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24.02 Opioid Analgesics in Pregnancy

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Overview

  1. Opioids are given for moderate to severe pain
    1. They will not provide the same relief as an epidural
  2. They are typically given IV in labor and fast-acting
  3. Given PO in the postpartum period to treat pain

Nursing Points

General

  1. Ideal to be given when needed for breakthrough/acute pain during labor, not chronically throughout pregnancy
    1. Newborn can be born addicted→ refer to addicted newborn lesson
  2. History taking is essential before administration to make sure they haven’t been taking them during pregnancy
  3. Some meds are contraindicated if someone is already dependent on specific meds, as they may elicit withdrawal symptoms for both baby and mom

Assessment

  1. Patient history
  2. Pain level
  3. How close is the patient to delivery

Therapeutic Management

  1. Medicate properly
    1. Hydromorphone (Dilaudid)
    2. Morphine
    3. Butorphanol tartrate (Stadol)
    4. Nalbuphine (Nubain)
    5. Oxycodone
    6. Hydrocodone
  2. Naloxone available
  3. Anti nausea medications
    1. Nausea is a side effect of Opioids
  4. Monitor for overdose
    1. Respirations less than 12/min is a concern
    2. Hypotension

Nursing Concepts

  1. Pharmacology
  2. Comfort
  3. Safety

Patient Education

  1. Fast acting
  2. Treatment options
Study Tools
OB Medications (Cheat Sheet)

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Pharmacology for Nursing (MedMaster)

Course Description

Jon Haws, BS, BSN, RN, CCRN Alumnus

Tarang Patel, DNP-NA, RN, CCRN, RPh

Nichole Weaver, MSN/Ed, RN, CCRN

Miriam Wahrman, MSN/Ed, RNC-MNN

Kara Tarr, BSN, RN

Nacole Riccaboni, MSN, AGACNP-BC, FNP-BC, CCRN, CMC

Module 0 – Pharmacology Course Introduction
00.01 Pharmacology Course Introduction
Module 1 – NCLEX Must Knows
01.01 12 Points to Answering Pharmacology Questions
  • Questions: 20
01.02 54 Common Medication Prefixes and Suffixes
  • Questions: 20
01.03 Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
  • Questions: 13
01.04 Essential NCLEX Meds by Class
  • Questions: 21
01.05 6 Rights of Medication Administration
  • Questions: 10
01.06 Pharmacodynamics
  • Questions: 5
01.07 Pharmacokinetics
  • Questions: 10
01.08 The SOCK Method – Overview
01.09 The SOCK Method – S
01.10 The SOCK Method – O
01.11 The SOCK Method – C
01.12 The SOCK Method – K
Module 2 – Math for Meds
02.01 Basics of Calculations
  • Questions: 10
Dimensional Analysis Nursing (dosage calculations/med math)
  • Questions: 1
02.03 Oral Medications
  • Questions: 7
02.04 Injectable Medications
  • Questions: 4
02.05 IV Infusions (Solutions)
  • Questions: 3
02.06 Complex Calculations (dosage calculations/med math)
  • Questions: 3
02.07 Interactive Pharmacology Practice
02.08 Interactive Practice Drip Calculations
02.09 Pediatric Dosage Calculations
Module 3 – Disease Specific Medications
03.01 Disease Specific Medications
  • Questions: 10
Module 4 – Antianxiety Agents
04.01 Antianxiety Meds
  • Questions: 2
04.02 Benzodiazepines
  • Questions: 10
04.03 Alprazolam (Xanax)
04.04 Lorazepam (Ativan)
04.05 Midazolam (Versed)
04.06 Diazepam (Valium)
04.07 Buspirone (Buspar)
03.03 Antianxiety Meds
  • Questions: 2
Module 5 – Antiarrhythmics
05.01 ACLS (Advanced cardiac life support) Drugs
  • Questions: 7
05.02 Amiodarone (Pacerone)
05.03 Adenosine (Adenocard)
05.04 Procainamide (Pronestyl)
Module 6 – Anticoagulants & Thrombolytics
06.01 Anti-Platelet Aggregate
  • Questions: 5
06.02 Clopidogrel (Plavix)
06.04 Warfarin (Coumadin)
  • Questions: 1
06.06 Enoxaparin (Lovenox)
06.07 Heparin
06.08 Thrombolytics
  • Questions: 4
06.09 Alteplase (tPA, Activase)
06.10 Streptokinase (Streptase)
  • Questions: 1
Module 7 – Anticonvulsants
07.01 Anticonvulsants
  • Questions: 4
07.02 Carbamazepine (Tegretol)
07.03 Divalproex (Depakote)
07.04 Gabapentin (Neurontin)
07.05 Lamotrigine (Lamictal)
07.06 Levetiracetam (Keppra)
07.07 Phenytoin (Dilantin)
Module 8 – Antidepressants
08.01 Antidepressants
08.02 Bupropion (Wellbutrin)
08.03 MAOIs
  • Questions: 3
08.04 Selegiline (Eldepyrl)
08.05 SSRIs
  • Questions: 5
08.06 Escitalopram (Lexapro)
08.07 Fluoxetine (Prozac)
08.08 Paroxetine (Paxil)
08.09 Sertraline (Zoloft)
08.10 TCAs
  • Questions: 3
08.11 Amitriptyline (Elavil)
Module 9 – Antidiabetic Agents
09.01 Antidiabetic Agents
  • Questions: 4
09.02 Glipizide (Glucotrol)
09.04 Insulin
  • Questions: 12
09.05 Insulin – Rapid Acting (Novolog, Humalog)
09.06 Insulin – Short Acting (Regular)
09.07 Insulin – Intermediate Acting (NPH)
09.08 Insulin – Mixtures (70/30)
09.09 Insulin – Long Acting (Lantus)
Module 10 – Antihistamines
10.01 Histamine 1 Receptor Blockers
  • Questions: 1
  • Cheat Sheets: 1
10.02 Diphenhydramine (Benadryl)
10.03 Promethazine (Phenergan)
10.04 Histamine 2 Receptor Blockers
  • Questions: 2
10.05 Cimetidine (Tagamet)
10.06 Famotidine (Pepcid)
10.07 Ranitidine (Zantac)
Module 11 – Antihypertensives
11.01 Renin Angiotensin Aldosterone System
11.02 Sympatholytics (Alpha & Beta Blockers)
  • Questions: 16
11.03 Atenolol (Tenormin)
11.04 Metoprolol (Toprol XL)
11.05 Propranolol (Inderal)
11.06 ACE (angiotensin-converting enzyme) Inhibitors
  • Questions: 4
11.07 Captopril (Capoten)
11.08 Enalapril (Vasotec)
11.09 Lisinopril (Prinivil)
11.10 Angiotensin Receptor Blockers
11.11 Losartan (Cozaar)
11.12 Calcium Channel Blockers
  • Questions: 3
11.13 Amlodipine (Norvasc)
11.14 Diltiazem (Cardizem)
11.15 Nifedipine (Procardia)
11.16 Verapamil (Calan)
11.17 Cardiac Glycosides
  • Questions: 9
11.18 Digoxin (Lanoxin)
Module 12 – Anti-Infectives
12.01 Anti-Infective – Aminoglycosides
  • Questions: 5
12.02 Gentamicin (Garamycin)
12.03 Anti-Infective – Antifungals
  • Questions: 5
12.04 Metronidazole (Flagyl)
  • Questions: 1
12.05 Nystatin (Mycostatin)
12.06 Anti-Infective – Antitubercular
  • Questions: 5
12.07 Isoniazid (Niazid)
12.08 Rifampin (Rifadin)
12.09 Anti-Infective – Antivirals
  • Questions: 5
12.10 Acyclovir (Zovirax)
12.11 Anti-Infective – Carbapenems
  • Questions: 5
12.12 Meropenem (Merrem)
12.13 Anti-Infective – Fluoroquinolones
  • Questions: 6
12.14 Ciprofloxacin (Cipro)
12.15 Levofloxacin (Levaquin)
12.16 Anti-Infective – Glycopeptide
  • Questions: 4
12.17 Vancomycin (Vancocin)
12.18 Anti-Infective – Lincosamide
  • Questions: 5
12.19 Clindamycin (Cleocin)
  • Questions: 2
12.20 Anti-Infective – Macrolides
  • Questions: 5
12.21 Erythromycin (Erythrocin)
12.22 Azithromycin (Zithromax)
12.23 Anti-Infective – Penicillins and Cephalosporins
  • Questions: 7
12.24 Amoxicillin (Amoxil)
12.25 Ampicillin (Omnipen)
12.26 Cefaclor (Ceclor)
12.27 Cefdinir (Omnicef)
12.28 Cephalexin (Keflex)
12.29 Anti-Infective – Sulfonamides
  • Questions: 5
12.30 Trimethoprim-Sulfamethoxazole (Bactrim)
12.31 Anti-Infective – Tetracyclines
  • Questions: 6
12.32 Tetracycline (Panmycin)
Module 13 – Antipsychotics
13.01 Atypical Antipsychotics
  • Questions: 2
13.02 Chlorpromazine (Thorazine)
13.03 Antipsychotics
  • Questions: 5
13.04 Haloperidol (Haldol)
13.05 Quetiapine (Seroquel)
13.06 Olanzapine (Zyprexa)
Module 14 – Autonomic Nervous System Meds
14.01 Autonomic Nervous System (ANS)
  • Questions: 4
14.02 Methylphenidate (Concerta)
14.03 Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
14.04 Dobutamine (Dobutrex)
14.05 Dopamine (Inotropin)
14.06 Carbidopa-Levodopa (Sinemet)
14.07 Parasympathomimetics (Cholinergics)
14.08 Neostigmine (Prostigmin)
14.09 Parasympatholytics (Anticholinergics)
  • Questions: 2
14.10 Atropine (Atropen)
14.11 Benztropine (Cogentin)
14.12 Diphenoxylate-Atropine (Lomotil)
Module 15 – Bronchodilators & Respiratory Drugs
15.01 Guaifenesin (Mucinex)
15.02 Bronchodilators
  • Questions: 2
15.03 Albuterol (Ventolin)
15.04 Montelukast (Singulair)
15.05 Salmeterol (Serevent)
Module 16 – Diuretics
16.01 Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
  • Questions: 1
16.02 Furosemide (Lasix)
  • Questions: 4
16.03 Hydrochlorothiazide (Hydrodiuril)
16.04 Spironolactone (Aldactone)
16.05 Mannitol (Osmitrol)
Module 17 – GI Meds
17.01 Bisacodyl (Dulcolax)
  • Questions: 1
17.02 Bismuth Subsalicylate (Pepto-Bismol)
17.03 Lactulose (Generlac)
17.04 Loperamide (Imodium)
17.05 Metoclopramide (Reglan)
17.06 Ondansetron (Zofran)
17.07 Pancrelipase (Pancreaze)
17.08 Sucralfate (Carafate)
17.09 Proton Pump Inhibitors
17.10 Omeprazole (Prilosec)
17.11 Pantoprazole (Protonix)
Module 18 – Hormone & Immune Related Drugs
18.01 Epoetin Alfa
  • Cheat Sheets: 2
18.02 Epoetin (Epogen)
18.03 Glucagon (GlucaGen)
  • Questions: 1
18.04 Iodine
18.05 Levothyroxine (Synthroid)
18.06 Propylthiouracil (PTU)
18.07 Cyclosporine (Sandimmune)
Module 19 – Lipid Lowering Drugs
19.01 HMG-CoA Reductase Inhibitors (Statins)
  • Questions: 2
19.02 Atorvastatin (Lipitor)
Module 20 – Mineral and Electrolyte Drugs
20.01 Magnesium Sulfate
  • Questions: 1
  • Cheat Sheets: 1
20.02 Magnesium Sulfate in Pregnancy
20.03 Magnesium Sulfate
20.04 Calcium Acetate (PhosLo)
20.05 Calcium Carbonate (Tums)
20.06 Ferrous Sulfate (Iron)
  • Questions: 4
20.07 Alendronate (Fosamax)
Module 21 – Mood Stabilizers
21.01 Mood Stabilizers
21.02 Lithium (Lithonate)
Module 22 – Non-Opioid Analgesics
22.01 Acetaminophen (Tylenol)
22.02 Phenazopyridine (Pyridium)
  • Questions: 1
22.03 NSAIDs
  • Questions: 4
22.04 ASA (Aspirin)
  • Questions: 1
22.05 Celecoxib (Celebrex)
22.06 Ibuprofen (Motrin)
22.07 Indomethacin (Indocin)
22.08 Ketorolac (Toradol)
22.09 Naproxen (Aleve)
Module 23 – OB Meds
23.01 Tocolytics
  • Questions: 2
23.02 Terbutaline (Brethine)
23.03 Uterine Stimulants (Oxytocin, Pitocin)
  • Questions: 6
23.04 Meds for Postpartum Hemorrhage (PPH)
  • Questions: 9
  • Cheat Sheets: 1
23.05 Methylergonovine (Methergine)
23.06 Oxytocin (Pitocin)
23.07 Prostaglandins in Pregnancy
  • Questions: 1
23.08 Rh Immune Globulin in Pregnancy
  • Questions: 2
23.09 Lung Surfactant for Newborns
  • Questions: 4
23.10 Eye Prophylaxis for Newborn
  • Questions: 2
23.11 Phytonadione (Vitamin K) for Newborn
  • Questions: 4
23.12 Hepatitis B Vaccine for Newborns
  • Questions: 4
Module 24 – Opioid Analgesics
24.01 Opioids
  • Questions: 7
24.02 Opioid Analgesics in Pregnancy
24.03 Butorphanol (Stadol)
24.04 Codeine (Paveral)
24.05 Fentanyl (Duragesic)
24.06 Hydrocodone-Acetaminophen (Vicodin, Lortab)
24.07 Hydromorphone (Dilaudid)
24.08 Meperidine (Demerol)
24.09 Methadone (Methadose)
24.10 Morphine (MS Contin)
24.11 Nalbuphine (Nubain)
24.12 Oxycodone (OxyContin)
Module 25 – Sedatives / Hyponotics
25.01 Sedatives-Hypnotics
25.02 Barbiturates
  • Questions: 3
25.03 Phenobarbital (Luminal)
25.04 Pentobarbital (Nembutal)
25.05 Anesthetic Agents
  • Questions: 5
25.06 Propofol (Diprivan)
25.07 Lidocaine (Xylocaine)
Module 26 – Steroids
26.01 Corticosteroids
  • Questions: 5
  • Cheat Sheets: 1
26.02 Betamethasone and Dexamethasone in Pregnancy
  • Questions: 2
26.03 Cortisone (Cortone)
26.04 Dexamethasone (Decadron)
26.05 Fluticasone (Flonase)
26.06 Methylprednisolone (Solu-Medrol)
Module 27 – Vasodilators
27.01 Hydralazine
  • Questions: 2
27.02 Hydralazine (Apresoline)
27.03 Nitro Compounds
  • Questions: 4
  • Cheat Sheets: 2
27.04 Nitroglycerin (Nitrostat)
27.05 Nitroprusside (Nitropress)
Module 28 – Vasopressors
28.01 Vasopressin
  • Questions: 1
28.02 Epinephrine (EpiPen)
  • Questions: 2
28.03 Norepinephrine (Levophed)
28.04 Vasopressin (Pitressin)
Module 29 – Medications By Class
29.01 ACLS (Advanced cardiac life support) Drugs
29.02 Anti-Infective – Aminoglycosides
29.03 Anti-Infective – Carbapenems
29.04 Anti-Infective – Macrolides
29.05 Anti-Infective – Fluoroquinolones
29.06 Anti-Infective – Sulfonamides
29.07 Anti-Infective – Tetracyclines
  • Questions: 6
29.08 Anti-Infective – Antifungals
29.09 Anti-Infective – Antivirals
29.10 Anti-Infective – Lincosamide
29.11 Thrombolytics
29.12 Anticonvulsants
29.13 Antidiabetic Agents
29.14 Sympatholytics (Alpha & Beta Blockers)
29.15 Anti-Infective – Antitubercular
29.16 Anti-Infective – Glycopeptide
29.17 Bronchodilators
29.18 Opioids
29.19 Barbiturates
29.20 Anesthetic Agents
Module 30- Antineoplastics
30.01 Antineoplastics
30.02 Alkylating Agents
30.03 Antimetabolites
30.04 Anti Tumor Antibiotics
30.05 Plant Alkaloids Topoisomerase and Mitotic Inhibitors
Module 31 – Medication Infusion
31.01 Patient Controlled Analgesia (PCA)
31.02 Epidural
31.03 Insulin Drips
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