pharm and care of pregnant or lactating women

Question 1

when using drug therapy there are special considerations for…

Answer 1

• before pregnancy
• during pregnancy
• lactation

Question 2

name some drugs related to pregnancy or lactation

Answer 2

• infertility drugs
• tocolytics
• ocytocic agents
• uterotonics

Question 3

whats the criteria for use of infertility drugs

Answer 3

unable to conceive after 1 year of trying

Question 4

what are some causes of infertility

Answer 4

women
ovulation disorder, blocked fallopian tubes, endometriosis, anomalies of the uterus, advanced age

men
absence of sperm, declining sperm counts, testicular anomalies, ejectulatory dysfunction

Question 5

what are some examples of drugs for infertility

Answer 5

• clomiphene citrate
• menotropin
• follitropins
• human chorionic gonadotropin
• leuprolide

Question 6

what does clomiphene citrate do

Answer 6

• ovarian stimulator
• increases FSH and LH to cause ovulation

Question 7

what does leuprolide do?

Answer 7

• prevent premature ovulation
• releases a higher quality egg

Question 8

describe the pharmacokinetics of drugs for infertility

Answer 8

• drug dependent (most are injection)
• PO, IM, SQ

Question 9

what are some adverse effects of drugs for infertility

Answer 9

• drug dependent
• multiple births
• hot flashes
• ovarian enlargement
• breast pain/tenderness
• visual disturbances
• abdominal distention
• headaches

Question 10

what are some contraindications of drugs for infertility

Answer 10

• drug dependent
• primary ovarian failure
• thyroid or adrenal disease
• ovarian cysts
• liver disease
• abnormal uterine bleeding
• thromboembolic disorders

Question 11

changes in pregnancy can alter…

Answer 11

pharmacokinetics

Question 12

describe maternal-placental-fetal circulation

Answer 12

• completed by week 3
• placental transfers occurs week 5
• toxic effects on fetus: low albumin, immature liver/kidneys, poor blood brain barrier

Question 13

what do drug effects on fetus depend on

Answer 13

• type/amount of drug
• duration of exposure
• level of fetal growth and development

Question 14

describe teratogenic

Answer 14

can cause serious fetal developmental harm

especially during the first 3 months of pregnancy (1st trimester)

Question 15

describe some drug effects during the 2nd and 3rd trimester

Answer 15

• growth retardation
• respiratory probs
• infections
• bleeding

Question 16

are all drugs potentially harmful to the fetus?

Answer 16

yeppers and they should be minimized or avoided if possible

Question 17

what are some guidelines for drug therapy during pregnancy

Answer 17

• ingested drugs reach fetus
• avoid drugs if possible
• lifestyle or nontherapeutic drugs can affect fetus
• avoid herbal supplements
• maintain healthy lifestyle
• notify HCP if think are pregnant
• drugs are excreted in breast milk
• avoid drugs of abuse

Question 18

name some maternal therapeutics

Answer 18

folic acid, prenatal vitamins
meds for:
- pregnancy associated probs
- chronic disease
- preterm labor
- pain management during labor
- induction of labor
- prevention of post partum hemmorhage

Question 19

name some fetal therapeutics

given to mom to effect fetus

Answer 19

• digoxin
• levothyroxine
• penicillin
• betamethasone
• Rh immune globulin (mom Rh neg)

Question 20

describe tocolytics

Answer 20

drugs that inhibit labor and maintain the pregnancy

Question 21

describe preterm labor

Answer 21

uterine contraction before 37 weeks

Question 22

what are some examples of tocolytics

Answer 22

• magnesium sulfate
• nifedipine
• terbutaline sulfate
• NSAIDS - indomethacin

Question 23

how does magnesium sulfate work as a tocolytic

Answer 23

stops neuromuscular contraction and relaxes uterine muscles

Question 24

what are some drugs used for labor induction

Answer 24

• prostaglandins: dinoprostone and misoprostol
• oxytocics: oxytocin

Question 25

how does oxytocin work for labor induction

Answer 25

- low dose is used - stimulates or strengthens uterine contraction

Question 26

what are some analgesics used for labor

Answer 26

- nalbuphine (safest) - epidural containing fentanyl/local anesthetic (bupivacaine)

Question 27

whats the downside of using epidurals for labor

Answer 27

needs to be done early and may slow contractions

Question 28

describe uterotonics

Answer 28

drugs used to stop postpartum hemorrhage

Question 29

name and describe a uterotonic

Answer 29

oxytocin - give a higher dose - strong contraction reduces uterine bleeding

Question 30

what may be used for lactation induction

Answer 30

- **metoclopramide** (stimulates prolactin) - galactagogues (herbs or foods that induce lactation)

Question 31

describe drug therapy during lactation

Answer 31

- drugs to treat postpartum depression: SSRIs (not ideal but a good option) - there are many meds contraindicated during lactation

Question 32

describe birth control during lactation

Answer 32

avoid progesterone-only birth control bc higher dose progesterone leads to reduction in milk production

Question 33

a couple has been trying to conceive for the past 8months without success. which of the following is the first drug of choice? 1) leuprolide 2) human gonadotropin 3) follitropin beta 4) clomiphene citrate

Answer 33

clomiphene citrate *clomiphene is an ovarian stimulator, increasing the amount of FSH and LH secreted by the pituitary gland. while other drugs can be used to treat infertility, clomiphene is first line drug choice*

Question 34

a woman with a seizure disorder has been taking phenytoin since she was 6 years old. she recently decided she wants to start a family. she understands the risk related to phenytoin during pregnancy. what should the nurse advise the woman about pregnancy? 1) discusss her concerns with her gynecologist and neurologist 2) she should stop taking phenytoin and take folic acid 3) she should begin a prenatal vitamin 4) she should consult a genetic counselor about her seizure disorder

Answer 34

discuss her concern with her gynecologist and neurologist *a patient should never stop taking seizure mes abruptly. while folic acid and prenatal vitamins are good, the phenytoin can be harmful to the fetus. the best thing to do would be to discuss the risk vs benefits with both docotrs and see which is the best way to proceed*