Fichas
N395 Maternity Meds- Pregnancy/Labor
Fichas del conjunto (28)
- 1Ampicillin Route & Dose RangeIV
2 gm initial dose
then 1-2 gm Q4 until birth
Goal: infuse minimum of 2 doses prior to birth - 2Ampicillin Class & ActionAntibiotic, bactericidal
Treatment for positive GBS ( Group B Strep)
inhibits cell wall mucopeptide synthesis
* For Pregnancy & Labor
- 3Ampicillin Side Effects & LR/PRGI disturbance, allergy, rash, anaphlaxis
L1/ B
- 4Betamethasone (Dexamethasone {discontinued in US}) Route & Dose RangeIM
Fetal Lung Maturation: 12 mg IM Q 24hrs x 2 doses - 5Betamethasone (Dexamethasone {discontinued in US}) Class & ActionLong-Acting Corticosteroid
To induce fetal lung maturation in expectant mothers between 24-24 weeks gestation at high risk of premature delivery
Notes: given to mother
inflammatory action unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects
* For Pregnancy & Labor - 6Betamethasone (Dexamethasone {discontinued in US}) Side Effects & LR/ PRSodium and fluid retention , hypokalemia, BP elevated, edema, diaphoresis, rash, dyspepsia, H/A
L3/ C - 7Calcium Gluconate Route & Dose RangeIV Push
1-2 g
Hyper magnesium status/ magnesium toxicity - 8Calcium Gluconate Class & ActionMineral
Given as the "antidote" to magnesium - 9Calcium Gluconate Side Effects & LR/PRNausea or vomiting; decreased appetite; constipation; dry mouth or increased thirst; increased urination
L3/C
may use during pregnancy; no known risk of fetal harm based on human data - 10Cytotec Route & Dose RangeOral, vaginal, rectal
1/4 of 25mg tablet intra-vaginally for labor
800-1000mcg rectally for PP hemorrhage - 11Cytotec Class & ActionProstaglandin Cytokine
***Induction of labor, PP hemorrhage, Gastric protectant
* Inhibits gastric acid secretion and protects GI Mucosa; produces uterine contractions (prostaglandin E1)
* for Pregnancy & Labor - 12Cytotec Side Effects & LR/PRCramping: keep woman in bed for one hour after administration
Uterine Hyper stimulation
L3/ X - 13Cytotec Black Box Warnings*** Pregnancy Black Box Warning
use in pregnancy women can cause abortion, premature birth, or birth defects; uterine rupture reported w/ use to induce labor or abortion past 8 weeks of pregnancy
do not use to decrease NSAID ulcer risk in pregnant pts of abortifacient property and warn not to give to others
*** Women of Childbearing Potential
do not use to decrease risk of NSAID- induced ulcers in women of childbearing potential unless high risk of gastric ulcer; in such pts only use if
1)negative serum pregnancy test <2wk prior to start of treatment;
2) pt capable of complying w/ effective contraception;
3) patient given oral and written warnings of hazards. risks of contraception failure, and danger of taken by other women of childbearing potential;
4) start med on 2nd or 3rd day of next normal menstrual period.
Postpartum: take the med immediately after a feed and wait 4 hrs until next feed. - 14Hemabate Route & DoseIM
Postpartum Hemorrhage
250 mcg IM x1
Max: 2 mcg total dose
May repeat Q15-90 min for refractory bleeding - 15Hemabate Class and ActionOxytocic Prostaglandin
Prostaglandin to control bleeding after birth
stimulates smooth muscle and uterine contractions (synthetic prostaglandin) - 16Hemabate Side Effects & LR/PRH/A, N &V and diarrhea
L3/C
*** do not give if patient has history of asthma
Appropriate Use ( Black Box Warning)
strictly follow recommended dose; use only by medically trained personnel in hospital w/ ICU and surgical facilities - 17Magnesium Sulfate Route & DoseIV
4-6 gm bolus x1 then 1-3 gm per hour x 12-24 hours IV
MAX: 40 g/24h; x5-7 days
Monitoring may include: Check your facility's
P&P
VS (BP, Pulse, Respiration) [For Respirations<
14/min : STOP MAG and notify OB provider
• Before initiation and after completion of
loading dose
• Then q 15 mins x 4
• Every 30 mins x 2
• Then every hour
Comes packaged as 40 grams in 1000 ml
of Normal Saline. You will have to
calculate at what rate to set the pump for
the Alaris pump for both the loading dose
and the maintaince dose
Breath sounds: before administration and every 2 hours
Reflexes: patellar (and clonus for PIH pts)
every hour. If absent STOP MAG and notify
OB provider
I&O: strict - obtain urine output q hour. For
output <25-30 ml/hour: STOP MAG and
notify OB provider
• For pts with PIH, check urine protein as
ordered - 18Magnesium Sulfate Class & ActionAlkaline earth metal sulfate
saline laxative and anticonvulsant
Preterm as a neuro protectant for the fetus
decreases CNS irritability and prevention of seizures in hypertensive disorders of pregnancy ( most common being preeclampsia conditions: relaxes the uterus to stop uterine contractions in preterm labors. - 19Magnesium Sulfate Side Effects & LR/PRSerious Reactions
• cardiovascular collapse; respiratory depression or paralysis; hypothermia; depressed cardiac function; pulmonary edema; fetal harm (prolonged in utero exposure)
Common Reactions
• depressed reflexes; hypotension; flushing; drowsiness; impaired cardiac function; diaphoresis; hypocalcemia; hypophosphatemia; hyperkalemia: vision changes, metallic taste in the mouth.
L1/B - 20Methergine Route & DosePO/IM 0.25 mg IM
0.2 mg PO tid-qid
up to 1wk - 21Methergine Class & ActionErgot derivative with vasoconstrictive properties
Stimulates uterine contractions to control bleeding after birth - 22Methergine Side Effects & LR/PRWill increase blood pressure
*** Do not give if patient is hypertensive. Avoid breast feeding during treatment and x12h after D/C; safety unknown; inadequate literature available to assess risk
L2/ C - 23Pitocin (synthetic Oxytocin) Route & doseIV
20-60 units diluted in 500 ml to 1000 ml
IM
Dose: 10 units IM x1 after placenta delivery;
labor induction or augmentation
[individualize dose IV]
Start: 0.5-2 milliunits/min IV, incr. 1-2 milliunits/min q15-40min until contraction pattern established.; Max: 20 milliunits/min
(augmentation), 40 milliunits/min (induction);
Alt: 6 milliunits/min IV, incr. 3-6 milliunits q15-40min, reduce increment if hyperstimulation occurs; Info: rates >9-10
milliunits/min rarely required at term, higher rates may be needed before term; mix 10 units/L IV fluid
Alt: 20 milliunits/min IV after placenta delivery until uterus
firmly contracted;
titrate rate to sustain contraction and control uterine atony;
Info: mix 10-40 units/L IV fluid - 24Pitocin (synthetic Oxytocin) Class & ActionBinds to oxytocin receptors in myometrium, increasing
intracellular Ca and stimulating uterine contractions
Stimulates uterine contractions; used to "firm" the uterus when hemorrhaging or prevent hemorrhaging;
Titrated dosages during induction/augmentation of labor; continuous doses after birth of placenta.
***Students may not administer Pitocin in this rotation. - 25Pitocin ( synthetic Oxytocin) Side Effects & LR/ PRHyperstimulation, uterine rupture, abruptio placenta
L2/X
***Black Box Warning: Not for Elective
Labor Induction
not indicated for elective labor induction since inadequate data to evaluate benefit vs risk; elective induction defined as labor initiation w/o medical indications - 26Terbutaline, Brethine Route & DoseSQ/IV 0.25 mg SQ
2.5 mg - 5 mg q 4-6 hours PO - 27Terbutaline, Brethine Class & ActionBeta-2 adrenergic
Relaxes uterus in pre-term labor or with a tetanic uterine contraction during an induction or for fetal distress - 28Terbutaline, Brethine Side Effects & LR/PRTachycardia in both mother and fetus, uncomfortable for women
HIGH ALERT MEDICATION: not used for long-term use to stop premature labor. May still be used as a one-time use to relax a uterus with systole.
If given more than one dose requires an EKG be done on the woman to rule out cardiac issues.