Butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain) are the preferred opioid analgesics used during labor because these medications:
are not expensive.
are administered orally.
do not cross the placenta.
do not cause significant respiratory depression in the mother or fetus.
The Correct Answer is D
Choice A rationale
The cost of a medication is a logistical consideration, not a scientific or pharmacological basis for its clinical preference during labor. The selection of an analgesic is primarily determined by its therapeutic profile, including efficacy, safety for both mother and fetus, and its mechanism of action, rather than economic factors.
Choice B rationale
The administration route is a clinical characteristic, but it does not explain why these specific drugs are preferred. Butorphanol and nalbuphine are typically administered intravenously or intramuscularly, not orally, to achieve rapid onset and predictable plasma concentrations, which is crucial for managing acute labor pain.
Choice C rationale
These medications, like most opioids, are lipophilic and have low molecular weights, allowing them to readily cross the placental barrier via passive diffusion. This is a significant aspect of their pharmacology. The preference for these specific drugs lies in their partial agonist/antagonist activity, which mitigates some of the risks of fetal respiratory depression.
Choice D rationale
Butorphanol and nalbuphine are synthetic opioid agonist-antagonists. This unique pharmacological profile means they bind to and activate kappa opioid receptors while acting as antagonists or partial agonists at mu opioid receptors. This dual action provides effective pain relief while concurrently limiting the degree of respiratory depression compared to full mu-opioid agonists, making them a safer choice for both mother and fetus during labor. *.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Respiratory depression in the newborn is a condition often associated with maternal opioid use during labor, as these drugs can cross the placental barrier and affect the fetal central nervous system. The situation described, involving prolonged rupture of membranes (PROM) for 24 hours, does not directly cause respiratory depression. Instead, it significantly increases the risk of infection.
Choice B rationale
Fetal hypoxia is caused by a lack of oxygen reaching the fetus, which can result from issues such as placental abruption, cord compression, or maternal hypotension. While infection from prolonged rupture of membranes can indirectly lead to fetal distress, it is not the primary or most direct concern. The most immediate and significant risk is ascending bacterial infection from the vagina.
Choice C rationale
Prolonged rupture of membranes (PROM) for more than 24 hours significantly increases the risk of ascending bacterial infection from the vagina into the uterus. This can lead to chorioamnionitis, a bacterial infection of the amniotic fluid and membranes, which can then progress to maternal sepsis. The bacteria can also cross the placenta or be ingested by the fetus, leading to fetal sepsis.
Choice D rationale
Precipitous labor is defined as a rapid labor that lasts less than three hours from the onset of contractions to birth. This condition is not directly related to prolonged rupture of membranes. A history of precipitous labor is an independent risk factor for future rapid births, and prolonged rupture of membranes has no effect on the speed of cervical dilation and effacement.
Correct Answer is B
Explanation
Choice A rationale
True labor contractions are characterized by their persistence and increasing intensity, unlike Braxton Hicks or false labor contractions which often subside with ambulation or a change in activity. This is due to the sustained release of oxytocin and prostaglandins, which stimulate continuous uterine muscle activity, leading to cervical change.
Choice B rationale
A key differentiator of true labor contractions is that they do not diminish with comfort measures like relaxation or taking a shower. These contractions are caused by physiological changes at the myometrial cellular level that are not easily influenced by external stimuli, and their progressive nature is essential for cervical effacement and dilation.
Choice C rationale
True labor contractions follow a predictable pattern, becoming regular in frequency, duration, and intensity over time. This is in contrast to false labor contractions, which remain irregular. The increasing regularity is a result of the synchronized rhythmic firing of myometrial cells as the labor process advances.
Choice D rationale
True labor contractions typically originate in the back and radiate to the lower abdomen, often described as a cramping or tightening sensation that encompasses the entire uterus. Discomfort localized only to the top of the uterus is more characteristic of Braxton Hicks contractions, which do not contribute to cervical change.
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