Transcript OB Review 3

OB Review 3
Study Guide and Review
Oral Contraceptive Pills
1. Combination pill which contains two
female hormones similar to the body’s
own estrogen and progesterone
2. Progestin-only pill (or mini-pill) which
does not contain estrogen
 are more likely to cause breakthrough
bleeding --- spotting
Estrogen
 The estrogen compound used in most oral
contraceptives is estradiol and is always used
with a progestin.
 May cause fluid retention-- With long term use.
 Blood Pressure should be checked periodically
 Effects on Reproduction. When used throughout
a menstrual cycle with progesterone:
 Estrogen changes the cellular structure of the
endometrium and prevents implantation of a
fertilized egg.
Progesterone
 Progesterone and blocks the actions of
Lutenizing Hormone
 Lutenizing Hormone (LH) ----(stimulates corpus
luteum), and FSH and prevents ovulation.
 No new egg follicles are developed
 No ovulation occurs.
 changes the lining of the uterus
 Makes it more difficult for the fertilized egg to
implant.
 Keeps the cervical mucus thick and sticky
 Barrier against entry of sperm into the uterus.
 Inhibits sperm transport by reducing fallopian
tube mobility.
Combined Oral Contraceptives Types
Monophasic: All 21 active pills contain a fix
dosage (same amount) of Estrogen &
Progestin (E/P) throughout the cycle.
Biphasic: 21 active pills contain 2 different
E/P combinations (e.g., 10/11)
Triphasic: 21 active pills contain 3 different
E/P combinations (e.g., 6/5/10)
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OCPs and LUPUS
 For years, OCPs were not recommended for
patients with LUPUS.
 There was a belief that OCPs may cause
increase in disease activity or flare-ups in
patients with LUPUS
 A major study funded by the National Institute of
Arthritis and Musculoskeletal and Skin Diseases
shows that women with lupus are able to take
oral contraceptives without an increased risk of
flare-ups.
Oral Contraceptives
COCs should not be used if a woman:
Is pregnant (known or suspected)
Is breastfeeding (can take progestin only)
Is jaundiced (symptomatic viral hepatitis or
cirrhosis)
Has ischemic heart disease or CVA
Cardiovascular Disease
Diabetes Mellitus - uncontrolled
Thrombophlebitis
Client Instructions
 If you forget to take 1 pill, take it as soon as you
remember, even if it means taking 2 pills on 1
day.
 If you forget to take 2 or more pills, you should
take 2 pills every day until you are back on
schedule.
 Use a backup method (e.g., condoms) or do not
have sex for 7 days.
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Morning after pill
 Emergency Contraceptive Pill
 Norgestrel and ethynil estradiol are administered
as soon after unprotected intercourse as
possible and repeated 12 hrs after.
 Should be no longer than 72 hours after
unprotected sexual intercourse
Emergency Pill
 Plan B
 Levonorgestrel
Seasonale
FDA Approval 2003
I tablet every day for 91 day regimen
Women can predict having menstrual
cycle every 3 months
4 menstrual periods a year.
Depo-Provera
Injectable Contraceptive
150 mg Intramuscular
Progesterone Only
NO Estrogen
Every 3 months
Inexpensive
The Endometrium
Is the innermost layer of the uterus
Sloughs with menstruation during each
month
Follicle Stimulating Hormone
 The Anterior pituitary gland releases FSH
(follicle stimulating hormone)
 FSH goes to the ovaries and causes the
ovarian graafian follicle (OVUM) to
develop/mature & ripen.
Rhogam Rh (D) immune globulin
Administered to Rh negative mothers after
delivery of a Rh positive infant.
300 mcg intramuscular
Administered within 72 hours post delivery
or abortion.
Danazol (Danocrine)
Fibrocystic Breast Disease (FBD)
Decreases symptoms of FBD
Endometriosis
Start during menstruation
May be used up to 6 months
Weight gain, acne, hirsutism, edema, hair
loss, hepatic dysfunction, breast size
reduction, menstrual disturbances.
tadalafil (Cialis)
Erectile Dysfunction
10 mg prior to sexual activity at frequency
of up to once daily –
Remains effective for longer time than other
medications for erectile dysfunction.
Contraindications: nitrates---Hypotention
Headache, dyspepsia, backache, myalgia,
nasal congestion, flushing, limb pain.
Premenstrual Syndrome (PMS)
Initial treatment:
Acetaminophen
NSAIDS: ibuprofen, naproxen
Other:
Psychological evaluation
Supplemental estrogen
Tranquilizers and antidepressants
Oxytocin
Produced by hypothalamus and secreted by
Posterior pituitary gland
Stimulates milk ejection during lactation, uterine
contraction during birth, and is released during
sexual orgasm in both men and women.
the mechanism of action is dependent on the presence
of estrogen
Oxytocin's role may be related to various
behaviors - social recognition, bonding, anxiety,
trust, and maternal behaviors.
oxytocin (Pitocin)
Labor induction
Postpartum bleeding or hemorrhaging
Increases uterine tone during post partum
period
Incomplete/Inevitable/Elective Abortion
Not indicated for inducing first trimester
abortion
Discontinue if uterine hyperactivity or fetal
distress occurs.
Stimulates the ejection of milk - Induces milk
letdown.
Oxytocin
10 U/1ml/amp, in 500ml N/S.
Uterine stimulant, by increasing
intracellular concentrations of calcium in
uterine myometrial tissue
Antidiuresis appears to be initiated by the
direct action of oxytocin on the kidney.
The action of the drug stimulates renal
tubular absorption of free water.
Monitor closely in patients for hypotension
Restricted fluid intake
Adverse reactions
Hypotension
- maternal arrhythmias
- myocardial infarction
Seizures, headache, memory dysfunction
and subarachnoid hemorrhage
Hyponatremia: water intoxication
- Ocular bleeding and blurred vision,
pulmonary edema
Uterine hypertonia or rupture
Flushing, nausea and vomiting
Oxytocin Water Intoxication
Pounding maternal pulse
Increased maternal blood pressure
Moist respirations - Rales
The rate of infusion should be decreased
when depression of FHR occurs.
Methergine
 Methylergonovine is an ergot derivative with
direct uterine and vascular smooth muscle
contractile properties
 0.2mg/1ml/amp.
 Administered after delivery of the placenta, or
during postpartum.
 Not be routinely administered intravenously:
inducing sudden hypertensive and cerebrovascular
accidents.
 Given slowly over a period of no less than 60
seconds, with careful monitoring of blood
pressure
Ritodrine HCI (Yutopar)
Preterm labor
Tocolytic agent: decreases uterine
contractility ----Inhibits uterine contractility
50mg/5ml/amp
Tachycardia - Pulmonary Edema
Nervousness
Self Care Instructions
Avoid sexual intercourse
breast massage
modified bedrest
Parlodel (Bromocriptine mesylate)
Lactation suppressant
Non-hormonal Ergot derivative
No sooner than 4 hours post-delivery
Monitor Blood Pressure for symptoms of
hypotension and hypertension
Headache, dizziness, fatigue, insomnia,
hallucinations, depression, abnormal
involuntary movements.
(B & O) Belladonna and opium suppositories
 Used to reduce bladder spasms after prostate
surgery.
 Contains more than a score of alkaloids:
morphine, narcotine, papaverine, and codeine,
 Relax smooth muscle, relieve pain, and cause
sedation.
BPH Non-surgical treatment:
Alpha blockers: Relieve bladder obstruction from BPH
by decreasing tonic contraction of prostatic smooth
muscle.
finasteride (Proscar)- Prevents progression of growth of
the prostate or actually shrinks the prostate.
Cytoxan
 Hospitalization when chemotherapy drug course
is 10 days or greater when Cytoxan used with no
other medication.
 Given as intravenous chemotherapy infusion.
 It can also be given in pill form
 Pill must be taken with large amounts of water,
to prevent irritation, and kidney or bladder
damage.
 Side Effects: Neutropenia,Low platelet count,
Hair loss, N/V/D, fatigue, mucositis, amenorrhea,
nail changes - brittle or yellowed
Cytoxan Adverse Reactions
Fever of 100.5°F or higher
Painful or bloody urine
Black and sticky (tarry) stools, or bloody
stools
Unusual bruises or bleeding
Persistent cough, pneumonia
Allergic symptoms: shortness of breath,
swelling of feet or ankles, rash, swollen
throat
Vacuum constriction device (VCD)
 Used to promote an
erection by increasing
blood supply to the penis.
 Creates a partial vacuum
around the penis, which
draws blood into the
corpora cavernosa.
 (a) a plastic cylinder, which
covers the penis;
 (b) a pump, which draws
air out of the cylinder; and
 (c) an elastic ring, which,
when fitted over the base
of the penis, traps the
blood and sustains the
erection after the cylinder
is removed.
Vasectomy
 Postoperative teaching
 Must avoid strenuous physical exercise for 1
week
Terbutaline Pump
 Have patient:
 Demonstrate programming
the pump
 Verbalize selection of
injection sites.
 Verbalize symptoms that
need to be reported.
 Medication is administered
into PUMP
Ergot derivatives
Substances derived from fungus that
grows in rye bread.
Stimulate uterine smooth muscle
Bromocriptain
Methergine
Not used for labor induction
Produce powerful uterine contractions.
Prostaglandins
 Hemabate
 Dinoprostione (Prostin E2, Prepidil)
 Stimulate contraction of uterine smooth muscle
 Uses: Induction of 2nd trimester abortion,
Therapeutic Abortion, glaucoma treatment,
erectile dysfunction
 Main side effect: Gastrointestinal distress
 Used to terminate pregnancies between 12th and
20th weeks
 Risks include a retained placenta, cervical
trauma, later infection, bleeding, asthma or
hyperthermia.
 The most serious complications are a ruptured
uterus and cardiac arrest.
Cervidil (Dinoprostone) also known as Prostin E2
 10 mg vaginal insert
(suppository)
 It is used to prepare for
induction
 Placed transversely in
posterior fornix of the
vagina
 Remove at onset of
active labor or 12 hours
after insertion.
 Adverse effects: Uterine
hyperstimulation
 Fetal distress
Hypertonic Saline to induce abortion
 Also called "saline
amniocentesis", "salting out"
abortion.
 Method is used after 16 weeks
of pregnancy because there
needs to be enough amniotic
fluid to allow introduction of a
needle into the amniotic sac.
Normal Side effects:
 Warmth sensation
 Tingling feeling
Complications:
 blood clots, hemorrhage,
seizures, coma or death. This
method is not used much due to
its dangers.