Inpatient Obstetrics Exam- RNC (medication review)

Inpatient Obstetrics Exam- RNC (medication review) Gestational age criteria for PRETERM LABOR candidates receiving antenatal steroids? - ✔✔All fetuses between 24.0 and 34.6 weeks gestation at preterm risk within 7 day ...

Inpatient Obstetrics Exam- RNC (medication review) Gestational age criteria for PRETERM LABOR candidates receiving antenatal steroids? - ✔✔All fetuses between 24.0 and 34.6 weeks gestation at preterm risk within 7 days. OR Fetuses greater than 34 weeks w/ an immature lung profile OR If the mother is eligible for tocolytics Gestational age criteria for preterm PROM candidates receiving antenatal steroids? - ✔✔Less than 32.0 weeks gestation; in the absence of chorioamnionitis (Tx at 32-33 weeks may also be beneficial) Antenatal corticosteroids are most effective when given within what time frame? - ✔✔24 hours and up to 7 days after administration of the second dose. ---- significant reduction in infant mortality is still associated when <24hrs has passed so steroids should always be given, if possible. When can a rescue course of antenatal steroids be given? - ✔✔If more than 2 weeks has passed since last dose; fetus is <32.6; and likely to deliver w/in 7 days Royal College of Obstetricians and Gynecologists advises that antenatal steroids should be given to ______. - ✔✔All women for whom an elective c/s is planned prior to 38.6 weeks gestation. Betamethose (Celestone) indications and dosage? - ✔✔Indicated for reduction of neonatal mortality, RDS, and IVH (intraventricular hemorrhage) in women at risk for preterm deliver less than 34 weeks gestation. --- Dosage: 12mg IM q24h x2 doses Dexamethasone (Decadron) indications and dosage? - ✔✔Indicated for reduction of neonatal mortality, RDS, and IVH (intraventricular hemorrhage) in women at risk for preterm deliver less than 34 weeks gestation. --- Dosage: 6mg IM q12h x4 doses 17 alpha-hydroxyprogesterone caproate (Delalutin, Makena) (aka synthetic progestin) indications and dosage? - ✔✔Documented history of previous spontaneous singleton birth before 37 weeks gestation. --- Dosage: 200mg IM every week from 16 to 36 weeks gestation. Progesterone (Progestin) indications and dosage? - ✔✔In women with a singleton pregnancy, no hx for preterm birth, and cervical length 20cm or less before 24 weeks. --- 200mg vaginal suppository nightly until 36 weeks OR Vaginal progesterone gel 8% gel (90mg daily) Nifedipine (Procardia) indications and dosage? - ✔✔Acute tx of preterm labor --- 20mg PO (may repeat in 30 min if CTX persist) then q3-8h after CTX have been controlled OR 10mg PO q20min for 3 total doses then 20mg PO q4-6h MAXIMUM DOSE 160mg per day Discontinue after 48 hrs, pulse >120BPM, or BP 90/60 Nifedipine contraindications? - ✔✔Allergy to nifedipine, sick sinus syndrome, secondary or tertiary heart block, hypotension, and hepatic dysfunction. Nifedipine side effects? - ✔✔Tachycardia, cutaneous flushing, HA, dizziness, nausea, vasodilation, and sever hypotension in hypovolemic pts. Drug induced maternal hepatoxicity has also been reported. Sulindac (Clinoril) indications and dosage? - ✔✔Acute tx of preterm labor --- 200mg PO q12 hours x 48h *d/c after 48h Sulindac (Clinoril) classification? - ✔✔NSAID (prostaglandin synthetase inhibitor/ cyclooxygenate COX inhibitor) Sulindac (Clinoril) side effects? - ✔✔GI irritation, heartburn, n/v, and possible HTN with beta blockers. Premature closure of fetal ductus arteriosis, decreased fetal renal function, and oligohydramnios. (Check AFI after 48h of therapy) Sulindac (Clinoril) contraindications? - ✔✔Hx of peptic ulcer, hemolytic dfxn, kidney or liver disease, after 32wks gestation, IUGR, chorio, oligo, ducal dependent cardiac defects, and twin transfusion syndrome. Use caution in asthmatics. Terbutaline (Brethine) indications and dosage? - ✔✔Acute tx of preterm labor --- 0.25mg SC q15-30min up to 0.5mg in 4 hours. Then 0.25mg q3h. *D/C after 48h or if pulse >120bpm Terbutaline (Brethine) contraindications? - ✔✔Hx of cardiac disease, poorly controlled DM, ante Artum hemorrhage, HTN, hyperthyroidism, fetal distress, severe preeclampsia, IUGR, chorio, and abruption. Terbutaline (Brethine) side effects? - ✔✔Chest pain, dyspnea, tachycardia, palpitation, tremor, HA, hypokalmia, hyperglycemia, n/v, nasal stuffiness, pulmonary edema, and fetal tachycardia.