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Medications and Hormones Associated with Pregnancy Chart
10/15/2013 4:36 PM
Meds
Purpose/Use/Application/Notes
Bethamehasone (Celestone)
Antenatal steroids
RhoGAM (Rh3 immune globulin)
Heparin.
Oral Coagulants
Digoxin (Lanoxin)
Procainamide (Pronestyle) sp??
Thiazide diuretics and furosemide
(Lasix)
Heparin sulfate
Magnesium sulfate
Calcium gluconate (Kalcinate)
Hydralazine (Apresoline)
Labetalol/Normodyne
Diazepam (Valium)
Furosemide (Lasix)
Labetolol (Normodyne)
Nifedipine
IV Magnesium sulfate
MOA
Antagonist/Notes
Side effects/Precautions/Notes
Classification
Medications below are related to pulmonary issues.
A glucocorticoid capable of inducing pulmonary maturation in the fetus and decreasing the incidence of respiratory distress syndrome in preterm infants when administered to the mother prior to delivery.
A Glucocorticoid.
Given to pregnant Pt’s w/Eclampsia to accelerate fetal lung maturation.
Given between 26-32 weeks to pregnant women to enhance fetal lung maturity.
Medications below are used to deal with cardiac issues (non BP issues) and blood issues.
Given to women w/Rh-negative blood to prevent antibody formation from Rh-positive conceptions. A woman who has RH negative blood should receive an injection of Rh (D) Immune Globulin (RhoGAM) within 72 hrs after giving birth to a
neonate w/Rh positive blood.
Used to treat class III and class Iv heart disease in pregnant women.
Anticoagulant.
Should be avoided by pregnant women because they cross the placenta.
Used to treat class 3 & 4 Heart disease I Pregnant women.
Antiarrhythmic.
Used to treat class 3 & class 4 heart disease in pregnant women.
Beta adrenergic blockers.
To control heart failure if activity restriction and reduced sodium intake don’t prevent it. In Class 3 and class 4 heart disease in pregnant women (page 486)
Is a Category C drug and may be used in pregnant women when it’s potential benefits outweigh it’s risks.
Used when?
The medications below are used to treat high blood pressure issues (high BP, eclampsia, preclamsia, etc.).
Used to: Suppress pre-term labor and to prevent seizures in
Monitor uterus for uterine atony, which would increase the risk of postpartum hemorrhage.
eclampsia by depressing the CNS by reducing the amount of
Decreased urine output is a s/s of adverse effect. Maintain a urine output of at least 30 ml/hr because Mg is excreted via the kidneys
acetylcholine produced by motor nerves/depressing seizure foci in
and can easily accumulate to toxic levels.
the brain and peripheral neuromuscular blockade.
May cause depression of deep tendon reflexes.
Produces a smooth muscle depressive effect which can lower
Magnesium toxicity: <14 resp/min, diminished deep tendon reflexes, urine output of less than 100 mL in 4 hrs, signs of fetal distress, mg
blood pressure.
serum level of 10 mg/dL.
Magnesium Sulfate: 4 to 7 mEq/L. (page 395)
The therapeutic serum level of Mg is 4-7 mEq/L.
Reduces edema by causing a shift from the extracellular spaces
8-10 mEq/L causes absent reflexes.
into the intestines. CL
10-12 mEq/L causes resp. depression.
15 mEq/L causes resp. paralysis.
Withold if the Pt’s resp. rate or urine output falls or if reflexes are diminished or absent.
Flushing, feeling warm.
Monitor for CNS depression.
In the case of impending toxicity, stop the infusion, don’t just slow it down.
Blurred vision.
Slurred speech, confusion.
Flushing, lethargy, headache, muscle weakness, diplopia, dry mouth, pulmonary edema, cardiac arrest
Lethargy, hypotonia, respiratory depression, demineralization with prolonged use.
Prevents ventricular fibrillation.
Nausea, constipation, upset stomach. Rapid intravenous injections may cause hypercalcemia which L/T vasodilation, cardiac arrhythmias,
10 mm ?? of 10% calcium glutonate is given by IV push over 3 to
decreased blood pressure, and bradycardia. Extravasation of can lead to cellulitis. Intramuscular injections may lead to local necrosis and
5 mins to treat magnesium toxicity.
abscess formation.
Also used immediately to trt a pt who develops hypocalcemia and
It is also reported that this form of calcium increases renal plasma flow, diuresis, natriuresis, glomerular filtration rate, and prostaglandin
tetany after a thyroidectomy.
E2 and F1-alpha levels.
Given for sustained elevated BP in pre-eclamptic/severe
Flushing, headache, dizziness, nausea, transient hypotension. Administration of calcium channel blockers should be used with care in
preeclampsia pts. Used to trt severe hypertensive preeclampsia.
patients with renal disease, cardiac disease, & hypotension. Concomitant use of calcium channel blockers and magnesium sulfate may
result in cardiovascular collapse. It should not be used concomitantly with magnesium sulfate.
Anti-hypertensives used to treat BP in severe preeclampsia
May also be given to seizure activity. ??
To treat pulmonary edema if it develops in Eclamsia Pts.
Used to treat severe preeclampsia.
Is one of the most commonly used tocolytic agents. Used to trt
Mother or fetus may require blood pressure monitoring.
severe hypertensive preeclampsia.
Prevent seizures in eclampsia.
Produces a smooth muscle depressive effect which can lower
blood pressure.
Anti-convulsant. A beta
adrenergic used for
tocolysis. This is considered
more of an anti convulsant
than an anti hypertensive.
Anti-hypertensive
An antihypertensive.
Anti-hypertensive
Medications below this line are used to effect uterine contractions.
Reduces edema by causing a shift from the
Monitor uterus for uterine atony, which would increase the risk of postpartum hemorrhage.
extracellular spaces into the intestines. CL
Decreased urine output is a s/s of adverse effect. Maintain a urine output of at least 30 ml/hr because Mg is
It also depresses the CNS, which decreases the
excreted via the kidneys and can easily accumulate to toxic levels.
2
Help suppress pret-term labor.
Terbutaline (Brethine)
Ergonovine (Ergotrate)
Tocolytics: Terbutaline (Brethine),
Ritodrine (Yutopar), Nifedipine
(Procardia),
Oxytocin (Pitocin is the synthetic form)
Estrogen
Fetal Cortisol
Progesterone
Nifedipine (Procardia, Adalat)
Dinoprostone (Cervidil)
Methergine/Ergonovine (ergotrate)/
methylergonovine
incidences of seizures.
Reduces the amount of acetylcholine produced
by motor nerves, thereby preventing seizures.
Believed to depress seizure foci in the brain and
peripheral neuromuscular blockade.
May cause depression of deep tendon reflexes.
Magnesium toxicity: <14 resp/min, diminished deep tendon reflexes, urine output of less than 100 mL in 4 hrs, signs
Magnesium Sulfate: 4 to 7 mEq/L. (page 395) is the therapeutic
of fetal distress, mg serum level of 10 mg/dL.
serum level for Pts w/ PIH to prevent seizure activity.
The therapeutic serum level of Mg is 4-7 mEq/L.
8-10 mEq/L causes absent reflexes.
Calcium gluconate (Kalcinate) is the antidote for magnesium
10-12 mEq/L causes resp. depression.
toxicity. 10 mm of 10% calcium glutonate is given by IV push over
15 mEq/L causes resp. paralysis.
3 to 5 mins.
Withold if the Pt’s resp. rate or urine output falls or if reflexes are diminished or absent.
Flushing, feeling warm.
Monitor for CNS depression.
In the case of impending toxicity, stop the infusion, don’t just slow it down.
Blurred vision.
Postpartum hemorrhage.
uterine atony.
Slurred speech, confusion.
Flushing, lethargy, headache, muscle weakness, diplopia, dry mouth, pulmonary edema, cardiac arrest
Lethargy, hypotonia, respiratory depression, demineralization with prolonged use
Anti-convulsant. A beta adrenergic used for tocolysis. This is considered more of an anti convulsant than an anti
hypertensive.
Relaxes smooth muscle of the bronchi Although terbutaline
It is a smooth muscle relaxant.
Flutter or tight sensation in the chest is a common adverse reaction to terbutaline.
relieves bronchospasm, Pt’s can receive it to reduce uterine
Selective B2 adrenergic agonist.
Although terbutaline relieves bronchospasm, Pt’s can receive it to reduce uterine motility.
motility.& uterus. Especially used for preterm labor and uterine
Is often the drug given first, especially if there is
Mouth dryness and thirst occur with the inhaled form of terbutaline but are unlikely in the subcutatneous form.
hyper stimulation. Given when delivery would result in premature
only low risk of preterm birth.
Hypokalemia is a potential adverse reaction following large doses of terbutaline but not at doses of .25 mg.
birth to buy time for the administration of betamethasone (a
Cardiac or cardiopulmonary arrhythmias, pulmonary edema, myocardial ischemia, hypotension, tachycardia, death.
glucocorticoid drug which greatly accelerates fetal lung maturity).
Fetal tachycardia, hyperinsulinemia, hypoglycemia, myocardial and septal hypertrophy, myocardial ischemia
Given to slow contractions, not stimulate them.
Tocolytics (also called anti-contraction medications or labor repressants) are medications used to suppress
Is often the drug given first, especially if there is only low risk of
premature labor.
preterm birth.
Withhold when cervix is dilated 4 cm or more or effaced 50% or more, or hemorrhaging, or has severe PIH, or when
fetal distress is evident.
Given to post partum Pts who have heavy bleeding, large clots, and should be used only if the bleeding doesn't respond to massage and oxytocin.
Tocolytics (also called anti-contraction medications or labor
Contraindications Older than 34 weeks gestation, weighs less than 2500 g, has intrauterine growth restriction or placental insufficiency Lethal congenital or
repressants) are medications used to
chromosomal abnormalities. Cervical dilation is greater than 4 centimeters Chorioamnionitis or intrauterine infection is present. BP issues (PIH, eclampsia,
suppress premature labor & are given when delivery would result
preeclampsia) active vaginal bleeding, placental abruption, cardiac disease or another condition which indicates that the pregnancy should not continue. Other cause of
in premature birth to buy time for the administration of
fetal distress or fetal death. In addition to drug-specific contraindications, several general factors may contraindicate delaying birth with the use of tocolytic
betamethasone, a glucocorticoid drug which greatly accelerates
medications:
fetal lung maturity,
Tocolysis is rarely successful beyond 24–48 hours because current meds do not alter the fundamentals of labor activation. However, just gaining 48 hours is sufficient to
β2-agonist
allow the pregnant women to be transferred to a center specialized for management of preterm deliveries and give administered corticosteroids the possibility to reduce
Used to stop labor contractions.
neonatal organ immaturity.
Tocolytic therapy is typically indicated for the Pt in premature
Research MOA.
labor.
Pulmonary edema
Palpitations
The hormone responsible for stimulating powerful uterine contractions during labor. Pitocin is given to Pts who are
If a contraction lasts 60 (or 90) seconds w/no sign of letting up tetany could be
Synthetic form of the
past their due date to initiate or augment uterine contractions or by IV after delivery of the placenta to control
occurring and could cause rupture of the uterus. Stop the oxytocin, monitor fetal
pituitary hormone used to
postpartum bleeding. A Pt who has postpartum hemorrhage caused by uterine atony should be given oxytocin as
heart tones, and notify the Dr.
stimulate uterine
prescribed.
Oxytocin causes water intoxication leading to seizures, coma, & death.
contractions.
Has a role in uterine contractions but is not given in synthetic form to help uterine contractility.
Believed to slow the production of progesterone by the placenta.
Has a relaxing effect on the uterus. Produced in large quantities by the corpus luteum.
Purpose??
One of the most commonly used tocolytic agents.
Cardiac disease. It should not be used simultaneously with magnesium sulfate.
Flushing, headache, dizziness, nausea, transient hypotension. Administration of calcium channel blockers should be used with care in patients with renal disease and
hypotension. Concomitant use of calcium channel blockers and magnesium sulfate may result in cardiovascular collapse. Depending on the tocolytic used the mother or
fetus may require monitoring, as for instance blood pressure monitoring when nifedipine is used as it reduces blood pressure.
Used to ripen the cervix.
A smooth muscle constrictor that mostly acts on the uterus by
Partial agonist/antagonist on serotonergic, dopaminergic and alpha-adrenergic
Adverse effects/Cholinergic effects include: Nausea, vomiting, diarrhea, dizziness,
stimulating uterine contractions. Used when a post delivery
receptors. Its specific binding and activation pattern on these receptors leads to
severe systemic hypertension (especially in patients with preeclampsia), pulmonary
mother is bleeding heavily/has a boggy fundus and the bleeding
a highly, if not completely, specific contraction of smooth uterus muscle via
hypertension, coronary artery vasoconstriction, convulsions.
3
Ritodine (Yutopar)
Relaxin
Morphine
Nubain
Meperdine hydrochloride (Demerol) &
morphine sulfate
Epidural
Narcan (see above)
Naloxone (Narcan)
Epidural
???
Imipramine/Tofranil,
nortriptyline/Pamelor
Glucagon
Insulin.
Oral hypoglycemic agents
Sodium bicarb
Vit K
Demerol (Meperidine)
Fetal cortisol
LH
FSH
Leutenizing hormone.
Estriol
HCG
Prolactin
Cehpalexin (Keftab), cefaclor (Ceclor),
clindamycin (Cleocin)
Antibiotics ampicillin and gentamicin
(gentak)
doesn’t respond to massage and oxytocin, spontaneous or elective serotonin receptors, while blood vessels are affected to a lesser extent compared
abortion to aid in expulsion of retained products of conception
to other ergot alkaloids.
after a missed abortion (miscarriage in which all or part of the fetus
remains in the uterus), and to help deliver the placenta after
childbirth.
For premature labor.
Hormone that causes joints to soften & relax during birth. Relaxes the urinary sphincter.
Pain treatment
Via an epidermal & following a cesarean section. It’s antagonist is naloxone hydrochloride (Narcan).
R Used w/Tet?
Narcotic analgesic.
Pain meds which can contribute to abdominal discomfort d/t the slowing of peristalsis. Used after C-Sections.
In excessive doses can also lead to cramping, respiratory depression, and coma.
Narcotic analgesic
Pt’s who receive epidural anesthesia during labor should be placed on the side w/the head elevated slightly.
Be careful of respiratory depression. For neonates with opioid induced resp. depression at birth, naloxone (Narcan), an opioid antagonist, is the drug of choice.
Treat narcotic toxicity.
Epidural
Give pregnant Pt 500 mL fluid bolus to help prevent hypotension in the Pt who wishes to receive an epidural for pain relief d/t the major
adverse effect of hypotension.
To treat nausea assoc. w/Hyperemesis gravidarum
Anti-depressants to treat Psychological Maladaptation.
Anti-emetics
Anti-depressants
Blood sugar issue medications
Raises blood glucose & is used to treat hypoglycemic reactions.
During the 3rd trimester of pregnancy the anti-insulin effects of placental hormones increase the Pt's insulin needs.
Human Placental lactogen
Contraindicated during pregnancy because of possible adverse effects on the fetus & newborn.
Used to treat heartburn. Except pregnant women shouldn’t use it cuz it may alter electrolyte balances.
Given to neonates shortly after birth to prevent hemorrhage.
Respiratory depression is a common fetal neonatal adverse reaction to a meperidine (Demerol) given with 2 hrs of delivery. ??
Hormones and steroids
The joint action of luteinizing hormone and FSH cause the ovarian follicle to mature. RRR
The joint action of luteinizing hormone and FSH cause the ovarian follicle to mature. RRR
Estriol determination is used to assess placental function, fetal well being, maternal renal functioning, and pregnancies
complicated by diabetes.
Peaks at the 10th wk of gestation.
Stimulates breast milk production
Antibiotics associated w/Pregnancy
Antibiotics for mastitis.
Estriol levels are measured to assess fetal well-being most commonly in pregnancies
complicated by diabetes.
To prevent bacterial endocarditis.
Ectopic Pregnancy related medications
Vaccinations
Methotrexate (Trexall) followed by
leucovorin (Wellcovorin)
Meds
Live-virus vaccines are contraindicated during pregnancy.
R this med.
Purpose/Use/Application
Used to treat ectopic pregnancy to stop the
trophoblastic cells from growing. Therapy
continues until negative HCG levels are achieved.
Page 485
MOA
Methotrexate (Trexall) prophylactically is the drug of
choice for choriocaxate carcinoma in Hydatidiform. ??
Antagonist or merged cell
Side effects & precautions
Classification