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Flashcards in Med Quiz II Deck (40)
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1

terbutaline sulfate: classification

tocolytic

2

Terbutaline sulfate: indications

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

3

Terbutaline sulfate: ADRs

  • 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

4

Terbutaline sulfate: nursing implications

  • 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

5

nifedipine: classification

tocolytic; CCB

6

Nifedipine: indications

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

7

nifedipine: contraindications

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

8

Nifedipine: ADRs

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

9

Nifedipine: nursing implications

  • 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

10

Nifedipine: dosage

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

11

betamethasone: classification

glucocorticoids

12

Betamethasone: indications

  • 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

13

betamethasone: contraindications

  • active infection, such as chorioamnionitis

14

Betamethasone: ADRs

  • 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

15

Betamethasone: nursing considerations

  • 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

16

indomethacin: classification

ductus arteriosus patency adjunct

17

Indomethacin: indications

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

18

indomethacin: contraindications

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

19

Indomethacin: ADRs

  • 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)

20

Indomethacin: nursing implications

  • 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

21

Carboprost tromethamine: classification

oxytoxics; prostaglandins

22

Carboprost tromethamine: Indications

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

23

carboprost tromethamine: contraindications

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

24

Carboprost Tromethamine: ADRs

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

25

Carboprost tromethamine: Nursing implications

  • 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

26

Methylergonovine: classification

ergo-alkaloid and oxytoxic

27

Methylergonovine: indications

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

28

methylergonovine: contraindications

  • 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

29

Methylergonovine: ADRs

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

30

Methylergonovine: Nursing implications

  • 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