Podcast
Questions and Answers
What is the primary goal of tocolysis in the context of preterm labor?
What is the primary goal of tocolysis in the context of preterm labor?
- To immediately halt labor and prepare for immediate delivery.
- To manage maternal pain during labor.
- To induce labor in a controlled environment.
- To prolong gestation, ideally for a few days to a week, to enhance fetal development and readiness. (correct)
Why are corticosteroids often co-administered with tocolytics?
Why are corticosteroids often co-administered with tocolytics?
- To counteract the side effects of tocolytics on the mother.
- To accelerate fetal lung maturity and reduce the risk of neonatal morbidity and mortality. (correct)
- To enhance the tocolytic effect and prolong labor indefinitely.
- To manage maternal hypertension during preterm labor.
Which of the following is a contraindication for the use of tocolytics?
Which of the following is a contraindication for the use of tocolytics?
- Non-reassuring fetal status. (correct)
- Preterm labor with intact membranes.
- Uterine tachysystole.
- Planned external cephalic version.
How do cyclooxygenase inhibitors like indomethacin work as tocolytics?
How do cyclooxygenase inhibitors like indomethacin work as tocolytics?
What is a significant side effect of using indomethacin as a tocolytic, particularly concerning the fetus?
What is a significant side effect of using indomethacin as a tocolytic, particularly concerning the fetus?
How do calcium channel blockers, like nifedipine, function as tocolytics?
How do calcium channel blockers, like nifedipine, function as tocolytics?
What is a common maternal side effect associated with the use of nifedipine as a tocolytic?
What is a common maternal side effect associated with the use of nifedipine as a tocolytic?
How does terbutaline, a beta agonist, work to suppress uterine contractions?
How does terbutaline, a beta agonist, work to suppress uterine contractions?
What are potential side effects associated with the use of terbutaline as a tocolytic?
What are potential side effects associated with the use of terbutaline as a tocolytic?
How does atosiban function as an oxytocin receptor antagonist to prevent uterine contractions?
How does atosiban function as an oxytocin receptor antagonist to prevent uterine contractions?
What are commonly observed side effects associated with the use of atosiban?
What are commonly observed side effects associated with the use of atosiban?
How do nitric oxide donors, such as nitroglycerin, promote uterine relaxation?
How do nitric oxide donors, such as nitroglycerin, promote uterine relaxation?
What is a notable side effect associated with nitroglycerin use as a tocolytic?
What is a notable side effect associated with nitroglycerin use as a tocolytic?
What is the primary route of administration for magnesium sulfate when used as a tocolytic?
What is the primary route of administration for magnesium sulfate when used as a tocolytic?
What is a critical consideration when administering magnesium sulfate as a tocolytic, regarding maternal safety?
What is a critical consideration when administering magnesium sulfate as a tocolytic, regarding maternal safety?
What potentially life-threatening side effects are associated with magnesium sulfate toxicity?
What potentially life-threatening side effects are associated with magnesium sulfate toxicity?
A pregnant woman at 32 weeks gestation presents with regular uterine contractions and cervical changes. Which tocolytic medication would be most appropriate if she also has a history of asthma?
A pregnant woman at 32 weeks gestation presents with regular uterine contractions and cervical changes. Which tocolytic medication would be most appropriate if she also has a history of asthma?
A patient is receiving magnesium sulfate for tocolysis. Which clinical finding would warrant immediate discontinuation of the medication?
A patient is receiving magnesium sulfate for tocolysis. Which clinical finding would warrant immediate discontinuation of the medication?
Which of the following tocolytic agents is associated with the highest risk of premature closure of the ductus arteriosus in the fetus and is therefore typically avoided after 32 weeks gestation?
Which of the following tocolytic agents is associated with the highest risk of premature closure of the ductus arteriosus in the fetus and is therefore typically avoided after 32 weeks gestation?
A patient in preterm labor is started on nifedipine. What is the most important nursing intervention related to this medication?
A patient in preterm labor is started on nifedipine. What is the most important nursing intervention related to this medication?
A patient receiving terbutaline complains of palpitations, tremor, and anxiety. Which nursing intervention is most appropriate?
A patient receiving terbutaline complains of palpitations, tremor, and anxiety. Which nursing intervention is most appropriate?
In the context of the myometrial cell, what effect does an increase in intracellular cyclic AMP (cAMP) have?
In the context of the myometrial cell, what effect does an increase in intracellular cyclic AMP (cAMP) have?
What is the role of myosin light chain phosphatase (MLCP) in smooth muscle cells, and how does it relate to uterine contraction?
What is the role of myosin light chain phosphatase (MLCP) in smooth muscle cells, and how does it relate to uterine contraction?
How does the mechanism of action of nitric oxide (NO) differ from that of beta-2 adrenergic agonists in achieving uterine relaxation?
How does the mechanism of action of nitric oxide (NO) differ from that of beta-2 adrenergic agonists in achieving uterine relaxation?
Which intracellular messenger is directly involved in stimulating the sarcoplasmic reticulum to release calcium in myometrial cells?
Which intracellular messenger is directly involved in stimulating the sarcoplasmic reticulum to release calcium in myometrial cells?
What is a potential consequence of using a tocolytic that causes vasodilation in a pregnant patient?
What is a potential consequence of using a tocolytic that causes vasodilation in a pregnant patient?
Which enzyme catalyzes the conversion of arachidonic acid into prostaglandins?
Which enzyme catalyzes the conversion of arachidonic acid into prostaglandins?
A pregnant patient is experiencing preterm labor at 30 weeks gestation. Her medical history includes well-controlled hypertension. Which tocolytic agent would be LEAST appropriate for this patient, considering her hypertension?
A pregnant patient is experiencing preterm labor at 30 weeks gestation. Her medical history includes well-controlled hypertension. Which tocolytic agent would be LEAST appropriate for this patient, considering her hypertension?
A physician orders indomethacin for a patient in preterm labor at 28 weeks gestation. What important assessment should the nurse prioritize before administering the first dose?
A physician orders indomethacin for a patient in preterm labor at 28 weeks gestation. What important assessment should the nurse prioritize before administering the first dose?
A patient has received a loading dose of magnesium sulfate for preterm labor. Which assessment finding indicates a therapeutic level of the medication?
A patient has received a loading dose of magnesium sulfate for preterm labor. Which assessment finding indicates a therapeutic level of the medication?
A patient is receiving magnesium sulfate for tocolysis. The healthcare provider prescribes calcium gluconate to be readily available. What is the primary reason for this order?
A patient is receiving magnesium sulfate for tocolysis. The healthcare provider prescribes calcium gluconate to be readily available. What is the primary reason for this order?
Which of the following is the mechanism of action of Atosiban?
Which of the following is the mechanism of action of Atosiban?
Which of the following is NOT a known mechanism through which magnesium sulfate may exert its tocolytic effect?
Which of the following is NOT a known mechanism through which magnesium sulfate may exert its tocolytic effect?
What is the rationale behind using tocolytics during an external cephalic version (ECV) procedure?
What is the rationale behind using tocolytics during an external cephalic version (ECV) procedure?
Which of the following medication is a nitric oxide donor?
Which of the following medication is a nitric oxide donor?
What is the direct effect of cyclic GMP on smooth muscle cells?
What is the direct effect of cyclic GMP on smooth muscle cells?
If the cell membrane of a uterine cell releases arachidonic acid, what enzyme acts on it next to initiate the process leading to uterine contraction?
If the cell membrane of a uterine cell releases arachidonic acid, what enzyme acts on it next to initiate the process leading to uterine contraction?
A pregnant woman is in preterm labor, and it's decided to use magnesium sulfate. After the loading dose, which of the following findings would be most concerning and warrant immediate intervention?
A pregnant woman is in preterm labor, and it's decided to use magnesium sulfate. After the loading dose, which of the following findings would be most concerning and warrant immediate intervention?
A pregnant patient at 32 weeks gestation is experiencing preterm labor. The care team is considering tocolysis to delay delivery. Which of the following factors would be most important to assess before initiating treatment with indomethacin?
A pregnant patient at 32 weeks gestation is experiencing preterm labor. The care team is considering tocolysis to delay delivery. Which of the following factors would be most important to assess before initiating treatment with indomethacin?
A patient in preterm labor is started on terbutaline. Which of the following pre-existing maternal conditions would raise the most concern regarding the use of this medication?
A patient in preterm labor is started on terbutaline. Which of the following pre-existing maternal conditions would raise the most concern regarding the use of this medication?
A patient is receiving magnesium sulfate for tocolysis. The nurse observes a sudden decrease in urine output. What is the priority nursing intervention?
A patient is receiving magnesium sulfate for tocolysis. The nurse observes a sudden decrease in urine output. What is the priority nursing intervention?
During tocolysis with nifedipine, a patient's blood pressure drops significantly. Which of the following interventions would be the most appropriate initial action?
During tocolysis with nifedipine, a patient's blood pressure drops significantly. Which of the following interventions would be the most appropriate initial action?
A patient in preterm labor is being considered for tocolysis. She has a history of well-controlled asthma and is currently 29 weeks pregnant. Which tocolytic agent should be used with caution or avoided?
A patient in preterm labor is being considered for tocolysis. She has a history of well-controlled asthma and is currently 29 weeks pregnant. Which tocolytic agent should be used with caution or avoided?
A patient is receiving intravenous magnesium sulfate as a tocolytic. The nurse assesses the following: respiratory rate of 10 breaths/min, absent deep tendon reflexes, and decreased level of consciousness. Which medication should the nurse prepare to administer?
A patient is receiving intravenous magnesium sulfate as a tocolytic. The nurse assesses the following: respiratory rate of 10 breaths/min, absent deep tendon reflexes, and decreased level of consciousness. Which medication should the nurse prepare to administer?
During preterm labor management, a physician decides to use atosiban. Which of the following mechanisms of action best describes how atosiban helps to suppress contractions?
During preterm labor management, a physician decides to use atosiban. Which of the following mechanisms of action best describes how atosiban helps to suppress contractions?
A labor and delivery nurse is caring for a patient receiving nitroglycerin for uterine relaxation. What is the primary mechanism by which nitroglycerin achieves this effect?
A labor and delivery nurse is caring for a patient receiving nitroglycerin for uterine relaxation. What is the primary mechanism by which nitroglycerin achieves this effect?
Which intracellular change is most directly associated with the myometrial relaxation caused by beta-2 adrenergic agonists?
Which intracellular change is most directly associated with the myometrial relaxation caused by beta-2 adrenergic agonists?
A patient is in preterm labor, and the healthcare provider orders magnesium sulfate. Which of the following assessment findings would indicate potential toxicity and warrant immediate intervention?
A patient is in preterm labor, and the healthcare provider orders magnesium sulfate. Which of the following assessment findings would indicate potential toxicity and warrant immediate intervention?
Flashcards
Tocolytics
Tocolytics
Medications used to delay delivery in preterm labor, typically before 34 weeks, to prolong fetal development or enable transfer to a higher acuity facility.
Tocolytics indications
Tocolytics indications
Inhibition of uterine contractions for procedures like external cephalic version or in cases of uterine tachysystole or suspected fetal distress.
Tocolytics contraindications
Tocolytics contraindications
Fetal demise, non-reassuring fetal status, severe preeclampsia/eclampsia, maternal hemorrhage, or premature rupture of membranes.
Indomethacin mechanism
Indomethacin mechanism
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Indomethacin side effects
Indomethacin side effects
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Nifedipine mechanism
Nifedipine mechanism
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Nifedipine side effects
Nifedipine side effects
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Terbutaline mechanism
Terbutaline mechanism
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Terbutaline side effects
Terbutaline side effects
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Atosiban mechanism
Atosiban mechanism
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Atosiban Side Effects
Atosiban Side Effects
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Nitroglycerin mechanism
Nitroglycerin mechanism
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Nitroglycerin side effects
Nitroglycerin side effects
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Magnesium sulfate onset
Magnesium sulfate onset
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Magnesium sulfate side effects
Magnesium sulfate side effects
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Study Notes
- Tocolytics are specific to obstetric anesthesia and are used to delay delivery in preterm labor, typically before 34 weeks
- The goal is to prolong the pregnancy by a few days to a week to promote fetal lung maturity or facilitate transfer to a higher acuity facility
- Often, corticosteroids are co-administered to enhance fetal lung maturity and reduce risks of morbidity and mortality
- Many tocolytics are used off-label and lack FDA approval for preterm labor
Indications for Tocolytics
- Preterm labor and contractions
- Assisting external cephalic version
- Uterine tachysystole (rapid contractions, more than 5 per 10 minutes)
- Suspected fetal distress
Contraindications for Tocolytics
- Fetal demise
- Non-reassuring fetal status
- Severe preeclampsia or eclampsia
- Maternal hemorrhage
- Premature rupture of membranes
Cyclooxygenase Inhibitors (e.g., Indomethacin)
- Mechanism: Non-specific inhibition of COX-1 and COX-2 enzymes, reducing prostaglandin production from arachidonic acid
- Prostaglandins normally lead to uterine contractions by increasing intracellular calcium
- Side effects include gastritis, nausea, oligohydramnios (reduced fetal urine production and amniotic fluid), and premature PDA closure
Calcium Channel Blockers (e.g., Nifedipine)
- Mechanism: Blocks calcium channels, inhibiting calcium influx into uterine cells and release from the sarcoplasmic reticulum
- Side effects: Vasodilation, dizziness, headache, and palpitations due to smooth muscle relaxation and compensatory cardiac output increase
Beta Agonists (e.g., Terbutaline)
- Mechanism: Stimulates beta-2 adrenergic receptors, increasing intracellular cAMP, which inhibits myosin light chain kinase
- Inhibition of myosin light chain kinase leads to smooth muscle relaxation
- Side effects: Vasodilation, hypotension, tachycardia, palpitations, tremor, shortness of breath, pulmonary edema, fetal tachycardia, and hypoglycemia
Oxytocin Receptor Antagonists (e.g., Atosiban)
- Mechanism: Competitively inhibits oxytocin binding to its receptors, preventing IP3 formation and calcium release from the sarcoplasmic reticulum
- Side effects: Hypersensitivity and injection site reactions
Nitric Oxide Donors (e.g., Nitroglycerin)
- Mechanism: Nitric oxide activates guanyl cyclase, increasing cyclic GMP, which activates myosin light chain phosphatase, promoting smooth muscle relaxation
- Side effects: Hypotension, headache, flushing, and palpitations
Magnesium Sulfate
- Mechanism: Not fully understood; may involve competition with calcium, decreased calcium release from the sarcoplasmic reticulum, membrane hyperpolarization, or inhibition of myosin light chain kinase
- Onset: Immediate, effective for about 30 minutes, typically given via continuous infusion
- Side effects: Flushing, headache, diaphoresis; toxicity can lead to respiratory depression, pulmonary edema, arrest, and neonatal hypotonia
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