Med Quiz II

Question 1

terbutaline sulfate: classification

Answer 1

tocolytic

Question 2

Terbutaline sulfate: indications

Answer 2

• tocolytic: management of preterm labor–>inhibition of uterine contractions

Question 3

Terbutaline sulfate: ADRs

Answer 3

• CV: maternal and fetal tachycardia, palpitations, cardiac dysrhythmias, chest pain, wide pulse pressure
• resp: dyspnea, chest discomfort
• CNS: tremors, restlessness, weakness, HA, dizziness
• metabolic: hypokalemia, hyperglycemia
• GI: n/v, reduced bowel motility
• skin: flushing, diaphoresis

Question 4

Terbutaline sulfate: nursing implications

Answer 4

• not approved by the FDA for use as a tocolytic
• do not use for longer than 48-72 hour
• assess woman’s apical HR and lung sounds before administering each dose
  
  • drug toxicity and d/c drug if: maternal HR over 120 bpm or respiratory findings such as “wet” lung sounds or more rapid rate
• report all non-reassuring maternal and fetal assessments to physician
• have propranolol ready as a reversal agent

Question 5

nifedipine: classification

Answer 5

tocolytic; CCB

Question 6

Nifedipine: indications

Answer 6

• CCB used for tocolysis
  
  • reduce uterine contractions b/c Ca is essential for muscular contractions (for preterm labor)

Question 7

nifedipine: contraindications

Answer 7

• AV heart block
• systolic BP <90
• coadministration with grapefruit juice

Question 8

Nifedipine: ADRs

Answer 8

• flushing
• HA
• inc in maternal and fetal HR
• maternal postural hypotension
• hyperglycemia
• will cause the FHR to have reduced variability

Question 9

Nifedipine: nursing implications

Answer 9

• observe for SEs
• report maternal pulse greater than 120 bpm
• educate on possible dizziness or faintness
  
  • sit or stand slowly and call for assistance if needed
• never give with mag sulfate

Question 10

Nifedipine: dosage

Answer 10

• Give 10-20 mg/3-6 hours until contractions become rare or stop

Question 11

betamethasone: classification

Answer 11

glucocorticoids

Question 12

Betamethasone: indications

Answer 12

• acceleration of fetal lung maturity to reduce the incidence and severity of respiratory distress syndrome (RDS)
  
  • greatest benefits if at least 24 hrs elapse b/w initial dose and birth of preterm infant
  • indicated if gestation b/w 24-34 wks

Question 13

betamethasone: contraindications

Answer 13

• active infection, such as chorioamnionitis

Question 14

Betamethasone: ADRs

Answer 14

• few b/c short term use of drug
• pulmonary edema possible secondary to sodium and fluid retention
• fever and elevated pulse rate secondary to infection
• UTI
• hyperglycemia

Question 15

Betamethasone: nursing considerations

Answer 15

• educate woman on potential benefits, but tell her drug cannot prevent all complications of prematurity
• if woman has diabetes, more frequent blood glucose checks are needed
• WBCs greater than 20,000 may indicate infection
  
  • but may have a temporary rise in platelets and WBCs for 72 hours that is expected
• assess lung sounds
• report chest pain, heaviness, or dyspnea
• report pain or burning with urination
• assess V/S for fever and elevated pulse

Question 16

indomethacin: classification

Answer 16

ductus arteriosus patency adjunct

Question 17

Indomethacin: indications

Answer 17

• tocolytic: to inhibit uterine contractions (for preterm labor)
• can be used to normalize volume of amniotic fluid if hydramnios is present

Question 18

indomethacin: contraindications

Answer 18

• alcohol intolerance
• active GI bleed
• ulcer dz
• thrombocytopenia
• use of NSAIDs

Question 19

Indomethacin: ADRs

Answer 19

• Maternal:
  
  • GI: n/v/heartburn
  • asthm ain aspirin sensitive women
  • inc BP in hypertensive women
• Fetal:
  
  • constriction of ductus arteriosus
  • pulmonary HTN
  • oligohydramnios (usually returns to normal when drug is d/c)

Question 20

Indomethacin: nursing implications

Answer 20

• limit use to preterm labor before 32 weeks gestation
• use for no longer than 48-72 consecutive hours
• observe for GI SEs
• observe for abnormal bleeding (such as prolonged bleeding after injection and bruising with no apparent cause)
• watch for signs of infection, b/c drug may mask them
• check height of fundus at beginning of therapy and daily thereafter to identify reduced amniotic fluid
• observe for decreased fetal movements and absent FHR accelerations w/ fetal movement (may indicate fetal condition deteriorating)
• use U/S and fetal echocardiography to determine if drug having adverse effects on fetus

Question 21

Carboprost tromethamine: classification

Answer 21

oxytoxics; prostaglandins

Question 22

Carboprost tromethamine: Indications

Answer 22

• Used for tx of postpartum hemorrhage caused by uterine atony
• Abortion

Question 23

carboprost tromethamine: contraindications

Answer 23

• acute PID
• asthma
• active pulmonary, hepatic, or renal dz
• use carefully if uterine scarring is present

Question 24

Carboprost Tromethamine: ADRs

Answer 24

• Tetanic contraction and laceration
• Uterine rupture
• Uterine hypertonus if used w/ oxytocin
• n/v/d
• Fever
• Flushing
• HA
• HTN or hypoTN
• Tachycardia
• Pulmonary edema

Question 25

Carboprost tromethamine: Nursing implications

Answer 25

* Refrigerate drug * Give via deep IM injection and aspirate carefully to avoid IV injection * Rotate sites if repeated * Monitor V/S * Administer antiemetics and antidiarrheals as ordered

Question 26

Methylergonovine: classification

Answer 26

ergo-alkaloid and oxytoxic

Question 27

Methylergonovine: indications

Answer 27

* Used for prevention and tx of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution

Question 28

methylergonovine: contraindications

Answer 28

* should not be used to induce labor * do not breastfeed during tx and for 12 hours after the last dose * use cautiously in eclamptic patients * exercise extreme caution in the 3rd stage of labor

Question 29

Methylergonovine: ADRs

Answer 29

* n/v * Uterine cramping * HTN * Dizziness * HA * Dyspnea * Chest pain * Palpitations * Peripheral ischemia * Seizure * Uterine and GI cramping

Question 30

Methylergonovine: Nursing implications

Answer 30

* Before admin, assess BP * Withhold if hospital policy says you should at a certain level * Tell mother to avoid smoking b/c constricts vessels and will inc BP * Report any ADRs

Question 31

magnesium sulfate: classification

Answer 31

tocolytic

Question 32

magnesium sulfate: indications

Answer 32

* prevention and control of seizures in severe preeclampsia * prevention of uterine contractions in preterm labor

Question 33

magnesium sulfate: ADRs

Answer 33

* from magnesium overdose: * flushing * sweating * hypoTN * depressed DTRs * CNS depression (including respiratory depression)

Question 34

magnesium sulfate: nursing implications

Answer 34

* monitor BP closely during administration * assess woman for respiratory rate above 12 breaths/minute, presence of DTRs, and urinary output greater than 30 mL/hour before administering * place resuscitation equipment in room * keep calcium gluconate (antidote) in room with syringes and needles

Question 35

Mg Sulfate: loading dose

Answer 35

* 4-6 g/30 min * then give 1-4 g for maintenance

Question 36

calcium gluconate: indication

Answer 36

* antidote for magnesium toxicity * prevent respiratory arrest if serum levels of magnesium get too high

Question 37

why are magnesium levels less likely to become toxic in a woman who is in preterm labor?

Answer 37

b/c her renal function is usually normal

Question 38

calcium gluconate: adverse reactions

Answer 38

* constipation * phlebitis * arrhythmias * n/v * HA * tingling * renal calciul/hypercalcemia

Question 39

calcium gluconate: contraindications

Answer 39

* hypercalcemia * renal calculi * v. fib

Question 40

calcium gluconate: nursing implications

Answer 40

* monitor for signs of hypocalcemia: numbness, tingling, Trousseau's/Chvostek's * monitor BP, pulse, EKG * administer with water and a meal