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35 Cards in this Set
- Front
- Back
oxytocics
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Proto: oxytocin (Pitocin)
other: dinoptosone (Cervidil) methyylergonovine (methergine) |
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oxytocics MOA
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uterine stimulation increases the strength, frequency, and length of uterine contractions
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oxytocics USE
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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 |
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oxytocic adverse
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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 |
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oxytocic contraindications
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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 |
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oxytocic interactions
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vasopressors can lead to hypertension- avoid concurrent use
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oxytocic admin
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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 |
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oxytocic effectiveness
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effective contractions
increase in uterine tone and no evidence of postpartum hemorrhage |
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tocolytic meds
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terbutaline sulfate ( Brethine)
others: nifedipine (Procardia, Adalat), indomethicin (Indocin) |
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tocolytic MOA
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Terbutaline selectively activates beta 2 adrenergic receptors (beta2 adrenergic agonsists), resulting in smooth muscle relaxation
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tocolytic use
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subcutaneous terbutaline can be used up to 48 hours to delay but not to prevent preterm labor
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tocolytic adverse
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tachycardia, palpitations, chest pain
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tocolytic interventions
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monitor beta adverse effects
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tocolytic contraindications
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greater than 34 weeks
acute fetal distress severe gestational hypertension or eclampsia vaginal bleeding cervical dilation greater than 6 cm |
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tocolytic interactions
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concurrent use of adrenergic agonsits can cause additive effects
concurrent use of beta blockers can blunt the effect of terbutaline |
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tocolytic admin
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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 |
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tocolytic effectiveness
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cessation of preterm labor
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hydroxyprogesterone (Makena) MOA
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progestin hormone is only FDA approved med to prevent preterm labor. MOA is unknown
only for women with single fetus |
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hydroxyprogesterone use
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preterm birth
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nifedipine (Adalat, Procardia)
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calcium channel blocker, is equally effective as terbutaline in suppressing preterm labor
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indomethacin (Indocin)
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supress labor by inhibiting synthesis of prostaglandins
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magnesium sulfate
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central nervous system depressant and relaxes smooth muscles
prevent seizures in clients who have preeclampsia significant adverse effects and increases fetal mortality |
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hydroxyprogesterone caproate (Makena) adverse
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injection-site reactions
diarrhea |
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hydroxyprogesterone caproate (Makena) contraindications
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greater than 14 weeks gestation
acute fetal distress vaginal bleeding cervical dilation greater than 6 cm |
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hydroxyprogesterone caproate interactions
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no significant interactions
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hydroxyprogesterone caproate admin
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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 |
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hydroxyprogesterone effectiveness
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cessation of preterm labor
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opioid analgesics
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meperidine hydrochloride (Demerol)
others: butorphanol (Stadol), nalbuphine (Nubain) |
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opioid analgesics MOA
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act in CNS to decrease perception of pain without loss of consciousness
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opioid analgesics use
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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 |
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opioid analgesics adverse
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dry mouth, nausea, vomiting, neonatal depression, tachycardia, hypotension, decreased fetal heart rate variability
sedation |
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opioid analgesics interventions
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provide ice chips, administer antiemetic if needed, have naloxone (Narcan available at delivery (neonatal depression)
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opioid analgesic contraindications
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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 |
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opioid analgesic admin
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naloxone (Narcan) is administered only in cases of severe respiratory depression in the newborn
monitor vitals, uterine contraction pattern, and continuous FHR monitoring |
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opioid analgesic effectiveness
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decreased pain during labor
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