Female Reproductive Cycle I

1
Female Reproductive Cycle I

• Pregnancy and Preterm Labor Drugs

2
Review

• AP of female reproductive system
• Feedback loop (pg. 808)

3
Physiological Changes

• 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

4
Placenta

• 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

5
To Prescribe or Not to Prescribe

• Risk/Benefits
• MD/NP must consider the aforementioned
  physiological changes

6
The Fetus

• Liver metabolism is slower
• What we give the mother can have prolonged
  effects on the fetus
• Impact fetal outcome

7
Lactation

• Remember the ways that drugs cross the
  placentasame 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.

8
Other Considerations

• Legal and illicit drugs
• Mothers underlying conditions still need to be
  treated
• Seizure disorders
• Diabetes
• HTN
• OTC drugs
• Cold remedies, stool softeners, pain medications
• FDA Category system-revisit

9
Teratogens

• 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

10
Fetal Effects Table 52-1

• Review

11
Therapeutic Drug and Herbal Therapy
12
Iron
13
Folic Acid
14
Multiple Vitamines
15
Drugs for Discomfort
16
Nausea and Vomiting
17
Heartburn
18
Constipation
19
Pain
20
Drugs to Decrease Uterine Muscle Contractility
21
PTL

• PTL that progresses to PTD accounts for most
  prenatal morbidity and mortality in US (excluding
  fetal abnormalities)
• No one cause

22
Risk Factors

• 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

23
PTL-Continued

• 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

24
Tocolytic Therapy in Absence of Contraindications

• 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)

25
Goals of Tocolytic Therapy

• 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

26
terbutaline (Brethine)

• 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)

27
Nursing Process/Brethine

• Assessment
• Diagnosis
• Plan
• Interventions
• Evaluation
• Review 822

28
Magnesium Sulfate

• 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

29
Adverse Reactions

• Low blood pressure
• Flushing
• Sweating
• Dizziness
• Nausea
• Headache
• Lethargy
• Slurred Speech
• Increased pulse rate

30
Remember To

• 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

31
Nursing Process

• Page 827

32
Nursing Process-Mag Sulfate

• Assess and monitor-Respirations, FHR, fetal
  activity, IO, breath and bowel sounds, DTR,
  weight, have antidote on hand----
• Diagnose
• Plan
• Implement
• Evaluate

33
Corticosteroids in PTL
34
Surfactant Development

• 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

35
Corticosteroids in PTL

• Betamethasone (Celestone)
• Seizures, headache, HTN, petechiae, ecchymoses,
  facial redness
• Dexamethasone
• Insomnia, nervousness, increased appetite,
  arthralgia, hypersensitivity reactions
• See Nursing Process for Betamethasone pg. 823

36
Drugs for Gestational HTN
37
Defined

• 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.

38
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

39
HELLP Syndrome

• Hemolysis
• Elevated Liver Enzymes
• Low Platelet Count

40
Goals

• Uncomplicated delivery
• Psychological support for client/family
• Reduction of vasospasm
• Prevention of seizures

41
Cure for Preeclampsia

• Delivery

42
First Line Therapy

• methyldopa (Aldomet)
• hyralazine (Apresoline)
• labetalol (Trandate)
• Beta-blockers
• Prazosin
• Nifedipin
• Clonidine

FIRST LINE
ALTERNATIVES