PowerPoints Pharm

• Estrogens


  Secreted by ovarian follicles, responsible for maturation of sex organs and secondary sex characteristics of women
• Progestins


  Secreted by corpus luteum (progesterone most abundant), prepare endometrium for implantation, high progesterone and estrogen levels in final third of uterine cycle provide negative feedback to shut off GNRH, FSH, and LH secretion
• Oral contraceptives


  Hormones used to prevent pregnancy, most are combination of estrogens and progestins, small doses prevent conception by blocking ovulation
• Estrogen-progestin contraceptives


  • Act by providing negative feedback to pituitary to shut down secretion of LH and FSH, prevent ovulation, four types: monophasic, biphasic, triphasic, and quadriphasic
• Progestin-only oral contraceptives


  • Produce thick, viscous mucus at entrance to uterus to discourage penetration by sperm, inhibit implantation of fertilized egg, less effective than estrogen-progestin
• Long-term hormonal contraceptive formulations


  • Depot injections (Depo-Provera), subdermal implants, transdermal patches, vaginal device (NuvaRing), intrauterine device (Mirena)
• Adverse effects associated with combination hormonal contraceptives


  • Breast milk reduction, cancer, glucose elevation, hypertension, increased appetite, weight gain, fatigue, depression, acne, hirsutism, lupus exacerbation, menstrual irregularities, migraines, nausea, edema, breast tenderness, teratogenicity, thromboembolic disorders
• Role of the nurse for oral contraceptive therapy


  Monitor blood pressure, monitor for symptoms of thrombophlebitis, reassure patient that side effects do not indicate pregnancy, teach patients to perform breast self-exams, provide information on routine mammogram schedules
• Emergency contraception


  May be administered within 72 hours after unprotected sex, prevents ovulation and implantation of fertilized egg, does not induce abortion, includes Plan B One Step, Plan B, and Ella
• Pharmacologic abortion


  Agents to abort implanted embryo, includes mifepristone (Mifeprex) and misoprostol (Cytotec)
• Causes of female infertility


  Pelvic infection, physical obstruction of uterine tubes, lack of ovulation
• Treatment of female infertility due to lack of ovulation


  Clomiphene (Clomid, Serophene) stimulates release of LH, results in maturation of increased number of ovarian follicles, induces ovulation in 80% of treated women
• When Amelia and Ed decided to have a third child, she stopped taking oral contraceptives. After a year of being unable to conceive, the health care provider prescribed clomiphene.
• Prenatal supplements


  • Iron (ferrous): Begin in second trimester, >need in 3rd trimester, and continue 6 weeks postpartum, increase absorption with vitamin C, folic acid: begin preconception and continue 3 months post, urine will be yellow, multivitamins: take with meals or pm to avoid nausea, avoid megadose, continue with breastfeeding
• Drugs for minor discomfort during pregnancy


  Nausea & vomiting: doxylamine succineate & pyridoxine (Diclegis), ondansetron (Zofran); Heartburn: antacids, sucralfate; Constipation: bulk-forming preparations (metamusil), docusate sodium, occasional use of other laxatives; Pain: acetaminophen, aspirin & ibuprofen
• Doxylamine succinate & pyridoxine (Diclegis)


  FDA approved drug for nausea & vomiting [antihistamine + Vitamin B6]
• Doxylamine succinate & pyridoxine (Diclegis)


  • Side effect: somnolence
  • Pregnancy category A
• Antacids

  • Aluminum hydroxide (Amphojel)
  • Magnesium hydroxide & aluminum hydroxide w/simethicone (Mylanta Extra Strength liquid, Almacone)
• Sucralfate (Carafate)

  Drug for heartburn
• Histamine2 receptor antagonists & proton pump inhibitors

  Drugs for heartburn, teratogenicity unknown
• Treatments for constipation


  • Bulk-forming preparations (safest)
  • Ducosate sodium (Colace)
  • Occasional use: milk of mag, mag citrate, lactulose, sorbitol, bisacodyl, senna
  • Avoid castor oil, mineral oil
• Acetaminophen (Tylenol)


  Most common pain medication during all trimesters
• Aspirin & ibuprofen


  Pregnancy category C; D in 3rd trimester
• Tocolytics


  Drugs that slow uterine contractions to delay labor
• Tocolytics


  • Used in patients with premature labor
  • Delay labor by 24–72 hours, often enough time for fetus to develop normal lung function
  • Adverse effects include tachycardia in both mother and fetus
• Amelia is 32 weeks pregnant and begins to have premature uterine contractions, so she is hospitalized and prescribed magnesium sulfate
• Nursing interventions for tocolytic therapy


  • Monitor VS, FHR, fetal activity, uterine contractions
  • I & O
  • Assess breath & bowel sounds, deep tendon reflexes, pain, uterine contractions
  • Weigh daily @ same time
  • Monitor serum magnesium
  • Have calcium gluconate IV available
  • Observe newborn for 24 to 48 hours after birth
• Corticosteroid Therapy


  Used to accelerate lung maturation & surfactant development in fetus in utero to reduce incidence & severity of respiratory distress syndrome (RDS) and increase survival of preterm infants
• Betamethasone (Celestone)


  • Effects/benefits begin 24 hrs after administration; last up to 1 week
  • Goal is to delay delivery by 48 hrs to maximize effect
  • Side effects: seizures, H/A, vertigo, edema, hypertension
• Dexamethasone


  Corticosteroid therapy
• Surfactant Therapy


  Drugs used to treat/reduce respiratory distress syndrome (RDS) in preterm infants
• Surfactant Therapy Drugs


  • beractant (Survanta)
  • calfactant (Infasurf)
  • poractant alfa (Curosurf)
• Surfactant Therapy Administration


  • Via endotracheal tube
  • Position- head elevated
  • Do not suction for 2 hrs after admin
  • D/C administration if child dusky, agitated, bradycardic, O2 sat < 95%, CO2 < 30 mm Hg
• Oxytocics


  Stimulate uterine contractions and promote induction of labor
• Tocolytics


  Inhibit uterine contractions during premature labor
• Oxytocin


  Natural hormone secreted by posterior pituitary that stimulates uterine contractions to induce labor
• Suckling stimulates release of oxytocin, which causes more milk ejection
• Role of the Nurse: Uterine Stimulant Therapy


  • Frequently assess patient in labor
  • Discontinue infusion if fetal distress detected
  • Assess for symptoms of water intoxication
  • Assess for side effects of oxytocin
• Amelia is admitted to the hospital for induction of labor and is receiving an oxytocin IV drip
• Ergot Alkaloids


  Enhance uterine contractility, not used during labor due to risk of sustained uterine contraction, fetal hypoxia, uterine rupture