23.01 Tocolytics

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Overview

  1. Anti-contraction meds, labor suppressant
  2. Tokos = Greek word for childbirth
  3. Lytic = lysis = decline of disease/symptoms

Nursing Points

General

  1. Use: prevent preterm labor by suppressing uterine contractions
    1. Preterm = before 37 weeks
  2. If preterm labor cannot be stopped, tocolytics allow time for the administration of betamethasone to attempt to quickly increase lung maturity over 24-48 hours

Assessment

  1. Assess contractions
    1. True labor v. false labor
  2. Fetal monitoring
    1. Assess for fetal distress

Therapeutic Management

  1. Follow your protocol/order set:
    1. Frequency of assessments
    2. Vitals
    3. Adverse reactions
    4. I&O
  2. Terbutaline (Brethine)
    1. Class: Beta 2 adrenergic-agonist
    2. MOA: Cause smooth muscle relaxation in uterus
    3. Nursing Implications
      1. Most adverse effects are cardiac related
        1. Maternal tachycardia
      2. Also causes bronchodilation
      3. See Autonomic Nervous System lesson in Pharmacology course
    4. Route
      1. IV, SubQ
  3. Nifedipine
    1. Class: Calcium channel blocker
    2. MOA: Disrupts calcium entry into the cell, which reduce smooth muscle contractions in uterus
    3. Nursing Implications
      1. Rapidly lowers BP, watch closely as you may need to give fluids or other meds to increase BP
      2. Don’t use with mag unless you really need to b/c it will lower BP further
    4. Route
      1. PO
      2. Multiple dosing options and no clear gold dosing standard
  4. Indomethacin
    1. Class: NSAID
    2. MOA: Inhibits prostaglandins, which cause uterine contractions
    3. Nursing Implications:
      1. Same bleeding precautions as other NSAIDs
      2. Don’t use if patient has peptic ulcers
      3. Should only be used if <32 weeks
      4. Can prematurely close fetus’ ductus arteriosus → assessment by ultrasound
      5. Can decrease fetal urine production → watch for oligohydramnios (deficiency of amniotic fluid)
    4. Route
      1. PO, rectal, vaginal
  5. Always monitor for potential adverse reactions and notify MD when noted

Nursing Concepts

  1. Pharmacology
  2. Safety
  3. Evidence based practice

Patient Education

  1. Thoroughly educate mother and support system about what to expect
  2. Medication purpose
  3. Side effects to notify about

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