Reproductive Medications Flashcards
Oral contraceptives considerations (2)
- Pill taken daily
- Adverse effects: breast tenderness, bleeding, n/v
Oral contraceptives education (2)
- Antibiotics, rifampin, phenytoin reduce effectiveness
- Don’t smoke
Ethinyl estradiol/norelgestromin (patch) consideration
Replace patch each week for 3 weeks
Ethinyl estradiol/norelgestromin (patch) education (2)
- Apply patch to butt, abdomen, upper torso, upper/outer arm
- Period starts on 4th week with no patch
Medroxyprogesterone consideration
- Injection given every 3 months during period
Medroxyprogesterone education (2)
- Use backup contraception for 7 days after first injection
- Fertility returns 1 year after stopping
Emergency contraception considerations (4)
- Larger than normal dose of oral contraceptives
- Take no later than 72 hours after unprotected sex
- 2nd dose 12 hours later
- May need antiemetics
Emergency contraception education (2)
- Discuss options with provider
- Don’t use as primary form of contraception
Etonogestrel, ethinyl estradiol vaginal ring considerations
- Placed deep into the vagina every 3 weeks
Etonogestrel, ethinyl estradiol vaginal ring education (3)
- One size fits most
- If it falls out rinse in warm water and replace within 3 hours
- Remove ring during week 4 and period should start
Intrauterine device (IUD) considerations (3)
- Not for women with diabetes, history of PID
- Risk of infection
- Can have cramping and heavier periods
IUD education (4)
- Hormonal IUD effective for up to 5 years
- Copper IUD effective for up to 10 years
- Monitor for signs of infection
- Verify string is present
Cervical diaphragm considerations (3)
- Use with spermicide
- Fitted by prescriber
- Refitted after birth or changes in weight
Cervical diaphragm education (2)
- Insert 6 hours before and 6 hours after sex
- Refit with 10 lb weight change or after birth
Condom considerations
- Use with spermicide
Condom education (3)
- Protects against STIs
- Apply/remove correctly
- Use only water-soluble lubricants
Spermicide considerations
- Available in creams, foams, gels, suppositories, films
Spermicide education (2)
- Should also use barrier method
- Insert up to 1 hour before sex
Cervical ripening medication action
Prostaglandins cause cervical softening in preparation for cervical dilation and effacement
Cervical ripening medications (2)
- Dinoprostone cervical gel
- Misoprostol
Cervical ripening medication precaution
- Contraindicated in patients with acute PID, history of pelvic surgery, abnormal fetal position
Cervical ripening medication side/adverse effects (5)
- Nausea
- Headache
- Tremors, tension
- Feeling of warmth in vaginal area
- Elevated temperature
Cervical ripening medication nursing interventions (4)
- Keep patient on bedrest for at least 2hours (30 minutes for gel) after insertion
- Monitor/record maternal vitals, fetal heart rate, uterine contractions
- Oxytocin may be needed
- Major adverse effect is tachysystole
Oxytocin action
Stimulates uterine contractions for inducing labor and prevents postpartum hemorrhage
Oxytocin use (3)
- Antepartum for contraction stress test
- Intrapartum for induction/augmentation of labor
- Postpartum to promote uterine tone
Oxytocin precautions (2)
- Contraindicated with placental abnormalities, fetal malpresentation, previous uterine surgery, fetal distress
- Bishop score of 6 or greater when planning induction
Oxytocin side/adverse effects (4)
- Intense uterine contractions
- Uterine hyper stimulation
- Uterine rupture
- Water intoxication
Oxytocin nursing interventions (5)
- Give as secondary infusion through pump for induction/augmentation
- Continuously monitor contractions, fetal heart rate
- Stop if any signs of uterine hyper stimulation, maternal/fetal distress
- Oxygen by face mask 10L for signs of hyper stimulation
- For postpartum use monitor for uterine bleeding
Methylergonovine action
Acts directly on the uterine muscle to stimulate forceful contractions
Methylergonovine use
Postpartum hemorrhage
Methylergonovine precautions
- Use extreme caution in patients with HTN, preeclampsia, heart disease, venoatrial shunts, mitral valve stenosis, sepsis, cardiovascular/hepatic/renal impairment
Methylergonovine side/adverse effects (3)
- Potent vasoconstriction
- HTN
- Headache
Methylergonovine nursing interventions (2)
- Continuously monitor bp
- Assess uterine bleeding and tone
Tocolytic action
Act on uterine muscle to stop contractions
Tocolytic medication use
- Stop preterm labor
Tocolytic medications (3)
- Terbutaline sulfate
- Nifedipine
- Magnesium sulfate
Terbutaline side/adverse effects (9)
- Nervousness
- Tremors
- Headache
- N/V
- Hyperglycemia
- Severe palpitations
- Chest pain
- Pulmonary edema
Terbutaline nursing interventions (4)
- Monitor contractions, FHT
- Monitor vitals
- Don’t give if pulse is greater than 130/min or patient has chest pain
- Give beta blocker as antidote
Nifedipine side/adverse effects (4)
- Hypotension
- Headache
- Nausea
- Flushing
Nifedipine nursing interventions (4)
- Monitor bp
- Avoid using with magnesium sulfate
- Monitor contractions, FHT
- Prevent complications with hypotension
Magnesium sulfate side/adverse effects (6)
- Warmth
- Flushing
- Respiratory depression
- Diminished DTRs
- Decreased urine output
- Pulmonary edema
Magnesium sulfate nursing interventions (4)
- Monitor vitals, DTRs
- Monitor magnesium levels
- Give through infusion pump in diluted form
- Use indwelling catheter to monitor urinary output
Betamethasone action
Stimulates production of surfactant in fetus between 24-34 weeks gestation
Betamethasone use
- Promote fetal lung maturity in preterm labor when delivery is likely
Betamethasone side/adverse effects (3)
- Fluid retention
- Elevated bp
- Maternal hyperglycemia and transient increase in WBC
Betamethasone nursing interventions (2)
- Give 2 doses IM 24 hours apart
- Emotional support to family
Rho(d) immune globulin (rhogam) action
Suppresses the stimulation of active immunity by Rh positive foreign blood cells that enter the maternal circulation at the time of delivery
Rhogam use
Rh factor incompatibility to prevent sensitization for future pregnancies
Rhogam precautions (3)
- Confirm mom is Rh negative
- Don’t give full dose/microdose IV
- Don’t give to baby
Rhogam nursing interventions (2)
- Given within 72 hours after birth if woman is Rh negative and the baby is Rh positive and coombs test is negative
- Prophylactic injection at 28 weeks and if fetal cells can mix with maternal blood (miscarriage, ectopic pregnancy, induced abortion, amniocentesis, chorionic villus sampling, abdominal trauma)
Varicella vaccine during pregnancy
- Should be given to women not vaccinated during postpartum period
- Use reliable contraception and avoid pregnancy for 3 months after vaccine
