Which of the following medications is not categorized as a tocolytic?
Oxytocin (Pitocin)
Magnesium Sulfate
Nifedipine (Procardia)
Indomethacin (Indocin)
The Correct Answer is A
Choice A rationale:
Oxytocin is a hormone that stimulates uterine contractions. It is not a tocolytic, which is a medication that inhibits uterine contractions. In fact, oxytocin is often used to induce labor or to augment labor that is progressing slowly.
It acts on the myofibrils in the uterine muscle, causing them to contract more forcefully and frequently. This leads to cervical dilation and effacement, and ultimately to the birth of the baby.
Oxytocin is typically administered as an intravenous (IV) infusion. The dosage is carefully titrated to achieve the desired effect on the uterus.
It is important to note that oxytocin can have serious side effects, including uterine hyperstimulation, fetal distress, and postpartum hemorrhage. Therefore, it should only be used under the close supervision of a healthcare provider.
Choice B rationale:
Magnesium sulfate is a tocolytic that is often used to prevent preterm labor. It works by relaxing the smooth muscle of the uterus.
It is typically administered as an IV infusion. The dosage is carefully monitored to ensure that the magnesium level in the blood does not become too high.
Side effects of magnesium sulfate can include flushing, nausea, vomiting, and headache. In rare cases, it can also cause serious complications such as respiratory depression and cardiac arrest.
Choice C rationale:
Nifedipine is a calcium channel blocker that is sometimes used as a tocolytic. It works by relaxing the smooth muscle of the uterus and blood vessels.
It is typically administered as an oral tablet. Side effects of nifedipine can include headache, dizziness, flushing, and low blood pressure.
Choice D rationale:
Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that is sometimes used as a tocolytic. It works by inhibiting the production of prostaglandins, which are substances that promote uterine contractions.
It is typically administered as an oral tablet or suppository. Side effects of indomethacin can include nausea, vomiting, heartburn, and diarrhea.
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Correct Answer is C
Explanation
Choice A rationale:
Insulin glargine (Lantus) is a long-acting insulin that does not have any immediate effect on blood glucose levels. It is not typically a concern for patients undergoing CT scans with contrast.
However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving insulin therapy, as the contrast media used in CT scans can sometimes cause hyperglycemia.
Choice B rationale:
Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing the absorption of carbohydrates from the intestines. This can help to reduce blood glucose levels after meals.
Acarbose is not typically a concern for patients undergoing CT scans with contrast. However, it is important to note that acarbose can sometimes cause gastrointestinal side effects, such as bloating, gas, and diarrhea. These side effects may be worsened by the contrast media used in CT scans.
Choice C rationale:
Metformin (Glucophage) is a biguanide that works by reducing glucose production in the liver and increasing insulin sensitivity in the muscles. It is a commonly used medication for the treatment of type 2 diabetes.
Metformin is a concern for patients undergoing CT scans with contrast because it can increase the risk of lactic acidosis. Lactic acidosis is a serious condition that can occur when there is a buildup of lactic acid in the blood. It can be caused by metformin, as well as by other factors such as dehydration, kidney problems, and liver problems.
The contrast media used in CT scans can also increase the risk of lactic acidosis. This is because the contrast media can sometimes cause kidney damage, which can impair the body's ability to remove lactic acid from the blood.
For this reason, metformin is typically discontinued for 48 hours before a CT scan with contrast. It is also important to ensure that patients are well-hydrated before and after the scan.
Choice D rationale:
Glipizide (Glucotrol) is a sulfonylurea that works by stimulating the release of insulin from the pancreas. It is a commonly used medication for the treatment of type 2 diabetes.
Glipizide is not typically a concern for patients undergoing CT scans with contrast. However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving sulfonylurea therapy, as the contrast media used in CT scans can sometimes cause hypoglycemia.
Correct Answer is D
Explanation
Choice A rationale:
Placing the tablet under the patient's nose is not an effective method of administering aspirin. Aspirin is not absorbed through the nasal mucosa.
This action would not provide any therapeutic benefit to the patient with a suspected myocardial infarction. It could potentially lead to aspiration of the tablet if the patient sneezes or coughs.
Choice B rationale:
Enteric-coated aspirin tablets are designed to dissolve in the intestines, not in the stomach. This delays the absorption of aspirin and its antiplatelet effects.
In a patient with a suspected myocardial infarction, it is crucial to achieve rapid absorption of aspirin to inhibit platelet aggregation and prevent further clot formation.
Therefore, enteric-coated aspirin is not appropriate in this situation.
Choice C rationale:
Chewing the aspirin tablet would indeed speed up its absorption. However, it also increases the risk of gastric irritation and bleeding.
Aspirin can be irritating to the stomach lining, and chewing it can exacerbate this effect.
This is particularly concerning in a patient with a suspected myocardial infarction, who may already be at risk for gastrointestinal bleeding due to decreased blood flow to the stomach.
Choice D rationale:
Giving the aspirin tablet with a small sip of water is the most appropriate action for the nurse to take in this situation. This allows for timely absorption of the aspirin while minimizing the risk of gastric irritation.
The water helps to dissolve the tablet and transport it to the stomach, where it can be absorbed into the bloodstream. It also helps to lubricate the esophagus and reduce the risk of the tablet becoming lodged in the throat.
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