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M6 13-005

Exam 9: Drugs For Labor & Delivery

Therapeutic Drugs Treatments for L&D may include but are not limited to... Anti-emetics. Antiulcer. Corticosteroids. Anticonvulsants. Antithypertensives. Anticoagulants.
Hyperemesis Gravidarum is treated with... Antiemetics. Antiulcers. Corticosteroid Agents.
Hyperemesis Gravidarum: Use Manage N/V
Hyperemesis Gravidarum: Antiemetics 1)promethazine (Phenergan). 2)diphenhydramine (Benadryl). 3)metoclopramide (Reglan). 4)ondansetron (Zofran). 5HT (serotonin) receptor antagonist.
Hyperemesis Gravidarum: Antiulcer 1)Histamine-Receptor Antagonists: a)famotidine (Pepcid). b)ranitidine (Zantac). 2)Gastric Acid Inhibitors/ Proton pump inhibitors: a)esomeprazole (Nexium). b)omeprazole (Prilosec).
Hyperemesis Gravidarum: Corticosteroids methylprednisolone
Management of hyperemesis: -Assess N/V, bowel sounds & ABD pain. -Monitor hydration status -May require IV -Labs -Daily Weights
Anti-Hypertensive Agents: Use Moderate to severe HTN. *In preeclampsia, when BP is ↑ to a degree that might be associated with intracranial bleeding. SBP>160
Anti-Hypertensive Agents: Action -Lower BP to <105-110 mm Hg Diastolic. -Relaxes Smooth muscle to reduce blood pressure.
Anti-Hypertensive Agents: Goal Prevention of end-organ damage such as stroke of CHF
Anti-Hypertensive Agents: Categories Vasodilators Beta Blockers Calcium Channel Blockers
Anti-Hypertensive Agents: Vasodilators hydralazine (Apresoline) is often the first line of treatment because it increases cardiac output and blood flow to the placenta.
Anti-Hypertensive Agents: Beta Blockers labetalol (Normodyne, Trandate)
Anti-Hypertensive Agents: Calcium Channel Blockers nifedipine (Procardia)
Anticonvulsant Agents Decrease the incidence and severity of seizures
Magnesium sulfate most commonly given
Anticonvulsant Agents: Action Depresses the central nervous system (CNS) to act as an anticonvulsant.
Magnesium Toxicity Hypotension. Depressed deep tendon reflexes. CNS depression. Respiratory depression: RR < 12 breaths/min.
Medications related to Induction of Labor Oxytocics
Oxytocics: Uses Induction of labor at term. Facilitation of uterine contractions at term. (Augmentation of labor). Facilitation of threatened abortion. Prevention or treatment of postpartum hemorrhage after expulsion of the placenta.
Oxytocics: Action Stimulates smooth muscle, producing uterine contractions similar to those in spontaneous labor. Stimulates mammary gland smooth muscle, facilitating milk “let down” Has vasopressor and antidiuretic effects. Rapidly metabolized. (Short half life)
Oxytocics: Side Effects Misc: ↑ uterine motility, painful contractions, abruptio placentae, decreased uterine blood flow, hypersensitivity, fetal distress due to hyper tetanic contractions or uterine tachysystole
Oxytocics: Nursing Implications Assess character, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate frequently throughout administration and with every dose change.
Oxytocics: Evaluation Onset of effective contractions (q 2-3 minutes, 40-90 seconds, fundus firm to palpation and IUPC reading of 50-80 mm Hg.
Insulin Drug Therapy: Goal in Pregnancy Maintain FBS <95mg/dl and postprandial glucose<120mg/dl
Insulin Drug: Management Management of gestational diabetes when diet fails to adequately control blood sugar. Management of Type 1 DM and ketoacidosis.
Types of Insulin (Rapid Acting) insulin aspart, rDNA origin (Novolog). insulin lispro, rDNA origin (Humalog). insulin glulisine (Apidra).
Types of Insulin (Intermediate Acting) 1) NPH (isophane insulin suspension): Humulin N, NPH Iletin II, Novolin N. 2) insulin zinc suspension (lente insulin): Humulin L, Lente Iletin II.
Types of Insulin (Long Acting) 1)Insulin determir (Levemir). 2)insulin zinc suspension, extended (ultralente insulin): Humulin U Ultralente, Ultralente U, Novolin U. (3)insulin glargine (Lantus).
Most common side effect of insulin Hypoglycemia
Diabetes Mellitus: Nursing Implications Observe for signs and symptoms of hypoglycemic reactions. Check type, species source, dose and expiration date with another licensed nurse. Do not interchange insulins without physician approval. Rotate sites.
When mixing insulins... draw regular insulin into syringe first to avoid contamination of regular insulin vial.
Diabetes Mellitus: Patient Teaching (Gestational) The patient must be taught the difference in onset, peak and duration of action for each type of insulin prescribed. Learn how to mix two insulins. Hypoglycemia prevention.
Patient and Family Teaching for patients with pre-existing diabetes: 1st Trimester Insulin needs generally decline because secretion of placental hormones antagonistic to insulin remain low.
Patient and Family Teaching for patients with pre-existing diabetes: 2nd Trimester Insulin needs increase when placental hormones initiate maternal resistance to the effects of insulin, which reach their peak.
Patient and Family Teaching for patients with pre-existing diabetes: Post-Partum Insulin needs should decline rapidly after the delivery of the placenta and abrupt cessation of placental hormones.
Drug Therapy for Cardiac Disease (Common) Anticoagulants. Anti-infectives. Calcium channel blockers
During Pregnancy: Anticoagulants prevention and treatment of thrombo-embolic disorders. -DO NOT DISSOLVE CLOTS -COUMADI IN IS CONTRAINDICATED D/T TERATOGENICITY
True of false: Heparin does not cross the placenta TRUE
ects Hemat: bleeding, anemia, thrombocytopenia.
During Pregnancy: Anticoagulant INteractions bleeding may be potentiated by aspirin or large doses of penicillins, penicillin-like agents, cefotetan, cefoperazone, valproic acid or NSAIDs.
During Pregnancy: Anticoagulant Assessment a) Bleeding gums. b) Nosebleeds. c) Unusual bruising. d) Tarry, black stools. e) Fall in hemocrit or blood pressure. f) Guaiac-positive stools. g) Blood in urine or NG aspirate.
During Pregnancy: Anticoagulant Labs aPTT
Antidote for heparins Protamine Sulfate
During Pregnancy: Calcium Channel Blockers Action Blocks calcium entry into cells of vascular smooth muscle ( relaxes the uterus) and decreases force of contractions in both the uterus and the myocardium
Calcium Channel Blockers Drug of Choice Tocolysis is usually nifedipine (Adalat, Adalat CC, Procardia, Procardia XL).
Most common types of anemias Iron-deficiency Anemia. Folic acid-deficiency. Sickle-cell Disease. Thalassemia.
Iron-deficiency anemia is treated with ferrous sulfate
Anti-anemic/Iron Sulfate: Use PO: prevention/treatment of iron-deficiency anemia. IM/IV: treatment/prevention of iron-deficiency anemia in patients who can not tolerate oral iron.
Anti-anemic/Iron Sulfate: Action Parenteral iron enters the bloodstream and organs of the reticuloendothelial system (liver, spleen, bone marrow), where iron is separated out and becomes part of iron stores.
Anti-anemic/Iron Sulfate: Side Effects (a)CNS: (IM/IV) seizures,dizziness, headache, syncope. (b)CV: (IM/IV) hypotension, tachycardia. (c)GI: nausea. -PO: constipation, dark stools, diarrhea, epigastric pain, GI bleeding. Iron is notorious for GI upset.
Anti-anemic/Iron Sulfate: Interactions Tetracycline and antacids decrease oral absorption of iron by forming insoluble compounds.
Anti-anemic/Iron Sulfate: Nursing Implications Assess patient for signs and symptoms of anaphylaxis with IV administration (rash, pruritus, laryngeal edema, wheezing).
Anti-anemic/Iron Sulfate: Labs Monitor hemoglobin, hematocrit, and reticulocyte values,Serum ferritin and iron levels.
Anti-anemic/Iron Sulfate: Evaluation Increase in hemoglobin, which may reach normal parameters after 1-2 mo of therapy. May require 3-6 mo for normalization of body iron stores.
Folic Acid-Deficiency (Megaloblastic) anemia is treated with folic acid since the pregnant woman needs double the amount during pregnancy for fetal and placental growth.
Folic Acid Supplement: Use Prevention and treatment of megaloblastic and macrocytic anemias. Given during pregnancy to promote normal fetal development.
Folic Acid Supplement: Action Stimulates the production of red blood cells, white blood cells, and platelets. Necessary for normal fetal development, restoration and maintenance of normal hematopoiesis.
Folic Acid Supplement: Category Therapeutic: antianemics, vitamins. Pharmacologic: water soluble vitamins. Examples: folic acid (folate, Folvite, vitamin B).
Folic Acid Supplement: Contraindications Uncorrected pernicious, aplastic, or normocytic anemias (neurologic damage will progress despite correction of hematologic abnormalities). Preparations containing benzyl alcohol should not be used in newborns.
Folic Acid Supplement: Nursing Implications Monitor plasma folic acid levels, hemoglobin, hematocrit, and reticulocyte count before and periodically during therapy.
Folic Acid Supplement: Patient Teaching Foods high in folic acid include vegetables, fruits, and organ meats; heat destroys folic acid in foods. May make urine more yellow!
Medications related to preterm labor Terbutaline (Brethaire, Bricanyl) Indomethacin (Indocin, Indocin I.V, Indocin SR, Indochron E-R) Calcium Channel Blockers:
Terbutaline (Brethaire, Bricanyl): Use Management of preterm labor (tocolytic).
Terbutaline (Brethaire, Bricanyl): Action Produces bronchodilation and uterine relaxation.
Terbutaline (Brethaire, Bricanyl): Category beta-adrenergic for tocolysis.
Terbutaline (Brethaire, Bricanyl): Precautions Cardiac disease. Hypertension. Hyperthyroidism. Diabetes. Glaucoma. Pregnancy (near term), lactation, and children <2 yr (safety not established).
Terbutaline (Brethaire, Bricanyl): Side Effects CNS: nervousness, restlessness, tremor, headache, insomnia. CV: angina, arrhythmias, hypertension, tachycardia. GI: nausea, vomiting. Endo: hyperglycemia.
Terbutaline (Brethaire, Bricanyl): Contraindications Use with caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) increases stimulant effect.
Terbutaline (Brethaire, Bricanyl): Assessment Monitor maternal pulse and blood pressure, frequency and duration of contractions, and FHR. Maternal side effects include tachycardia, palpitations, tremor, anxiety, and headache. Pulmonary edema. Monitor mom for symptoms of hyperglycemia.
Terbutaline (Brethaire, Bricanyl): Labs Monitor maternal serum glucose and electrolytes. May cause hypokalemia and hyperglycemia. Monitor neonate's serum glucose, because hypoglycemia may occur in neonates.
Terbutaline (Brethaire, Bricanyl): Evaluation control of preterm labor in a fetus of 20-36 wk gestational age.
Indomethacin (Indocin): Use in Pregnancy Tocolysis (treatment of pre-term labor)
Indomethacin (Indocin): Neonatal Alternative to surgery in the management of patent ductus arteriosus in premature neonates.
Indomethacin (Indocin): Action inhibits prostaglandin synthesis
Indomethacin (Indocin): Category prostaglandin synthesis inhibitor
Indomethacin (Indocin): Contraindications Pregnancy or lactation (not recommended after 32 weeks of pregnancy due to potential for premature closure of the fetal ductus arteriosus).
Indomethacin (Indocin): Side Effects F and E: hyperkalemia, dilutional hyponatremia, hypoglycemia. Hemat: thrombocytopenia, blood dyscrasias, prolonged bleeding time.
Indomethacin (Indocin): Interactions Additive adverse GI effects with aspirin , other NSAIDs , corticosteroids , or alcohol. Chronic use of acetaminophen increases the risk of adverse renal reactions. Increased risk of bleeding
Indomethacin (Indocin): Nursing Implications Monitor respiratory status, heart rate, blood pressure, echocardiogram, and heart sounds routinely throughout therapy.
Indomethacin (Indocin): Labs Chem-10 Urine (Glucose and protein may ↑)
Indomethacin (Indocin): Administration Administer after meals, with food, or with antacids to decrease GI irritation. Tx is limited to 48-72 consecutive hours in pregnant Pts.
Indomethacin (Indocin): Patient Teaching Advise patient to take this medication with a full glass of water and to remain in an upright position for 15-30 min after administration. Take meds exactly as directed. If miss a dose, take as soon as remembered.
Calcium Channel Blockers: Use in pregnancy Tocolysis (to stop pre-term labor)
Calcium Channel Blockers: Action Blocks calcium entry into cells of vascular smooth muscle (relaxes the uterus) and decreases the rate and force of contractions in both the uterus and the myocardium.
Calcium Channel Blockers: Drug of Choice nifedipine (Adalat, Adalat CC, Procardia, Procardia XL).
Calcium Channel Blockers: Contraindications Hypersensitivity. Bradycardia. 2nd or 3rd degree heart block. Uncompensated CHF. Precaution: Lactation.
Calcium Channel Blockers: Side Effects CNS: headache, fatigue, drowsiness, flushing. CV: tachycardia, edema, mild hypotension Metabollic: hyperglycemia
Calcium Channel Blockers: Nursing Implications Monitor VS, I&Os, Weights. Assess for signs of CHF.
Calcium Channel Blockers: Patient Teaching Continue taking medication, even if feeling well. Minimize orthostatic hypotension, by making position changes slowly. Advise patient to carry identification describing medication and medication regimen at all times.
Calcium Channel Blockers: Evaluation Decrease or absence of uterine contractions without compromised ADLS due to orthostataic hypotension. Fetus maintains normal growth curve. Placental perfusion remains WNL.
Steroids: Use in Pregnancy Steroids are given to women in pre-term labor between 24 and 34 weeks EGA if delivery seems unavoidable to reduce the severity of RDS and intra-ventricular brain hemorrhage.
Steroids: Adverse Effects Temporary increase in leukocytes and glucose intolerance (may affect screening tests for GDM). Nervousness & Insomnia
Steroids: Nursing Implications Monitor VS to identify fever increased HR Tach Pt to report Chest Pain.
Endocervical Gel used to "ripen" the cervix in pregnancy at or near term when induction of labor is indicated.
Vaginal Suppository 1)Induction of midtrimester abortion. 2)Management of missed abortion up to 28 wk. 3)Management of nonmetastatic gestational trophoblastic disease (benign hydatidiform mole).
Prostaglandins: Action Produce contractions that are similar to that of labor occurrence. Initiates softening, effacement and dilation of the cervix. Stimulates GI smooth Muscle.
Prostaglandins: Category (a)Therapeutic: cervical ripening agent. (b)Pharmacologic: oxytocics , prostaglandins. (c)Example: 1)dinoprostone (Prepidil): prostaglandin gel. 2)dinoprostone (Cervidil): vaginal insert.
Prostaglandins: Contraindications The gel/insert should be avoided in situations in which prolonged uterine contractions should be avoided, including: -Painful C-section -Cephalopelvic disportion -Traumatic delivery or difficult labor -Multiparity -Fetal Distress -??? vaginal bleedi
Prostaglandins: Side Effects 1)GU: uterine contractile abnormalities, warm feeling in vagina. 2)MS: back pain. 3)Misc: fever. GU: uterine rupture, urinary tract infection, uterine hyperstimulation, vaginal/uterine pain. anaphylaxis, chills, fever.
Prostaglandins: Interactions Augments the effects of other oxytocins
Prostaglandins: Nursing Implications Monitor activity: Uterine, fetus, cervix. Assess for hypertonus sustained activity. Insert should be removed at the onset of active labor.
Prostaglandins: Patient Teaching Cervical Ripening: inform patient that she may experience a warm feeling in her vagina during administration. Advise patient to notify health care professional if contractions become prolonged.
Medications related to intrapartum pain management. Systemic Drugs, Regional Pain Meds, General Anesthesia Opioid Analgesia Adjunctive Medications Narcotic Antagonists
Opioid Analgesics (1)meperidine (Demerol). (2)fentanyl (Sublimaze). (3)butorphanol (Stadol). (4)nalbuphine (Nubain).
Adjunctive Medications: Hydroxyzine (use) 1)Treatment of anxiety. 2)Preoperative sedation. 3)Antiemetic. 4)Antipruritic. 5)May be combined with opioid analgesics.
Hydroxyzine: Side Effects drowsiness, agitation, ataxia, dizziness, headache, weakness. urinary retention
Hydroxyzine: Interactions CNS Depression (drugs that can induce this) Anticholinergic effect meds.
Hydroxyzine: Nursing Implications Assess patient for profound sedation and provide safety precautions as indicated (side rails up, bed in low position, call bell within reach, supervision of ambulation and transfer). Falls risk
Hydroxyzine: Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may help decrease dry mouth. If dry mouth persists for more than 2 wk, consult dentist about saliva substitute.
Created by: jtzuetrong