pharm and care of pregnant or lactating women Flashcards
when using drug therapy there are special considerations for…
- before pregnancy
- during pregnancy
- lactation
name some drugs related to pregnancy or lactation
- infertility drugs
- tocolytics
- ocytocic agents
- uterotonics
whats the criteria for use of infertility drugs
unable to conceive after 1 year of trying
what are some causes of infertility
women
ovulation disorder, blocked fallopian tubes, endometriosis, anomalies of the uterus, advanced age
men
absence of sperm, declining sperm counts, testicular anomalies, ejectulatory dysfunction
what are some examples of drugs for infertility
- clomiphene citrate
- menotropin
- follitropins
- human chorionic gonadotropin
- leuprolide
what does clomiphene citrate do
- ovarian stimulator
- increases FSH and LH to cause ovulation
what does leuprolide do?
- prevent premature ovulation
- releases a higher quality egg
describe the pharmacokinetics of drugs for infertility
- drug dependent (most are injection)
- PO, IM, SQ
what are some adverse effects of drugs for infertility
- drug dependent
- multiple births
- hot flashes
- ovarian enlargement
- breast pain/tenderness
- visual disturbances
- abdominal distention
- headaches
what are some contraindications of drugs for infertility
- drug dependent
- primary ovarian failure
- thyroid or adrenal disease
- ovarian cysts
- liver disease
- abnormal uterine bleeding
- thromboembolic disorders
changes in pregnancy can alter…
pharmacokinetics
describe maternal-placental-fetal circulation
- completed by week 3
- placental transfers occurs week 5
- toxic effects on fetus: low albumin, immature liver/kidneys, poor blood brain barrier
what do drug effects on fetus depend on
- type/amount of drug
- duration of exposure
- level of fetal growth and development
describe teratogenic
can cause serious fetal developmental harm
especially during the first 3 months of pregnancy (1st trimester)
describe some drug effects during the 2nd and 3rd trimester
- growth retardation
- respiratory probs
- infections
- bleeding
are all drugs potentially harmful to the fetus?
yeppers and they should be minimized or avoided if possible
what are some guidelines for drug therapy during pregnancy
- 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
name some maternal therapeutics
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
name some fetal therapeutics
given to mom to effect fetus
- digoxin
- levothyroxine
- penicillin
- betamethasone
- Rh immune globulin (mom Rh neg)
describe tocolytics
drugs that inhibit labor and maintain the pregnancy
describe preterm labor
uterine contraction before 37 weeks
what are some examples of tocolytics
- magnesium sulfate
- nifedipine
- terbutaline sulfate
- NSAIDS - indomethacin
how does magnesium sulfate work as a tocolytic
stops neuromuscular contraction and relaxes uterine muscles
what are some drugs used for labor induction
- prostaglandins: dinoprostone and misoprostol
- oxytocics: oxytocin
how does oxytocin work for labor induction
- low dose is used
- stimulates or strengthens uterine contraction
what are some analgesics used for labor
- nalbuphine (safest)
- epidural containing fentanyl/local anesthetic (bupivacaine)
whats the downside of using epidurals for labor
needs to be done early and may slow contractions
describe uterotonics
drugs used to stop postpartum hemorrhage
name and describe a uterotonic
oxytocin
- give a higher dose
- strong contraction reduces uterine bleeding
what may be used for lactation induction
- metoclopramide (stimulates prolactin)
- galactagogues (herbs or foods that induce lactation)
describe drug therapy during lactation
- drugs to treat postpartum depression: SSRIs (not ideal but a good option)
- there are many meds contraindicated during lactation
describe birth control during lactation
avoid progesterone-only birth control bc higher dose progesterone leads to reduction in milk production
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
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
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
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
