N395 Maternity Meds- Pregnancy/Labor

Kate Parvey
Flashcards by Kate Parvey, updated more than 1 year ago
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N395 Maternity Meds
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Ampicillin Route & Dose Range 4ec1ba48-0022-40b9-a775-9425a08aa52b.png (image/png) IV 2 gm initial dose then 1-2 gm Q4 until birth Goal: infuse minimum of 2 doses prior to birth
Ampicillin Class & Action 4c5341c9-030a-490a-8919-610de718b0d9.png (image/png) Antibiotic, bactericidal Treatment for positive GBS ( Group B Strep) inhibits cell wall mucopeptide synthesis * For Pregnancy & Labor
Ampicillin Side Effects & LR/PR 0be4f28c-31b3-47e6-a9d1-00e8d4d80c08.png (image/png) GI disturbance, allergy, rash, anaphlaxis L1/ B
Betamethasone (Dexamethasone {discontinued in US}) Route & Dose Range IM Fetal Lung Maturation: 12 mg IM Q 24hrs x 2 doses
Betamethasone (Dexamethasone {discontinued in US}) Class & Action Long-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
Betamethasone (Dexamethasone {discontinued in US}) Side Effects & LR/ PR Sodium and fluid retention , hypokalemia, BP elevated, edema, diaphoresis, rash, dyspepsia, H/A L3/ C
Calcium Gluconate Route & Dose Range IV Push 1-2 g Hyper magnesium status/ magnesium toxicity
Calcium Gluconate Class & Action Mineral Given as the "antidote" to magnesium
Calcium Gluconate Side Effects & LR/PR Nausea 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
Cytotec Route & Dose Range Oral, vaginal, rectal 1/4 of 25mg tablet intra-vaginally for labor 800-1000mcg rectally for PP hemorrhage
Cytotec Class & Action Prostaglandin Cytokine ***Induction of labor, PP hemorrhage, Gastric protectant * Inhibits gastric acid secretion and protects GI Mucosa; produces uterine contractions (prostaglandin E1) * for Pregnancy & Labor
Cytotec Side Effects & LR/PR Cramping: keep woman in bed for one hour after administration Uterine Hyper stimulation L3/ X
Cytotec 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.
Hemabate Route & Dose IM Postpartum Hemorrhage 250 mcg IM x1 Max: 2 mcg total dose May repeat Q15-90 min for refractory bleeding
Hemabate Class and Action Oxytocic Prostaglandin Prostaglandin to control bleeding after birth stimulates smooth muscle and uterine contractions (synthetic prostaglandin)
Hemabate Side Effects & LR/PR H/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
Magnesium Sulfate Route & Dose IV 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
Magnesium Sulfate Class & Action Alkaline 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.
Magnesium Sulfate Side Effects & LR/PR Serious 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
Methergine Route & Dose PO/IM 0.25 mg IM 0.2 mg PO tid-qid up to 1wk
Methergine Class & Action Ergot derivative with vasoconstrictive properties Stimulates uterine contractions to control bleeding after birth
Methergine Side Effects & LR/PR Will 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
Pitocin (synthetic Oxytocin) Route & dose IV 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
Pitocin (synthetic Oxytocin) Class & Action Binds 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.
Pitocin ( synthetic Oxytocin) Side Effects & LR/ PR Hyperstimulation, 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
Terbutaline, Brethine Route & Dose SQ/IV 0.25 mg SQ 2.5 mg - 5 mg q 4-6 hours PO
Terbutaline, Brethine Class & Action Beta-2 adrenergic Relaxes uterus in pre-term labor or with a tetanic uterine contraction during an induction or for fetal distress
Terbutaline, Brethine Side Effects & LR/PR Tachycardia 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.
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