NURS 371 Pharmacology Final Exam 2025

What is the action of RhoGAM? - -suppresses immune response in Rh negative mothers from making antibodies against fetal Rh positive blood What is the routine for RhoGAM administration? - -at 28 wks gestation as routine antepartum prevention in woman w/ Rh negative blood and then give again 72 hrs after birth if baby is Rh positive What lab work needs to be done before RhoGAM administration? - -blood taken at 28 wks (indirect Coombs) to see if the mother is sensitized; after birth, a direct Coombs is done on cord blood to determine baby's blood type and again looks for sensitization When is RhoGAM contraindicated? - -not indicated if mother is already sensitized or if baby is Rh negative What is the dose and injection site for RhoGAM? - -300 mcg IM inj. in deltoid or anterolateral portion of thigh; NOT GLUTEAL; may also be given IV over 3-5 min What are the antenatal drugs? - -1) Tocolytic agents 2) Nifedipine (Procardia) 3) Mag. Sulfate 4) Calcium gluconate 5) Terbutaline sulfate (Brethine) 6) Glucocorticoids What is the action of tocolytic agents? - -inhibit myometrial contractions, improves blood flow to through placenta to baby What are the tocolytics? (Not My Time) - -1) Nifedipine (Procardia) 2) Mag. Sulfate 3) Brethine What is the action of nifedipine? - -inhibits Ca++ ion movement into muscle cells, inhibits uterine activity to arrest preterm labor What are the AE's of nifedipine? - -HA, dizziness, flushing, hypoTN r/t vasodilation effects (safety issue), and nausea How is nifedipine administered? - -10-20mcg PO q3-4hrs until UC's stop, followed by lon g acting formula of 30-60mg q8-12hrs while steroids are given What is some teaching for nifedipine? - --rise slowly (ortho hypoTN) Nurs 371 Nurs 371 -avoid grapefruit (interferes w/ effect) -do not use with mag. sulfate or terbutaline Why is MAGNESIUM SULFATE given to pregnant women? - -To PREVENT SEIZURES (CNS depressant) induced by hypertension (preeclampsia) and to decrease frequency and intensity of UC's by relaxing the smooth muscle of uterus What is the dosage? - -loading dose is 4-6g over 20-30 min and the maintenance dose is 1-4 g/hr; given as IVPB When is mag sulfate contraindicated? - -in myasthenia gravis pts and in renal failure pts (so monitor urine output b/c it is excreted by the kidneys) What should we monitor the newborn for whose mother was given mag. sulfate? - lethargy, hypotonia, respiratory depression What to monitor/assess in a pt receiving mag. sulfate? - -BP, respiration, O2 sat., loss of or diminished DTR's (first sign of toxicity), urine output, LOC, serum magnesium level What are the maternal AE's r/t mag. sulfate (not concerned)? - -hot flashes (fan or cold compresses), n/v, blurred vision, dry mouth, lethargy, drowsiness, that usually appear at loading does and go away afterwards What do FHT's look like in a baby whose mother is receiving mag. sulfate? - -decreased variability, deceleration, no accelerations What are intolerable AE's of mag sulfate for mother (concerned) Hint: BURP? - -stop infusion if mother has urine output <100ml over 4 hrs, RR <12bpm, total loss of reflexes, BP decrease, altered mental status, muscle weakness, serum mag level >8/9 What is calcium gluconate? - -the antidote for magnesium toxicity, given slowly b/c of cardiac changes, always have at bedside How is calcium gluconate administered? - -10mL of 10% calcium gluconate (1g) given IVP over 3-5 min What class of medication is terbutaline sulfate (Brethine)? - -beta-adrenergic agonist (beta mimetic) What is the action of terbutaline sulfate? - -given as SQ inj, stimulates B2 adrenergic receptors to relax bronchial smooth muscle and to relax uterine muscle, blocking UC's What are some safety concerns with terbutaline? - -hold if HR is 120 or greater, not given to women w/ hx of cardiac disease Nurs 371 Nurs 371 What are some maternal AE's of terbutaline and what will the fetal heart rate look like? - -maternal AE's include palpitations, termors, nervousness, flushing; FHR will be tachycardic What is the purpose of the glucocorticoid meds (dexamethasone and betamethasone)? - -stimulates fetal lung maturity and surfactant production and decreases RDS in situations of PTL/PTD (FYI: lungs are the last thing to develop in babies) How is the glucocorticoid meds given? - -given as DEEP IM inj. (local muscle atrophy), multiple doses, birth should be delayed for 24 hrs after completion of treatment (so 48 hrs total tx) What are the doses for eas glucocorticoid? - --betamethisone: 12mg IM x 2 doses w/ 24 hrs b/t doses -dexamethasone: 6mg IM x 4 doses w/ 12 hrs b/t doses What are the intrapartal drugs? - -1) cervical ripening agents (prostaglandins) 2) pitocin 3) pain relief drugs 4) methergine 5) rubella virus vaccine Describe prostaglandins. - -consists of dinoprostone (Cervidil), dinoprostone gel (Prepidil), and misoprostol (Cytotec); they are used to induce labor by cervical ripening and start contractions, misoprostol also used to stop maternal hemorrhage What is Pitocin and its action/purpose? - -it is a synthetic form of oxytocin (which is produced by the pituitary gland) and it stimulates smooth muscle contractions of the uterus used for augmentation and induction of labor, also used to control PP hemorrhage What are some AE's of pitocin for mother and baby? - -UTERINE TACHYSYTOLE, placental abruption, uterine rupture, fetal hypoxia r/t decreased uterine bloodflow, abnormal FHR, water intoxication r/t anti-diuretic effects, HR/BP fluctuations, arrhythmias, uterine ejection What are the nursing considerations for Pitocin? - -HIGH ALERT MED, monitor fetal tracings q15min w/ every change in dose during first stage of labor, and then q5min during second stage of labor, monitor maternal vitals q30-60min and with every dose change, assess I&O (urine output should be 120mL or more q4h) How is Pitocin given and at what dose? - -given IV, ordered in mU/min, often mixed as 10units/1000mL or 20units/1000mL, connect line to proximal port, begin at 1mU/min and then increase by 1-2mU/min no more frequently than q30-6