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68wm6 p2 Dru Lab Del

Drugs for Labor and Delivery

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