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68wm6 p2 Dru Lab Del
Drugs for Labor and Delivery
| Question | Answer |
|---|---|
| What is used in Tx of hyperemesis gravidarum? | antiemetics, antiulcer, and corticosteroid agents |
| What are some antiemetics used in Tx of hyperemesis gravidarum? | *promethazine (Phenergan) *diphenhydramine (Benadryl) *metoclopramide (Reglan) *ondansetron (Zofran) |
| What are some antiulcers used in Tx of hyperemesis gravidarum? | *famotidine (Pepcid) *ranitidine (Zantac) |
| What is the corticosteroid used in Tx of hyperemesis gravidarum? | methylprednisolone |
| What food helps replace chloride lost when hydrochloric acid is vomited? | Salty foods or Salting food (sodium chloride). |
| What is the goal for diastolic blood pressure when taking antihypertensives? | < 90mmHg diastolic |
| What antihypertensive increases cardiac output and blood flow to the placenta? | hydralazine (Apresoline) {vasodilator} |
| How do antihypertensives work? | Relaxes arterial smooth muscle to reduce blood pressure |
| What are contraindications of antihypertensives? | *Hypersensitivity *Coronary artery disease *Cardiovascular disease |
| 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. |
| Abrupt withdrawal from antihypertensives may cause what? | rebound hypertension |
| What is given to prevent uterine contractions in preterm labor? | Anticonvulsants |
| 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 |
| What is the most commonly given anticonvulsant? | Magnesium sulfate |
| What are the contraindications of anticonvulsants? | *Hypermagnesemia *Hypocalcemia *Anuria *Heart block *Active labor or within 2 hours of delivery (unless used for preterm labor) |
| What are the S/Sx of magnesium toxicity? | *Flushing *Sweating *Hypotension *Depressed deep tendon reflexes *CNS depression |
| Before giving an anticonvulsant, what should the respiratory rate be at? | Respiratory rate > 16 per minutes before each dose |
| What should be present before an anticonvulsant is given? | Deep tendon reflexes |
| What should a PTs urine output be at before administration of an anticonvulsant? | Urine output should be greater than 30 mL/hr before administration |
| What is the therapeutic serum magnesium levels of anticonvulsants? | 4 - 8 mg/dl |
| What is the antidote for anticonvulsants and where should it be kept? | calcium gluconate (Keep in room, with needles and syringes) |
| 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 |
| What is the purpose of intranasal oxytocin? | promote milk letdown in lactation women (Syntocin) |
| 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 |
| 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 |
| How long is magnesium sulfate continued postpartum to prevent seizures? | at least 24 hours |
| What is anticoagulant therapy initiated with, what is it maintained with? | Initiated with heparin or heparin-like agent, Maintained with warfarin |
| Why is heparin safer to use with pregnant women than warfarin? | Heparin does NOT cross the placenta |
| What labs monitor warfarin? | PT or INR |
| What labs monitor heparin? | aPTT |
| What is the antidote for heparin? | protamine sulfate |
| What is the antidote for Warfarin? | vitamin K (phytonadione [AquaMEPHYTON]) |
| What is the use of adenosine? | Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm |
| What is the use of digoxin? | *Treatment of CHF *Atrial flutter and fibrillation (slows ventricular rate) *Paroxysmal atrial tachycardia |
| What is the action of adenosine? | *Slows conduction time through the AV node *Produces coronary artery vasodilation |
| What is the action of digoxin? | *Increases the force of myocardial contraction *Decreases conduction through the SA and AV nodes |
| What is the class of adenosine and digoxin? | antiarrhythmics |
| When must the EKG, pulse, and blood pressure be monitored in the PT with IV antiarrhythmics? | Continuously |
| When must the EKG, pulse, and blood pressure be monitored in the PT with oral antiarrhythmics? | Periodically |
| When must the apical heart rate be at to administer adenosine and digoxin? | Apical HR > 50 |
| What is the use of betablockers? | *Management of hypertension *Management of angina pectoris *Prevention of MI |
| What are the contraindications of beta-blockers? | *Uncompensated CHF *Pulmonary edema *Cardiogenic shock *Bradycardia or heart block |
| What is the use of calcium channel blockers? | *Management of hypertension *Treatment and prophylaxis of angina pectoris or coronary artery spasms |
| 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 |
| What is given to decrease the progression of diabetic nephropathy? | Captopril (ACE inhibitor) |
| 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 |
| What is used to treat iron-deficiency anemia? | Ferrous sulfate (iron) |
| 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 |
| What are early symptoms of ferrous sulfate (iron) toxicity? | *Stomach pain *Fever *Nausea *Vomiting (may contain blood) *Diarrhea |
| What are late symptoms of ferrous sulfate (iron) toxicity? | *Bluish lips, fingernails, and palms *Drowsiness *Weakness *Tachycardia *Seizures *Metabolic acidosis *Hepatic injury *Cardiovascular collapse |
| How long may a PT be on iron therapy before hemoglobin reaches normal perameters? | 1-2 months |
| How long may a PT be on iron therapy before normalization of body iron stores? | 3-6 months |
| 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 |
| What should the PT on folic acid therapy be assessed for before therapy and periodically throughtout? | signs of megaloblastic anemia (fatigue, weakness, dyspnea) |
| What are foods high in folic acid? | vegetables, fruits, and organ meats |
| What destroys folic acid in foods? | Heat |
| 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. |
| What are the types of tocolytic drugs? | *Beta-adrenergics (terbutaline) *Anticonvulsants (magnesium sulfate) *Prostaglandin synthesis inhibitors (indomethacin) *Calcium antagonists (nifedipine {Procardia}, nicardipine {Cardene}) |
| What are the maternal side effects of terbutaline? | tachycardia, palpitations, tremor, anxiety, and headache |
| What should the mother and infant be monitored for it mother takes terbutaline? | Hypoglycemia |
| How should terbutaline be administered? | Begin infusion at 10 mcg/min. Increase dosage by 5 mcg every 10 min until contractions cease |
| What drug is initiated as an alternative to surgery in the management of patent ductus arteriosus in premature neonates? | indomethacin (Prostaglandin Synthesis Inhibitor) |
Created by:
Shanejqb
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