOT water; placing things in freezer for 24hrs to kill nits/lice

82
Q

Scabies

A

burrowing mite
— Not just a STD
— Close contact with children that have the mite; for adults = sexual
— Not limited to just the anus, but anywhere on the body

Tx:
— Permethrin = drug of choice for pregnant women
— Ivermectin
— Lindane
— Topical ointment = keep on for 8-12 hours and then washed off
DO NOT use Lindane on pregnant women or girls <10 years-old

83
Q

Scabies vs. Pinworms

A

(They are both mites, however)

Scabies: burrowing mite
Pinworms: worms found in the intestines and causes anal itching at night

84
Q

Trichomoniasis

A

most common curable STI in the US
— caused by Protozoan infection; may not know they have it

S/Sx:
males: urethritis, epididymitis, prostatitis
females: yellow-green vaginal d/c, may have vulvar irritation

Tx:
— Metronidazole (Flagyl)
— Tinidazole (Tindimax)

85
Q

Vulvovaginal Candidiasis

A

yeast infection
— vaginosis = overgrowth of fungus in vagina

Causes: ABOs, >sex partners, >sex activity

S/Sx:
— pruritos, vaginal soreness, dyspareunia
— external dysuria, thick curly vaginal discharge
— vulvar edema, fissures, excoriations

Tx:
— Clotrimazole, miconazole, triconazole
— Butoconazole, terconazole, fluconazole
— if on antibiotics, may give a couple more doses to ensure rid of infection

KTR: drugs similar in name to these are PPIs (-azole), so be careful when reading

86
Q

Difference b/w vaginosis & vulvovaginal candidiasis

A

(both can result in disturbance in vaginal flora)

Vaginosis: overgrowth of anaerobic bacteria in the vagina

*Vulvovaginal candidiasis: overgrowth of fungus in the vagina

87
Q

What is the major concern for women who have vulvovaginal candidiasis and are diabetic?

A

Increase risk of developing

88
Q

What is the major concern for women who have vulvovaginal candidiasis and are diabetic?

A

There is an increase risk of developing these yeast infections (sometimes frequent); make sure to follow-up to ensure they do not have it

89
Q

What are the changes in drug action during pregnancy? Why does this matter?

Hint: there’s 5

A

1) Effect of circulating steroid hormones on the liver’s metabolism of drugs
2) Reduced GI motility and increased gastric pH
3) increased glomerular filtration rate and increased renal perfusion —> >rapid renal excretion of drugs
4) expanded maternal circulating blood volume
5) alteration in the clearance of drugs in later pregnancy —> decrease in serum + tissue concentrations of drugs

This matters because because of alterations in the normal physiology of the body, drugs should not be ordered in lower doses with longer intervals between doses because of the possibility of subtherapeutic serum concentrations | late pregnancy/labor can alter the 1/2 lives of some drugs (labor = increase 1/2 life)
— It is also believed that drug clearance can decrease as a result of reduced blood flow associated with uterine contractions when a patient is in supine position
— DM, gestational HTN —> decreased renal perfusion, subsequent drug accumulation…PROBLEM

90
Q

The most common indications for the use of drugs during pregnancy are…?

A

— To supplement nutrition with iron, vitamins, and minerals
— Treat N/V, gastric acidity, and mild discomforts

caution must be exerted always

91
Q

Herbal medicines that should be avoided

A
  • Feverfew and sage are emmenagogues that stimulate blood flow in the uterus.
  • Kava decreases platelets.
  • Dong-quai, garlic, and ginkgo biloba increase bleeding when used with anticoagulants.
  • Ginseng may decrease the action of anticoagulants.
  • St. John’s wort has mutagenic effects on the cells of the developing embryo and fetus.
  • Pennyroyal taken by mouth or applied to skin can be abortifacient.
92
Q

Name the (3) uterotropic drugs used to alter uterine muscle contractility

A

1) Prostaglandins
2) Oxytocin
3) Methergine (Ergot alkaloid)

93
Q

Why would you induce labor?

A

— Appropriate when pregnancy has continued beyond term
— When early vaginal delivery is likely to decrease morbidity or mortality for the mother/infant

94
Q

Purpose of Cytotec

A

— Increases prostaglandins in the body and causes uterine contractions; used in early pregnancy as part of a medical abortion
— Helps ripen the cervix (preparing it to open and dilate) @ any gestational age
— Can help prevent postpartum hemorrhage
— Used to prevent GI upset from NSAIDs (reduce prostaglandins by inhibiting the COX enzymes)

95
Q

What are the 2 types of pain in childbirth? Examples?

A

1) Visceral = organs
— Example: uterus
2) Somatic pain
— Examples: skin, muscle, bone, joint, connective tissue

96
Q

Difference b/w 2 primary types of anesthesia for labor and delivery
Chapter 50, objective #1

A

— Local anesthetics = for local infiltration (e.g. episiotomy)
— Regional blocks = makes a specific part of the body numb to relieve pain or allow surgical procedures to be done (e.g. epidural, spinal)

97
Q

Commonly used vs. Not so commonly administration

A

— Common types of peridural anesthesia = spinal, epidural & combined spinal-epidural blocks
— Less commonly = caudal, paracervical, pudendal blocks