Exam 9: Drugs For Labor & Delivery
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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.
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
jtzuetrong
Popular Medical sets