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Ch. 53 Pharm
Femal Reproductive Cycle 1
| Question | Answer |
|---|---|
| What drugs have shorter half-lives during pregnancy? | Antibiotics and Barbiturates |
| What are the changes in drug action during pregnancy? | Clearance of drugs, expanded circulating blood volume, increased GFR, reduced GI motility and increased gastric pH, effects of hormones on liver metabolism* |
| What drugs have longer half-lives during preganancy? | Analgesics, Hypnotics, and Antibiotics |
| How does labor affect half-lifes? | Because drug clearance decreases as a result to reduced blood flow associated with uterine contractions. |
| What is the placentas major role? | It exchanges numerous substances, along with medications. |
| The rate of exchange across the placenta depends on? | Maternal and fetal blood flow, molecular weight, ionization, protein-binding, metabolic activity and dose |
| Why is liver metabolism slower in the fetus? | Because of the immaturity of the liver |
| Most commong drugs taken during pregnancy | Iron supplaments, vitamin supplaments, antiemetics, antacids, stool softeners, nasal decongestants, mild analgesics, antibiotics |
| What are teratogens? | Substances that cause developmental abnormalities |
| What three factors are important in determining the teratogenicity of a drug? | Time, Dose, and Duration of exposure |
| What is the recommended dose of Iron in a pregnant woman? | 27 mg/day |
| Iron Adverse Reactions/Side Effects | Nausea, constipation, black stools, GI irritation, epigastric pain, vomitting, and diarrhea |
| Iron Implications | Liquids cause decoloration of teeth (administer through a straw), take on an empty stomach, take with water or juice, adminster with food of irritation occurs, seperate doses if inhibiting other drugs. |
| What drugs are inhibited by iron supplementation | Levodopa, levothyroxine, methylodopa, penacillamine, quinolones, tetracycline. |
| What is the recommended dose of Folic Acid for a pregnant woman? | 400 mcg/day |
| What is the purpose of Folic Acid | Improves outcome of pregnancy |
| Folic Acid Deficiency causes | spontaneous abortion, birth defects, neural tube defects, prematurity, low weight, seperation of placenta |
| 3 ways to increase Folic Acid intake | Supplements, dietary fortification, and food choices |
| Folate en-riched foods | Bread, rolls, flour, cornmeal, rice, pasta, and cereal |
| Folic Acid Adverse Reactions | Allergic bronchospasm, rash, itching, erythema, malaise, yellower urine |
| Prenatal vitamins include | Vitamin A, D, E, C, B complex, B12, iron, calcium |
| Prenatal vitamins | prevent congenital defects |
| Increased HcG causes | Nausea |
| Increased Progesterone causes | Heartburn, and Constipation |
| Hormones that cause a decrease in the motility of the GI tract causes | Vomitting |
| Hyperemesis Gravidarum | severe vomitting that requires hospitilizaton |
| Nonpharmacologic actions for nausea/vomitting | Eat crackers, dry toast, avoid fatty high seasoned food, eat small frequent meals, drink fluids between meals instead of with, eat high protein snacks before bedtime, quit smoking, take iron supplements at bedtime |
| Drugs associated with Nausea and vomitting | Promethazine, doxylamine, scopolamine, metoclopromide |
| Promethazine (Phenergan) Adverse Reactions/Side Effects | Dizziness, drowsiness, excitation, fatigue, photosensitivity, nausea, constipation |
| Doxylamine (Unisom) | competes with free histamines for H1 receptor site |
| Doxylamine (Unisom) Adverse Reactions/Side Effects | Sedative, thick bronchial secretions, drowsiness, dizziness, blurred vision, dry mouth, decreased coordination, and abdominal pain |
| Promethazine (Phenergan) | blocks dopamine receptors in brain |
| Scopolamine (Scopace) | antagonizes histamine and seratonin |
| Scopolamine (Scopace) Adverse Reactions/Side Effects | confusion, drowsiness, fatigue, dry skin, bloated feeling. |
| Metoclopramide (Reglan) | Blocks dopamine receptors in chemoreceptor trigger zone of CNS |
| Metoclopramide (Reglan) Adverse Reactions/Side Effects | Restlessness, drowsiness, diarrhea, weakness and insomnia |
| Pyrosis | Heartburn |
| Heartburn | Burning sensation in epigastric and sternal regions that occur with reflux of stomach acids |
| Nonpharmacologic actions for Heartburn | Limit meal size, avoid greasy seasoned food, avoid gas forming food, eat slowly, avoid citrus juices, drink adequate fluid between meals, and avoid reclining right after a meal |
| Drugs used for Heartburn | Antacids, Simethicone, Sucralfate |
| Aluminum Hydroxide (Amphojel) | Used for heartburn. Neutralizes gastric acid |
| Aluminum Hydroxide (Amphojel) Adverse Reactions/Side Effects | Dehydration, hypophosphatemia, GI obstruction |
| Aluminum Hydroxide (Amphojel) Drug Interactions | Decreased effects with tetracycline, phenothiazine, benzodiazepines, digoxin |
| Aluminum/ Magnesium Hydroxide with simethicone (Mylanta) | Used for heartburn. Neutralizes gastric acidity of antiflatulence action. |
| Aluminum/ Magnesium Hydroxide with simethicone (Mylanta) Adverse Reactions/Side Effects | Acid rebound, constipation (aluminums), laxatives (magnesiums) |
| Aluminum/ Magnesium Hydroxide with simethicone (Mylanta) Drug Interactions | Digoxin, iron salts, and indomethacin may decrease absorption. Decreased pharmacologic effects with benzodiazepines, corticosteroids. Increased pharmacologic effects with levodopa |
| Magaldrate with simethicone (Riopan Plus) | Used for heartburn. Neutralizes gastric acid |
| Magaldrate with simethicone (Riopan Plus) Adverse Reactions/Side Effects | Acid rebound, constipation (aluminums), laxatives (magnesiums) |
| Magaldrate with simethicone (Riopan Plus) Drug Interactions | Decreased absorption of phenothiazines, isoniazid, and tetracyclines |
| Histamine 2 receptor antagonists (H2RA) | Use reverse binding to histamine receptors of parietal cells causing a decrease in gastric acid secretion |
| Nonpharmacologic actions of Constipation | Increase fluid intake, increase dietary fiber intake, moderate physical excersize |
| Drugs associated with constipation | Metamucil, docusate sodium, milk of magnesium, magnesium citrate, lactelose, sorbitol |
| Pain during pregnancy occurs from | Headaches, sinus congestion, eye strain, backaches, joint pain, and round ligament pain |
| Nonpharmacologic actions for pain | Rest, calming enviornment, relaxation excersizes, ice packs, warm moist heat, postural changes, body mechanics |
| Acetaminophen (Tylenol) | Category B, most common, weak prostaglandin inhibitor, can be used in all trimesters |
| Acetaminophen (Tylenol) Pharmacokinetics | 20%-50% protein bound, half-life 2/3 hours, partially metabolized by liver |
| Acetaminophen (Tylenol) Pharmacodynamics | Onset - 10/30 minutes, Peak - 1/2 hours, Duration- 3/5 hours |
| Acetaminophen (Tylenol) Adverse Reactions/Side Effects | Skin eruptions, urticaria, bruising, erythema, hypoglycemia, jaundice, thrombocytopenia, hemolytic anemia |
| Aspirin (Ibuprofen) | Mild analgesics, category C drug, prostaglandin inhibitor, initiates and prolongs labor |
| Antidepressants Adverse Reactions/Side Effects | Low birth weight, small for age, preterm delivery, increased neonatal irritability, decreased attentiveness |
| Preterm labor (PTL) | between 20-37 weeks |
| Risk factors of PTL | maternal age, low socioeconomic status, intrauterine infection, smoking, druge use, and UTIs |
| Nonpharmacologic actions of PTL | Bed rest, hydration, pelvic rest, and screening for UTIs |
| Tocolytic Therapy | Drug therapy to reduce uterine contractions |
| Drugs used to decrease Uterine Contractility | Beta-Adrenergic Agents and Calcium Antagonists |
| Tocolytic Therapy goals | Interrupt/Inhibit uterine contractions, Delay delivery, and allow safe transport of mother |
| Beta-Adrenergic Agents (Brethine) | Stimulate beta receptors on smooth muscle |
| Beta-Adrenergic Agents (Brethine) Pharmacokinetics | Given subQ, minimally protein bound, metabolized by liver and half-life 11/16 hours |
| Beta-Adrenergic Agents (Brethine) Pharmacodynamics - ORAL | Onset - 30/45 minutes, Peak - 1/2 hours, Duration - 4/8 hours |
| Beta-Adrenergic Agents (Brethine) Pharmacodynamics - IV & SubQ | Onset - 15 minutes, Peak - 30/60 minutes, Duration - 1.5/4 hours |
| Beta-Adrenergic Agents (Brethine) Side Effects | Tremors, malaise, weakness, dypsnea, increased systolic and decreased diastolic, chest pain, hyperglycemia, nausea, vomitting, diarrhea |
| Beta-Adrenergic Agents (Brethine) Serious Adverse Reactions - Maternal | Pulmonary edema, dysrythmias, ketoacidosis, anaphylactic shock |
| Beta-Adrenergic Agents (Brethine) Serious Adverse Reactions - Fetal | Tachycardia, hypoglycemia, hyperinsulemia |
| Beta-Adrenergic Agents (Brethine) Drug Interactions | Additive effect with CNS depressants and neuromuscular blocking agents |
| Beta-Adrenergic Blocking Agents | Propranolol HCL, nadolol, pinodolol, metaprolol tetrate |
| Calcium Antagonists (Magnesium Sulfate) | CNS depressant, relaxes smooth muscle of uterus, safer than beta agents, fewer adverse effects, excreted from the kidney |
| Calcium Antagonists (Magnesium Sulfate) Adverse Reactions | flushing, increased feeling of warmth, perspiration, dizziness, increased pulse, hypotension, lethargy |
| Tocolytic Therapy Interventions | Monitor vital signs, urine output, breath and bowel sounds, uterine contractions, weigh daily |
| Corticosteroid Therapy (Celestone) | acclerate lung maturation and surfactant development, decrease risk if RDS |
| Surfactant contains | Sphingomyelin and lecithin, 2:1 ratio (favoring lecithin) |
| Betamethasone (Celestone) | Prescribed when PTL occurs before 33rd week. |
| Betamethasone (Celestone) Adverse Effects | Seizures, headache, vertigo, edema, hypertension, increased sweating |
| Gestational Hypertension | Elevated blood pressure without proteinuria after 20 gestational weeks prior to pregnancy- Most common complication during pregnancy |
| Preeclampsia | Gestational Hypertension with proteinuria Systolic - 140 Diastolic- 90 |
| Preeclampsia Treatment goals | Reduce vasospasm, prevent seizures, delivery of adequate fetus, family support |
| Preeclampsia Adverse Reactions/Side Effects | Weight Gain, deep tendon reflexes, cerebral/visual symptoms, severe headache, and epigastric pain |
| Eclampsia | New onset grand seizures in patient with preeclampsia |
| Eclampsia results from | Decreased levels of vasodilating prostaglandins resulting in vasospasms and delayed delivery |
| Nonpharmacologic actions for gestational hypertension | Reduced activity, lying on left side, increased protein in diet, psychosocial therapy |
| Drugs associated with gestational hypertension | Aldomet, Apresoline, Trandate |
| Drugs to avoid if diagnosed with gestational hypertension | Diuretics, and angiotensin enzyme inhibitors |
| Aldomet Adverse Reactions/Side Effects | Peripheral edema, anxiety, nightmares, drowsiness, headache, dry mouth and fever |
| Apresoline | Acts by causeing arteriolar vasodilation. Lowers blood pressure |
| Aldomet | Stimulates central alpha adrenergic receptors. Decreases outflow to heart and kidneys |
| Apresoline Adverse Reactions/Side Effects | Headache, nausea, nasal congestion, dizziness, tachycardia, and palpitations |
| Magnesium Sulfate | Prevents and treats seizures. Acts as CNS depressant |
| Magnesium Sulfate Adverse Reactions/Side Effects | Lethargy, flushing, increased warmth, perspiration, thirst, decreased muscle tone, depressed tendon reflexes. |
Created by:
cdanella
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