OB Meds and Dosage PRCC questions and answers

Maternal Contraindications for Pitocin Admin -severe preeclampsia/ eclampsia -predisposition to unterine rupture ( mom >35 y/o, multigravida 4 or more, overdistation of utersus, previous major sx of the cervix or uterus) -cephalopelvic disproportion -malpresentation or malpostion of fetus -cord prolapse -more the one previous C-sec -preterm baby -rigid, unripe cervix -total placenta previa -presence of noreassuring fetal status Pitocin use to initiating uterine contractions to induce labor and may also be used to enhance ineffective contractions give in port closest to the Iv insertion site Pitocin Goals to achieve stable contractions every 2-3 mins that last 40-60 seconds the uterus should relax to full baseline resting tone between each contraction Risks of pitocin Hyperstimulation of the uterus with can leas to decrease in placental perfusion and nonreassuring fetal status maternal HTN, tachysystolic labor patterns, uterine rupture, rapid labor and birth decrease in placental fnx water intoxication Fetal effects include: hypoxia non-reassuring fetal status hyperbilirubinemia trauma from rapid birth fetal bradycardia Sedative Tranquilizers in false labor, latent labor, ROM without labor minimize maternal anxiety and fear promote rest/relaxation ***Provides no pain relief Sedative/Tranquilizer in Active Labor reduces anxiety and apprehension potentiate analgesics (opiods) Minimize emesis promethazine Hydroxyzine HCL Barbituates (hypnotics) Secobarbital Sodium- SECONAL IM/PO reduce anxiety during latent phase of labor onset 15-30 mins duration 1-4 hours Pentobartial soduim-NEMBUTAL Adverse effects of Sedative Hypnotics MATERNAL paradoxically increase in pain and excitability Lethargy decrease in sensory perception hypotenison FETUS Decrease in FHR variability respiratory depression sleepiness poor suck reflex Phenothiazine derivatives Promethazine HCL-PHENERGAN antihistamine used with narcotic analgesics during 1st stage labor IM/IV Onset IM 20 mins IV 3-5 Mins IV DO NOT GIVE UNDILUTED <25mg/min give in furtherst port from IV site if given with MEPERIDINE give over several mins IM-Given Ztrack can cause extravastion and abscesses Hydroxyzine pamoate VISTARIL anxiety and PRE OP PO/ IM onset 15-30 mins peak 2 hours duration 4-6 hours Phenothiazide Derivatives (Promethazine/ Hydroxyzine) Adverse Effects- MATERNAL Confusion - dizziness Disorientation Excess sedation Hypotension Tachycardia Blurred vision Headache Restlessness Weakness Urinary retention (promethazine) Constipation (hydroxyzine) Phenothiazide Derivatives (Promethazine/ Hydroxyzine) Adverse Effects-FETUS ↓ FHR variability CNS depression Hypotonia Lethergy Poor feeding Hypthermia Narcotic Agonist Parentally or regional block reduce amt of anesthetic needed when given with neuroaxial anesthesia = ↓ side effects; ↑pain relief Fentanyl citrate SUBLIMAZE M or IV 50 to 100 x potent as morphine sulfate IV Onset 1-2 min Peak 3-5 min Duration 30 - 60 min IM : onset 7-15min; Peak 20-30min Duration 1-2 hou Nursing ConsiderationsIV inject over 3 to 5 minutes (too rapid muscle rigidity)Respiratory depression neonates (used in labor)Monitor urinary outputHerbal interactions: ↑CNS depression - St John WortContraindicated in severe asthmaNaloxone- antidot Fentanyl Nursing Considerations IV inject over 3 to 5 minutes (too rapid muscle rigidity Respiratory depression neonates (used in labor) Monitor urinary output