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List 4 physiological changes that occur in pregnancy and the effect they have on absorbtion, distribution, metabolism and elimination?
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1) Glomerular filtration increases by 50% therefore water soluble drugs are absorbed more rapidly
2) Alveolar ventilation increases by 70% thus less drug needed 3) Nausea and vomitting impact on drug absorbtion in the GIT 4) Oestrogen and progesterone increase and inhibit enzyme activity in the liver resulting in increased drug accumulation. |
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What side effects may be experianced with MagSulph infusions?
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Muscle weakness
Flushing Nausea Headache Acute respiratory distress- due to muscle weakness in diaphragm and respiratory muscles |
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List 6 midwifery actions to monitor the therapeutic levels of MagSulph?
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1)Therapeutic drug monitoring- through serum bloods
2)Strict fluid balance chart 3) Assessment of muscle tone 4)Vital signs 5)Levels of consciousness 6)Respiratory assessment |
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How does MagSulph work in relation to pre-eclampsia?
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MagSulp is an anti-convulsant.
It treats pre-eclampsia by calming the spasms of the cerebral blood vessels and therefore induces bmore effective cerebral perfusion |
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Describe 2 methods of drug transfer into breastmilk?
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Passive and Active diffusion
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Describe 3 modes of action of Progesterone Implants?
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1)Thickens the viscocity of cervical mucous
2)Prevents ovulation 3)Alterates the endometrium |
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Identify when Mirena should be inserted postnatally and provide a rationale?
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Anytime after 6 weeks postpartum.
To allow full involution and healing of the uterus |
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When is the use of a Galactogogue indicated? Provide a physiological rationale?
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In the event that there is low milk supply due to low prolactin levels
As it a dopamine antagonist, it increases prolactin levels, which are further stimulated by regular breast expressing |
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Disuss and provide a physiological rationale for 1 common adverse effect that may occur after the insertion of an epidural?
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Blood pressure drops, causing hypotension.
This is due to the anaesthetics effect on the nerves of blood vessels causing vasodilation. |
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Discuss 2 ways in which the adverse effects can be managed?
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1) Strict monitoring of blood pressure
2) I.V fluids and possible medication commenced Also ensure woman is not lying supine, as this can further induce hypotension. |
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Why is it necessary to monitor blod levels of MagSulph?
Provide 2 symptoms of MagSulph toxicity? |
Any toxicity would be indicated in the concentration of the maternal blood plasma.
1) Water toxicity 2)Respiratory paralysis |
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Describe the absorbtion and metabolism of an intramuscular administration of drug to a neonate?
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The muscle mass of a neonate is in proportion to it's gestational age. It would be easy to accidently deliver the drug into the subcut tissue resulting in a unpredictable and slow absorbtion
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Define Visceral pain?
When would a woman experiance visceral pain in labour? |
Visceral pain is experianced when the nociceptors are activated in the thoracic, abdominal and pelvic organs.
It usually dominates the 1st stage of labour |
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Define Somatic pain?
When would a woman experiance somatic pain in labour? |
Somatic pain is experianced when nociceptors are activated in the muscle, tissue and skin.
It usually dominates the transitional and 2nd stages of labour. |
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What do midwives need to check before administering medications via the I.M route to the neonate?
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That it is the correct and preferred route for the drug.
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