OB Picmonic Drugs PDF

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OB Picmonic drugs ...

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OB clinical medications DRUG Ampicillin *500 mg qid *Gonerrhea tx= 3500 mg (1) *Peds= 100 mg/ kg/ day *Broad spectrum *Ineffective to Staphylococcus *May be combined with Beta Lactamase Inhibitor (e.g. clavulanic acid= Augmentin) for Staph. Aureus Ancef (Cefazolin)

Apresoline (Hydralazine) *10- 50 mg quid (4x/ day) *Often administered with a beta blocker to prevent reflex tachycardia *Administer with diuretic to prevent volume expansion r/t hypotension SE *CONTRAINDICATED in angina & CAD *Can cause angina Betamethasone *IM 12 mg, 2 x w/ 24 hrs apart (painful) (NOT PO) Cefotan (Cefotetan) *1000- 2000 mg (IV) *I.e. Cephalosporin *DISCONTINUE IF rash, hypotension, urticaria, difficulty breathing *Eliminated by kidneys… caution with renal impairments due to risk of toxic accumulation *DO NOT give Calcium via same route (risk of death) *Risk of alcohol

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MECHANISM Bactericidal by weakening bacterial cell wall  allowing water to enter cell Cell lysis/ rupture

INDICATIONS Infections r/t gram (+) Streptococcus pneumonia, Clostridium tetani; gram (-) Haemophilus influenza, E. coli, Salmonella, & Shigella

SIDE EFFECTS Rash (may be r/t allergic rxn contact HCP

Broad spectrum antibiotic

Cesarean= C section

*Increases cyclic GMP levels & inhibits smooth muscle contraction greater vasodilation of arterioles *Vasodilator  relaxes smooth muscles & decrease peripheral resistance  lowers BP *Directly relaxes arteriolar muscle decreasing afterload to treat severe HTN & HF Antenatal glucocorticoid

*Severe HTN *1st line TX for intrapartum HTN (+ methyldopa) *CHF (reduces afterload decreasing pumping against resistance)

Rash (may be r/t allergic rxn contact HCP Diarrhea *Eat probiotics (yogurt) to decrease incidence Drug induced Lupus= autoimmune response r/t chronic use (s/s= anti- histone antibodies)

Bactericidal by disrupting cell wall lysis & death

Stimulate lung maturation Infections

Diarrhea *Eat probiotics (yogurt) to decrease incidence

Reflex tachycardia r/t a sudden BP decrease to maintain cardiac output Hypotension that can lead to Na+/ water retention increases blood volume (administer diuretic) *S/S= Dizziness, headache, & fatigue

Assess mother for hyperglycemia Transient decrease in fetal breathing/ movement Allergic reactions **Maculopapular rash= develops several days post Thrombophlebitis *Minimize by rotating IV infusion site & administer slowly Bleeding r/t reduction of prothrombin levels *Caution with anticoagulants or thrombolytic agents IF YOU TAKE ALCOHOL WITH…  Disulfiram- like reaction= flushing of

OB clinical medications

2

intolerance

Cyotec (Misoprostol) *Vaginal administration

*Stimulates uterine contractions *May be used as a cervical ripening agent

DRUG Demerol (Meperidine) *50- 150 mg q4h prn for pain *Peds= 1.1- 1.8 mg/kg q4h prn for pain

MECHANISM Activates CNS & peripheral opioid receptors  producing pain relief, sedation, respiratory depression, cough suppression, & decreased intestinal peristalsis

Short ½ life Toxicity= tremors, seizures, irritability, & dysphoria *Prevent by taking < 48 hours & do not exceed 600 mg/ 24 hours *DO NOT take if renal failure metabolites will accumulate in kidneys OD= Respiratory depression Depoprovera *IM q3 months EMLA Cream *Topical anesthetic Erythromycin

Ephedrine (IV) *Do not exceed 150 mg/ day (adults); 75 mg/ day (peds)

face, headache, N/V, chest pain, weakness, blurred vision, mental confusion, sweating, choking, low BP, anxiety ` Can cause uterine rupture or placental abruption

INDICATIONS Moderate- severe pain

SIDE EFFECTS Tremors r/t toxic metabolite called normeperidine

Post anesthesia shivering r/t anesthesiainduced hypothermia & cold environment in OR (to reduce shivering threshold)

Constipation r/t decreased GI peristalsis & reduced secretion of fluids into intestines *Prevent with laxatives or stool softeners

*URI, LRI *Skin & soft tissue infections

Rash, urticaria, N/V, GI discomfort

*Rhinitis= nasal decongestion

*with larger doses… Nervousness, anxiety, dizziness, vertigo Loss of appetite, insomnia Tachycardia, palpitations, sweating Vomiting

CNS depression *Respiratory Sedation *Avoid driving IF taken with MAOIs, SSRIs, or Tricyclic antidepressants excessive activation fo serotonin receptors & decreased reuptake of serotonin high risk of serotonin syndrome, coma, & death

Contraceptive given after child birth Reduces pain Inhibits protein synthesis by irreversibly binding to 50S ribosomal subunit stuning cell growth Indirect sympathomimetic= releases stored catecholamines (NE) from sympathetic

*Hypotension (will react on the alpha

Hepatotoxicity, jaundice, eosinophilia

OB clinical medications

Hemabate (Carboprost) *250 mg IM = Analog *Caution with HTN & asthma

DRUG Hepatitis B Vaccine *3 doses, IM @ birth, 1- 2 MO, & 6- 18 MO *Obtain parental consent Labetalol (Normodyne, Trandate) (Normodyne, Trandate) *Contraindicated for asthma Magnesium Sulfate *1- 40 g daily *IM 1- 5 g daily till normal *IV 1- 4 g Calcium Gluconate for Magnesium toxicity *Calcium increases muscle contractions SE 1. Hypotension 2. Decreased CO

neurons *Alpha agonist= constricts smooth muscle of resistance blood vessels (skin & splanchnic beds) increases peripheral resistance & venous return *Beta agonist= increases HR & contractility; increases lipolysis & renin release causing vasodilation; decreases uterine tone leading to ciliary muscle relaxation & increase aqueous humor production *Synthetic prostaglandin induces uterine contractions (remember after birth, the uterine should continue contracting to stop bleeding. If not, post partum hemorrhage) MECHANISM Provides infants with anti-hepatitis B antibodies

3 agonist effect, & increase BP

Painful urination

*Urinary Incontinence (will constrict urinary sphincters & vaso constricts renal arteries) *Dysmenorrhea

*Postpartum hemorrhage (to induce intense uterine contractions) *Abortion in 2nd trimester by generating strong uterine contractions INDICATIONS

GI Distress (N/V/D) r/t stimulating smooth muscle tissue in stomach/ intestines HTN r/t prostaglandins causing vasoconstriction Fever- drug induced? Or infection? Bronchoconstriction SIDE EFFECTS Rash, redness, swelling @ injection site

Beta blocker used for vasodilation w/out significant change in CO

HTN

Orthostatic hypotension

Muscle relaxant & CNS depressant by stopping the release of acetylcholine  decreases neuromuscular irritability & cardiac conduction

Preterm labor contractions (to relax the uterine muscle)

Warm feeling *Prevent by slow IV administration

*Resolving preterm labor contractions by relaxing the uterus *Decreasing

Preeclampsia (to act as muscle relaxant & decrease presence of hyperreflexia & lower risk of seizures)

Flushing & hypotension due to vasodilator effect leading to pulmonary edema/ headache *Monitor BP & cardiac rhythm Decreased deep tendon reflexes (due to depressed CNS) *Assess for skeletal muscle weakness & hypotonia

OB clinical medications 3. Decreased urine output Magnesium Toxicity can lead to cardiac arrest & respiratory depression Methergine (Methylergonovine) *1 mL IM q2- 4 hours *I mL IV administer < 60 sec. *1 tablet (0.2mg) qid (1 week) *2nd line of TX after oxytocin due to delayed onset *Contraindicated in preexisting HTN *Assess for peripheral weakness, tingling of toes & fingers, and angina *Assess for HR & cardiac rhythm *DO NOT USE TO INDUCE LABOR Naloxone (Narcan) *2 mg in 500 mL of NS or 5% dextrose solutions *Peds= 0.01 mg/ kg *Administer q2-3 minutes till desired response *IV PUSH SLOWLY *small dose to prevent withdrawal symptoms *> 10 mg? Reevaluate the CNS depression DRUG Nubain (Nalbuphine) *Antidote= Naloxone *20 mg (max of 160 mg daily) *10 mg/ 70 kg subq

Percocet

(PO)

4 Decreased RR (due to depressed CNS)  Respiratory depression *Assess for hypoxemia

hyperreflexia & preventing onset of seizures from eclampsia

Decreased urine output (due to decreased renal perfusion r/t hypotension & low CO) *Increases chance of Magnesium toxicity Ergot alkaloids= produces strong uterine contractions (by stimulating smooth muscle contractions) *Controls postpartum hemorrhage & migraines *Excites adrenergic, dopaminergic, & serotonergic receptors *Produces vasoconstriction for migraines

Opioid antagonist by competing for opioid receptor sites in body

*Migraine by constricting cerebral blood vessels (remember during a migraine, cerebral blood vessels dilate) *Postpartum Hemorrhage (uterus becomes boggy and not able to contract properly to stop bleeding) by producing powerful contractions uterus becomes firm & stops bleeding Reverse sedation, respiratory depression, coma, & analgesia r/t opioid induced CNS depression

Paralytic Ileus r/t parenteral administration N/V due to stimulating the muscle within the stomach increased GI s/s (N/V/D) Severe HTN r/t vasoconstrictor effects *May lead to decreased tissue perfusion ischemia *Assess for peripheral weakness, tingling, & angina Tachycardia r/t adrenergic agonist

Severe N/V r/t administered rapidly *administer slowly as an IV push medication Excitable state Immediate onset of withdrawal symptoms r/t chronic use *irritability, insomnia, runny nose, yawning, N/V/D

MECHANISM Opioid agonistantagonist

Acetaminophen/ oxycodone

INDICATIONS *Pain after alternative TX is inadequate *Supplement to balanced anesthesia for preop, postop, & obstetrical analgesia during L&D Moderate- severe pain

SIDE EFFECTS Sedation CNS effects (nervousness) Respiratory depression Blurred vision

Sedation, Respiratory depression , Hypersensitivity

OB clinical medications Pitocin (Oxytocin) *For every 10 mU, add 1- 1000 mL of NS or LR rotate in infusion bottle *initial dose= 0.5- 1 mU/ min (3- 6 mL dilute oxytocin/ hr) *30- 60 min= 1- 2 mU/ min *Monitor I’s & O’s *IV pump/IM (destroyed by GI) *Short ½ life DO NOT ADMINSTER IF… *Immature fetus (before 20 weeks of gestation or fetal lung immaturity) *Cervix not ripened  risk of fetal or maternal injuries *Active Genital Herpes Infection (requires cesarean delivery due to risk of vertical transmission) Procardia (Nifedipine) *30, 60, 90 mg *Caution in heart blocks & decreased BP *NO grapefruit *monitor BP, pulse, & Ca2+ Terbutaline (Brethine) *SUBQ NOT IV *0.25 mg into lateral deltoid *2nd (15 min later) = 0.25 mg *4 hours, don’t exceed 0.5 mg *Place on cardiac monitor due to risk of Beta 1 stimulation *monitor blood sugar in diabetics

Begins & increases strength of uterine contractions by stimulating receptors on uterine muscle wall; & stimulates milk ejection from nipple

*Calcium channel blocker= blocks calcium transport resulting in inhibition of contraction systemic vasodilation BETA 2 AGONISTS= bronchodilation (reducing resistance of airway in asthmatics); & relaxing smooth muscles of uterus/ delaying onset of labor

5 *To increase & strengthen contractions (given in conjunction with cervical ripening medications or after cervix is ripened) *Control postpartum hemorrhage by controlling uterine bleeding (after separation of placenta) by causing contraction of uterine wall decreases blood flow to tissues

TO PREVENT USE LOWEST DOSE *Higher doses= stronger contractions placental insufficiency, water intoxication, uterine rupture

HTN, angina, migraines, CHF

Arrhythmias Elevated liver function tests Gingival hyperplasia Steven Johnson syndrome

*Bronchospasm in asthmatics

Hypotension *IF Beta 1 receptors are stimulated increases HR  decrease in BP  fluid volumes shift compartments  changes in electrolytes hypokalemia

*Tocolytic= delays preterm labor by relaxing smooth muscle of uterus & stopping contractions

Uterine rupture r/t strength of muscle contractions *Multiparity >5 (> 5 pregnancies) or any previous uterine scarring = higher risk due to weakened uterine walls Water Intoxication r/t antidiuretic effects preventing urine formation

Tremor r/t overstimulation of beta 2 and possibly 1 Tachycardia r/t Beta 1 stimulation (heart) that overstimulates cardiac muscles *S/S= angina, palpitations, & cardiac ischemia, chest pain, nervousness, somnolence, & flushing Pulmonary Edema r/t Beta 1 stimulation increases the leaking of fluid from capillaries

OB clinical medications

6 Hyperglycemia in diabetic patients r/t overstimulation of Beta 2 receptors *May require increased dose of insulin SIDE EFFECTS Will DECREASE uterine activity ADVERSE EFFECTS ON FETAL CIRCULATION Will travel to baby through breast milk

DRUG Toradol *IV, IM, PO *DO NOT TAKE during preg. or nursing *DO not take > 5 days *Decrease effectiveness of HTN & diuretic medications

MECHANISM NSAID *pain relief due to prostaglandin inhibition by blocking enzyme cyclooxygenase

INDICATIONS Moderate pain *NOT FOR PREGNANT WOMEN OR NURSING MOTHERS

Tylenol W/ Codeine Acetaminophen + Codeine *Assess mom & baby for respiratory depression *Caution when nursing Vitamin K *Newborn= 0.5- 1 mg within 1 hour of birth *I mg subq *2.5- 50 mg for anticoagulant *IV inject 1mg/ minute SLOW *IV should be the last option (can cause shock & cardiac arrest) *Adequate intestinal absorption is dependent upon presence of bile salts

Opioid analgesic

Moderate to severe labor pain/ post cesarean (csection)

Sedation CNS effects (nervousness) Respiratory depression Blurred vision

Essential in synthesis of prothrombin & clotting factors II, VII, IX, & X (allows the blood to coagulate) *Inadequate supply spontaneous bleeding

Hypoprothrombine mia= Lack of prothrombin *Prothrombin= precursor to thrombin *Thombin converts fibrinogen to fibrin= clotting *V. K. increases synthesis of prothrombin

Shock r/t IV administration hypersensitivity reaction shock & death

Newborn prophylaxis *Babies are born with a V. K. deficiency *Single does to increase prothrombin levels and prevent bleeding Bleeding from warfarin OD

GI bleeding, Steven Johnson Syndrome, anaphylaxis

Kernicterus= parenteral administration causing serum bilirubin levels to rise in newborns (high risk in prematurely) *Bilirubin= neurotoxic substance & can cause bilirubin- induced brain dysfunction Cardiac Arrest r/t IV administration...