PREGNANCY & PRETERM LABOR DRUGS - Don’t mix antacid w/ iron, give iron 2hrs.

before or
• Changes in drug action during pregnancy 4hrs. after antacid
1) Effect of circulating steroid hormones on the
liver’s metabolism of drugs FOLIC ACID
2) Ease of renal perfusion • To prevent spontaneous abortion, and neutral tube
3) Resulting in more rapid renal excretion of defects (failure of the embryonic neutral tube to
drugs close properly) can lead to spinabifida, or skull &
4) Expanded maternal circulating blood brain malfunction of the baby
volume, resulting in dilution of drugs. • May also contribute to premature birth, low birth
5) Alteration in the clearance of drugs in later weight & abruptio placenta.
pregnancy, resulting in a decrease in serum • Folic acid is recommended to be given 1mnth before
and tissue concentration of drugs. conception and for the 1st 2-3 mnths after
conception at 0.4mg – 0.8mg
The most common indications to why it is important to use • Folate rich foods like green leafy vegies, asparagus,
drugs during pregnancy are to supplement the mother and papaya, strawberries, and oranges should be given.
her unborn baby with Iron, vitamins, and minerals, to treat • Adverse reactions to folic acid:
her nausea and vomiting, gastric acidity, and mild discomfort. - FA side effects are uncommon however,
patients may experience:
➢ Rash
THERAPEUTIC DRUGS IN PREGNANCY ➢ Allergic bronchospasm
➢ Pruritus
IRON ➢ Erythema
➢ Malaise
• Fetal and maternal daily supplement for iron in
➢ Urine may turn into intensely
27mg/day. During pregnancy
yellow.
• Goal in giving iron supplement is to prevent
maternal iron deficiency anemia and not to supply
MULTIPLE VITAMINS
the fetus w/ iron.
• Prenatal Vitamin preparations are routinely
• The recommended iron demand during the course recommended for pregnant women that contains:
of pregnancy are: - Vitamin A
- 1st trimester: 6.4mg/day - B complex
- 2nd trimester: 18.8mg/day - B12
- 3rd trimester: 22.4mg/day - Vitamin C
• Pregnant patients generally have decreased - Calcium
hematocrit early in 3rd trimester. - Vitamin D
• If w/ below 30% the iron dosage must be increased. - Vitamin E
• In taking iron preparations the most common side - Iron.
effects are:
- Nausea & vomiting DRUGS FOR MINOR DISCOMFORTS OF PREGNANCY
- Constipation NAUSEA & VOMITING
- Black, tarry stools • Morning sickness
- GI irritations • 88% of patient’s complain
- Epigastric pain The FDA approves pyridoxine hydrochloride & doxylamine
- Discoloration of urine succinate for treatment of morning sickness.
- Diarrhea • MOA – (mechanism of Action)
Nursing Consideration: • Competes w/ histamine for h2 receptor sites.
- As nurse, observe the following in giving iron
• Dosage: 2tabs at hs PO
preparation:
- dilute iron w/ water and use straw in giving liquid
• SE: CNS depression so avoid driving and operates
machinery.
iron to prevent staining of teeth
- Iron is best absorbed w/ juice and on an empty • CI: known hypersensitivity
stomach • To doxylamine succinate
- Vit. C increases iron absorption HEARTBURN
- If there would be gastric irritation, you may • Also called pyrosis is a burning sensation in the
administer iron w/food. epigastric & sternal regions that occurs w/ reflux of
- Don’t administer iron w/ milk, cereal, tea, coffee or acidic stomach content.
eggs • Antacids = first line of therapy for heartburn in
pregnancy.
 • Long term use in discouraged to prevent fetal • To be given deep IM, don’t forget to aspirate prior to
problems. injection.
• Over the counter antacids commonly used in • This is CONTRAINDICATED before DELIVERY of
pregnancy: PLACENTA
• Aluminum hydrochloride • Use cautiously in patient w/ HYPERTENSION, ACUTE
• MOA: neutralize gastric acid RENAL DISEASE, CARDIAC DISEASE, and ASTHMA.
• Adverse drug reaction for carbopost:
• Dosage: recommended 600mg in 5-6x per day.
- Diarrhea
• SE: constipation, dehydration, and GI obstruction
- Nausea & Vomiting
MAGNESIUM HYDROCHLORIDE
- Fever
• MOA: anti-flatulent & neutralizes gastric acidity - Abdominal pain w/ cramps.
• SE: constipation, dehydration, and GI obstruction.
METHYLERGOMETRINE MALEATE
CONSTIPATION AND PAIN • MOA/INDICATION: for prevention of postpartum
• Causes maybe related to hormonal changes hemorrhage, subinvolution, and post abortion
specifically progesterone – decreases gastric motility hemorrhage.
• Docusate sodium = 1st line of treatment for • Acts on the smooth muscle of the uterus producing
constipation during pregnancy sustained contractions and shortening the 3rd stage of
• PAIN: headache from eyestrain, hormonal changes labor.
and sinus congestion are common. • NOT routinely given per IV bec. Of increase in BP and
• Acetaminophen – most common non-prescription cerebrovascular accident.
drug during pregnancy & can be used during all • POUTE & DOSAGE: IM 0.2mg after delivery then orally
trimester of pregnancy @ 0.2mg 3-4x daily up to 7days post partum.
• Dosage: 325mg or 500mg @ 3-4 hrs. interval but not
exceed than 8tabs/24hrs. PROTOTYPE DRUG: OXYTOCIN
• rate of absorption in dependent on the rate of • DRUG CLASS: Oxytocic agent
gastric emptying. • MOA – used to induce labor during pregnancy and to
control post partum hemorrhage and to prevent
uterine atony post delivery.
DRUGS THAT ENHANCE UTERINE CONTRACTILITY • DOSAGE: FOR INDUCTION OF LABOR = incorporate 10
units (1 ampule) to IVF 1liter of Lactated Ringer’s
Solution.
DRUGS FOR CERVICAL RIPENING • Connect as piggyback line
DINOPROSTONE GEL • TO CONTROL POST PARTUM HEMORRHAGE and FOR
• this is a naturally occurring form of PROSTAGLANDIN POST DELIVERY CONTARINDICATION – incorporate
used to open an unfavorable cervix. 10-40 units in an IVF (intravenous fluid)
• At or near term in women needing labor induction. • IM: 3-10 units after the delivery of the placenta
Must be at room temperature and administered. • C/I (Contraindications):
• Using sterile technique.patient must remain in - Proven CPD (cephalopelvic Disproportion)
recumbent position 15-30 mins ff. administration and - Fetal intolerance of labor
2. - Hypersensitivity
• Hours after insertion of the gel. - Anticipated CS (caesarean section)
DINOPROSTONE VAGINAL INSERTS • PHARMACOKINETICS:
• Assess cervical dilation and effacent. - Absorption: not well absorbed per orem.
• At the time of insertion, after insertion patient to. Well absorbed through IM.
• Remain in lying position for 30 mins- 2hrs. - Distribution: widely distributed in
• Monitor fetal heart tone and uterine stimulation extracellular fluid. Minute amounts in fetal
circulation.
CARBOPOST TROMETHAMINE - Metabolism: 1-9 mins rapidly metabolized in
• Dosage: IM initially @ 0.25mg and repeat every 15- the liver.
30mins. As needed - Excretion: Urine.
• MAXIMU DOSAGE: 4 doses if patient is hypertensive • PHARMACODYNAMICS:
• This is naturally occurring prostaglandin that - IM: onset 3-6mins
stimulates directly uterine smooth muscles. - Peak: 40mins
• Also used as a treatment for postpartum hemorrhage - Durations: 2-3 hrs.
2ndary to uterine atony. - IV: onset within 1min.
- Duration: 1hr.
• THERAPEUTIC EFFECT:
 - To induce or augment labor contractions. • Systemic analgesics that can caused decrease
- To treat uterine atony alertness.
- To stimulate milk letdown. • Nurse: observe the patient as she cares for her
• MOA: promotes uterine contraction by increasing newborn to ensure safety.
intracellular concentrations of calcium in uterine • MORPHINE SULFATE ans CODEINE SULFATE should be
myometrium assessed for bowel function and respirations because
• SIDE EFFECTS: it can cause constipation and respiratory depression.
- Hypertension
- Dysrhythmias IBUPROFEN & KETOROLAC
- Uterine hyperstimulation
• Used to control postpartum discomfort and pain
- Tachysystole (6 or more uterine
• NSAIDS – non-steroidal anti-inflamatory drugs.
contractions on 20 mins)
• ADVERSE REACTION: • These NSAIDs are effective in relieving mild to
- Seizures moderate pain cause by postpartum uterine
- Water intoxication contractions, episiotomy, and perineal wounds.
- (characterized as nausea & vomiting, Nursing Interventions for NSAIDs:
hypertension, tachycardia, cardiac 1. To minimize GI distress best taken w/ food that an
arrhythmias. empty stomach
2. Assess for GI bleeding (dark, bloody stool, blood in
NURSING INTERVENTION for OXYTOCIN urine, coffee ground emesis)
1) Have tocolytic drug such as Terbutaline and oxygen 3. NSAIDs inhibits platelet synthesis and may prolong
readily available. bleeding time.
2) Monitor maternal Pulse and BP, uterine activity and 4. Avoid alcohol, aspirin, cortisoids (may increase the
FHR during administration risk for GI toxicity).
3) Monitor I & O.
4) Maintain patient in a sitting or lateral recumbent
position to promote placental infusion. DRUGS THAT PROMOTE POST PARTUM BOWEL
5) Monitor for signs of uterine rupture (extreme pain in FUNCTION
uterus) • Constipation maybe common to patient’s in the
6) Use IV pump to administer the drug. postpartum period because peristalsis is decreased
due to the residual effect of progesterone on the
smooth muscle.
DRUG USED DURING THE POST PARTUM • Maybe more experienced by CS delivery.
• The period from delivery until 6 weeks postpartum, • Pharmacologic measures include: use of stool
pharmacologic and non-pharmacologic measures softener and laxative stimulants
commonly used during postpartum periods have 5
• SIDE EFFECTS and ADVERSE REACTIONS:
primary purposes:
- Abdominal cramps
1. To prevent uterine atony & postpartum
hemorrhage
- Nausea and vomiting
2. To relieve pain from uterine contractions, - Diarrhea
perineal wounds and hemorrhoids - Rash
3. To enhance or suppress lactation,
production and release milks by mammary LAXATIVES
glands • for patient to have bowel movement by 2-4 days
4. To promote bowel function postpartum.
Nursing Interventions:
5. To enhance immunity
• docusate sodium & Sennosides
PAIN RELIEF FOR UTERINE CONTRACTION 1. store at room temp.
2. if in liquid prep give w/ milk or fruit juice to
• A few days postpartum there is afterbirth pains from
mask the bitter taste.
uterine eschemia during contractions.
3. Take w/ a full glass of water.
• Non-steroidal agents maybe used to control BISACODYL
postpartal discomforts and pain narcotic agents are
1. Store tablets & suppositories below 77 degrees &
reserved for more severe pain such as in cs section or
avoid excess hu,idity
extensive perineal lacerations.
2. Do not crush tablets.
3. Do not administer w/ in 1-2hrs of milk or antacid
CODEINE & MEPERIDINE
because enteric coating may dissolve resulting in
abdominal cramping & vomiting
 4. Take with a full glass of water. DRUG ADMINISTERED TO PRETERM, FULL TERM,
&HEALTHY NEONATES
MINERAL OIL
1. Do not give w/ or immediately after meals.
• When a preterm neonate is born respiratory distress
2. Give w/ fruit juice or a carbonated drink to disguise
syndrome (RDS) can develop due to immature lung
the bitter taste.
development and breathing control, which makes
the neonate prone to decrease airway muscle tone
MAGNESIUM HYDROXIDE
and surfactant level.
1. Shake the container well. Donot give 1-2hrs before
or after oral drugs because of the effects on
• Lung surfactant is needed to decrease the surface
tension of the alveoli (air sacs) to allow the lungs to
absorption.
fill w/ air and prevent the alveoli from deflating.
2. Take w/ a full glass of water.
3. Give 1-2 hrs after any oral antibiotics • One approach to minimize respiratory difficulties in
the preterm neonate is administration of surfactant
SENNA supplement thus it will maintain distention of the
1. Protect from light and heat alveolar sac.

SIMETHICONE DRUGS ADMINISTERED TO PRETERM NEONATES

1. Administer after meals and at bedtime.
2. If chewable tablets are ordered, instruct the patient SYNTHETIC SURFACTANT
to chew tablets thoroughly before swallowing and to • when preterms are born they still possesan
follow with a full glass of water. immature lung development and breathing control,
decrease airway muscle tone and surfactant level
HEALTH TEACHING TO LAXATIVES: thus the neonate may suffer from RDS (respiratory
1. Advise patients that stool softeners are given to distress syndrome)
enable bowel movement w/o straining
2. Advise patients that measures to prevent and treat EXOGENOUS SURFACTANT THERAPY FOR PREVENTION &
constipation includes drinking 6-8 glasses of fluid per TREATMENT OF RDS
day. Ingesting high fiber rich food, increasing
ambulation. BERACTANT
3. Advise patient regarding temp. and storage • ROUTE & DOSAGE: 4ml/kg per dose divided into 4
requirements for particular drugs. equal amounts.
4. Caution patient that prolonged, frequent, or USES & CONSIDERATIONS:
excessive use may result in electrolyte imbalance or • Bovine-derived surfactant to be administered for
dependence on the drug. prophylactic and treatment of RDS in premature
5. Advise patient that most laxatives contain sodium. infants.
Instruct them to check w/ their physician if they are • Drug must be given by health care personnel
on a low sodium diet before using any laxatives. experienced w/ using ventilators for prevention or
rescue in treatment of RDS
• Administered through Fr.5 catheter inserted into an
NEONATAL AND NEWBORNS DRUGS ET tube.
• Labor is determined to be preterm if it occurs before
37 weeks age of gestation, tocolytic therapy is CALFACTANT
administered to delay labor and delivery if there is • ROUT & DOSAGE: 3ml/kg per dose divided in 2 equal
no complications. amounts
• But if preterm labor cannot be halted, premature • Calf-derived surfactant to be administered for
delivery of the newborn is inevitable, which puts the prophylactic and treatment of RDS in premature
newborn at risk for health problems. infants
• Premature neonates are at risk for respiratory
distress, hypothermia, hypoglycemia, and PORACTANT
hyperbilirubinemia, and they may have also feeding • ROUTE & DOSAGE: 2.5ml/kg per dose divided in 2
difficulties. There are drugs administered on these equal amounts administer each half amount to each
preterm neonates to help them w/ these major main bronchus
complications from being preterm babies. • Porcine-derived surfactant to be administered for
prophylactic and treatment of RDS in premature
Nursing intervention for Synthetic Surfactant: 3. Administer erythromycin ointment before
1. Maintain a patent airway = all surfactants require a administration of phytonadione and hepB vaccine.
patent endotracheal tube for administration and 4. Monitor any reactions on the neonate after
specified alterations in positioning the infant administration.
throughout the procedure.
2. Monitor infant’s BS before, during, and after
surfactant therapy DRUGS FOR WOMEN’S REPRODUCTIVE HEALTH
3. Maintain adequate respiratory stays. • Women are special group of the world's population
4. Monitor ABG’s and obtain a chest radiography study. they have specific special health care needs
5. Don’t perform ET suction immediately after throughout their reproductive and post reproductive
administration of surfactant unless signs of airway life cycle.
obstruction are present.
6. Position and reposition the infant as needed for • A woman's reproductive cycle begins with menarche
equal distribution of surfactant throughout the until menopause. In order to achieve a healthy
lungs. reproductive well-being, certain medications are
7. Support and educate parents. needed across her reproductive years until cessation
of menstruation.

DRUG ADMINISTERED TO FULL TERM HEALTHY NEONATES • Menopause also brings major physiological changes
associated with this and to help women cope up with
ERYTHROMYCIN OPHTHALMIC OINTMENT these changes, certain drugs are available as
• This is the common anti-ineffective administered to prescribed by the physician. In this module, you will
a newborn’s eye. It is given as a prophylactic learn the different pharmacologic products that
treatment against eye infections maybe used throughout the reproductive and
• Side effects include chemical conjunctivitis that menopausal life cycle of women.
would manifest as eye edema and inflammation that
lasts about 24-48hrs.
• This is use in Crede’s Prophylaxis.
• DOSAGE & ROUTE: administered within 1hr. after DRUGS USED FOR COMBINED HORMONAL
delivery, place 1cm of this drug w/o touching the tip CONTRACEPTIVES, PROMOTE FERTILITY, FOR
of the ointment in the newborn’s eyes. MENOPAUSE
• USES: prevention of ophthalmic neonatorum &
protection against gonococcal and chlamydial PROGESTIN contraceptives contains a synthetic version of
conjuncticitis. estrogen and a compound. (e.g. Ethinyl estradiol) most
commonly used synthetic estrogen found in combined
PHYTONADIONE hormonal contraceptives.
• This is a synthetic Vitamin K, a fat soluble vitamin
given to a newborns to prevent vitamin K deficiency. There are some cases when women is not capable of
• Administered as single dose injection. reproduction, and this is termed as infertility or the inability to
• Side effects: pain on the injection site. conceive a child after 12 months of unprotected sexual
• Allergic reactions urticarial and rash have been intercourse.
reported.
• DOSAGE & ROUTE: 0.5-1mg into vastus lateralis w/in There are two types of infertility, we have primary infertility if
1hr after birth. a couple has never conceived or has never carried a pregnancy
• this is an anticoagulant for prevention of to term. Secondary infertility describes a couple who has
hemorrhagic disease of the newborn. conceived and brought a pregnancy to term but is unable to
• It is readily absorbed by IM injection. conceive afterwards. After age of 40 the chance of achieving
pregnancy for women decreases by 5%. In both men and
HEPATITIS B INJECTION women as they get older, fertility rates also decrease.
• DOSAGE & ROUTE: 0.5ml IM within 12hrs. after birth However, women has more high risk of being infertile as their
in the vastus lateralis of the newborn. age progresses.
• It protects the newborn from Hepatitis B.
Menopause is defined as the cessation of menstruation
Nursing Intervention for full term healthy neonates: in women, it normal occurs at a varying age of 35 and
1. Do not delay skin to skin contact between mother above. This is a naturally occurring event and part of the
and infant while preparing medications. normal life cycle of women.
2. Wear gloves when administering medications.
The menopause has three stages: perimenopause or pre DRUGS PROMOTE FERTILITY
menopause, menopause, and post menopause during
which certain physiologic events occur. This event in a
woman's life carries symptoms associated with
menopause and certain pharmacological treatments are
available to help menopaused women, cope up with this
major hormonal changes.

COMBINED HORMONAL CONTRACEPTIVES

FIRST GENERATION:
1. Norethindrone
2. Norethindrone acetate SIDE EFFECTS:
3. Ethyniodoldiacetate 1. Breast discomfort
These are the earliest progestin formulations to be used in oral 2. Fatigue
contraceptives. 3. Dizziness
4. Depression
SECOND GENERATION: 5. Nausea
1. Norgestrel 6. Increased appetite
2. Levonorgestrel 7. Dermatitis
8. Urticaria
THIRD GENERATION: 9. Anxiety
1. Desogestrel 10. Heavier menses
2. Norgestimate 11. Abdominal bloating

• The new-generation progestins have a higher efficacy

rating and fewer effects on lipid and carbohydrate DRUGS FOR MEN’S REPRODUCTIVE HEALTH
metabolism compared with f 1st and 2nd generations Men just like women also has some problems with their
• DRSP – drosppirenone is a fourth generation reproductive health well-being. Alterations in male's capacity
progestin to reproduce can be associated with range of developmental,
• It can increase K level altering water and electrolyte endocrine, infectious, inflammatory, malignant, and psycho
imbalance emotional process..

MECHANISM OF ACTION ANDROGEN The drug family clearly associated with male
• The estrogen component of Combined Hormonal reproductive process.
Contraceptives inhibits ovulation by preventing the
formation of a dominant follicle. When a dominant
follicle does not mature, Estrogen remains at a DRUGS RELATED TO MALE REPRODUCTIVE DISORDERS
consistent level and is unable to reach the peak level • Androgens or male sex hormones are responsible in
needed to stimulate LH (Luteinizing Hormone) surge. the control of sexual processes, accessory sexual
When the LH surge is suppressed, ovulation is organs, cellular metabolism and bone and muscle
prevented, and pregnancy does not occur. growth.

ROUTE OF DELIVERY: • Testosterone is an anabolic steroid that you learned

in anatomy and physiology, which is the principal sex
hormone in men. Small amounts of testosterone is
also being synthesized by the ovaries in women.

• The normal plasma concentration in males are 270 to

1070 ng/dL but it slowly declines 1% per year after the
age of 30. In this lesson you will learn about
pharmacological intervention intended for men's
reproductive health well being.
 MOST COMMON PHOSPHODIESTERASE FOR ERECTILE
DYSFUNCTION

ADVERSE REACTIONS:
1. Acne
2. Urinary urgency
3. Gynecomastia
4. Red skin
5. Jaundice
6. Depression
7. Habituation
8. Allergic reaction

DRUGS USED IN OTHER MALE REPRODUCTIVE DISORDERS

SEXUAL DYSFUNCTION IN MALES