The document discusses various drugs used during pregnancy for common discomforts like nausea, heartburn, constipation and pain. It covers iron, folic acid and multivitamins for nutritional needs in pregnancy. It also discusses drugs that decrease or enhance uterine contractions like magnesium sulfate, terbutaline and oxytocin. Nursing responsibilities are outlined for monitoring mothers and fetuses when using these medications.

1. Reproduct
ive
and
Gender-
Related
Agents
Ma. Tosca Cybil A. Torres, RN,
MAN

2. Therapeutic Drug
Use in
Pregnancy

3. • Iron
– In pregnancy, approximately 2x the normal
amount of iron is need to meet fetal and
maternal daily requirements
– 27mg daily
– Needed during the 2nd trimester where the
fetus begins to store iron
– GOAL: to prevent maternal deficiency, not
supply the fetus

4. • Iron
– Ex:
• Ferrous sulfate 20% (300mg of ferrous sulfate is equivalent
to 60mg elemental iron)
– Adverse effect:
• Nausea, constipation, black or tarry stools, epigastric pain,
vomiting, and diarrhea
– Nursing implications:
• Liquid for should be diluted and administered through a
straw to prevent teeth discoloration
• May inhibit absorption of others medications, appropriate
separation of doses should be followed
• Instruct to take between meals---1hour before meals is
suggested
• Do not administer with milk or antacids
• Advise client to swallow whole, not to crush

5. • Folic Acid
– Needed to prevent spontaneous abortion or birth
defects, premature births, LBW, and premature
separation of the placenta
– RDA: 400mcg to women of childbearing age
– RDA: 600mcg for pregnant women
– Recommended amount should be ingested from
folate-enriched foods and supplementation
• Ex:
– Bread, rolls, flour, cornmeal, rice, pasta, and cereals
• Adverse reactions:
– Allergic bronchospasm, rash, pruritus, erythema,
and general malaise
– May turn urine in an intense yellow

6. • Multivitamins
– Preparations generally supply vitamins
A,D,E,C,B complex, iron, calcium and other
minerals
– Helps prevent congenital defects
– Most effective if taken with meals
– Vitamin A in large doses can be teratogenic
– Excessive ingestion of vitamins D,E, and K
can be toxic

7. Drugs for
Minor
Discomforts
of
Pregnancy

8. • Physiologically, minor discomforts in
pregnancy are associated with increased
level of human chorionic
gonadotropin(HCG) levels
• Increased levels of progesterone relaxes
smooth muscles which contributes to the
discomforts of heart burn and constipation
• Elevated female sex hormones during
pregnancy changes the motility of the GI
tract and the enlarging fetus displaces the
bowel

9. • Nausea and vomiting (morning
sickness) are major complaints
during early pregnancy and
hyperemesis gravidarum which
needs hospitalization for hydration
and nutrition

10. • The FDA did not approve any drug for the
treatment of morning sickness but the common
drugs used are:
– Prokinetic agents
• Metoclopramide (Reglan)
– Anticholinergic
• Scopolamine (Scopace)
– Phenothiazine
• Promethazine (Phenergan)
– Antihistamines
• Meclizine(Antivert)
– SE: dizziness, drowsiness, dry mouth and nose, blurred vision,
diplopia, urinary retention, palpitations and tachycardia

11. • Heartburn (pyrosis)
– Burning sensation in the epigastric and
sternal regions that’s occurs with reflux of
acidic stomach contents
– Results from a normal increase in
progesterone----relaxing the cardiac
sphincter

12. Pharmacological management
• Antacids- first line of therapy if client did not respond to non
pharmacological management
– Magnesium hydroxide and aluminum hydroxide with
Simethicone(Maalox plus)
» For heartburn with antiflatulence action
– Aluminum hydroxide (Amphojel)
» For heartburn secondary to reflux
» Action: neutralization of gastric acidity
» SE: constipation
» AR: dehydration, GI obstruction
» Nursing responsibility:
• Instruct to store liquid form in room
temperature, not to let it freeze, and to shake
bottle well before pouring

13. • Constipation
– Frequent in pregnancy due to decreased GI
motility
– Safest oahrmacological management is the use of
bulk-forming preparation with fiber
• Metamucil
• Docusate sodium –stool softener
Avoid use of castor oil----promotes uterine contractions
Avoid intake of mineral oil----reduces absorption of
vitamin K

14. • Pain
– Acetaminophen(Tylenol, Datril)
• Pregnancy category B
• With analgesic and antipyretic effects
• A weak prostagladin inhibitor and does not have
significant anti-inflammatory effect
• should be used cautiously in clients at risk for infection
because of the possibility of masking s/sx
• SE: skin eruptions, urticaria, unusual
bleeding, erythema, hypoglycemia, jaundice, hemolytic
anemia, thrombocytopenia

15. • Pain
– Aspirin (ASA, Bayer, Ecotrin)
• Classified as a mild analgesic
• Pregnancy category C
• Prostaglandin synthetase inhibitor that has
antipyretic, analgesic, and anti-inflammatory properties
• No known teratogenic effect, risk for anomalies is small
• Inhibits the initiation of labor and actually prolong
labor
• May increase risk of anemia and antepartum
hemorrhage

16. Drugs
that
Decreas
e Uterine
Muscle
Contracti

17. • Tocolytic Therapy
– Drug therapy that decreases uterine muscle
contractility for clients who are experiencing true
PTL (with cervical changes)
– Goal:
• to inhibit or interrupt uterine contractions to
create additional time for in utero fetal
maturation
• delay delivery so antenatal corticosteroids can be
delivered to facilitate fetal lung maturation
• to allow safe transport of mother to an
appropriate facility

18. • Tocolytic therapy
– Beta-Sympathomimetic Drugs
• Act by stimulating beta2 receptors of smooth muscles.
The frequency and intensity of uterine contractions
decrease as the muscle relaxes
• Prototype:
– Terbutaline (Brethine)-most commonly used
• AR:
– maternal side effects include tremors, malaise, weakness,
dyspnea, tachycardia (maternal and fetal), chest pain,
vomiting, diarrhea, constipation, pulmonary edema,
dysrrhythmias, anaphylactic shock.
– Fetal side effects include tachycardia and potential
hypoglycemia
• Drug interactions:
– general anesthetics--- can produce additive hypotension
– Corticosteroids--- pulmonary edema

19. • Nursing considerations:
– Monitor and assess uterine activity and FHT
– Maintain client in left lateral position as much as
possible to facilitate uteroplacental perfusion
– Monitor maternal V/S
– monitor daily weight to assess fluid overload;
strict I & O monitoring
– Report significant increase and persistence in
uterine contractions despite tocolytic therapy
– Report any leaking of amniotic fluid, any vaginal
bleeding, or discharge, or complains of rectal
pressure
– Monitor for side effects such as palpitations and
dizziness

20. • Tocolytic therapy
– Magnesium Sulfate
• Calcium antagonist and CNS depressant----relaxes
smooth muscles of the uterus through calcium
displacement
• Increases uterine perfusion---beneficial for the
fetus
• Less expensive with lesser adverse effects than
beta-sympathomimetics
• Excreted by the kidneys and crosses the placenta
• Maintenance dose be titrated to keep uterine
contractions under control
• Contraindicated for clients with MG, impaired
kidney function and recent MI

21. Magnesium sulfate
• Adverse Reactions:
– Mother: flush, feelings of increased warmth,
perspiration, dizziness, nausea, headache, lethargy,
slurred speech, sluggishness, nasal congestion,
decreased GI action, increased pulse rate, and
hypotension.
– Fetus: decreased heart rate and slight hypotonia with
diminished reflexes and lethargy for 24 to 48 hours
– Toxicity: respiratory depression and arrest, circulatory
collapse, cardiac arrest
– Antidote for toxicity: calcium gluconate (10mg IV push
over 3 minutes)

22. Corticosteroid Therapy in
preterm labor

23. • Corticosteroid Therapy in preterm
labor
–Accelerates lung maturation with
resultant surfactant development in
the fetus in utero-----decreasing the
incidence and severity of respiratory
distress syndrome (RDS) with increased
survival of preterm infants

24. – Prototype:
• Betamethasone(Celestone)
– Given to prevent RDS to preterm infants by injecting the mother
before delivery to stimulate surfactant production in the fetal lung
– Not effective in treating preterm infants after delivery
– More effective if given at least 24hrs but less than 7days before
delivery in week 33 and before
– less effective with multifetal birth
– AR: rare but includes
seizures, headache, vertigo, edema, hypertension, increased
sweating, petechiae, ecchymoses, and facial erythema
– Nursing responsibilities:
» Shake suspension well. Avoid exposing to excessive heat or light
» Inject to large muscle
» Monitor maternal V/S
» Maintain accurate I & O

25. • Dexamethasone
– Has a rapid onset of action and a shorter duration
of action
– AR: insomnia, nervousness, increased
appetite, headache, hypersensitivity reactions

26. Drugs for
Pregnancy Induced
Hypertension (PIH)

27. • PIH
– Most common serious complication of pregnancy
– Most often observed after 20 weeks gestation
intrapartum and during the first 72 hours post
partum
– Believed to be related to decreased levels of
vasodilating prostaglandins with resulting
vasospasm
– Prototype:
• Methyldopa(aldomet) and hydralazine (Apresoline)
– First line therapy for pre-eclampsia

28. • Methyldopa(Aldomet)
– MOA: stimulates the central alpha-adrenergic
receptors that results in a decreased sympathetic
outflow to the heart, kidneys, and peripheral
vasculature
– AR: peripheral
edema, anxiety, drowsiness, headache, dry
mouth, mental depression
– Nursing responsibilities:
• Assist client to left lateral recumbent position
• Teach about s/sx of progressive PIH
• Advise diet rich in protein, normal sodium diet, and
increase OFI
• Monitor BP and report persistent and progressive
elevation in readings

29. • Magnesium Sulfate
– Prevention and treatment of seizure r/t PIH.
– Acts as CNS depressant. Decreases acetylcholine
from motor nerves, which blocks neuromuscular
transmission and decreases incidence of seizures.
Secondary effect is reduction of BP as the smooth
muscles relaxes
– Increases uterine blood flow
– S/E: lethargy, flush, feelings of increased warmth,
perspiration, thirst, sedation, slurred speech,
hypotension, decreased muscle tone

30. – Nursing interventions: (Magnesium sulfate)
• Continuous fetal monitoring
• Monitor for maternal toxicity----weakness and
lethargy from the blocking of the
neuromuscular transmission.
• Have calcium gluconate available-----as
antidote for toxicity
• Maintain client in left lateral position in low
stimulation environment
• Monitor for S/E

31. • Hydralazine
– Antihypertensive agent. Acts by causing arterial
vasodilation.
– Objective of treatment is to maintain diastolic BP
between 90 mmHg and 110 mmHg
– AR: headache, N and V, nasal
congestion, dizziness, tachycardia, palpitations, an
d angina
– Nursing interventions:
• Take pulse and BP every 5 minutes until stabilized
• Observe for change in LOC and headache
• Monitor FHT
• Monitor I and O

32. Drugs that Enhance
Uterine Muscle
Contractility

33. • Uterotropic drugs enhance uterine contractility
by stimulating the smooth muscle of the uterus.
• Prototype:
– Oxytocin(Pitocin)
• indicated for the initiation or improvement of uterine
contractions, where this is desirable and considered
suitable for reasons of fetal or maternal concern, in order to
achieve vaginal delivery.
• Indicated for:
– induction of labor in patients with a medical indication for the
initiation of labor
– stimulation or reinforcement of labor, as in selected cases of
uterine inertia
– adjunctive therapy in the management of incomplete or inevitable
abortion

34. • Oxytocin (Pitocin, Syntocinon)
– MOA: promotes uterine contractions by increasing
intracellular concentrations of calcium in uterine
myometrial tissue
– S/E: hypotension, dysrrhythmias, uterine
hyperstimulation
– AR: seizures, asphyxia, cardiac dysrrhythmias
– Nursing interventions:
• Have oxygen readily available
• Monitor maternal pulse and BP, uterine activity, and FHT
• Maintain in left lateral position to maintain placental
perfusion
• Monitor for signs of placental rupture---FHT decelerations,
sudden increased pain, loss of uterine contractions,
hemorrhage, and rapidly developing hypovolemic shock

35. • Ergot alkaloids
– Act by direct smooth-muscle-cell receptor
stimulation
– Not used during labor because they can cause
sustained uterine contractions (tetanic
contractions)------fetal hypoxia and possibly
rupture of the uterus
– Effective in control of postpartum hemorrhage
and promotion of uterine involution
– Prototype:
• Ergonovine maleate (Ergotrate)
• Methylergonovine maleate (Methergine)

36. • Ergot alkaloids
– S/E: uterine cramping, nausea and vomiting, dizziness,
hypertension, sweating, tinnitus, chest pain, dyspnea,
sudden severe headache. Ergot toxicity(ergotism)----
pain in arms, legs, and lower back, numbness, cold
hands and feet, muscular weakness, diarrhea,
hallucinations, seizures, and blood hypercoagulability
– Nursing responsibilities:
• Assess lochia and uterine tone before administration
• Monitor clients BP----notify AP if systolic BP increases by 25
mmHg or diastolic BP by 20 mmhg over baseline
• Protect drugs from exposure to light
• Monitor for side effects or symptoms of ergot toxicity
(ergotism)
• Inform client that she will feel intense uterine cramps after
receiving the drug
• Instruct not to smoke----increases vasoconstricting effect