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Pharm 2 > pharm and care of pregnant or lactating women > Flashcards

pharm and care of pregnant or lactating women Flashcards

1
Q

when using drug therapy there are special considerations for…

A
  • before pregnancy
  • during pregnancy
  • lactation
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2
Q

name some drugs related to pregnancy or lactation

A
  • infertility drugs
  • tocolytics
  • ocytocic agents
  • uterotonics
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3
Q

whats the criteria for use of infertility drugs

A

unable to conceive after 1 year of trying

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4
Q

what are some causes of infertility

A

women
ovulation disorder, blocked fallopian tubes, endometriosis, anomalies of the uterus, advanced age

men
absence of sperm, declining sperm counts, testicular anomalies, ejectulatory dysfunction

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5
Q

what are some examples of drugs for infertility

A
  • clomiphene citrate
  • menotropin
  • follitropins
  • human chorionic gonadotropin
  • leuprolide
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6
Q

what does clomiphene citrate do

A
  • ovarian stimulator
  • increases FSH and LH to cause ovulation
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7
Q

what does leuprolide do?

A
  • prevent premature ovulation
  • releases a higher quality egg
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8
Q

describe the pharmacokinetics of drugs for infertility

A
  • drug dependent (most are injection)
  • PO, IM, SQ
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9
Q

what are some adverse effects of drugs for infertility

A
  • drug dependent
  • multiple births
  • hot flashes
  • ovarian enlargement
  • breast pain/tenderness
  • visual disturbances
  • abdominal distention
  • headaches
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10
Q

what are some contraindications of drugs for infertility

A
  • drug dependent
  • primary ovarian failure
  • thyroid or adrenal disease
  • ovarian cysts
  • liver disease
  • abnormal uterine bleeding
  • thromboembolic disorders
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11
Q

changes in pregnancy can alter…

A

pharmacokinetics

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12
Q

describe maternal-placental-fetal circulation

A
  • completed by week 3
  • placental transfers occurs week 5
  • toxic effects on fetus: low albumin, immature liver/kidneys, poor blood brain barrier
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13
Q

what do drug effects on fetus depend on

A
  • type/amount of drug
  • duration of exposure
  • level of fetal growth and development
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14
Q

describe teratogenic

A

can cause serious fetal developmental harm

especially during the first 3 months of pregnancy (1st trimester)

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15
Q

describe some drug effects during the 2nd and 3rd trimester

A
  • growth retardation
  • respiratory probs
  • infections
  • bleeding
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16
Q

are all drugs potentially harmful to the fetus?

A

yeppers and they should be minimized or avoided if possible

17
Q

what are some guidelines for drug therapy during pregnancy

A
  • ingested drugs reach fetus
  • avoid drugs if possible
  • lifestyle or nontherapeutic drugs can affect fetus
  • avoid herbal supplements
  • maintain healthy lifestyle
  • notify HCP if think are pregnant
  • drugs are excreted in breast milk
  • avoid drugs of abuse
18
Q

name some maternal therapeutics

A

folic acid, prenatal vitamins
meds for:
- pregnancy associated probs
- chronic disease
- preterm labor
- pain management during labor
- induction of labor
- prevention of post partum hemmorhage

19
Q

name some fetal therapeutics

given to mom to effect fetus

A
  • digoxin
  • levothyroxine
  • penicillin
  • betamethasone
  • Rh immune globulin (mom Rh neg)
20
Q

describe tocolytics

A

drugs that inhibit labor and maintain the pregnancy

21
Q

describe preterm labor

A

uterine contraction before 37 weeks

22
Q

what are some examples of tocolytics

A
  • magnesium sulfate
  • nifedipine
  • terbutaline sulfate
  • NSAIDS - indomethacin
23
Q

how does magnesium sulfate work as a tocolytic

A

stops neuromuscular contraction and relaxes uterine muscles

24
Q

what are some drugs used for labor induction

A
  • prostaglandins: dinoprostone and misoprostol
  • oxytocics: oxytocin
25
Q

how does oxytocin work for labor induction

A
  • low dose is used
  • stimulates or strengthens uterine contraction
26
Q

what are some analgesics used for labor

A
  • nalbuphine (safest)
  • epidural containing fentanyl/local anesthetic (bupivacaine)
27
Q

whats the downside of using epidurals for labor

A

needs to be done early and may slow contractions

28
Q

describe uterotonics

A

drugs used to stop postpartum hemorrhage

29
Q

name and describe a uterotonic

A

oxytocin
- give a higher dose
- strong contraction reduces uterine bleeding

30
Q

what may be used for lactation induction

A
  • metoclopramide (stimulates prolactin)
  • galactagogues (herbs or foods that induce lactation)
31
Q

describe drug therapy during lactation

A
  • drugs to treat postpartum depression: SSRIs (not ideal but a good option)
  • there are many meds contraindicated during lactation
32
Q

describe birth control during lactation

A

avoid progesterone-only birth control bc higher dose progesterone leads to reduction in milk production

33
Q

a couple has been trying to conceive for the past 8months without success. which of the following is the first drug of choice?

1) leuprolide
2) human gonadotropin
3) follitropin beta
4) clomiphene citrate

A

clomiphene citrate

clomiphene is an ovarian stimulator, increasing the amount of FSH and LH secreted by the pituitary gland. while other drugs can be used to treat infertility, clomiphene is first line drug choice

34
Q

a woman with a seizure disorder has been taking phenytoin since she was 6 years old. she recently decided she wants to start a family. she understands the risk related to phenytoin during pregnancy. what should the nurse advise the woman about pregnancy?

1) discusss her concerns with her gynecologist and neurologist
2) she should stop taking phenytoin and take folic acid
3) she should begin a prenatal vitamin
4) she should consult a genetic counselor about her seizure disorder

A

discuss her concern with her gynecologist and neurologist

a patient should never stop taking seizure mes abruptly. while folic acid and prenatal vitamins are good, the phenytoin can be harmful to the fetus. the best thing to do would be to discuss the risk vs benefits with both docotrs and see which is the best way to proceed

Pharm 2 (34 decks)

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