Drugs for Labor and Delivery
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| What is used in Tx of hyperemesis gravidarum? | antiemetics, antiulcer, and corticosteroid agents
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| What are some antiemetics used in Tx of hyperemesis gravidarum? | *promethazine (Phenergan) *diphenhydramine (Benadryl) *metoclopramide (Reglan) *ondansetron (Zofran)
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| What are some antiulcers used in Tx of hyperemesis gravidarum? | *famotidine (Pepcid) *ranitidine (Zantac)
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| What is the corticosteroid used in Tx of hyperemesis gravidarum? | methylprednisolone
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| What food helps replace chloride lost when hydrochloric acid is vomited? | Salty foods or Salting food (sodium chloride).
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| What is the goal for diastolic blood pressure when taking antihypertensives? | < 90mmHg diastolic
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| What antihypertensive increases cardiac output and blood flow to the placenta? | hydralazine (Apresoline) {vasodilator}
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| How do antihypertensives work? | Relaxes arterial smooth muscle to reduce blood pressure
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| What are contraindications of antihypertensives? | *Hypersensitivity *Coronary artery disease *Cardiovascular disease
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| When and how often must BP be monitored after giving an antihypertensive? | every 2 - 3 minutes for the first 30 minutes after initial dose and periodically throughout the course of therapy.
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| Abrupt withdrawal from antihypertensives may cause what? | rebound hypertension
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| What is given to prevent uterine contractions in preterm labor? | Anticonvulsants
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| How do anticonvulsants act? | *Decreases acetylcholine released by motor nerve impulses, thereby blocking neuromuscular transmission *Depresses the central nervous system (CNS) to act as an anticonvulsant
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| What is the most commonly given anticonvulsant? | Magnesium sulfate
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| What are the contraindications of anticonvulsants? | *Hypermagnesemia *Hypocalcemia *Anuria *Heart block *Active labor or within 2 hours of delivery (unless used for preterm labor)
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| What are the S/Sx of magnesium toxicity? | *Flushing *Sweating *Hypotension *Depressed deep tendon reflexes *CNS depression
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| Before giving an anticonvulsant, what should the respiratory rate be at? | Respiratory rate > 16 per minutes before each dose
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| What should be present before an anticonvulsant is given? | Deep tendon reflexes
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| What should a PTs urine output be at before administration of an anticonvulsant? | Urine output should be greater than 30 mL/hr before administration
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| What is the therapeutic serum magnesium levels of anticonvulsants? | 4 - 8 mg/dl
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| What is the antidote for anticonvulsants and where should it be kept? | calcium gluconate (Keep in room, with needles and syringes)
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| What are the purposes of IV oxytocin? | *Induction of labor at term *Facilitation of uterine contractions at term *Facilitation of threatened abortion *Postpartum control of bleeding after expulsion of the placenta
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| What is the purpose of intranasal oxytocin? | promote milk letdown in lactation women (Syntocin)
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| What are the actions of Oxytocin? | *Has vasopressor and antidiuretic effects *Stimulates smooth muscle, producing uterine contractions similar to those in spontaneous labor *Stimulates mammary gland smooth muscle, facilitating lactation
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| When giving oxytocin, what indicates oxytocin must be DC'd and PT should be turned on her left side due to risk of fetal anaoxia? | contractions occur < 2 minutes apart and are > 50 - 65 mmHg on monitor, if they last 60 - 90 seconds or longer, or if significant change in fetal heart rate develops
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| How long is magnesium sulfate continued postpartum to prevent seizures? | at least 24 hours
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| What is anticoagulant therapy initiated with, what is it maintained with? | Initiated with heparin or heparin-like agent, Maintained with warfarin
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| Why is heparin safer to use with pregnant women than warfarin? | Heparin does NOT cross the placenta
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| What labs monitor warfarin? | PT or INR
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| What labs monitor heparin? | aPTT
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| What is the antidote for heparin? | protamine sulfate
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| What is the antidote for Warfarin? | vitamin K (phytonadione [AquaMEPHYTON])
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| What is the use of adenosine? | Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm
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| What is the use of digoxin? | *Treatment of CHF *Atrial flutter and fibrillation (slows ventricular rate) *Paroxysmal atrial tachycardia
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| What is the action of adenosine? | *Slows conduction time through the AV node *Produces coronary artery vasodilation
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| What is the action of digoxin? | *Increases the force of myocardial contraction *Decreases conduction through the SA and AV nodes
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| What is the class of adenosine and digoxin? | antiarrhythmics
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| When must the EKG, pulse, and blood pressure be monitored in the PT with IV antiarrhythmics? | Continuously
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| When must the EKG, pulse, and blood pressure be monitored in the PT with oral antiarrhythmics? | Periodically
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| When must the apical heart rate be at to administer adenosine and digoxin? | Apical HR > 50
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| What is the use of betablockers? | *Management of hypertension *Management of angina pectoris *Prevention of MI
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| What are the contraindications of beta-blockers? | *Uncompensated CHF *Pulmonary edema *Cardiogenic shock *Bradycardia or heart block
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| What is the use of calcium channel blockers? | *Management of hypertension *Treatment and prophylaxis of angina pectoris or coronary artery spasms
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| What is the action of calcium channel blockers? | *Dilate coronary arteries in both normal and ischemic myocardium and inhibit coronary artery spasm *Blocks calcium entry into cells of vascular smooth muscle and myocardium
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| What is given to decrease the progression of diabetic nephropathy? | Captopril (ACE inhibitor)
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| What is the action of ACE inhibitors? | *Block conversion of angiotensin I to the vasoconstrictor angiotensin II. *Inactivates the vasodilator bradykinin and vasodilatory prostaglandins. *Increase plasma renin levels, reduce aldosterone levels *Result is systemic vasodilation
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| What is used to treat iron-deficiency anemia? | Ferrous sulfate (iron)
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| While the PT is recieving Iron therapy, how often must hemoglobin, hematocrit, and reticulocyte values be checked? | prior to and every 3 wk during the first 2 mo of therapy and periodically thereafter
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| What are early symptoms of ferrous sulfate (iron) toxicity? | *Stomach pain *Fever *Nausea *Vomiting (may contain blood) *Diarrhea
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| What are late symptoms of ferrous sulfate (iron) toxicity? | *Bluish lips, fingernails, and palms *Drowsiness *Weakness *Tachycardia *Seizures *Metabolic acidosis *Hepatic injury *Cardiovascular collapse
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| How long may a PT be on iron therapy before hemoglobin reaches normal perameters? | 1-2 months
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| How long may a PT be on iron therapy before normalization of body iron stores? | 3-6 months
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| Fill in the blanks: The diagnosis of iron-deficiency anemia should be reconfirmed if hemoglobin has not increased by _________ in 2 wk | 1 g/100 ml
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| What should the PT on folic acid therapy be assessed for before therapy and periodically throughtout? | signs of megaloblastic anemia (fatigue, weakness, dyspnea)
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| What are foods high in folic acid? | vegetables, fruits, and organ meats
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| What destroys folic acid in foods? | Heat
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| True or False: Tocolytics should only be used in labor. | False. Tocolytics are PRIMARILY used for conditions other than preterm labor and therefore have effects on body systems other than the reproductive system.
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| What are the types of tocolytic drugs? | *Beta-adrenergics (terbutaline) *Anticonvulsants (magnesium sulfate) *Prostaglandin synthesis inhibitors (indomethacin) *Calcium antagonists (nifedipine {Procardia}, nicardipine {Cardene})
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| What are the maternal side effects of terbutaline? | tachycardia, palpitations, tremor, anxiety, and headache
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| What should the mother and infant be monitored for it mother takes terbutaline? | Hypoglycemia
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| How should terbutaline be administered? | Begin infusion at 10 mcg/min. Increase dosage by 5 mcg every 10 min until contractions cease
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| What drug is initiated as an alternative to surgery in the management of patent ductus arteriosus in premature neonates? | indomethacin (Prostaglandin Synthesis Inhibitor)
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