NS210 Exam 4/OB Medicatons

  1. Tocolytics
    Drugs that promote uterine relaxation by interfering with uterine contractions. May prolong pregnancy for 2 to 7 days, where steroids can be given to improve fetal lung maturity. Ordered if preterm labor occurs before 34 weeks of gestation (pass 34 ok to deliver) in attempt to delay birth and thus reduce the severity of respiratory distress syndrome & other complications associated with prematurity.
  2. Tocolytics Contraindications
    Contraindicated for abruptio placental, acute fetal distress or death, PIH (pregnancy induced hypertension) eclampsia or severe preeclampsia, cardiac disease, active vaginal bleeding, dilation of more than 6 cm, intrauterine infection, chorioamnionitis (chorion & amniotic fluid are infected by bacteria usually starts from mother's urogenital tract), maternal hemodynamic instability
  3. Tocolytic Drugs
    • Magnesium sulfate(reduces the muscle's ability to contract)
    • Terbutaline (Brethine, a beta-adrenergic)
    • Indomethacin (Indocin, a prostaglandin synthetase inhibitor)
    • Nifedipine (Procardia, a calcium channel blorcker)
  4. Magnesium Sulfate
    • Tocolytic drug. Causes CNS depression and relaxes uterine muscles. Also used as tx for preeclampsia for seizures (control).
    • IVPB to primary line on pump. Can be given with terbutaline. (check if meds compatible on site. 4-6g/ 15-30 mins. Loading, maintenance, dose, action)
    • Adverse effects: Hypotension, pulmonary edema, hypocalemia.
  5. Magnesium Sulfate Management
    • Monitor DTR (deep tendon reflexes/normal:+2 to +3) & VS hourly, LOC (headache, blurred vision, dizziness), I&O, Resp. (less than 12 can lead to resp depression)
    • Limit fluids to 1500-2400cc q 24 hrs (increase fluids can cause pulmonary edema)
    • Magnesium serum levels normal 4 - 6 above 10 = toxicity. Calcium Gluconate must be available to reverse toxicity. (raises calcium decreases magnesium. should be on every emergency cart)
  6. Beta Adrenergic Agents [Ritodrine, Brethine]
    • Tocolytic drugs. Relaxes smooth muscle of the uterus & bronchioles. Usually delays birth for up to 48 hrs.
    • Ritodrine can be given PO, SC, or IV
    • Brethine can be given SC & PO
    • s/e: Tachycardia, hypotension, pulmonary edema, fluid retention, hyperglycemia, hypokalemia, hypocalcemia
  7. Beta Adrenergic Agents [Ritodrine, Brethine] Management
    • Monitor: I&O/Foley, resp. status, daily weight, edema
    • Limit fluid to 1500 - 2400cc in 24 hrs (increase can lead to pulmonary edema)
  8. Calcium Channel Blockers
    • Tocolytic drug. Blocks calcium movement into muscle cells, inhibits uterine activity to arrest preterm labor.
    • Given PO or sublingual
    • Do not give with magnesium sulfate or will cause hypotension (cam feel anxious)
    • s/e: tachycardia, hypotension, peripheral edema
  9. Calcium Channel Blockers [Procardia] Management
    Monitor for adverse effects : flushing of skin, headache, transient tachycardia, palpitations, postural hypertension, peripheral edema and transient fetal tachycardia
  10. Prostaglandin Synthetase Inhibitors
    • Tocolytic drug. Inhibits prostaglandins, which stimulate contractions; inhibits uterine activity to arrest preterm labor.
    • Given PO with food to reduce GI irritation
    • s/e: decrease platelet aggregation, premature closing of the PDA (patent ductus arteriosus- allows circulation. left to right shunt of blood from descending aorta to main pulmonary artery. must remain open for fetal life) Preterm babies given indomethocin to close the PDA b/c once out of the womb, must close but since preterm not mature enough to close on its on. If Indomethocin does not close the PDA for the newborn, surgery is done to close it.
  11. Prostaglandin Synthetase Inhibitors[Indomethocin] Management
    • Do not give to women with peptic ulcer disease.
    • Monitor n/v heartburn, rash, prolonged bleeding time, oligohydramnios, & hypertension.
    • Monitor baby
  12. Antenatal glucocorticoid therapy [Betamethasone]
    • (Celestone) Promotes fetal lung maturity by stimulating surfactant production (coats the alveoli (air sacs) to allow it to remain open throughout resp. cycle. w/c prevent or reduce RDS), prevents or reduces risk of respiratory distress syndrome
    • & intraventricular hemorrhage in the preterm neonate less than 34 weeks' gestation (24 - 34 weeks)
    • Dosage: 2 doses of 12 mg IM 24 hrs apart
    • s/e: Pulmonary edema. If given with a Beta Adrenergic medication may cause hypoglycemia
    • DO NOT give if maternal infection (mask s/s of infection)
  13. Antenatal glucocorticoid therapy [Betamethasone] Management
    • Monitor for maternal infection or pulmonary edema.
    • Assess maternal lung sounds and monitor for signs of infection.
  14. Oxytocin (Pitocin)
    • Used to start or support labor (Labor induction &/Augmentation) Stimulates contractions of uterus. Produced by the posterior pituitary.
    • Needs a bisphop score (identifies ripening of cervical: dilation,effacement,intensity of contraction, station) above 8 w/c indicates successful vaginal birth, less than 6 usally indicates cervical ripening method should be used prior to use of Oxytocin.
  15. Oxytocin (Pitocin) Indications
    • Inadequate uterine contractions
    • Post term
    • PROM:premature rupture of membranes (infection a complication of PROM)
    • PIH: pregnancy induced HTN
    • Fetal death
  16. Oxytocin (Pitocin) Contraindications
    • CPD: cephalopelvic disproportion (baby's head too big to fit through pelvis. also failure to progress)
    • Prolapsed cord: compress cord
    • Transverse lie
    • Non reassuring FHR (brady/tachy)
    • Previous classic C/S (top to bottom. can rupture. cannot deliver vaginally)
    • Placenta Previa (tearing/dulling cervical area)
    • Cancer of the cervix
  17. Oxytocin (Pitocin) Complications
    • Dose related (titrate up- mid level)
    • Water intoxication (has an antidiuretic effect. dilutional hyponatremia=edema. intracellur may be dehydrated.)
    • Tetanic contractions (continuous contraction)
    • Placental separation
    • Uterine rupture
  18. Oxytocin (Pitocin) Administration
    • IVPB through primary line (titrate up. must be on pump)
    • 100 Oxytocin in 1000cc Lactated ringers (10U or more. 10U = 1cc)
    • Start 0.5-2 mU/min and increase till 20 -49 mU/min (increase at tolerated
  19. Oxytocin (Pitocin) Maternal Fetal Assessment
    • Monitor uterine contractions & FHR (baseline FHR & VS)
    • Contraction pressure maintained at 40 - 90 mmHg pressure. (stable)
    • Uterine hyper stimulation is contraction pressures above 90 mmHg
    • Monitor VS, uterine contractions, & FHR q 30 mins (BP, HR, RR, O2 sat) I & O (O=120 mL q4h/ I=1000cc q8h),for water intoxication (LOC, edema, drowsy,O decrease, I increase)
    • s/e: n/v, headaches, hypo/hypertension (w/ regional anesthesia may also see these s/e)
  20. Oxytocin (Pitocin)
    Emergency Measures/Documentation
    • DC per hospital protocol
    • Turn to left side (increase perfusion to kidneys)
    • Increase IV to 2000cc/hr unless water intoxication
    • Oxygen 7-8L via mask with pulse ox
    • HOB elevated
    • Document: Dosage times,rate & any change in rate maternal fetal response, VS, nursing interventions, I&O
  21. Prostaglandin [Dinoprostone]
    • Medication for Cervical Ripening & Induction.
    • Promotes cervical ripening & uterine contractions.
    • Cervidil suppository
    • Prepidil gel: prostaglandin E2, softens, effaces and dilate cervix (q6h max 24 hrs. wear gloves, can be absorbed)
    • Indications: used before oxytocin is given when bishop score is 4 or below.
    • Nursing Management: monitor FHR, uterine contraction, & VS
    • s/e: n/v, headache, diarrhea
  22. Prostaglandin [Misoprostol]
    • Cytotec: vaginal insert. Prostiglandin E1
    • s/e: n/v, hyper stimulation of the uterus
    • Nursing Implications: Oxytocin administration 4 hrs after the last dose is given
  23. Epidural Block
    • Block pain sensation via nerve pathways that go from uterus to spinal cord
    • To prevent hypertension give 500-1000cc IV Lactated Ringers before the procedure (bolus before epidural)
    • Nursing Management: Monitor I&O (may not feel if bladder is full), encourage voiding q2h, monitor uterine contractions & FHR (decrease perfusion to placenta, kidneys, etc.) (walking, spinal epidurals)
  24. Ataratics [vistaril/phenergan]
    • Medication for pain management.
    • Decrease n/v
    • Increase sedation & decrease anxiety
    • Given with opioids will increase effectiveness (can be given together)
  25. Barbiturates [seconal]
    • Medication for pain management.
    • Given early in labor to increase sedation
    • Not for pain relief
    • Crosses placenta & excreted in breast milk (causes sedation to baby)
  26. Benzodiazepines [valium]
    • Medication for pain management.
    • (for 1st stage of labor)
    • Tranquilizing & sedative action
    • Decreases n/v
    • Valium also used for seizure control
    • Causes CNS depression in mom and baby (no vigorous cry, baby floppy, baby does not respond = resp. etc. Must give Narcan)
  27. Opiods [stadol, fentanyl, demerol]
    • Medication for pain management.
    • Morphine like medications
    • Used for moderate to severe pain control
    • Used for regional anesthesia
    • Crosses the placenta & causes CNS depression in mom and baby
    • Can cause a decrease in FHR & uterine contractions
    • s/e: n/v & pruritus (itching)
Card Set
NS210 Exam 4/OB Medicatons
NS210 Exam 4 OB/Medications