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Template for medications affecting labor and delivery for pharmacology exam
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Medications Affecting Labor and Delivery Defining characteristics: Used to bring about or increase labor or used to manage preterm labor Oxytocin: uterine stimulant Increase the force, regularity, and endurance of uterine contractions. Therapeutic for overdue deliveries, PROM, preeclampsia, improving dysfunctional labor, delivering placenta, achieving postpartum bleeding, Pre-assess high risk factors, assess contractions and characteristics, assess fetal status, Assess VS, Assess I&) Complications: Water intoxication, Uterine tachysystole, severe HTN Contraindications: Maternal-sepsis, unripe cervix, genital herpes, hx of uterine surgery Fetal-immature lungs, cephalopelvic disproportion, malpresentation, prolapsed umbilical cord, fetal distress, impending spontaneous abortion Nursing considerations: Use IV pump. Titrate dose no more than 6 milliunits every 40 minutes. Assess VS every30-60 minutes and with every dose change. Contractions should be every 2-3 minutes and last 45-60 seconds each. Assess for uterine tachysystole. Continuous monitoring FHT for rate and rhythm. Tocolytics: uterine relaxation Hydroxyprogesterone caproate prevents pre-term labor. Therapeutic uses, Nifedipine May be used as maintenance dose to suppress pre-term labor SEs include hypotension, headache, dizziness, nausea Contraindications: hypersensitivity. Use cautiously with hypotension, hepatic or renal disease, acute MI. Avoid use with magnesium sulfate. (skeletal muscle blockade) Interactions: increase effects of digoxin, phenytoin, beta blockers, antihypertensives. Avoid the use of grapefruit juice St John’s wart, ranitidine, cimetidine grape related to increased effect of nifedipine. Magnesium Sulfate: CNS depressant and relaxes smooth muscle. Prevents seizures in preeclampsia Maternal SEs-hypocalcemia, dyspnea, hot flashes, transient hypotension, Intolerable SEs- RR < 12/min, altered mental status, pulmonary edema, severe hypotension, urine output < 25mL/hr, serum magnesium > or = 10mEq Fetal-reduced fetal heart rate variability, nonreactive NST Nursing actions: Assess DTR, VS, serum magnesium, limit IV fluids to 125/hr, have calcium gluconate on hand. Assess toxicity. Limit fluid intake to 2500-300mL/day. Assess glucose for with DM. Increases the effects of digoxin. Glucocorticoid medications: Produce and release surfactant which stimulates fetal lung maturity. Reduce fetal respiratory distress syndrome, intraventricular, necrotizing enterocolitis and death. Complications: decreased fetal breathing and movements Administer deep IM for clients who are 24-34 weeks gestation at least 24 hours prior to but no more than 7 days prior to delivery. Administer betamethasone12mg Im for 2 doses 24 hours apart; 6mg IM for 4 doses 12 hours apart