Download Female Reproductive Cycle I

Pregnancy and Preterm Labor
Drugs
 A&P
of female reproductive system
 Feedback loop (pg. 808)
 Altered
hepatic metabolism of drugs
 Reduced GI motility
 Increased GI pH
 Increased GFR-more rapid excretion
 Expanded blood volume = dilution
 Alteration in drug clearance
• Implications: Drug dosages and dosing intervals
should be considered
 Allows
for the exchange of many
substances including medications
 Speed of exchange/transfer varies
• Maternal and fetal blood flow
• Molecular weight of the substance being
•
•
•
•
exchanged
Degree of ionization (does it have a charge)
Degree of protein binding (↑ do not cross readily)
Metabolic activity of the placenta
Maternal dose
 Risk/Benefits
 MD/NP
must consider the
aforementioned physiological changes
 Liver
metabolism is slower
 What we give the mother can have
prolonged effects on the fetus
 Impact fetal outcome
 Remember
the ways that drugs cross the
placenta—same can be applied to breast
tissue.
 Know drugs that accumulate in the breast
tissue because these drugs can be
transported to the infant during feeding.
 Your role in teaching the mother cannot
be underestimated.
 Legal
and illicit drugs
 Mother’s underlying conditions still need
to be treated
• Seizure disorders
• Diabetes
• HTN
 OTC
drugs
• Cold remedies, stool softeners, pain medications
 FDA
Category system-revisit
 Terat/o
– greek monster
 -gen = to produce
 Substances that are teratogenic are those
that produce birth
defects/developmental abnormalities
 Period of possibility begins 2 weeks after
conception
 Weeks 2-10 organogenesis
 Timing, dose and duration of exposure
 Review
 PTL
that progresses to PTD accounts for
most prenatal morbidity and mortality in
US (excluding fetal abnormalities)
 No one cause
• Younger than 18 but
•
•
•
•
•
older than 40
Low SES
Previous hx of PTL
Intrauterine infections
Polyhyraminos
Multiple gestation
• Uterine abnormalities
• Antepartum
hemorrhage
• Smoking
• Incompetent cervix
• UTI
 Goal
is to stop the preterm labor
 Tocolytics Contraindicated in:
• Pregnancy ↓ 20 wks gestation (ultrasound)
 Considered a miscarriage
• Bulging or PROM
• Confirmed fetal death or anomalies incompatible
with life
• Maternal hemorrhage and severe fetal
compromise
• Chorioamnionitis
 Beta2 agonists
(Beta Sympathomimetics)
• Terbutaline (Brethine)
 Recall Table 17-1 Page 268
 Beta2 receptors are located in uterus
 An agonist produces a response
 Giving a Beta2 agonist will relax the uterus
 Giving a Beta2 antagonist (Beta-Blocker) would have
the opposite effect.
 Calcium
antagonist
• Magnesium Sulfate (Mag Sulfate)
 Interrupt
uterine contractions to provide
additional time in utero
 Delay delivery so corticosteroids can be
given to promote fetal lung maturity
 Allow safe transport to another facility if
needed
 SQ/oral/IV
 Minimally
protein bound
 Half life 11-16 hours
 IV/SQ
• Onset 15 minutes
• Peak 30-60 minutes
• Duration 1-4 hours (SQ)
 Assessment
 Diagnosis
 Plan
 Interventions
 Evaluation
 Review
822
 Calcium
antagonist (blocks response)
 CNS depressant *****
 Fewer side effects than Brethine
 Given IV
 Dose is titrated to keep contractions
under control
 Need to draw magnesium levels
 Contraindicated –myasthenia gravis,
impaired kidney function, recent MI
 Low
blood pressure
 Flushing
 Sweating
 Dizziness
 Nausea
 Headache
 Lethargy
 Slurred Speech
 Increased pulse rate

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
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

Assess for neuro, respiratory or cardiac depression.
Antidote: Calcium Gluconate (10 mg IV Push over 3
minutes)
Assess magnesium levels 4-7 mg/dL
Loss of patellar reflexes often first sign of toxicity-8-10
mEq/L
Respiratory depression-Levels greater than 10-15
mEq/L
Cardiac Arrest-Levels greater that 20-25mEq/L
 Page
827
 Assess
and monitor-Respirations, FHR,
fetal activity, I&O, breath and bowel
sounds, DTR, weight, have antidote on
hand--- Diagnose
 Plan
 Implement
 Evaluate
 Clients
at risk for PTL
 Accelerates lung maturation and lung
surfactant development
 Decreases RSD
 Increases survival
 L/S ratio predicts fetal lung maturation
• Lecithin/sphingomyelin
 Betamethasone
(Celestone)
• Seizures, headache, HTN, petechiae,
ecchymoses, facial redness
 Dexamethasone
• Insomnia, nervousness, increased appetite,
arthralgia, hypersensitivity reactions
• See Nursing Process for Betamethasone pg. 823
 Elevated
BP without proteinuria after 20
wks. Had normal BP to begin with.
Categories of GHTN
 Preeclampsia: Gestational
hypertension
with proteinuria.
 Eclampsia: New-onset grand mal seizures
in client with preeclampsia.
 Systolic
greater than 140mm/Hg or
diastolic greater than 90mm/Hg
 Proteinuria greater than 300mg in a 24
hour urine collection
 After 20th week
 Graded as mild to severe
 Hemolysis
 Elevated
Liver Enzymes
 Low Platelet Count
 Uncomplicated
delivery
 Psychological support for client/family
 Reduction of vasospasm
 Prevention of seizures
 Delivery
 methyldopa
(Aldomet)
 hyralazine (Apresoline)
 labetalol (Trandate)
 Beta-blockers
 Prazosin
 Nifedipin
 Clonidine
ALTERNATIVES
FIRST LINE