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21 Cards in this Set
- Front
- Back
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Premesis
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-combo pyridoxine, folic acid, calcium carbonate
-used for minimizing nausea in preg |
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Transplacental drug transer
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-by 5th week after conception placenta functions as major transport for materials including drugs
-drug exposure during 5-10 wks of gestation has greatest potential effects on organ development -teratogenic effects: abml development; loss of preg; growth imapirment |
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Teratogenic drugs
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-capable of causing developmental abnormalities in utero
1. chemo 2. warfarin 3. alcohol 4, sex hormones (DES) 5. NSAIDs 6. anticonvulsants 7. oral hypoglycemias 8. Retinoids 9. thalidomide, 10. tetracyclies 11. antithyroid drugs |
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General recommendations in preg
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1. folic acid
2. rubllea and varicella vaccine 3. stop drinking, smoking, drugs 4. control maternal chronic illness |
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Prenatal vitamins
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-most contain vit A, thiamine, riboflavin, niacinamide, pyridosine, B12, folic acid, Vit C, D and E, iron
-some have calcium, fatty acids (Primacare) -improves cognitive function, visual acuity, reduces risk of postpartum depression |
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Problems during preg
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1. GERD (small meals)
2. Constipation (fiber and water, avoid laxatives) 3. N/V 4. Gestational DM 5. HTN 6. UTI (must be treated) 7. Hemorrhoids (topical, phenylephrine) |
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Treatment of Gestational DM
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-nutrition counseling (restrict carbs to 35 to 40 percent of daily calories)
-self blood glucose monitoring 4 times/day -goals: fasting levels <100; postprandiol <120 -Insulin therapy for pts with high levels |
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UTIs and preg
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-asymptomatic bacteruria must be treated with abx
-screen with urine cx at onset of prenatal care -Cephalexin or Nitrifurantoid for 7 days -pyelonephritis requires hospitalization for IV hydration and IV abx: 3rd gen cephalosporin or cefazolin |
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Preterm labor
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-labor before 37wks
-Tocolytic drugs-prolong preg and allow for admin of antenatal steroids to improve pulmonary maturity of fetus -Magnesium sulfate, B2 agonist, Nifedipine |
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Magnesium sulfate IV infusion
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-supressess nerve impulses to uterus by antagonizing intracellular calcium
AE: pulmonary edema, toxic doses tetany (monito DTRs, esp patellar), muscle paralysis and respiratory depression |
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B2 agonists
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-Ritodrine (IV) or terbutaline (SQ)
-works by binding to B2 receptors causing relaxation of uterus -AE: hyperkalemia, arrhythmias, hyperglycemia and pulmonary edema |
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Nifedipine
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-sublingually
-calcium channel blocker -hypotension |
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IDOMETHACIN
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-adjunct agent
-interrupts prostaglandins |
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Antenatal steroids
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-given to pregnant women at 24-34 wks who are at risk of delivery in next days
-Beclomethasone or Dexamethasone -reduces respiratory distress syndrome, IVH, death in infants |
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Tocolytics-C/I
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-infection
-placenta abruptio -advanced labor -fetal compromise -severe preeclampsia -beta agonists: arrhythmias -mag sulfate: MG -PG inhibitors: allergies, active PUD, renal impairment |
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Group B strep infection
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-women screened at 35-37 wks
-If cultures are positive or status unknown and fever > 100.4 or ROM > 18 hours -Penicillin G 5 million U IV at onset of labor or ROM then 2.5 million U every 4 hours until delivery Allergic to PCN then Clindamycin or erythromycin |
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Induction of labor
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-indications for induction:
1. cervical ripening--> to increase effacement and dilation of cervix 2. Bishop scores:(higher the score the better) Cervical dilation, effacement, station, consistency, position grade ripening |
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Induction of labor drugs
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Cervical ripening:
-Prostaglandin analogs (E2) dinosprostone gel or insert misoprostol (E1 analog) Uterine contractions: -Oxytocin (Pitocin): stimulates contractions; Iv infusions increased at 30 min intervals |
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Benefits of inducing labor
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1. Reduced incidence of chorioamnionitis
2. Reduces perinatal morbidity and mortality 3. reduced neonatal infections with oxytocin |
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Risks of inducing labor
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1. uterine hypercontractility
2. FHR changes with oxytocin 3. Pain 4. Respiratory distress in preterm babies |
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C/I to induction of Labor
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1. Previous C-section and use of prostaglandins
2. Placenta previa 3. Prior classical uterine incision 4. Active genital herpes C/I to cervical ripening: above plus; ruptured membranes, maternal fever and regular contractions |
