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83 Cards in this Set
- Front
- Back
Define gravidity
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Number times a woman experiences pregnancy
- Multiple birth is one pregnancy |
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Define Parity
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Number of a woman’s pregnancies which exceed 20 weeks gestation
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Define G4P2113
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G= number of pregnancies
P= Full term deliveries Preterm deliveries Abortions Living children |
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Effect of progesterone in the GI tract:
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decreases GI motility.
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Physiological changes in response to pregnancy:
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↑ Cardiac output
↑ Renal perfusion and function ↑ Blood volume (by 50%) ↓ GI motility ↑ Weight gain |
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Increased physiological demands due to pregnancy:
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Calories - additional 300/day
Protein - additional 10 gm/day Calcium - 1200 mg/day Folic acid - 400 mcg/day Iron - additional 30 mg/day from 2nd trimester on |
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How pregnancy affects the half life of renally eliminated drugs?
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Half life become shorter
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What type of drugs acquire a larger apparent Vd during pregnancy?
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Lipophobic drugs (hydrophilic)
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How pregnancy affects the extent and rate of absorption of oral administrated drugs?
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Potentially decreases them.
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Effects of smoking on the fetus?
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Low birth weight
Premature birth Increase risk of respiratory issues |
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What immunizations should be kept up to date during pregnancy?
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Rubella
Hep B Influenza Varicella Tdap |
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Which weeks during pregnancy present the greatest risk for dramatic structural malformations?
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Second through eighth week
(organogenesis period) |
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What are the risks of drug use during the 2nd and 3rd trimester of pregnancy?
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Effects on growth, neurologic developments, mental development, and reproduction
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What are the factors affecting drug placental transfer?
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Low protein binding
High lipophilicity Low molecular weight (< 600) Unionized state |
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What drugs are important human teratogens especially during the first trimester?
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Phenytoin
Lithium Misoprostol Retinoids (systemically) Thalidomide |
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What drugs are important human teratogens especially during the 3rd trimester?
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ACE inhibitors
Carbamazepine Valproic Acid Tetracyclines (for 2nd and 3rd) |
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What abnormality can be produced by the used of ACE-I during pregnancy?
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Renal failure / agenesis
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What abnormality can be produced by the used of Carbamazepine and Valproic Acid during pregnancy?
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Neural tube defects
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What abnormality can be produced by the used of Phenytoin during pregnancy?
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Fetal hydantoin syndrome
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What abnormality can be produced by the used of Lithium during pregnancy?
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Ebstein's anomaly
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What drug is an important teratogen throughout pregnancy and what abnormality it produces?
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Alcohol
Fetal alcohol syndrome |
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What abnormality can be produced by the used of tetracyclines during pregnancy?
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Discoloration of teeth
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Potential abnormalities due to the use of warfarin during pregnancy include:
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Fetal warfarin syndrome
(critical period 6-9 weeks) |
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What are some suspected teratogens?
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Benzodiazepines
Estrogens Progestogens Quinolones |
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Important drugs with Non-teratogenic AE:
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Antithyroid drugs
Aminoglycosides Aspirin Barbiturates Benzodiazepines Beta-Blockers Caffeine Chloramphenicol Cocaine Diuretics Isoniazid Narcotic analgesics Nicotine NSAIDs Oral hypoglycemic agents PTU (propylthiouracil) Sulfonamides |
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Agents Considered Safe to use during pregnancy:
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Acetaminophen
Cephalosporins Corticosteroids Docusate sodium Erythromycin Multiple vitamins Narcotic analgesics Penicillins Phenothiazines Thyroid hormones Tricyclic antidepressants |
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What are some references to obtain info of drugs used during pregnancy?
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Primary literature
Drugs in Pregnancy and Lactation - Briggs www.motherisk.org www.toxnet.nlm.nih.gov www.reprotox.org |
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How to treat morning sickness during pregnancy:
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- Use Nonpharmacologic Treatment
First options: - Doxylamine (antihistamine) - Meclizine - Vit. B6 and B12 Secondary options: Promethazine Metoclopramide Ondansetron |
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How to treat constipation during pregnancy:
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It could be a side effect of iron and calcium supplementation.
Treatment: Fluids Physical exercise High fiber foods Bulk-forming laxatives Stool softeners Milk of magnesia |
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What therapies are contraindicated to treat constipation during pregnancy?
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NO enemas or strong stimulant laxatives
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Treatment of GERD during pregnancy:
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Ranitidine (Zantac®)
Metoclopramide (Reglan®) for severe PPIs |
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Treatment of Epilepsy during pregnancy:
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ALL anticonvulsants are considered teratogenic
Uncontrolled epilepsy poses greater threat to the fetus than drug therapy Single drug therapy when possible Folic acid supplementation 0.4 – 5 mg daily Vitamin K 10 mg PO daily in the last month |
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What medications have to be screened for neural tube defects when use to treat epilepsy during pregnancy?
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Carbamazepine (Tegretol®)
Divalproex sodium (Depacon®) Valproic acid (Depakote®) |
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Risk for gestational DM:
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>30 years of age
Obese Previous history positive family history Racial background |
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During what weeks should a pregnant patient be screened for gestational DM?
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Screening between the 24-28th week of gestation
Tight glycemic control is key |
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How to treat DM during pregnancy:
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Tight glucose control with drug therapy if unable to control blood glucose on diet alone
Initiate therapy for - FBS > 90 – 99 - 1 hr post prandial > 140 - 2 hr post prandial of >120 – 127 Goal: maintain FBS 80 - 110 and 2 hr post prandial of <155 |
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When glyburide can be considered for the treatment of DM in a pregnant patient?
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After the 11 week of gestatio
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What is the risk for using metformin during pregnancy?
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Risk of premature birth
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For how long and for what should a neonate from a diabetic patient be closely monitor?
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Monitor neonate closely first 24 hrs for hypoglycemia
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What is the preferred agent to prevent thromboembolism in pregnant woman?
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LMWH
2nd: low dose ASA and heparin DO NOT USE WARFARIN |
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Treatment of bacterial vaginosis on a pregnant woman:
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Metronidazole
- 500 mg po BID X 7 days - 250 mg po TID X 7 days Clindamycin 300 mg po BID X 7 days Do not use vaginal preparations |
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What drug is a good option to treat high blood pressure in a pregnant woman?
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Nifedipine
Avoid ACE-I and ARBs |
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Drugs that can be used to treat headache during pregnancy?
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Non-pharmacologic tx
APAP, codeine, narcotics Sumatriptan - probably OK |
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How is pregnancy- induce hypertension defined?
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Elevation of blood pressure after the 20th week in excess of 140 systolic and/or 90 diastolic
Elevation of 30 mm Hg systolic or 15 mm HG diastolic above the baseline |
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What are the common signs of pre-eclampsia?
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High blood pressure
Protein in the urine Pitting edema others: blurred vision abdominal pain elevated liver enzymes |
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What is the difference between pre-eclampsia and eclampsia?
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Eclampsia is defined as pre-eclampsia with seizures
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Pre-eclampsia prophylaxis:
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ASA 50 – 150 mg daily
Calcium supplementation |
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Drug of choice to treat high blood pressure during pre-eclampsia:
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methyldopa (Aldomet®)
(hardly used) |
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Alternative drugs to treat pre-eclampsia:
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hydralazine (Apresoline®), labetalol
nifedipine |
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Drugs contraindicated in the treatment of pre-eclampsia:
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ACE-I
Diuretics |
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Treatment for mild to moderate pre-eclampsia:
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Bed rest
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Treatment for moderate to severe pre-eclampsia:
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- Hospitalization
- Magnesium sulfate 2 - 4 gm IV bolus, followed by 1-3 gm IV/hr until delivery |
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What is the optimal magnesium serum concentration during the treatment of pre-eclampsia?
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maintain serum concentration @ 4-7 mEq/L (fairly high)
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What complications can be seen at magnesium concentrations of more than 13mEq/L and 15mEq/L?
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Respiratory depression >13 mEq/L
Cardiac arrest > 15 mEq/L |
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How to reverse magnesium toxicity?
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with calcium gluconate
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What is the mechanism of action of magnesium to treat pre-eclampsia?
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Magnesium helps with PIH because it relaxes smooth muscle raising the seizure threshold
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When to delivery a baby during pre-eclampsia?
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Use Hydralazine and labetalol IV to control blood pressure
Delivery if no response within 24-48 hrs |
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How to treat seizures during eclampsia?
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Treat with magnesium sulfate 5 – 6 gm IV bolus
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What are some possible pre-eclampsia Complications?
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Seizures
DIC (Disseminated Intravascular Coagulopathy) HELLP syndrome: - Hemolysis - Elevation of Liver enzymes - Low Platelets |
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Definition of premature labor:
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Contractions with cervical changes prior to 37th week
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Goal in the treatment of premature labor:
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to postpone delivery 24 – 48 hours
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Premature labor treatment:
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Bed rest
Fluids Antibiotics for Group B Strep Prophylaxis Corticosteroids (for less than 34wks of gestation) |
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What antibiotics are preferred in the prophylaxis of Group B strep during premature labor?
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Pen G
Ampicillin Ancef (if pen allergy w/o hives) Clindamycin (high resistant) Vancomycin |
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What are the corticosteroids of choice during premature labor?
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Betamethasone
Dexamethasone |
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What is the role of corticosteroids during premature labor?
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Corticosteroids stimulate baby’s lungs to make surfactant
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What tocolytic should be used for women with contractions but NO cervical changes during premature labor?
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Terbutaline (beta-2 agonists)
(limit use to inpatient and for less than 72 hrs) No commonly used outpatient or if contractions present due to SE |
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What tocolytic should be used for women with contractions AND cervical changes during premature labor?
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Magnesium sulfate
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What tocolytic can be used orally for the outpatient treatment of premature labor?
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NSAIDs: indomethacin and katerolac
CCB: Nifedipine (preferred) |
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What is the SE of magnesium when used during premature labor?
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pulmonary edema
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What is a possible SE of NSAIDs when used during premature labor?
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premature constriction of ductus arteriosus
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Miscarriage and PTL is associated with low levels of ...
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Progesterone
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What are some indications for labor induction:
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Post-term pregnancy (> 40wks)
Maternal medical problem Suspected fetal compromise Fetal demise Premature/prolonged rupture of membranes Chorioamnionitis: infection of the membranes that surround the baby and hold water in. |
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Desired physiological effects to induce labor:
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Cervical ripening
Contraction stimulation |
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Drugs used for cervical ripening during post term induction:
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Prostaglandin E2
Misoprostol |
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Drugs used for contraction stimulation during post term induction:
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Oxytocin (Pitocin®)
- IV titrated to frequency and strength of contraction |
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Herbal agents for labor induction:
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Laminaria
Evening primrose oil Black haw Black and blue cohosh Red raspberry leaves |
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What narcotic analgesics should be used during labor and delivery?
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Fentanyl (preferred)
Morphine |
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SE of narcotics used for analgesia during labor and delivery:
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Fetus: CNS and respiratory depression and skeletal muscle flaccidity (floppy baby syndrome)
Mom: rigors and N/V |
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How is fentanyl usually administrated during labor and delivery?
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- Usually combined with bupivacaine
- Administered via continuous infusion into the epidural space |
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How to reverse narcotic overdose or hypersensitivity?
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Nalaxone
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How to reverse Heparin overdose or hypersensitivity?
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Protamine
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How to reverse Oxytocin overdose or hypersensitivity?
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Magnesium sulfate
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Which laxatives are contraindicated in pregnancy?
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castor oil and mineral oil
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