Uterine Stimulants and Depressants
Contraindications of uterine relaxants
Cardiac dysrhythmias, maternal cardiac disease, pregnancy before 20 weeks
Once contraction cease, you should do what when taking uterine relaxants?
Discontinue both medications
Why is long term indomethacin (NSAID) not recommended?
Due to birth defects
When is Oxytocin NOT used?
During the 1st trimester, except in some cases of spontaneous or induced abortion
Nursing implications for uterine relaxants and stimulants
Follow specific administration guidelines carefully for administration
What weeks of gestation are considered premature labor?
20-37th weeks of gestation
What weeks of gestation would you use uterine relaxants?
20-37th weeks of gestation
After what gestational week would we use tocolytics?
20th week of gestation
Contraindications for Pitocin
Abnormal fetal position inside the uterus, placenta previa, significant uterine bleeding
When can you use Ergot alkaloids?
After delivery of infant to prevent postpartum uterine atony and hemorrhage
When should ergot alkaloids be given?
After delivery of the placenta
Do you give Oxytocin (Pitocin) IV or IM?
Always give IV through IV pump
What should you assess before administering Indomethacin (NSAID)?
Hx of coagulation disorder, chronic hypertension, heart failure, impaired liver function, CV disease
What should you assess before administering nifedipine (Ca channel blocker)?
Hx of hypertension and CV problems
Contraindications to uterine stimulants in early pregnancy
IUD, birth control, ectopic pregnancy, use of anticoagulants, bleeding disorders, use of sympathomimetics (Enhanced vasoconstrictive effects, possibly leading to severe hypertension)
When taking uterine relaxants, how should you position the patient and why?
In the last lateral recumbent position to minimize hypotension, increase renal blood flow, and increase blood flow to the fetus
How do Ergot alkaloids work?
Increase force and frequency of uterine contractions
How does a calcium channel blocker work as a uterine relaxant?
Inhibits myometrial activity by blocking calcium influx (Recall the effects of Ca++ channel blockers on the blood vessels and heart)
How does an NSAID work as a uterine relaxant?
Inhibits prostaglandin activity (Recall the inflammatory pathway and effects on other organs)
How does magnesium sulfate IV stop labor?
It is a muscle relaxer, relaxing uterine muscle and slowing down contractions
What happens when ergot alkaloids are given to a patient hypertension?
It may precipitate seizures or a stroke
What do you keep at bedside for emergency uses in case of severe hypertension during labor?
Magnesium sulfate
Is prostaglandins natural or synthetic?
NATURAL HORMONE!
If you are pregnant before 20 weeks, can you take uterine relaxants?
No
Uterine Stimulants are AKA...?
Oxytocics
What are names of oxytocics?
Oxytocin (Hormonal drug) Prostaglandins Ergot derivatives Progesterone antagonist
What drug class would you use to induce labor at or near full-term gestation?
Oxytocin (Pitocin)
Adverse effects of uterine relaxants?
Palpitations, tachycardiac, hypotension, tremors, anxiety
What should you monitor during uterine relaxants and stimulants therapy?
Patient's vital signs and fetal condition
What may nifedipine lead to?
Potentially life-threatening maternal-fetal problems
What are other uses for Pitocin?
Prevent or control postpartum uterine bleeding, complete an incomplete abortion (after miscarriage), promote milk ejection during lactation,
What uterine stimulant will soften the cervix and enhance uterine muscle tone?
Prostaglandins
In what condition should the cervix be in to administer Oxytocin?
Ripe
Is oxytocin synthetic or natural?
SYNTHETIC! Also called Pitocin It induces labor at or near full-term gestation (40 weeks) Enhances labor when contractions are weak and ineffective
Why is labor not stopped before week 20?
Spontaneous labor before the 20th week is commonly associated with a nonviable fetus
What uterine relaxant was previously given?
Terbutaline (Has maternal and fetal risks)
Why would you take uterine altering meds?
To alter uterine contractions to promote labor, prevent the start or progression of labor, and for postpartum use (Reduce risk of postpartum hemorrhage)
When would you use prostaglandins?
To cause potent contraction of smooth muscle fibers of uterus, to induce labor by softening cervix and enhancing uterine muscle tone
What are progesterone antagonists for?
To stimulate uterine contractions to induce abortion
When indomethacin (NSAID) and nifedipine (Ca channel blocker) are ineffective and delivery is proceeding, you:
Use Corticosteroids (betamethoasone or dexamethasone) to promote lung maturity in the fetus between 24 to 34 weeks of gestations
What are tocolytics used for?**
Uterine relaxant: Used to stop labor that begins before term to prevent premature birth**
Before administrating uterine stimulants, what should you assess and document?
Vital signs: Patient's BP, pulse, and respiration Determine the fetal HR and contraction-related fetal heart rates
What are nonpharmacological measures to stop labor and relax uterus?
bed rest, sedation, hydration
What are names of uterine relaxants?
indomethacin nifedipine magnesium sulfate
