OB Review 3

1. OB Review 3 Study Guide and Review

2. Oral Contraceptive Pills • Combination pill which contains two female hormones similar to the body’s own estrogen and progesterone • Progestin-only pill (or mini-pill) which does not contain estrogen • are more likely to cause breakthrough bleeding --- spotting

3. Estrogen • The estrogen compound used in most oral contraceptives is estradiol and is always used with a progestin. • May cause fluid retention-- With long term use. • Blood Pressure should be checked periodically • Effects on Reproduction. When used throughout a menstrual cycle with progesterone: • Estrogen changes the cellular structure of the endometrium and prevents implantation of a fertilized egg.

4. Progesterone • Progesterone and blocks the actions of Lutenizing Hormone • Lutenizing Hormone (LH) ----(stimulates corpus luteum), and FSH and prevents ovulation. • No new egg follicles are developed • No ovulation occurs. • changes the lining of the uterus • Makes it more difficult for the fertilized egg to implant. • Keeps the cervical mucus thick and sticky • Barrier against entry of sperm into the uterus. • Inhibits sperm transport by reducing fallopian tube mobility.

5. Combined Oral Contraceptives Types • Monophasic: All 21 active pills contain a fix dosage (same amount) of Estrogen & Progestin (E/P) throughout the cycle. • Biphasic: 21 active pills contain 2 different E/P combinations (e.g., 10/11) • Triphasic: 21 active pills contain 3 different E/P combinations (e.g., 6/5/10)

6. OCPs and LUPUS • For years, OCPs were not recommended for patients with LUPUS. • There was a belief that OCPs may cause increase in disease activity or flare-ups in patients with LUPUS • A major study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases shows that women with lupus are able to take oral contraceptives without an increased risk of flare-ups.

7. Oral Contraceptives COCs should not be used if a woman: • Is pregnant (known or suspected) • Is breastfeeding (can take progestin only) • Is jaundiced (symptomatic viral hepatitis or cirrhosis) • Has ischemic heart disease or CVA • Cardiovascular Disease • Diabetes Mellitus - uncontrolled • Thrombophlebitis

8. Client Instructions • If you forget to take 1 pill, take it as soon as you remember, even if it means taking 2 pills on 1 day. • If you forget to take 2 or more pills, you should take 2 pills every day until you are back on schedule. • Use a backup method (e.g., condoms) or do not have sex for 7 days.

9. Morning after pill • Emergency Contraceptive Pill • Norgestrel and ethynil estradiol are administered as soon after unprotected intercourse as possible and repeated 12 hrs after. • Should be no longer than 72 hours after unprotected sexual intercourse Emergency Pill • Plan B • Levonorgestrel

10. Seasonale • FDA Approval 2003 • I tablet every day for 91 day regimen • Women can predict having menstrual cycle every 3 months • 4 menstrual periods a year.

11. Depo-Provera • Injectable Contraceptive • 150 mg Intramuscular • Progesterone Only • NO Estrogen • Every 3 months • Inexpensive

12. The Endometrium • Is the innermost layer of the uterus • Sloughs with menstruation during each month

13. Follicle Stimulating Hormone • The Anterior pituitary gland releases FSH (follicle stimulating hormone) • FSH goes to the ovaries and causes the ovarian graafian follicle (OVUM) to develop/mature & ripen.

14. Rhogam Rh (D) immune globulin • Administered to Rh negative mothers after delivery of a Rh positive infant. • 300 mcg intramuscular • Administered within 72 hours post delivery or abortion.

15. Danazol (Danocrine) • Fibrocystic Breast Disease (FBD) • Decreases symptoms of FBD • Endometriosis • Start during menstruation • May be used up to 6 months • Weight gain, acne, hirsutism, edema, hair loss, hepatic dysfunction, breast size reduction, menstrual disturbances.

16. tadalafil (Cialis) • Erectile Dysfunction • 10 mg prior to sexual activity at frequency of up to once daily – • Remains effective for longer time than other medications for erectile dysfunction. • Contraindications: nitrates---Hypotention • Headache, dyspepsia, backache, myalgia, nasal congestion, flushing, limb pain.

17. Premenstrual Syndrome (PMS) • Initial treatment: • Acetaminophen • NSAIDS: ibuprofen, naproxen • Other: • Psychological evaluation • Supplemental estrogen • Tranquilizers and antidepressants

18. Oxytocin • Produced by hypothalamus and secreted by Posterior pituitary gland • Stimulates milk ejection during lactation, uterine contraction during birth, and is released during sexual orgasm in both men and women. • the mechanism of action is dependent on the presence of estrogen • Oxytocin's role may be related to various behaviors - social recognition, bonding, anxiety, trust, and maternal behaviors.

19. oxytocin (Pitocin) • Labor induction • Postpartum bleeding or hemorrhaging • Increases uterine tone during post partum period • Incomplete/Inevitable/Elective Abortion • Not indicated for inducing first trimester abortion • Discontinue if uterine hyperactivity or fetal distress occurs. • Stimulates the ejection of milk - Induces milk letdown.

20. Oxytocin • 10 U/1ml/amp, in 500ml N/S. • Uterine stimulant, by increasing intracellular concentrations of calcium in uterine myometrial tissue • Antidiuresis appears to be initiated by the direct action of oxytocin on the kidney. • The action of the drug stimulates renal tubular absorption of free water. • Monitor closely in patients for hypotension • Restricted fluid intake

21. Adverse reactions • Hypotension - maternal arrhythmias- myocardial infarction • Seizures, headache, memory dysfunction and subarachnoid hemorrhage • Hyponatremia: water intoxication- Ocular bleeding and blurred vision, pulmonary edema • Uterine hypertonia or rupture • Flushing, nausea and vomiting

22. Oxytocin Water Intoxication • Pounding maternal pulse • Increased maternal blood pressure • Moist respirations - Rales • The rate of infusion should be decreased when depression of FHR occurs.

23. Methergine • Methylergonovine is an ergot derivative with direct uterine and vascular smooth muscle contractile properties • 0.2mg/1ml/amp. • Administered after delivery of the placenta, or during postpartum. • Not be routinely administered intravenously: • inducing sudden hypertensive and cerebrovascular accidents. • Given slowly over a period of no less than 60 seconds, with careful monitoring of blood pressure

24. Ritodrine HCI (Yutopar) • Preterm labor • Tocolytic agent: decreases uterine contractility ----Inhibits uterine contractility • 50mg/5ml/amp • Tachycardia - Pulmonary Edema • Nervousness • Self Care Instructions • Avoid sexual intercourse • breast massage • modified bedrest

25. Parlodel (Bromocriptine mesylate) • Lactation suppressant • Non-hormonal Ergot derivative • No sooner than 4 hours post-delivery • Monitor Blood Pressure for symptoms of hypotension and hypertension • Headache, dizziness, fatigue, insomnia, hallucinations, depression, abnormal involuntary movements.

26. (B & O) Belladonna and opium suppositories • Used to reduce bladder spasms after prostate surgery. • Contains more than a score of alkaloids: morphine, narcotine, papaverine, and codeine, • Relax smooth muscle, relieve pain, and cause sedation. • BPH Non-surgical treatment: • Alpha blockers: Relieve bladder obstruction from BPH by decreasing tonic contraction of prostatic smooth muscle. • finasteride (Proscar)- Prevents progression of growth of the prostate or actually shrinks the prostate.

27. Cytoxan • Hospitalization when chemotherapy drug course is 10 days or greater when Cytoxan used with no other medication. • Given as intravenous chemotherapy infusion. • It can also be given in pill form • Pill must be taken with large amounts of water, to prevent irritation, and kidney or bladder damage. • Side Effects: Neutropenia,Low platelet count, Hair loss, N/V/D, fatigue, mucositis, amenorrhea, nail changes - brittle or yellowed

28. Cytoxan Adverse Reactions • Fever of 100.5°F or higher • Painful or bloody urine • Black and sticky (tarry) stools, or bloody stools • Unusual bruises or bleeding • Persistent cough, pneumonia • Allergic symptoms: shortness of breath, swelling of feet or ankles, rash, swollen throat

29. Vacuum constriction device (VCD) • Used to promote an erection by increasing blood supply to the penis. • Creates a partial vacuum around the penis, which draws blood into the corpora cavernosa. • (a) a plastic cylinder, which covers the penis; • (b) a pump, which draws air out of the cylinder; and • (c) an elastic ring, which, when fitted over the base of the penis, traps the blood and sustains the erection after the cylinder is removed.

30. Vasectomy • Postoperative teaching • Must avoid strenuous physical exercise for 1 week

31. Have patient: Demonstrate programming the pump Verbalize selection of injection sites. Verbalize symptoms that need to be reported. Medication is administered into PUMP Terbutaline Pump

32. Ergot derivatives • Substances derived from fungus that grows in rye bread. • Stimulate uterine smooth muscle • Bromocriptain • Methergine • Not used for labor induction • Produce powerful uterine contractions.

33. Prostaglandins • Hemabate • Dinoprostione (Prostin E2, Prepidil) • Stimulate contraction of uterine smooth muscle • Uses: Induction of 2nd trimester abortion, Therapeutic Abortion, glaucoma treatment, erectile dysfunction • Main side effect: Gastrointestinal distress • Used to terminate pregnancies between 12th and 20th weeks • Risks include a retained placenta, cervical trauma, later infection, bleeding, asthma or hyperthermia. • The most serious complications are a ruptured uterus and cardiac arrest.

34. 10 mg vaginal insert (suppository) It is used to prepare for induction Placed transversely in posterior fornix of the vagina Remove at onset of active labor or 12 hours after insertion. Adverse effects: Uterine hyperstimulation Fetal distress Cervidil (Dinoprostone) also known as Prostin E2

35. Also called "saline amniocentesis", "salting out" abortion. Method is used after 16 weeks of pregnancy because there needs to be enough amniotic fluid to allow introduction of a needle into the amniotic sac. Normal Side effects: Warmth sensation Tingling feeling Complications: blood clots, hemorrhage, seizures, coma or death. This method is not used much due to its dangers. Hypertonic Saline to induce abortion