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35 Cards in this Set

  • Front
  • Back
oxytocics
Proto: oxytocin (Pitocin)
other: dinoptosone (Cervidil)
methyylergonovine (methergine)
oxytocics MOA
uterine stimulation increases the strength, frequency, and length of uterine contractions
oxytocics USE
induction of labor (posterm), premature rupture of membranes
enhancement of labor
management of postpartum hemorrhage
dinoprostone (Cervidil) is a prostaglandin used to promote cervical ripening and to stimulate uterine contractions
methergine is used for emergency intervention for serious postpartum hemorrhage
oxytocic adverse
oxytocin- uterine rupture- preassess risk factors, such as multiple deliveries
monitor strength, length and duration of contractions
have magnesium sulfate on standby if needed for relaxation of myometrium
methylergonovine- hypertensive crisis- monitor for manifestations of hypertensive crisis
oxytocic contraindications
sepsis
unripe cervix
genital herpes
history of multiple births, or uterine surgery
Fetal factors: immature lungs, cephalopelvic disproportion, fetal malpresentation, prolapsed umbilical cord, fetal distress, threatened spontaneous abortion

methergine should not be given to clients who have hypertension and should be used cautiously with organ failure
oxytocic interactions
vasopressors can lead to hypertension- avoid concurrent use
oxytocic admin
use infusion pump to admin IV oxytocin
gradually increase flow rate per prescribed parameters such as increase 1mcg/min every 30 min
monitor uterine contractions
monitor for uterine hyperstimulation
monitor fetal heart rate and rythm
oxytocic effectiveness
effective contractions
increase in uterine tone and no evidence of postpartum hemorrhage
tocolytic meds
terbutaline sulfate ( Brethine)
others: nifedipine (Procardia, Adalat), indomethicin (Indocin)
tocolytic MOA
Terbutaline selectively activates beta 2 adrenergic receptors (beta2 adrenergic agonsists), resulting in smooth muscle relaxation
tocolytic use
subcutaneous terbutaline can be used up to 48 hours to delay but not to prevent preterm labor
tocolytic adverse
tachycardia, palpitations, chest pain
tocolytic interventions
monitor beta adverse effects
tocolytic contraindications
greater than 34 weeks
acute fetal distress
severe gestational hypertension or eclampsia
vaginal bleeding
cervical dilation greater than 6 cm
tocolytic interactions
concurrent use of adrenergic agonsits can cause additive effects
concurrent use of beta blockers can blunt the effect of terbutaline
tocolytic admin
monitor FHR, uterine contractions, pulse, blood pressure, respiratory rate, lung sounds, and daily weights
withohold meds if chest pain or HR more than 120/min
limit fluid intake to 1500- 2400 mL/24 hour
tocolytic effectiveness
cessation of preterm labor
hydroxyprogesterone (Makena) MOA
progestin hormone is only FDA approved med to prevent preterm labor. MOA is unknown
only for women with single fetus
hydroxyprogesterone use
preterm birth
nifedipine (Adalat, Procardia)
calcium channel blocker, is equally effective as terbutaline in suppressing preterm labor
indomethacin (Indocin)
supress labor by inhibiting synthesis of prostaglandins
magnesium sulfate
central nervous system depressant and relaxes smooth muscles
prevent seizures in clients who have preeclampsia
significant adverse effects and increases fetal mortality
hydroxyprogesterone caproate (Makena) adverse
injection-site reactions
diarrhea
hydroxyprogesterone caproate (Makena) contraindications
greater than 14 weeks gestation
acute fetal distress
vaginal bleeding
cervical dilation greater than 6 cm
hydroxyprogesterone caproate interactions
no significant interactions
hydroxyprogesterone caproate admin
discontinue if thrombosis develops
monitor blood sugar if DM
monitor for magnesium sulfate toxicity- discontinue if loss of deep tendon reflexes, urinary output less than 25 to 30 mL/hr, respiratory rate less than 12/min, pulmonary edema, and or chest pain
calcium gluconate should be administered as an antidote for magnesium sulfate toxicity
hydroxyprogesterone effectiveness
cessation of preterm labor
opioid analgesics
meperidine hydrochloride (Demerol)
others: butorphanol (Stadol), nalbuphine (Nubain)
opioid analgesics MOA
act in CNS to decrease perception of pain without loss of consciousness
opioid analgesics use
given opioid analgesics IM or IV but IV is recommended during labor because of it's quick action
butorphanol and nalbuphine provide pain relief without causing significant respiratory depression in mother or fetus
opioid analgesics adverse
dry mouth, nausea, vomiting, neonatal depression, tachycardia, hypotension, decreased fetal heart rate variability
sedation
opioid analgesics interventions
provide ice chips, administer antiemetic if needed, have naloxone (Narcan available at delivery (neonatal depression)
opioid analgesic contraindications
delivery within 4 hours of admin
if opiod is given too soon, it can delay the progression of labor. If given too late, it can depress neonatal respirations
opioid analgesic admin
naloxone (Narcan) is administered only in cases of severe respiratory depression in the newborn
monitor vitals, uterine contraction pattern, and continuous FHR monitoring
opioid analgesic effectiveness
decreased pain during labor