Reproduct
              ive
              and
            Gender-
            Related
            Agents
Ma. Tosca Cybil A...
Therapeutic Drug
     Use in
   Pregnancy
• Iron
  – In pregnancy, approximately 2x the normal
    amount of iron is need to meet fetal and
    maternal daily requi...
• Iron
   – Ex:
       • Ferrous sulfate 20% (300mg of ferrous sulfate is equivalent
         to 60mg elemental iron)
   –...
• Folic Acid
  – Needed to prevent spontaneous abortion or birth
    defects, premature births, LBW, and premature
    sep...
• Multivitamins
  – Preparations generally supply vitamins
    A,D,E,C,B complex, iron, calcium and other
    minerals
  –...
Drugs for
   Minor
Discomforts
     of
Pregnancy
• Physiologically, minor discomforts in
  pregnancy are associated with increased
  level of human chorionic
  gonadotropi...
• Nausea and vomiting (morning
  sickness) are major complaints
  during early pregnancy and
  hyperemesis gravidarum whic...
• The FDA did not approve any drug for the
  treatment of morning sickness but the common
  drugs used are:
  – Prokinetic...
• Heartburn (pyrosis)
  – Burning sensation in the epigastric and
    sternal regions that’s occurs with reflux of
    aci...
Pharmacological management
   • Antacids- first line of therapy if client did not respond to non
     pharmacological mana...
• Constipation
  – Frequent in pregnancy due to decreased GI
    motility
  – Safest oahrmacological management is the use...
• Pain
  – Acetaminophen(Tylenol, Datril)
     • Pregnancy category B
     • With analgesic and antipyretic effects
     •...
• Pain
  – Aspirin (ASA, Bayer, Ecotrin)
     • Classified as a mild analgesic
     • Pregnancy category C
     • Prostagl...
Drugs
  that
Decreas
e Uterine
 Muscle
Contracti
• Tocolytic Therapy
   – Drug therapy that decreases uterine muscle
     contractility for clients who are experiencing tr...
• Tocolytic therapy
  – Beta-Sympathomimetic Drugs
     • Act by stimulating beta2 receptors of smooth muscles.
       The...
• Nursing considerations:
  – Monitor and assess uterine activity and FHT
  – Maintain client in left lateral position as ...
• Tocolytic therapy
   – Magnesium Sulfate
     • Calcium antagonist and CNS depressant----relaxes
       smooth muscles o...
Magnesium sulfate
• Adverse Reactions:
  – Mother: flush, feelings of increased warmth,
    perspiration, dizziness, nause...
Corticosteroid Therapy in
      preterm labor
• Corticosteroid Therapy in preterm
  labor
  –Accelerates lung maturation with
   resultant surfactant development in
   ...
– Prototype:
   • Betamethasone(Celestone)
      – Given to prevent RDS to preterm infants by injecting the mother
       ...
• Dexamethasone
  – Has a rapid onset of action and a shorter duration
    of action
  – AR: insomnia, nervousness, increa...
Drugs for
Pregnancy Induced
Hypertension (PIH)
• PIH
  – Most common serious complication of pregnancy
  – Most often observed after 20 weeks gestation
    intrapartum a...
• Methyldopa(Aldomet)
  – MOA: stimulates the central alpha-adrenergic
    receptors that results in a decreased sympathet...
• Magnesium Sulfate
  – Prevention and treatment of seizure r/t PIH.
  – Acts as CNS depressant. Decreases acetylcholine
 ...
– Nursing interventions: (Magnesium sulfate)
  • Continuous fetal monitoring
  • Monitor for maternal toxicity----weakness...
• Hydralazine
  – Antihypertensive agent. Acts by causing arterial
    vasodilation.
  – Objective of treatment is to main...
Drugs that Enhance
  Uterine Muscle
   Contractility
• Uterotropic drugs enhance uterine contractility
  by stimulating the smooth muscle of the uterus.
• Prototype:
  – Oxyto...
• Oxytocin (Pitocin, Syntocinon)
  – MOA: promotes uterine contractions by increasing
    intracellular concentrations of ...
• Ergot alkaloids
  – Act by direct smooth-muscle-cell receptor
    stimulation
  – Not used during labor because they can...
• Ergot alkaloids
  – S/E: uterine cramping, nausea and vomiting, dizziness,
    hypertension, sweating, tinnitus, chest p...
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Reproductive System Drugs

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Reproductive System Drugs

  1. 1. Reproduct ive and Gender- Related Agents Ma. Tosca Cybil A. Torres, RN, MAN
  2. 2. Therapeutic Drug Use in Pregnancy
  3. 3. • Iron – In pregnancy, approximately 2x the normal amount of iron is need to meet fetal and maternal daily requirements – 27mg daily – Needed during the 2nd trimester where the fetus begins to store iron – GOAL: to prevent maternal deficiency, not supply the fetus
  4. 4. • Iron – Ex: • Ferrous sulfate 20% (300mg of ferrous sulfate is equivalent to 60mg elemental iron) – Adverse effect: • Nausea, constipation, black or tarry stools, epigastric pain, vomiting, and diarrhea – Nursing implications: • Liquid for should be diluted and administered through a straw to prevent teeth discoloration • May inhibit absorption of others medications, appropriate separation of doses should be followed • Instruct to take between meals---1hour before meals is suggested • Do not administer with milk or antacids • Advise client to swallow whole, not to crush
  5. 5. • Folic Acid – Needed to prevent spontaneous abortion or birth defects, premature births, LBW, and premature separation of the placenta – RDA: 400mcg to women of childbearing age – RDA: 600mcg for pregnant women – Recommended amount should be ingested from folate-enriched foods and supplementation • Ex: – Bread, rolls, flour, cornmeal, rice, pasta, and cereals • Adverse reactions: – Allergic bronchospasm, rash, pruritus, erythema, and general malaise – May turn urine in an intense yellow
  6. 6. • Multivitamins – Preparations generally supply vitamins A,D,E,C,B complex, iron, calcium and other minerals – Helps prevent congenital defects – Most effective if taken with meals – Vitamin A in large doses can be teratogenic – Excessive ingestion of vitamins D,E, and K can be toxic
  7. 7. Drugs for Minor Discomforts of Pregnancy
  8. 8. • Physiologically, minor discomforts in pregnancy are associated with increased level of human chorionic gonadotropin(HCG) levels • Increased levels of progesterone relaxes smooth muscles which contributes to the discomforts of heart burn and constipation • Elevated female sex hormones during pregnancy changes the motility of the GI tract and the enlarging fetus displaces the bowel
  9. 9. • Nausea and vomiting (morning sickness) are major complaints during early pregnancy and hyperemesis gravidarum which needs hospitalization for hydration and nutrition
  10. 10. • The FDA did not approve any drug for the treatment of morning sickness but the common drugs used are: – Prokinetic agents • Metoclopramide (Reglan) – Anticholinergic • Scopolamine (Scopace) – Phenothiazine • Promethazine (Phenergan) – Antihistamines • Meclizine(Antivert) – SE: dizziness, drowsiness, dry mouth and nose, blurred vision, diplopia, urinary retention, palpitations and tachycardia
  11. 11. • Heartburn (pyrosis) – Burning sensation in the epigastric and sternal regions that’s occurs with reflux of acidic stomach contents – Results from a normal increase in progesterone----relaxing the cardiac sphincter
  12. 12. Pharmacological management • Antacids- first line of therapy if client did not respond to non pharmacological management – Magnesium hydroxide and aluminum hydroxide with Simethicone(Maalox plus) » For heartburn with antiflatulence action – Aluminum hydroxide (Amphojel) » For heartburn secondary to reflux » Action: neutralization of gastric acidity » SE: constipation » AR: dehydration, GI obstruction » Nursing responsibility: • Instruct to store liquid form in room temperature, not to let it freeze, and to shake bottle well before pouring
  13. 13. • Constipation – Frequent in pregnancy due to decreased GI motility – Safest oahrmacological management is the use of bulk-forming preparation with fiber • Metamucil • Docusate sodium –stool softener Avoid use of castor oil----promotes uterine contractions Avoid intake of mineral oil----reduces absorption of vitamin K
  14. 14. • Pain – Acetaminophen(Tylenol, Datril) • Pregnancy category B • With analgesic and antipyretic effects • A weak prostagladin inhibitor and does not have significant anti-inflammatory effect • should be used cautiously in clients at risk for infection because of the possibility of masking s/sx • SE: skin eruptions, urticaria, unusual bleeding, erythema, hypoglycemia, jaundice, hemolytic anemia, thrombocytopenia
  15. 15. • Pain – Aspirin (ASA, Bayer, Ecotrin) • Classified as a mild analgesic • Pregnancy category C • Prostaglandin synthetase inhibitor that has antipyretic, analgesic, and anti-inflammatory properties • No known teratogenic effect, risk for anomalies is small • Inhibits the initiation of labor and actually prolong labor • May increase risk of anemia and antepartum hemorrhage
  16. 16. Drugs that Decreas e Uterine Muscle Contracti
  17. 17. • Tocolytic Therapy – Drug therapy that decreases uterine muscle contractility for clients who are experiencing true PTL (with cervical changes) – Goal: • to inhibit or interrupt uterine contractions to create additional time for in utero fetal maturation • delay delivery so antenatal corticosteroids can be delivered to facilitate fetal lung maturation • to allow safe transport of mother to an appropriate facility
  18. 18. • Tocolytic therapy – Beta-Sympathomimetic Drugs • Act by stimulating beta2 receptors of smooth muscles. The frequency and intensity of uterine contractions decrease as the muscle relaxes • Prototype: – Terbutaline (Brethine)-most commonly used • AR: – maternal side effects include tremors, malaise, weakness, dyspnea, tachycardia (maternal and fetal), chest pain, vomiting, diarrhea, constipation, pulmonary edema, dysrrhythmias, anaphylactic shock. – Fetal side effects include tachycardia and potential hypoglycemia • Drug interactions: – general anesthetics--- can produce additive hypotension – Corticosteroids--- pulmonary edema
  19. 19. • Nursing considerations: – Monitor and assess uterine activity and FHT – Maintain client in left lateral position as much as possible to facilitate uteroplacental perfusion – Monitor maternal V/S – monitor daily weight to assess fluid overload; strict I & O monitoring – Report significant increase and persistence in uterine contractions despite tocolytic therapy – Report any leaking of amniotic fluid, any vaginal bleeding, or discharge, or complains of rectal pressure – Monitor for side effects such as palpitations and dizziness
  20. 20. • Tocolytic therapy – Magnesium Sulfate • Calcium antagonist and CNS depressant----relaxes smooth muscles of the uterus through calcium displacement • Increases uterine perfusion---beneficial for the fetus • Less expensive with lesser adverse effects than beta-sympathomimetics • Excreted by the kidneys and crosses the placenta • Maintenance dose be titrated to keep uterine contractions under control • Contraindicated for clients with MG, impaired kidney function and recent MI
  21. 21. Magnesium sulfate • Adverse Reactions: – Mother: flush, feelings of increased warmth, perspiration, dizziness, nausea, headache, lethargy, slurred speech, sluggishness, nasal congestion, decreased GI action, increased pulse rate, and hypotension. – Fetus: decreased heart rate and slight hypotonia with diminished reflexes and lethargy for 24 to 48 hours – Toxicity: respiratory depression and arrest, circulatory collapse, cardiac arrest – Antidote for toxicity: calcium gluconate (10mg IV push over 3 minutes)
  22. 22. Corticosteroid Therapy in preterm labor
  23. 23. • Corticosteroid Therapy in preterm labor –Accelerates lung maturation with resultant surfactant development in the fetus in utero-----decreasing the incidence and severity of respiratory distress syndrome (RDS) with increased survival of preterm infants
  24. 24. – Prototype: • Betamethasone(Celestone) – Given to prevent RDS to preterm infants by injecting the mother before delivery to stimulate surfactant production in the fetal lung – Not effective in treating preterm infants after delivery – More effective if given at least 24hrs but less than 7days before delivery in week 33 and before – less effective with multifetal birth – AR: rare but includes seizures, headache, vertigo, edema, hypertension, increased sweating, petechiae, ecchymoses, and facial erythema – Nursing responsibilities: » Shake suspension well. Avoid exposing to excessive heat or light » Inject to large muscle » Monitor maternal V/S » Maintain accurate I & O
  25. 25. • Dexamethasone – Has a rapid onset of action and a shorter duration of action – AR: insomnia, nervousness, increased appetite, headache, hypersensitivity reactions
  26. 26. Drugs for Pregnancy Induced Hypertension (PIH)
  27. 27. • PIH – Most common serious complication of pregnancy – Most often observed after 20 weeks gestation intrapartum and during the first 72 hours post partum – Believed to be related to decreased levels of vasodilating prostaglandins with resulting vasospasm – Prototype: • Methyldopa(aldomet) and hydralazine (Apresoline) – First line therapy for pre-eclampsia
  28. 28. • Methyldopa(Aldomet) – MOA: stimulates the central alpha-adrenergic receptors that results in a decreased sympathetic outflow to the heart, kidneys, and peripheral vasculature – AR: peripheral edema, anxiety, drowsiness, headache, dry mouth, mental depression – Nursing responsibilities: • Assist client to left lateral recumbent position • Teach about s/sx of progressive PIH • Advise diet rich in protein, normal sodium diet, and increase OFI • Monitor BP and report persistent and progressive elevation in readings
  29. 29. • Magnesium Sulfate – Prevention and treatment of seizure r/t PIH. – Acts as CNS depressant. Decreases acetylcholine from motor nerves, which blocks neuromuscular transmission and decreases incidence of seizures. Secondary effect is reduction of BP as the smooth muscles relaxes – Increases uterine blood flow – S/E: lethargy, flush, feelings of increased warmth, perspiration, thirst, sedation, slurred speech, hypotension, decreased muscle tone
  30. 30. – Nursing interventions: (Magnesium sulfate) • Continuous fetal monitoring • Monitor for maternal toxicity----weakness and lethargy from the blocking of the neuromuscular transmission. • Have calcium gluconate available-----as antidote for toxicity • Maintain client in left lateral position in low stimulation environment • Monitor for S/E
  31. 31. • Hydralazine – Antihypertensive agent. Acts by causing arterial vasodilation. – Objective of treatment is to maintain diastolic BP between 90 mmHg and 110 mmHg – AR: headache, N and V, nasal congestion, dizziness, tachycardia, palpitations, an d angina – Nursing interventions: • Take pulse and BP every 5 minutes until stabilized • Observe for change in LOC and headache • Monitor FHT • Monitor I and O
  32. 32. Drugs that Enhance Uterine Muscle Contractility
  33. 33. • Uterotropic drugs enhance uterine contractility by stimulating the smooth muscle of the uterus. • Prototype: – Oxytocin(Pitocin) • indicated for the initiation or improvement of uterine contractions, where this is desirable and considered suitable for reasons of fetal or maternal concern, in order to achieve vaginal delivery. • Indicated for: – induction of labor in patients with a medical indication for the initiation of labor – stimulation or reinforcement of labor, as in selected cases of uterine inertia – adjunctive therapy in the management of incomplete or inevitable abortion
  34. 34. • Oxytocin (Pitocin, Syntocinon) – MOA: promotes uterine contractions by increasing intracellular concentrations of calcium in uterine myometrial tissue – S/E: hypotension, dysrrhythmias, uterine hyperstimulation – AR: seizures, asphyxia, cardiac dysrrhythmias – Nursing interventions: • Have oxygen readily available • Monitor maternal pulse and BP, uterine activity, and FHT • Maintain in left lateral position to maintain placental perfusion • Monitor for signs of placental rupture---FHT decelerations, sudden increased pain, loss of uterine contractions, hemorrhage, and rapidly developing hypovolemic shock
  35. 35. • Ergot alkaloids – Act by direct smooth-muscle-cell receptor stimulation – Not used during labor because they can cause sustained uterine contractions (tetanic contractions)------fetal hypoxia and possibly rupture of the uterus – Effective in control of postpartum hemorrhage and promotion of uterine involution – Prototype: • Ergonovine maleate (Ergotrate) • Methylergonovine maleate (Methergine)
  36. 36. • Ergot alkaloids – S/E: uterine cramping, nausea and vomiting, dizziness, hypertension, sweating, tinnitus, chest pain, dyspnea, sudden severe headache. Ergot toxicity(ergotism)---- pain in arms, legs, and lower back, numbness, cold hands and feet, muscular weakness, diarrhea, hallucinations, seizures, and blood hypercoagulability – Nursing responsibilities: • Assess lochia and uterine tone before administration • Monitor clients BP----notify AP if systolic BP increases by 25 mmHg or diastolic BP by 20 mmhg over baseline • Protect drugs from exposure to light • Monitor for side effects or symptoms of ergot toxicity (ergotism) • Inform client that she will feel intense uterine cramps after receiving the drug • Instruct not to smoke----increases vasoconstricting effect
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