Pharmacology Quiz on Narcotic Agonists

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Questions and Answers

What is a potential effect of rapid IV administration of fentanyl citrate?

Increased heart rate

Nausea and vomiting

Enhanced cognitive function

Muscle rigidity (correct)

What should be monitored in neonates whose mothers received fentanyl during labor?

Enhanced physical strength

Respiratory depression (correct)

Hyperactivity

Increased appetite

Which herbal supplements may increase CNS depression when used with fentanyl?

Ginseng and valerian root

Ginger and garlic

Echinacea and elderberry

St John's wort, kava kava, and gotu kola (correct)

What indicates a possible withdrawal symptom in a neonate?

If the mother had a regular opioid use during pregnancy (A) Signup and view all the answers

What is the recommended administration duration for fentanyl citrate via IM/IV?

3-5 minutes (A) Signup and view all the answers

Which class of drugs should be used cautiously with fentanyl due to overdose risk?

CNS depressants, phenothiazines, ethanol, and tricyclic antidepressants (B) Signup and view all the answers

What is the dosage range for fentanyl citrate when administered via IM/IV?

50-100 mcg (C) Signup and view all the answers

What consequence is associated with the interaction of fentanyl and frequent CNS depressant usage?

Heightened risk of overdose (C) Signup and view all the answers

What is a potential effect of administering certain medications during labor?

Drowsiness (D) Signup and view all the answers

Which condition is NOT a contraindication for certain labor induction methods?

Healthy maternal status (B) Signup and view all the answers

What is one of the mechanical methods for labor induction?

Membrane stripping (B) Signup and view all the answers

What happens when a 36F indwelling catheter is inserted through the cervix?

Mechanical stimulation similar to membrane stripping (C) Signup and view all the answers

Which is a false statement regarding prostaglandins used in labor induction?

They are administered intravenously. (A) Signup and view all the answers

Intrauterine growth retardation is associated with which of the following?

Decreased fetal access to nutrients (C) Signup and view all the answers

What is the role of the balloon in the second mechanical method for labor induction?

To create space for extraamniotic saline infusion (B) Signup and view all the answers

Which condition is characterized by documented fetal intolerance of uterine contractions?

Positive contraction stress test (A) Signup and view all the answers

What is the recommended observation time for the patient after administering Oxytocin?

30 minutes to 2 hours (B) Signup and view all the answers

What is the initial dose for intravaginal medication to ripen an unfavorable cervix?

10 mg over 12 hours (B) Signup and view all the answers

What should be assessed prior to the insertion of the cervical ripening agent?

Cervical dilation and effacement (D) Signup and view all the answers

Which complication requires monitoring after the insertion of the medication?

Fetal heart rate decelerations (C) Signup and view all the answers

What is a common gastrointestinal side effect of the cervical ripening medication?

Nausea (A) Signup and view all the answers

What is the maximum dosage of dinoprostone that can be administered for labor induction?

1.5 mg (D) Signup and view all the answers

How long should a patient remain recumbent after the administration of gel?

15-30 minutes (B) Signup and view all the answers

What is the recommended time frame for sequential use of oxytocin after gel administration?

6-12 hours (B) Signup and view all the answers

What are the characteristics of the dinoprostone vaginal insert for labor induction?

Contains 10 mg of dinoprostone, released at 0.3 mg/h. (D) Signup and view all the answers

What is the appropriate action if a patient experiences uterine hyperstimulation after administration?

Administer oxygen or beta-adrenergic drugs (A) Signup and view all the answers

What is the proper technique for administering dinoprostone vaginal inserts?

Administer at room temperature and wear sterile gloves. (B) Signup and view all the answers

How long should the dinoprostone vaginal insert be left in place during labor induction?

12 hours (B) Signup and view all the answers

Which is NOT recommended regarding the placement of the dinoprostone insert?

Insert above the level of the cervical os (D) Signup and view all the answers

What is the recommended route and dosage of beractant for an infant?

4 mL/kg per dose intratracheally (B) Signup and view all the answers

What precaution should be taken when preparing beractant for administration?

Swirl the vial gently and do not shake (A) Signup and view all the answers

When should the prophylactic dose of beractant ideally be given?

Within 15 minutes of birth, if possible (C) Signup and view all the answers

How many maximum doses of beractant can be given to an infant in 48 hours?

4 doses (C) Signup and view all the answers

At what temperature should beractant be stored?

36° to 46° F (B) Signup and view all the answers

What should be monitored following the administration of beractant?

Infant’s arterial or transcutaneous measurement of systemic oxygen or carbon dioxide (C) Signup and view all the answers

What is the appearance of a properly prepared beractant dose?

White to light brown (A) Signup and view all the answers

What is important about warming the beractant vial before use?

It should not be artificially warmed (B) Signup and view all the answers

Study Notes

Fentanyl Citrate (Sublimaze)

Administer via IM/IV in doses of 50-100 mcg.
Caution: Rapid IV administration may cause muscle rigidity.
Monitor neonates for respiratory depression if the mother received this drug during labor.
Withdrawal symptoms may occur in neonates from maternal opioid use during pregnancy.
Risk of overdose increases with concurrent use of CNS depressants, phenothiazines, ethanol, and tricyclic antidepressants.
Herbal interactions include heightened CNS depression with St. John’s wort, kava kava, and gotu kola.
Potential side effects: drowsiness, respiratory depression, sedation, euphoria, hallucinations, headache, palpitations, and monitor respiratory rate.

Labor Induction Contraindications

Documented fetal intolerance of uterine contractions.
Conditions: chorioamnionitis, prematurity, postdates (>42 weeks), placenta previa, suspected abruptio placentae, severe gestational hypertension.
Additional factors: intrauterine growth retardation, maternal diabetes (classes B-F), multifetal gestation, isoimmunization, and history of uterine trauma.

Approaches to Labor Induction

Methods include mechanical techniques and prostaglandins.

Mechanical Methods

Involves the use of a 36F indwelling catheter inserted through an undilated cervix, followed by balloon inflation.
The bulb of the catheter mimics membrane stripping. Once expelled, initiate IV oxytocin.
Another method includes extraamniotic saline infusion via a catheter to induce labor.
Membrane stripping releases prostaglandins, enhancing the uterine response.

Prostaglandin Use

Prepidil (dinoprostone) may be inserted intravaginally; max dose is 1.5 mg, supplied in three doses.
Administration requires sterile technique; monitor for uterine hyperstimulation.
Assess cervical dilation and effacement post-insertion.

Beractant (Survanta)

Administer 4 mL/kg via ET, divided into four doses.
Monitor infant’s arterial or transcutaneous oxygen and carbon dioxide levels.
Store at 36° to 46°F (2°-8°C); warm before use but do not shake or artificially warm.

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Description

Test your knowledge on narcotic agonists including fentanyl citrate and other herbal supplements. This quiz covers key points regarding their uses, administration routes, and potential side effects. Prepare to understand the implications of rapid IV administration and muscle rigidity.