Pregnancy Preterm Labor Flashcards
Effect of circulating steroid hormones on the liver’s metabolism of drugs.
Reduce gastrointestinal (GI) motility and increased gastric pH.
Increased glomerular filtration rate and increased renal perfusion, resulting in more rapid renal excretion of drugs.
Expanded maternal circulating blood volume, resulting in dilution of drugs.
Alteration in the clearance of drugs in later pregnancy, resulting in a decrease in serum and tissue concentration of drugs.
Physiology of pregnancy
27 mg/day during pregnancy.
Best absorbed with water or juice in an empty
stomach. Vitamin C increases the absorption of Iron.
Iron
Common side effecfs of iron
Nausea
Constipation
Black tarry stool
GI irritation
Epigastric pain
Vomiting
Discoloration o
Vitamin B9, Folate is needed in increased amount.
400 mcg of folic acid daily.
Folic acid
What does folic acid prevent in early pregnancy
Spontaneous abortion or birth defects.
Neural tube defects which lead to spina bifida or skull
and brain malformations.
Vitamins A, B – Complex, B12, C, Calcium, D, E, Iron, and other Minerals.
Multiple vitamins
Drugs for morning sickness (nausea and vomiting)
Doxylamine Succinate
Pyridoxine Hydrochloride
Nonpharmacologic measures of morning sickness (give 3)
Eating crackers, dry toast, or other carbohydrates before rising.
Avoiding high-fat or highly seasoned foods. Eating small, frequent meals.
Drinking fluids between meals.
Drinking apple juice between meals.
Eating a high-protein bedtime snack.
Stopping smoking.
Taking an iron supplement at bedtime.
Drugs for pyrosis/heartburn
Sucralfate (Carafate)
Give 3 pharmacologic measures of pyrosis
Nonpharmacologic Measures:
Limiting the size of meals.
Avoiding highly seasoned or greasy foods.
Avoiding gas-forming foods (ex. cabbage, onions).
Eating slowly and chewing thoroughly.
Avoiding citrus juices.
Drinking adequate fluids but not with meals.
Avoiding reclining immediately after eating.
Drugs for constipation
Metamucil
Docusate Sodium (stool softener)
3 pharmacologic measures for constipation
Nonpharmacological Measures:
Increased fluid intake.
Increased dietary fiber intake.
Moderate Physical Exercise.
Drugs 4 headache
Acetaminophen – most commonly ingested.
Ibuprofen – classified as a pregnancy category C drug. If taken in late pregnancy, it may cause
premature closure of the ductus arteriosus.
Give 3 Nonpharmacological Pain-relief Measures:
Rest
A calming environment. Relaxation exercises.
Alteration in routine.
Mental imagery.
Ice packs.
Warm, moist heat.
Postural changes.
Correct body mechanics. Changes in footwear.
Antidepress
Antidepressant drugs
Selective Serotonin Reuptake Inhibitors (SSRIs) Tricyclics
What are the adverse affects of antidepressant drugs
HARMACOLOGY
o Low birthweight
o Infants born small for gestational age.
o Preterm delivery.
o Increased neonatal irritability and
decreased attentiveness.
Is birth that occurs before the completion of 37weeks of pregnancy, regardless of birthweight.
Cervical changes and uterine contractions that occur between 20 and 37 weeks of pregnancy.
Preterm labor
Give 3 Nonpharmacologic Treatment Measures for preterm labor
Bed rest.
Hydration (6 to 8 glasses of fluids daily or more, IV
fluid bolus).
Pelvic rest (no sexual intercourse or douching).
Screening for intrauterine and UTI.
Stopping Preterm Labor
:
Focus is on stopping contractions before cervix dilated beyond 3 cm.
Fetal surveillance includes monitoring heart rate, assesing lung maturity.
Tocolytic drugs should not be used if
Woman is hemorrhaging because bleeding will increase.
Fetal distress is noted.
Cervix is dilated 5 cm or more because it will no
longer be effective.
Tocolytic theraphy
Tocolytic Therapy decreases uterine contraction.
Beta2 – Adrenergic Receptor Agonists
Calcium Antagonists
Magnesium Sulfate
Calcium Channel Blockers
Nifedine (Procardia)
Indomethacin (Indocin) Prostaglandin Inhibitors
Goals of tocolytic theraphy
Interrupt or inhibit uterine contractions to create additional time for fetal maturation in utero.
Delay delivery so antenatal corticosteroids can be delivered to facilitate fetal lung maturation.
Allow safe transport of the patient to the appropriate facility if required.
Stimulating beta2 – receptors on uterine smooth muscle.
Decreases the intensity and frequency of uterine contraction as it relaxes the muscle.
Terbutaline
Adverse Reaction in Preterm Labor
:
Maternal Side effects include tremors, dizziness, nervousness, tachycardia, hypotension, chest pain, palpitations, nausea, vomiting, hyperglycemia, and hypokalemia.
Calcium antagonist.
Central nervous depressant.
Relaxes the smooth muscle of the uterus through
calcium displacement.
Used more as a tocolytic.
Adminstered as a 4 – 6 g IV loading dose over 20 –
30 minutes followed by a 2 – 4 g/hour continuous
infusion for 12 – 24 hours after contraction ceased.
Continuous infusion should not eceed 5 to 7 days or
a maximum of 40 g/ 24 hours.
Magnesium sulfate
Antidote 4 magnesium sulfate
calcium gluconate and emergency equipment
nearby for respiratory depression.
it speed up maturity of lungs.
Corticosteroid
Corticosteroid drugs
Betamethasone
Dexamethasone
Purposes of corticosteroids
Accelerates lung maturation and lung surfactant development in the fetus in the utero.
Decreases the incidence and severity of respiratory distress syndrome (RDS).
Increase survival or preterm infants. Promotion of Fetal Lung Maturity
Promotion of fetal lung maturity
goal of tocolytic therapy until steroids can hasten lung maturity.
RDS can be reduced if steroids are given to mother 24 to 28 hours before birth in fetus less than 34 weeks of gestation.
After delivery, infant is treated with prophylactic surfactant therapy to reduce risk of developing RDS.
Gestational hypertension with proteinuria.
Delivery of infant and placenta is the only cure.
Preeclampsia
Signs and Symptoms of Preeclampsia:
Hypertension
Protein in the urine.
Headaches
Visual Problems.
Pitting Edema.
– a severe sequela of preeclampsia.
HELLP Syndrome
Hemolysis
Elevated liver enzymes
Low platelet count
Treatment of Preeclampsia:
Methyldopa (Aldomet)
Hydralazine (Apresoline)
Labetalol (Trandate)
Prazosin (Minipress)
Nifedipine (Procardia)
Clonidine (Catapres)
Maternal seizure.
New on-set grand mal seizures in patient with
preeclampsia.
Delivery is generally postponed for 1 to 3 hours if
fetal status allows.
Eclampsia
