Exam 1 pharmacology 341B

Drugs used for preeclampsia

"Hungry Nurses Lack Major Manners" Hydralazine Nifedipine Labetalol Magnesium sulfate Methyldopa

Using ginger for nausea can have what adverse effect?

increased risk of bleeding

The client is scheduled to be treated with Oxytocin by nasal spray. The nurse plans to administer the drug: a. 2 to 3 minutes after the client nurses her baby. b. 2 to 3 minutes before the client nurses her baby. c. after delivery of the placenta. d. as delivery of the placenta is imminent.

ANS: B Oxytocin given via nasal spray should be administered 2 to 3 minutes before the client is ready to nurse and should not be administered to a pregnant client.

Which OTC analgesics are safe during pregnancy and which should be avoided?

Acetaminophen = safest, most commonly used Aspirin= not recommended due to bleeding risk and might prolong labor Ibuprofen= not recommended due to bleeding risk; may cause premature closure of fetal ductus arteriosis

Risk factors for preterm labor

Age <18 or >40, UTI, multiple gestations, + smoking/drug use

The nurse is assessing a patient who has been taking ferrous sulfate prophylactically during pregnancy. Which assessment finding will require an intervention from the nurse? a. The patient says she takes the ferrous sulfate with an antacid. b. The patient states she swallows the ferrous sulfate with orange juice. c. The patient says she has very dark stools. d. The patient states she has indigestion.

a. The patient says she takes the ferrous sulfate with an antacid.

Vaginal examination assessment confirms early cervical dilation. The drug terbutaline is ordered. Given the fetus is at 28-week gestations, which additional drug would the nurse anticipate to be added to the mother's drug regimen? a. A cephalosporin b. Dexamethasone c. Aspirin d. Magnesium sulfate

b. Dexamethasone Patients at risk for preterm delivery (24-34 weeks' gestation) should receive antenatal corticosteroid therapy with betamethasone or dexamethasone. An off-label use, administration of antenatal corticosteroids accelerates lung maturation and lung surfactant development in the fetus in utero, decreasing the incidence and severity of respiratory distress syndrome (RDS) and increasing survival of preterm infants.

The best candidate for treatment with dinoprostone (Cervidil) is the woman who needs her: a. labor stopped. b. cervix ripened. c. labor stimulated. d. labor prolonged.

ANS: B This medication allows the cervix to efface and dilate.

What is thought to cause nausea and vomiting during pregnancy?

hCG

What can folic acid deficiency cause?

-neural tube defects -spina bifida -premature birth -low birth weight

Adverse effects of terbutaline

(beta 2 agonist/ sympathomimetic) tremors, nervousness, palpitations, tachycardia, hyperglycemia, hypotension, hypokalemia (black box warning = cardiac arrest )

Toxic reactions to iron

*call doctor* Pallor, shock, N/V, green than black diarrhea + hematemesis (vomiting blood) Fatal for kids!

Magnesium sulfate contraindications

-Heart block, myocardial damage -myasthenia gravis

Magnesium sulfate class / moa

-calcium antagonist / CNS depressant moa: relaxes smooth muscle of uterus though calcium displacement

Tocolytic therapy

-drugs used to relax the uterus + stop contractions -can be used to prolong the pregnancy

Adverse reactions for magnesium sulfate

-flushing/ feelings of increased warmth - sweating - slurred speech - sleepiness -increased pulse -hypotension

examples of tocolytics

-given to stop contractions / prolong pregnancy Magnesium sulfate terbutaline nifedipine indomethacin

Drug interactions of terbutaline

-increased effects of anesthetics can l/t hypotension -pulmonary edema can occur with concurrent use of corticosteroids -cardiovascular effects w/ other sympathomimetics (epinephrine, albuterol)

What is oxytocin used for?

-induction of labor -control of postpartum hemorrhage -prevent uterine atony postdelivery

Nursing implications of iron

-liquid forms can cause temporary tooth discoloration and therefore should be diluted and taken through a straw -Best absorbed with vitamin C -Iron should be administered 2 hours before or 4 hours after antacids, b/c it changes the rate of absorption

What are first line treatments for mild preeclampsia?

-methyldopa -hydralazine -labetalol

initial actions for preterm labor

-void -lay on left side -drink extra fluids

Which trimester is the fetus most susceptible to teratogens?

1st trimester; weeks 2-12 gestation

Doxylamine Succinate/Pyridoxine Hydrochloride

2 FDA approved drugs for morning sickness

When does a fetus begin to become sensitive to teratogens?

2 weeks after conception

What are the daily requirements of iron for a pregnant woman?

27 mg

During which trimester of a pregnancy should a women start supplementing iron?

2nd trimester

For patients who had a history of a pregnancy with a neural tube defect; what is the recommended dose of folic acid?

4 mg (4000mcg)

Magnesium sulfate dose

4-6 g IV loading dose over 20-30 minutes, then 2-4g/hr continuous infusion for 12-24 hours after contractions stopped

Recommended dose of folic acid? Duration?

400 mcg daily before pregnancy if childbearing age 600 mcg daily if pregnant duration: 1 month before conception and 2-3 months after

betamethasone

A corticosteroid whose purpose is to release surfactant and therefore enhance fetal lung maturity -given BEFORE labor; most effective if even at least 24 hours, preferably 48 hours

What is Dinoprostone?

A naturally occurring prostaglandin (PGE2), which is used intravaginally/cervically to cause "ripening" (effacement + dilation) near term

Prenatal vitamins contain:

A,D,E,C,B complex, iron, + calcium

The client is being treated with hydralazine hydrochloride (Apresoline). What would be a positive outcome for the client as a result of treatment with this medication? a. Diastolic BP is maintained between 90 and 110 mm Hg. b. Diastolic BP is maintained between 70 and 90 mm Hg. c. Systolic BP is maintained between 100 and 120 mm Hg. d. Systolic BP is maintained between 90 and 110 mm Hg.

ANS: A The goal of treatment with this medication is to maintain the diastolic BP between 90 and 110 mm Hg.

A young women in labor, G1P0, is diagnosed with pregnancy-induced hypertension (PIH). She is ordered to receive magnesium sulfate. What are the other components of her nursing care? (Select all that apply.) a. Maintaining a quiet environment b. Assessing vital signs and fetal heart tones frequently c. Providing large amounts of PO and IV fluids to maintain fluid volume d. Allowing the woman to ambulate ad lib e. Assessing for clonus and deep tendon reflexes f. Monitoring urine hourly for protein

ANS: A, B, E, F The client would be prescribed bed rest and would receive maintenance fluids.

Which emergency drug must be available when caring for a patient receiving magnesium sulfate? a. Naloxone b. Calcium gluconate c. Dextrose d. Dopamine

ANS: B Calcium gluconate is the antidote for magnesium sulfate

For which reason will betamethasone IM be administered to the mother in premature labor? a. To stop uterine contractions b. To prevent precipitous labor c. To stimulate lung maturity in the fetus d. To stimulate prolactin to enhance breastfeeding

ANS: C Glucocorticoids may be administered IM to accelerate fetal lung maturation to minimize respiratory distress syndrome.

The client is scheduled for treatment with betamethasone (Celestone). The nurse anticipates that this medication will be administered via the _____ route. a. oral b. intravenous c. intramuscular d. subcutaneous

ANS: C The medication will be given intramuscularly for two doses.

A patient tells the nurse that he was told by the prescriber that the analgesic he is taking is very effective. Which statement by the patient demonstrates an understanding of the drugs effectiveness? a. I dont have to worry about toxicity, since it takes a large amount of this drug to cause an overdose. b. It has no side effects and doesnt interact with other drugs. c. I only have to take it every 12 hours. d. It might make me sleepy, and it lessens pain for several hours at a time.

ANS: D A drug is effective if it produces the intended effects, even if it also produces side effects. Because no drug is completely safe, the level of toxicity does not determine effectiveness. All drugs have side effects and many react with other substances; these do not affect the drugs effectiveness. Ease of administration is independent of a drugs effectiveness.

The client is scheduled for treatment with betamethasone (Celestone). The nurse anticipates that the medication will be administered to the client during which week _____ or before of her pregnancy. a. 38 b. 36 c. 35 d. 33

ANS: D The medication is designed to be administered to the client during week 33 or earlier.

A 26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400 assessment includes blood pressure, 100/70 mm Hg; respiration, 10; fetal heart tone, 100/min; urine output, 20 mL/hr; and absent patellar reflex. Which is the priority nursing action? a. Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15 minutes. b. Stop the IV magnesium sulfate and contact the health care provider. c. Place the patient on her left side and administer oxygen. d. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes.

ANS: D The patient is exhibiting signs of magnesium sulfate toxicity, including respiratory depression. The infusion should be stopped at once. The antidote, calcium gluconate, should be administered.

Methyldopa

Alpha 2 agonist used in pregnant women with hypertension (preeclampsia) -dont use with active hepatic disease or concurrent use of MAOIs -sedation is transient during initial use or dosage increases

Which OTC pain medications are contraindicated during pregnancy?

Aspirin- can inhibit the start of labor or cause bleeding Ibuprofen- can cause premature closure of the fetal ductus arteriosis

Terbutaline

Beta 2 agonist used as a tocolytic to suppress premature labor, but cardiac stimulatory effects may be hazardous to mother and fetus (has a black box warning) -MOA: relaxes uterine smooth muscle by acting on B-2 receptiors to stop premature contractions. -hold for pulse greater than 120**

What is the only known cure for preeclampsia? A. Magnesium sulfate B. Antihypertensive medications C. Delivery of the fetus D. Administration of ASA every day of the pregnancy

C. Delivery of the fetus

Dexamethasone

Corticosteroid similar to betamethasone whose purpose is to release surfactant and therefore enhance fetal lung maturity. -has a shorter half life than betamethasone

Folic acid rich foods

Dark leafy green vegetables, asparagus, papaya, strawberries, and orange (also folate enriched breads and grains)

oxytocin interactions

HTN can occur with vasopressors HypoTN can occur with anesthesia -cinnamon = synergistic effect

What does increased progesterone cause in pregnancy?

It relaxes smooth muscles, l/t heartburn and constipation

What foods/drinks to avoid with iron?

Milk, cereal, tea, coffee, or eggs

HELLP syndrome

Severe form of pre-eclampsia Labs H emolysis E levated L iver enzymes L ow P latelets (<100) PE -Jaundice, edema, hypertension, tachycardia, dehydration, tachypnea Treatment -delivery of baby

side effects of folic acid

Side effects are rare but include; Bronchospasm, rash, and malaise -may turn urine bright yellow

Why should oxytocin be given IVPB as a secondary line close to the needle?

So it can be promptly removed if necessarily and little residual will remain in the line.

Common side effects of iron

N/V/D, constipation, GI irritation, discoloration of urine, black tarry stools, + epigastric pain

What are the antacids of choice for pregnancy?

Nonsystemic, low sodium products that contain aluminum and magnesium hydroxide in combination

Contraindications for iron

Peptic ulcer disease (not able to properly absorb the dose)

What is the goal of iron supplementation during pregnancy?

To prevent iron-deficiency anemia in the mother; NOT to supply the fetus. The fetus will be adequately supplied through the placenta even if the mom is deficient.

How long should iron replacement therapy last in a pregnant woman?

Up to 6 weeks postpartum

Iron causes the decreased absorption of which drugs?

Zinc, tetracycline, and penicillin

A pregnant patient asks the nurse for suggestions of nonpharmacologic ways to reduce nausea and vomiting when she wakes up. Suggestions include: (select all that apply) a. Eating crackers, dry toast, or other carbohydrates before rising b. Eating small frequent meals c. Eating a high-protein snack before bed d. Eating highly seasoned foods e. Eating high fat foods

a. Eating crackers, dry toast, or other carbohydrates before rising b. Eating small frequent meals c. Eating a high-protein snack before bed

A patient with severe preeclampsia is on magnesium sulfate. The lab report shows a magnesium sulfate level of 7 mEq/L. Which of these is the most appropriate initial nursing interventions? a. Continue to monitor the patient because this level is therapeutic b. Contact the HCP and report the level c. Prepare to administer 1g of calcium gluconate d. Turn the patient on the left side, and administer 10 L of oxygen via nasal cannula

a. Continue to monitor the patient because this level is therapeutic Therapeutic levels of mag sulfate are 4-7 mEq

A prenatal client discloses that she takes high doses of vitamins. Which is the most accurate instruction that the nurse can provide in response to the clients statement? a. High levels of vitamins may cause harm to the fetus. b. Only water-soluble vitamins may be harmful during pregnancy. c. Megadoses of vitamins are associated with positive birth outcomes. d. Vitamin supplementation is not needed during pregnancy.

a. High levels of vitamins may cause harm to the fetus.

A young adolescent- Gravida 1, para 0- is admited to labor and delivery with preterm labor at 29 weeks gestation. Which nursing interventions should the nurse include? (select all that apply) a. administration of antenatal glucocorticoid b. liver function tests c. bed rest in the left lateral position d. administration of bolus IV fluids e. administration of tocolytics f. administration of an anthypertensive

a. administration of antenatal glucocorticoid c. bed rest in the left lateral position d. administration of bolus IV fluids e. administration of tocolytics

A patient is complaining of continued constipation during pregnancy after trying non-pharmacologic measures. What would be a first line treatment for constipation during pregnancy? a. docusate sodium b. magnesium citrate c. castor oil d. mineral oil

a. docusate sodium

Which OTC pain medication can be used in all trimesters of pregnancy?

acetaminophen

A pregnant patient who is in her first trimester states that she is constantly experiencing headaches. What is the nurse's best response? a. "Take low-dose aspirin each morning." b. "What have you tried to treat the headaches?" c. "I will call the health care provider for a prescription." d. "This is expected during the first trimester."

b. "What have you tried to treat the headaches?"

A client is ordered to receive iron and antacids. The nurse teaches the client that iron and antacids should be administered: a. at the same time. b. 2 hours apart. c. with the antacid first. d. with the iron first.

b. 2 hours apart. Antacids impair the absorption of iron, so they should be taken 2 hours apart.

A pregnant patient is receiving magnesium sulfate to inhibit uterine contractions. The patient develops depressed reflexes and confusion. What is the nurse's priority action? a. Administer atropine IV. b. Administer calcium gluconate. c. Administer epinephrine. d. Administer protamine sulfate.

b. Administer calcium gluconate.

A pregnant woman experiences constipation. The nurse anticipates that which laxative may be used first after activity and dietary methods are unsuccessful? a. Mineral oil b. Psyllium (Metamucil) c. Lactulose d. Milk of magnesia

b. Psyllium (Metamucil)

A 28-week primipara is experiencing contractions on a regular basis. Vaginal examination assessment confirms early cervical dilation. The drug terbutaline is ordered. Which maternal side effects would the nurse anticipate to observe in this patient? a. Hypoglycemia and thirst b. Tachycardia and palpitations c. Constipation and abdominal distention d. Hypocalcemia and muscle cramping

b. Tachycardia and palpitations Maternal side effects include tremors, dizziness, nervousness, tachycardia, hypotension, chest pain, palpitations, nausea, vomiting, hyperglycemia, and hypokalemia.

A client is admitted to the labor and delivery unit and is being treated with terbutaline (Brethine). The nurse plans the clients care with the knowledge that this medication is used to: a. induce labor. b. decrease uterine contractions. c. stimulate fetal heart rate. d. enhance placental blood flow.

b. decrease uterine contractions. Terbutaline therapy is used to stop preterm labor.

The nurse is teaching a pregnant patient how to decrease the GI distress she experiences with prenatal vitamins. The nurse instructs the patient to do what? a. take her vitamins between meals b. eat when she takes her vitamins c. drink orange juice when she takes her vitamins d. drink milk when she takes her vitamins

b. eat when she takes her vitamins

Betamethasone (Celestone) is ordered for a client in preterm labor. The client asks the nurse what the medication will do to help her. The nurse explains to the client that the medication will: a. help her to breathe more effectively during the labor process. b. prevent her infant from developing respiratory distress syndrome. c. help her infant to breathe more effectively during the labor process. d. prevent her from developing congestive heart failure during labor.

b. prevent her infant from developing respiratory distress syndrome.

A client diagnosed with pregnancy-induced hypertension (PIH) is treated with magnesium sulfate. The nurse tells the client that the purpose of this treatment is to: a. prolong labor. b. prevent seizures. c. increase blood pressure. d. stimulate urination.

b. prevent seizures.

The nurse in labor and delivery is reviewing messages to be returned to patients. Which patient statement alerts the nurse to call that patient first? a. "I'm 32 weeks pregnant and taking calcium carbonate for my heartburn. Is there anything else I can take?" b." I'm 38 weeks pregnant and taking ibuprofen for my backache. Should I take aspirin too?" c. "I'm 8 weeks pregnant and taking folic acid. Will it hurt me or the baby if I stop?" d. "I checked my blood glucose with a friend's machine and it was 120 mg. I'm not diabetic. Is that normal?"

b." I'm 38 weeks pregnant and taking ibuprofen for my backache. Should I take aspirin too?"

Why is it important for women of childbearing age to ingest the recommended dose of folic acid each day?

because the neural tube closes within the first 4 weeks of pregnancy; a woman may not know she is pregnant at this time

Nonpharmacologic tx for preterm labor

bedrest, increased fluids, pelvic rest, screening for UTI

Metoclopramide

brand: Reglan class: GI prokinetic agent Use: Antiemetic. Management of nausea and vomiting. MOA: Blocks dopamine receptors in the CTZ; causes enhanced motility and accelerated gastric emptying without stimulating secretions. SE: restlessness, drowsiness, diarrhea, insomnia, depression, tardive dyskinesia Contraindicated: GI obstruction, perforation, or hemorrhage, pheochromocytoma, or hx of seizure disorder

Ondansetron

brand: Zofran class: 5-HT3 Receptor Antagonist Use: Severe hyperemesis gravidarum MOA: Blocks the " 5-HT3" seratonin receptors in the CTZ + vagal nerve terminals Caution: Use with caution in patients with a prolonged QT interval Drug interactions: Drugs that alter the activity of liver enzymes

A pregnant patient complains of constipation and has not had a bowel movement in 5 days. What is the nurse's first intervention? a. Administer Metamucil. b. Administer docusate sodium. c. Assess the patient's fluid intake. d. Increase the patient's dietary fiber.

c. Assess the patient's fluid intake.

A 36-week primigravida patient has been admitted to the unit with a blood pressure of 200/120 mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the health care provider will order? a. Nifedipine (Procardia) b. Furosemide (Lasix) c. Magnesium sulfate d. Terbutaline (Brethine)

c. Magnesium sulfate In cases of preeclampsia or eclampsia, magnesium sulfate is used to control seizure activity. Nifedipine, a calcium channel blocker, is sometimes given as a tocolytic agent. Terbutaline is given as a tocolytic agent.

The nurse at an infertility clinic is working with a preconceptional couple. The nurse advises the woman to take which supplement for at least 3 months before becoming pregnant? a. iron b. ginger c. folic acid d. vitamin B6

c. folic acid

The nurse is assessing a patient who is in preterm labor who is receiving magnesium sulfate. What is the finding of most concern? a. lethargy b. feelings of warmth c. loss of patellar reflexes d. positive clonus 2+ bilaterally

c. loss of patellar reflexes

Antidote for magnesium sulfate

calcium gluconate 1g IV push over 3 minutes

Hydralazine Hydrochloride

class: antihypertensive / vasodilator max dose: 20mg use: preeclampsia to decrease BP considerations: -usually well tolerated, but maternal tachycardia and increased cardiac output + oxygen consuption may occur -usually not given to pregnant preeclamptic pts with a diastolic BP >105 bc of risk for reduced intervillous bloodflow

labetalol

class: beta blocker moa: blocks a, b1, + b2 receptors to lower BP use: preeclampsia to lower BP AE: orthostatic hypotension; ventricular arrhythmia

What is anenatal corticosteroid therapy? What are examples?

corticosteroids that are given during premature labor along with tocolytics to accelerate lung development and surfactant production in the fetus in utero. (dexamethasone + betamethasone)

what is the difference between gestational hypertension and preeclampsia?

gestational hypertension = htn during pregnancy without proteinuria preeclampsia = htn during pregnancy with proteinuria

What would be a positive outcome of administration of oxytocin (Pitocin) 10 units (intramuscularly) after the third stage of labor? a. Relaxation of the uterus b. Relief of afterbirth discomfort c. Suppression of lactation d. Prevention of uterine atony

d. Prevention of uterine atony Oxytocin tones the uterus after delivery to decrease blood loss.

The nurse at a prenatal clinic is reviewing messages to be returned to patients that afternoon. Which patient will the nurse call first? a. Primigravida, 10 gestational weeks, with nausea and vomiting who requests information about ginger b. Gravida 2, 35 gestational weeks, with Braxton-hicks contractions who requests information c. Gravida 2, 32 gestational weeks, with gestational diabetes and a blood glucose of 132 who requests information about her insulin d. Primigravida, 28 gestational weeks, with preeclampsia who requests information about taking ibuprofen for headache

d. Primigravida, 28 gestational weeks, with preeclampsia who requests information about taking ibuprofen for headache Ibuprofen can cause premature closure of the ductus arteriosis when taken in late pregnancy

A 5-month-pregnant patient enters the clinic and states, "I have no money for any kind of vitamins, and I have never taken any." What is the nurse's primary intervention? a. Refer the patient to social services. b. Check the patient's hemoglobin and hematocrit. c. Start the patient on folic acid. d. Screen the patient for fetal neural tube defects.

d. Screen the patient for fetal neural tube defects. The development of neural tube defects occurs early in the pregnancy, so it would be appropriate to screen for this first.

A primigravida patient, 8 gestational weeks, is at the prenatal clinic for her 1st exam. She complains of nausea and vomiting, "every morning". Which comment made by the patient would indicate the need for further teaching? a. my friend gave me ginger cookies to eat b. i have been eating dry crackers before i get up c. i try to avoid foods with strong smells d. i have been drinking chamomile tea every day

d. i have been drinking chamomile tea every day

The best candidate for induction of labor is the woman: a. experiencing a multiple gestation pregnancy. b. experiencing umbilical cord prolapse. c. whose fetus will probably be premature. d. who fetus is post due date.

d. who fetus is post due date.

magnesium toxicity symptoms

depressed tendon reflexes, confusion, cardiac or respiratory arrest

Iron supplements can cause a false positive of which test result?

fecal occult blood test

Long term use or large doses of which antacid can cause fetal damage? (cardiovascular effects)

magnesium antacids

Which antacid can be used for pregnancy only if the benefits outweigh the risks?

omeprazole

______________ can be administered for severe cases of hyperemesis gravidarium

ondansetron

what is the main goal of tocolytic therapy?

to delay preterm labor for at least 48 hours to allow time to administer corticosteroids so the fetal lungs can mature

oxytocin nasal spray

used after birth to stimulate milk letdown