OB Pharm and What Drugs You HAVE to Know

Okay. So we have the share screen feature. So I'll try not to take it in and just kind of be typing down thing. Um, I used to always do my chicken scratch, but now you guys will hopefully be able to read it much better. Um, okay. We have awesome. We have so many people reviewing for their end. CLECs this is great. So, okay, give me, bear with me while I share my screen and we'll go ahead and get started. Oh, let me first introduce myself to you guys so you know who I am. So I am Miriam and I, um, did the ob course on NRSNG. Um, so all the lessons that you see, you probably hear my voice, um, and hopefully hear in your head while you guys are taking your tests and all that in class. I'm helping you get through it. So I do that. And then now that that's set, I'm helping review other content. I'm helping with the, um, nursing practice questions and just whatever else they gave me to do and then love doing these tutoring sessions for you. All right. So let me share my screen.
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Alright. Can you guys see that?
Okay.
Okay, perfect. I didn't want to get started and make sure everybody can see or see the screen and know what we're doing. All right, so I'm going to take us through this process of this pregnant patient.
Um,
I just moved that heavily guys since the secret. So we'll go through this and then there'll be time at the end for you guys to ask any questions that you have that is, um, related to this or really anything ob. Alright, so let's start first. You have this patient. Okay. She is pregnant. So we are at the very beginning. She should be taking prenatal vitamin, which I just, um, abbreviate, SRP and be prenatal vitamins. So that's our number one thing all pregnant people should take. And this is because of the folic acid. So just kind of the basics of beginning here. So she's getting her folic acid and this is to prevent our neural tube defects and TD neural tube defects from forming that extra folic acid. So all women when they are thinking about conceiving or if they've just gotten pregnant, um, not planned, then they need to start taking this prenatal vitamin here.
All right, so your patient's pregnant, she's doing her prenatal vitamins. Fantastic. But now she goes into preterm labor. So our goal here with our, um, preterm labor is going to be to stop it. Right? Makes Sense. So how are we going to stop it? Okay, so we are going to have a few choices here. Um, the Pheta pain is one, um, is a calcium channel blocker. It will kind of stop those smooth muscle contractions that are happening. We obviously need to watch the patient's blood pressure with this since this is also a blood pressure medication. Right? So, um, I'll just put, so you know, B p watching, um, so we are going to give the fed pain. That's kind of been the first line treatment at least around here where I am. Um, this is obviously gonna vary between hospitals and units and that kind of thing.
The other big drug that's used a lot is called [inaudible]. Butylene. You might hear nurses say, we're going to turbo them. That's their talking about Sir to tribute a lien. This is given by IB. This medication we have to watch for maternal tachycardia. So this can cause maternal tachycardia. Um, this is one of those things where the benefit can outweigh the risk, but we want to monitor for this. Okay. So that's our tribute. Eataly. The other drugs that is used a lot to stop is going to be Indo methicillin, which is an n said, um, this one we just have to watch the baby's heart, um, because it can close one of those ductus with that. Um, but it is still used. The risk is very low. Um, they're obviously in the hospital when they're getting this. Um, but firstline is usually in a fed a pain.
Alright, so this patient, we have now stopped her labor. Uh, several weeks later she comes back and she is preeclamptic this train wreck patient. She keeps coming back to the unit. All right, so she's pretty clamped it. What does that mean? So preeclampsia is our patients that have, um, an elevated blood pressure and it's going to be one 40, over 90, usually times two checks, um, and they have to be spilling protein in their urine. Okay. So those are kind of our key things here for Preeclampsia. So elevated blood pressure, which is one 40 over 90 and not just one time. We're going to have to see that a couple of times and the protein. So I just remember the protein and the p Preeclampsia, um, always go together. Okay. So this patient comes back, she's symptomatic of this. This is all happening. So she's preeclamptic. So how are we going to treat that?
Well, we can do a couple things. Magnesium sulfate is going to be our big drug here to give. And the reason why we give this is it prevents seizures because our pre-clinic patients are patients that are at risk for having a seizure. When they have a seizure, they become e Clampton. So we are preeclamptic, we haven't seen as yet, but we could. Um, eclamptic means they've seen, so they get max sulfate and this is going to prevent the seizure from happening. And the awesome thing about the side effect of Mag Sofi is it is going to lower the blood pressure. So we really give it, this is often kind of a question that's asked. Um, we give it for this preventing seizures, but the side effect is lowering the blood pressure. If our preeclamptic patients need something else to help lower their blood pressure, love Beta wall is going to be our first kind of line there to give his labetalol, um, just to an antihypertensive to lower our blood pressure.
Okay. So we have fixed our preeclampsia patient kind of. Okay. So she's pretty classic. Um, of course this would really never happen because if they're planted, they probably aren't going to make it to term. But let's just say for our train wreck of the patient's sake, um, she gets to 41 weeks and is still pregnant. Okay. We need to have a baby, right? So we're going to induce her. So with our induction, there's a few things that can happen. They can have, um, prostoglandins is just started, the drug class and prostate leanings are going to be drugs like cervidil. Um, and site attacker B is the other one, which is also called Miso. Prestel. So notice me. So, so these drugs are drugs that are prostoglandins and they are cervical. I need to spell correctly here. Cervical ripening. So what does that mean? Cervical ripening means we're softening that cervix and um, getting it softened and ready to dilate.
Cause that's our goal, right? We need it to dilate so we can have a baby. Okay. So those are our acrostic leanings. Um, the other thing we can do is give oxytocin or pitocin and this is going to stimulate contractions. Um, so a lot of times they'll come in and get a service, they'll place a side attack, whatever it is, and then they will go ahead and get the oxytocin, pitocin with it to stimulate those contractions or to start. Um, so those are our drugs for that. Um, the other thing, which is not a drug, but I just want to mention here while we're talking about is a fully bulb you'll hear fully bulb induction. So when you guys think about those urinary catheters, you put that little balloon up in the bladder, you know, blow it up and it keeps that half that are in place, right?
Well, with a Foley Bulb, that balloon is placed in the cervix. It's blown up and it's going to cause that cervix to mechanically, manually dilate. Um, and then they will, so after that they'll give some oxytocin pitocin to get the contractions started as well. So that's just another way to induce somebody. All right, so we've been doing start, she's finally in labor and of course she is in pain. So several things we can do here we can give, um, things like state all or new vein. Those are kind of some narcotics that we can give while they're in labor. Um, so these drugs, we had some auto-correct. Let me fix that. The state, all our new bank. Um, so these drugs are given, usually Ivey to, to the mom. And this will help as the narcotic to relieve some of that pain that she's having. The important thing to know here, so to take note of and star is that we want to have narcan available.
If the baby is close to delivering and she gets these drugs and then she delivers the baby can have respiratory depression and that's just because the drug affects them. So it's okay if the baby stays in Utero, but if the baby quickly delivers thereafter, then the NICU might need to attend and have narcan at the bedside to reverse that respiratory depression in the baby. Um, just because they're opioids. So we get respiratory depression. Okay. So we typically don't want to give those. If the mom is very close to delivering, she's in early labor and it's just having so much pain, it doesn't quite want the epidural yet. Then stayed all our new bank could be a good option. Um, and then like I just mentioned epidural, so we should all hopefully know what that is. That's just where we um, have anesthesia com place the epidural and um, kind of paralyzing them.
The lower half of the body, so that will take away that pain. Um, so they can have that. Uh, the other thing that's used a lot now is nitrous oxide. So nitrous oxide, it's laughing gas and it just kind of helps take the edge off for the patient so they can get back also at hospitals that offer it. Not all hospitals offer it, but it is becoming kind of a widespread use now. Okay. So she delivers, she has this baby and of course she has a postpartum hemorrhage because she's a train wreck. Right? And she was preeclamptic. Um, and that puts them more at risk. Um, for a postpartum hemorrhage. I'm just going to put pre e more at risk. Okay. So this patient has a postpartum hemorrhage. So our goal here, just like in preterm labor is to stop it, right? We want to stop that bleeding.
So what can we do to stop it? We have a few options here. Usually first line we're going to quickly, if it's not already going, give oxytocin pitocin because that will stimulate contractions. So the woman will be start contracting, um, clamped down that uterus. And hopefully stop. If that does not work or we need more medication, we can give something called two things. Methyl are gone. Oh Bean, um, or methergine. Um, and this will cause the contractions also to stop the bleeding with this drug. It is contraindicated and these will always usually be tough questions to make sure you know, this contra indicated in a patient that is hypertensive because it causes that vascularity, um, to construct. So it can cause, um, worsening hypertension in a person that is already hypertensive. Okay. So that's our math region. Our other one is carb prose and this is also, um, you'll hear hemo Hemabate.
So this drug does the same thing, um, works like math or gym, but this one is going to be contra indicated if the patient has asthma. Okay. So you are typically going to be asked questions and always have these two as a choice and your patient will either have asthma or either have hypertension. Um, sometimes it's a benefit risk thing and the doctor just needs to be reminded like, Hey, I'm, are you sure you want to give methods in this patient? It was preplanned stick or whatever it may be. Um, so we might not want to get, so those are our contra indications. But of course the benefit risks thing can always play a part in that. Okay. So those drugs and then another one is the cytotech which of you remember we also gave that as something that would cause an induction to happen because it causes those contractions.
Society tech or Miso can also be given to stop a postpartum hemorrhage. And then a newer drug I want to tell you guys about that is not actually um, in the lessons on NRSNG because it is kind of a brand new thing that's being used. And I think you all will start, you'll see it probably in clinical, um, or you'll see it on questions. I just want to make you aware is Transi mc acid. Um, it's also known as TX a so this is becoming kind of a first line treatment that we are giving to all women after they deliver. Um, and this is going to prevent or manage a postpartum hemorrhage. Um, it is, it's drug classes. It's an anti five Grin Olympics. So that means what we are causing blood clots to form and it's allowing them to not break down. It's antifibrinolytic.
Um, so it's just kind of being given as a prophylactic to these patients. Um, so just a newer drug out there that is being widespread used right now. Alright. So we stopped the bleeding. Awesome. Now she is just in her postpartum world with her baby and she is in pain. So she's having contractions that post, um, after the delivery, the contractions happen with the uterus to clamp down and get it back to its normal state. So we can give Motrin or Ibuprofen. Um, obviously Kodokan or um, Norco are used a lot. Uh, whatever people are using sometimes, um, other and says Tylenol of course also. So just depending on the patient allergies, all that. But those are kind of our drugs for postpartum, just normal pain control. All right, now let's talk about the baby. So the baby's going to get some medicine. So at birth the baby will get Arithromycin and vitamin K. So arithromycin is an antibiotic ointment that's given in the eyes and it is given to treat or to prevent if the mom had chlamydia or gonorrhea.
So that is going to be our antibiotic to that because it can prevent blindness from happening to the baby. If the baby passes through a birth canal that had chlamydia or gonorrhea, that baby can go blind. I'm so Erythromycin is given prophylactic because these two, um, STDs or stes are typically asymptomatic so a woman could have them and not be known. Um, so we get arithromycin to all babies and then vitaminK , vitaminK is going to help the baby with blood clotting cause the baby's not born with all the factors that it needs right at birth for blood clotting. Um, so vitaminK given to all babies. And one other thing, um, is our Hep B. So after the baby delivers, it'll get hep-b before going home. Usually just its first round of um, a vaccine, that series of three. So that is that. The other thing I meant to mention up here when our patient way up here that was in preterm labor, she is going to get when she's in preterm labor, something called Beta methazone or dexamethazone.
And as you can see, if you notice with your drugs, that one means it's a steroid, right? So what this does is it is given to the mom, but it is for the baby's lungs, um, fetal lung maturity. So that way if we can't stop her preterm labor, the baby has a better chance of doing okay respiratory wise when it's born. So we will give these drugs. Um, and typically that's if she's between 24 and 34 weeks pregnant at 35 weeks, it is said that those lungs should be mature. Um, so just between 24 and 34 weeks, we'll give the Beta methazone to the mom and it's given ivy, um, for fetal lung maturity. Let's say that when the baby is born, the baby has trouble respiratory wise, um, maybe the Beta methazone didn't work or whatever it may be. Yes, I'll scroll up and just one second.
Let me type this for the baby. Um, the baby will get surfactant and that's just through a m e t tube down in the lungs, um, to help. And this will help with the lung maturity. Um, so I'm just telling you that because sometimes that's a question with the surfactant versus the Beta medicine. So Beta Methadone is given to the mom mom for lung maturity and the surfactant is given to the baby. So let me scroll up here. That is my, just on that and I'll let you guys just kind of look or take pictures, whatever, and I'll keep it up here and then I'll scroll back down. Um, to make sure everybody has it. One other thing here to say about the magnesium sulfate. So this causes relaxation. Haven't think about just magnesium in general. So we have to watch, um, reflexes on the patient and we also need to have calcium gluconate at the bedside.
And that is because this is the reversal agent. If the mom becomes too mad toxic. So if we see that she has no reflexes, I'm not responding to things. Um, and she is toxic with a magnesium than calcium gluconate will reverse that. So that's our antidote for that. And that's usually a has question as well. Steve, are you good if I scroll down? Yes. Mag can also be given for preterm labor, correct. Magnesium sulfate, um, can be given yes for free preterm Labor to help those contractions as well. I'll add that there's so many drugs, right? And they have all these different uses uses and hopefully you guys have a better understanding. Um, okay, sorry. Preterm labor. Can you start at the top for screenshots? Yes. Okay. So let's, here we are, we're all the way at the top with our pregnant patient and I'll give you a second and then we'll scroll down to make sure everybody is covered. Don, are you good? Okay. So let's come down here to get the bottom of our screen here. Um, Yep. There's our postpartum hemorrhage. Let me scroll a little bit more and we'll get all that. Cause postpartum hemorrhage was at the bottom. There we go.
Okay.
Hopefully you guys got it. What questions do you guys have about these medications or anything? Ob, anything you've seen in clinical, something you're not sure of and I'm happy to try to help. I'm going to stop my screen sharing if you guys got that so that, um, you're not just staring at that and then hit me with any questions that you have. There we go. All right. What questions do you guys have? We that helped kind of taken a patient through everything. Obviously some of that stuff. Um, your patient hopefully wouldn't be that big of a train wreck. Um, but hopefully that kind of helped to do that and see each little, um, phase oh, dosage for mag sulfate. Let me go to the course and see because that could also vary with what we're giving. Um, give me one second. I don't, let's see if we have it. Sorry. It's being low. Slow loading here. There we go. And I will give you a link to that lesson. Um, yes. So
yeah.
First let me give you the link and then I will copy and paste what's in here. There's really two Max sulfate and then obviously it's gonna, um, or be varied if you're giving for preterm labor, what you're giving it for.
Okay.
That there is um, the mag levels and the therapy. Great. So usually the MAG is going to be given for, so I'm putting, these are our lab range levels so there'll be tracking that on the patient to make sure they're in a therapeutic range. Um, and I think I missed a question up here and then I'll get down to about it. Um, Preeclampsia is high B. Yes. So preeclampsia is high BP, so, and it's one 40 over 90 is your number. So one 40, over 90. And like I said, not just one time. Right. We want to see back a couple times cause some people have that white coat syndrome could have one high one. We're not gonna Freak. Yeah. Um, and they will have protein in the urine. So that is the other big key. There is protein in the year end. You are not preeclampsia unless you're spilling protein.
Um, and then that will be that they do not have seizures. If they have a seizure, then it turns to a clamp. Sia. So that's just the difference there. Um, and then what our common ob questions that tend to show up most on an NCLEX exams. Um, Chris, I've been asked this a lot or different things with ob and in class, I feel like it's a specialty, so I don't know. Um, you know, I, I wish I had the answers for all the and class questions because, um, I know it would make everyone's life easier, but I don't. So, and it is just varied on, you know, how the computer system is pulling the questions in. Um, so I will say that drugs are a big thing because pharmacology can be pulled in. So just knowing all the drug stuff for in class. Um, and then just looking at, I think the antepartum lesson is probably a good one to Kinda, um, looking, watch the video on and I can take you into that in a second and show you, um, because it has all the different testing and what you're kind of looking for a, if you kinda know the drugs and what to, how to treat the different things, that's awesome.
And then knowing like contraction, stress test, what we're looking for, non-stress tests, what we're looking for, then that would be good to know. Um, so I wish I can give you more of an answer, but unfortunately, who ever knows what's going to be on that in class because it's just pulled from all over the place. Um, but just don't focus on things that you already know if you know it and move on and go to something else. Um, you know, it's only Maggie, it's just mag sulfate. That is what is given,
um,
magnesium chloride is just because, yes. So true. Um, you're welcome. Yeah. That, that man isn't chloride. That's not anything that's used for ob. So magnesium sulfate is going to be what's used. It's just your different, um, labs that you were talking about. Let me show you guys too. I'm gonna screen share again just to show you one other thing. Give me one second.
Tire spin.
Okay, so over here, hopefully you guys can this. If you go into Arison g and you can type, um, I had typed originally ob farm [inaudible] and it'll take you really into, oh, it's, I just click one of them, which is our rh Immunoglobulin, which I did not mention that one. So I can go back and tell you guys about that in just a second. So this takes you into, you can see on the right hand side all of the lessons that are there. Um, and then down at the bottom, all of module 12 is the pharmacology. So it has the newborn and maternal mr going to be maternal. There's not that many for that newborn, but just to kind of click through if you need more on any of these, um, or you're a little confused on something later when you look back at your notes, go into here and all of less than 12 when they're split apart for you. So Toca lytics, that's our how we stop preterm labor. Um, and then it goes down from there so you can use that and it kind of tells you I v Po and the things to watch for with each one. Um, so hopefully that will kind of help with that. Um, just so you can see.
Always helpful. Um, oh, so the rh immune globulin and I wanted to mention, so our h if you have your patient, I was supposed to say that our um, train wreck patient was a negative. Um, but so many things to remember when we were going through her story. So if your patient is a negative blood type, so any negative, um, a B negative, ab, negative, [inaudible], negative, any of those, you are going to have her half Rogan's rote GAM shot given. And it's just an I am injection and it is given around 28 weeks. Okay. So she gets it around 28 weeks. And that is because she's a negative rh status, which means she doesn't have these antibodies. So she's a negative stat. So we don't want her to have any blood, make sure that baby and start making antibodies against the pregnancy after she delivers.
If her baby is a positive blood type, um, if she, if the baby's a negative blood type, we don't have to worry if the baby's, uh, positive blood type, then we need to give her Rhogam again and that's going to be within 72 hours of delivery. Um, and what's that's going to do is to prevent future pregnancy. So if any blood mixture happened at delivery, then it will prevent her from making antibodies against any future babies that she becomes pregnant with so that her body doesn't attack it. The body will start to see us foreign. Um, so that's what that is given for. So she will get it that 28 at eight ish week and then within three days of delivering. Um, and then any time in the pregnancy that there is a possibility that blood mixture occurred. So that means a car accident. Um, anything like that that maybe a motor vehicle accident like that seatbelt hitting, um, things that could cause a blood mixture or a fall. It's very rare, but the effects of it can be totally detrimental if she has a problem with a future or her body attacking the pregnancy. So that's why it's given. Um, also any woman that has a negative blood type that has a miscarriage should also just be given Rhogam, um, for that miscarriage. So that's your program. Um, and there's a whole lesson on that if you need more about that. Also. What other questions do you guys have any other questions?
Okay.
Okay. Do you guys know a second? I know sometimes when questions it takes a minute to type them or if you guys have anything that you really, um, want to have a tutoring session on that's ob related or I also do the communication stuff. Let me know. I'm going to be putting in my time for my next set of tutoring sessions. And so do you have anything that you really are, um, having trouble with or would like to hear more about? Um, let me know and I can do that for you all. I'm glad you guys joined me on this Saturday morning. I wasn't sure how many we had, but we had a great turnout.
Oh good. I'm glad. It was great. I hope it was helpful and I didn't confuse you guys more with our train wreck patient. I think ob farm is a good one. Very helpful. Great. Yes, it's a lot of information but hopefully not be, have these screenshots. Are you taking notes down it you can kind of go back through and remember the little things. Awesome. Oh good. I'm glad. It's less scary. It's a lot of medication, a lot. So just remember if you just practice knowing what it's used for, um, and then if you're any contrary indication things to watch for and if there's an antidote, like the calcium glute kink from acts. So faith and you guys will be perfect. You'll be all set. Good. I'm glad it was helpful. All right guys. Look, you don't have any other questions. Um, then thank you for joining me. And as always, happy nursing.