Pharm Quiz for OB

ANTEPARTUM — Prenatal vitamins

ROUTE: PO | USE: Prevent nutritional deficiencies; support pregnancy/fetal growth | MOA: Replaces vitamins/minerals needed during pregnancy | SIDE EFFECTS: Nausea, GI upset, constipation | NURSING: Take with food if GI upset; do not exceed recommended dose; keep away from children

ANTEPARTUM — Folic acid (folate)

ROUTE: PO | USE: Prevent neural tube defects; support RBC production | MOA: Needed for DNA synthesis/cell division | SIDE EFFECTS: Usually well tolerated | NURSING: Ideally begin before pregnancy; higher dose may be prescribed for increased NTD risk

ANTEPARTUM — Iron supplements

ROUTE: PO; IV if indicated | USE: Prevent/treat iron-deficiency anemia | MOA: Required for hemoglobin production | SIDE EFFECTS: GI upset, constipation, dark stools | NURSING: Vitamin C ↑ absorption; calcium ↓ absorption; keep away from children

ANTEPARTUM — Rh(D) immune globulin

ROUTE: IM | USE: Prevent Rh sensitization in unsensitized Rh-negative patients | MOA: Anti-D antibodies clear Rh-positive fetal RBCs before sensitization | SIDE EFFECTS: Injection-site reaction; rare hypersensitivity | NURSING: Commonly ~28 weeks and within 72 hr after birth of Rh-positive infant; also after indicated sensitizing events; verify Rh/antibody status

ANTEPARTUM — Glucose oral solution

ROUTE: PO | USE: Screen/diagnose gestational diabetes | MOA: Standardized glucose load → evaluates glucose response | SIDE EFFECTS: Nausea, dizziness | NURSING: Follow exact test protocol/timing; vomiting may invalidate the test

ANTEPARTUM — Low-dose aspirin

ROUTE: PO | USE: Prevention of preeclampsia in patients with appropriate risk factors | MOA: Irreversibly inhibits platelet COX → ↓ thromboxane and platelet aggregation | SIDE EFFECTS: GI upset, bruising/bleeding, hypersensitivity | NURSING: 81 mg daily when indicated; begin 12–28 weeks (optimally before 16 weeks) and continue until delivery; assess bleeding risk/allergy; patients should not self-initiate aspirin in pregnancy

ANTEPARTUM — Enoxaparin

ROUTE: SubQ | USE: Prevention/treatment of venous thromboembolism (VTE) during pregnancy | MOA: Low-molecular-weight heparin; potentiates antithrombin → primarily inhibits factor Xa | SIDE EFFECTS: Bleeding, bruising/injection-site reaction; thrombocytopenia (rare) | NURSING: Monitor for bleeding; do not rub injection site; verify timing of last dose before labor/delivery or neuraxial anesthesia

ANTEPARTUM — Labetalol

ROUTE: PO, IV | USE: Treatment of chronic or acute hypertension in pregnancy; may also be used postpartum | MOA: Blocks α1 and β-adrenergic receptors → ↓ vascular resistance and BP | SIDE EFFECTS: Hypotension, dizziness, fatigue, bradycardia | NURSING: Monitor BP/pulse; caution with asthma/bradycardia; may continue or initiate postpartum; teach slow position changes

ANTEPARTUM — Nifedipine

ROUTE: PO | USE: Treatment of hypertension in pregnancy; also used for tocolysis in preterm labor | MOA: Calcium-channel blocker → relaxes vascular smooth muscle; also decreases uterine smooth-muscle contraction | SIDE EFFECTS: Headache, flushing, dizziness, hypotension, tachycardia | NURSING: Monitor BP/pulse; immediate-release may be used for acute severe hypertension; extended-release commonly used for maintenance; may be continued/initiated postpartum

ANTEPARTUM — Doxylamine succinate

ROUTE: PO | USE: Nausea and vomiting of pregnancy; typically used with pyridoxine | MOA: H1 antihistamine with anticholinergic effects | SIDE EFFECTS: Drowsiness, dizziness, dry mouth | NURSING: Pyridoxine ± doxylamine is a first-line medication approach for nausea/vomiting of pregnancy; warn about sedation

ANTEPARTUM — Pyridoxine (vitamin B6)

ROUTE: PO | USE: First-line treatment for nausea and vomiting of pregnancy; may be used alone or with doxylamine | MOA: Vitamin B6 involved in amino-acid metabolism and neurotransmitter synthesis; mechanism for reducing pregnancy-related nausea is not fully understood | SIDE EFFECTS: Usually well tolerated; high/prolonged doses may cause sensory neuropathy | NURSING: Often tried first, with doxylamine added if needed; may be taken on a scheduled basis; avoid excessive supplementation from multiple products

ANTEPARTUM — Ondansetron

ROUTE: PO/ODT, IV | USE: Treatment of persistent nausea and vomiting when initial therapy is inadequate | MOA: Selective 5-HT3 serotonin-receptor antagonist → reduces nausea/vomiting | SIDE EFFECTS: Headache, constipation, dizziness; QT prolongation (rare but important) | NURSING: Generally used when first-line measures are inadequate; monitor hydration/electrolytes with significant vomiting; use caution with QT-prolonging conditions/medications

ANTEPARTUM — Nitrofurantoin

ROUTE: PO | USE: UTI/cystitis | MOA: Antibiotic; disrupts bacterial cellular processes | SIDE EFFECTS: GI upset, headache | NURSING: Check allergies; not for pyelonephritis; avoid with G6PD deficiency

ANTEPARTUM — Azithromycin

ROUTE: PO | USE: Chlamydia | MOA: Macrolide; inhibits protein synthesis | SIDE EFFECTS: GI upset, diarrhea | NURSING: Check allergies; partner treatment important

ANTEPARTUM — Ceftriaxone

ROUTE: IM | USE: Gonorrhea | MOA: Cephalosporin; inhibits cell-wall synthesis | SIDE EFFECTS: Injection-site pain, GI upset, allergic reaction | NURSING: Check allergies; assess for other STIs

ANTEPARTUM — Acyclovir / Valacyclovir

ROUTE: PO; IV acyclovir | USE: Genital HSV treatment/suppression | MOA: Inhibits viral DNA replication | SIDE EFFECTS: Headache, GI upset | NURSING: Suppressive therapy commonly begins at 36 weeks; assess for lesions/prodromal symptoms near labor

ANTEPARTUM — Tdap vaccine

ROUTE: IM | USE: Maternal immunization; passive infant pertussis protection | MOA: Stimulates active immunity/placental antibody transfer | SIDE EFFECTS: Injection-site pain, mild fever | NURSING: Every pregnancy, 27–36 weeks (prefer earlier in window)

ANTEPARTUM — Influenza vaccine

ROUTE: IM | USE: Prevent influenza in mother/infant | MOA: Stimulates active immunity/placental antibody transfer | SIDE EFFECTS: Injection-site pain, mild fever | NURSING: Inactivated/recombinant vaccine; any trimester; annually during influenza season

ANTEPARTUM — Maternal RSV vaccine (RSVpreF)

ROUTE: IM | USE: Protect infant from severe RSV disease | MOA: Maternal antibodies cross placenta → passive infant protection | SIDE EFFECTS: Injection-site pain, fatigue, headache | NURSING: 32 0/7–36 6/7 weeks; seasonal; currently not repeated in subsequent pregnancies per 2026 ACOG guidance

ANTEPARTUM — COVID-19 vaccine

ROUTE: IM | USE: Prevent maternal/severe COVID-19; passive infant protection | MOA: Stimulates active immunity/placental antibody transfer | SIDE EFFECTS: Injection-site pain, fatigue, headache, fever | NURSING: May be given in any trimester; follow current vaccine recommendations

POSTPARTUM — Oxytocin

ROUTE: IV, IM | USE: Prevent/treat postpartum hemorrhage (PPH) due to uterine atony | MOA: Stimulates uterine smooth-muscle contraction | SIDE EFFECTS: Cramping, nausea; hypotension with rapid IV administration | NURSING: Assess fundus, bleeding, VS; first-line uterotonic for PPH

POSTPARTUM — Carboprost tromethamine

ROUTE: IM | USE: PPH due to uterine atony | MOA: Prostaglandin F2α → strong uterine contractions | SIDE EFFECTS: Diarrhea, nausea/vomiting, fever, bronchospasm | NURSING: Avoid in asthma; assess bleeding, fundus, VS

POSTPARTUM — Methylergonovine

ROUTE: PO, IM | USE: Prevention/treatment of PPH due to uterine atony | MOA: Ergot alkaloid → sustained uterine contraction | SIDE EFFECTS: Nausea, headache, hypertension | NURSING: Check BP; avoid with hypertension/preeclampsia

POSTPARTUM — Misoprostol

ROUTE: PO, SL, buccal, rectal | USE: Prevention/treatment of PPH | MOA: Prostaglandin E1 → uterine contraction | SIDE EFFECTS: Fever, chills, diarrhea, cramping | NURSING: Assess bleeding/fundus; route and dose vary by indication; also used for cervical ripening/induction

POSTPARTUM — Acetaminophen

ROUTE: PO | USE: Mild pain/fever | MOA: Central analgesic/antipyretic | SIDE EFFECTS: Hepatotoxicity with excessive dose | NURSING: Consider total daily acetaminophen from all combination products

POSTPARTUM — Ibuprofen

ROUTE: PO | USE: Postpartum pain/cramping | MOA: NSAID → inhibits prostaglandin synthesis | SIDE EFFECTS: GI upset, bleeding, renal effects | NURSING: Common first-line postpartum analgesic; give with food if needed

POSTPARTUM — Ketorolac

ROUTE: IV, IM | USE: Short-term moderate postoperative/postpartum pain | MOA: NSAID → inhibits prostaglandin synthesis | SIDE EFFECTS: GI irritation/bleeding, renal effects | NURSING: Short-term use only; avoid concurrent NSAIDs

POSTPARTUM — Hydrocodone/acetaminophen

ROUTE: PO | USE: Moderate–severe pain | MOA: Opioid agonist + nonopioid analgesic | SIDE EFFECTS: Sedation, constipation, respiratory depression | NURSING: Assess pain/sedation; account for total acetaminophen dose

POSTPARTUM — Oxycodone/acetaminophen

ROUTE: PO | USE: Moderate–severe pain | MOA: Opioid agonist + nonopioid analgesic | SIDE EFFECTS: Sedation, constipation, respiratory depression | NURSING: Assess pain/sedation; account for total acetaminophen dose

POSTPARTUM — Intrathecal morphine

ROUTE: Intrathecal | USE: Extended analgesia after cesarean birth | MOA: Opioid agonist | SIDE EFFECTS: Pruritus, nausea, urinary retention, delayed respiratory depression | NURSING: Monitor respiratory status/sedation per neuraxial opioid protocol

POSTPARTUM — Methocarbamol

ROUTE: PO, IV | USE: Adjunct for postpartum/postoperative musculoskeletal pain | MOA: Centrally acting skeletal muscle relaxant | SIDE EFFECTS: Drowsiness, dizziness | NURSING: Assess sedation/fall risk; caution with other CNS depressants

POSTPARTUM — Rh(D) immune globulin

ROUTE: IM | USE: Prevent Rh sensitization after birth | MOA: Prevents maternal immune response to Rh-positive fetal RBCs | SIDE EFFECTS: Injection-site reaction; rare hypersensitivity | NURSING: Unsensitized Rh-negative mother + Rh-positive infant; give within 72 hr of birth when indicated

POSTPARTUM — Rubella vaccine

ROUTE: SubQ | USE: Postpartum immunization of rubella-nonimmune patient | MOA: Live attenuated vaccine → active immunity | SIDE EFFECTS: Injection-site reaction, fever, arthralgia | NURSING: Contraindicated during pregnancy; safe postpartum; avoid pregnancy for 28 days after vaccination

POSTPARTUM — Benzocaine topical spray

ROUTE: Topical | USE: Perineal discomfort | MOA: Local anesthetic | SIDE EFFECTS: Local irritation; rare methemoglobinemia | NURSING: Apply to perineum as directed; external use only

POSTPARTUM — Witch hazel pads

ROUTE: Topical | USE: Perineal/hemorrhoidal discomfort | MOA: Astringent/cooling effect | SIDE EFFECTS: Local irritation | NURSING: Apply externally as needed

POSTPARTUM — Hydrocortisone 1%

ROUTE: Topical | USE: Hemorrhoidal/perineal itching and inflammation | MOA: Corticosteroid → ↓ inflammation | SIDE EFFECTS: Local irritation; skin thinning with prolonged use | NURSING: External use; short-term use as directed

POSTPARTUM — Medroxyprogesterone acetate (DMPA)

ROUTE: IM or SubQ | USE: Postpartum contraception | MOA: Progestin → suppresses ovulation; thickens cervical mucus | SIDE EFFECTS: Irregular bleeding, weight change; delayed return to fertility | NURSING: Long-acting contraception; repeat about every 3 months

POSTPARTUM — Etonogestrel implant

ROUTE: Subdermal | USE: Long-acting reversible contraception | MOA: Progestin → suppresses ovulation; thickens cervical mucus | SIDE EFFECTS: Irregular bleeding, headache | NURSING: May be inserted postpartum; teach patient to check/feel implant site

POSTPARTUM — Simethicone

ROUTE: PO | USE: Gas discomfort | MOA: Breaks up gas bubbles | SIDE EFFECTS: Minimal | NURSING: Symptomatic relief; not systemically absorbed

POSTPARTUM — Docusate

ROUTE: PO | USE: Stool softener; prevention/treatment of constipation | MOA: Allows water/fat into stool → softens stool | SIDE EFFECTS: Cramping, diarrhea | NURSING: Encourage fluids, fiber, ambulation; softens stool—does not stimulate bowel motility

POSTPARTUM — Senna

ROUTE: PO | USE: Constipation requiring stimulant laxative | MOA: Stimulates intestinal motility | SIDE EFFECTS: Cramping, diarrhea | NURSING: Distinguish from stool softener; generally used when additional bowel stimulation is needed

POSTPARTUM — Magnesium hydroxide

ROUTE: PO | USE: Constipation | MOA: Osmotic laxative → draws water into bowel | SIDE EFFECTS: Diarrhea, cramping | NURSING: Encourage fluids; caution with renal impairment

POSTPARTUM — Bisacodyl

ROUTE: PO, rectal | USE: Constipation | MOA: Stimulant laxative → increases intestinal motility | SIDE EFFECTS: Cramping, diarrhea | NURSING: Short-term use; suppository may be used when oral measures are inadequate

NORMAL NEWBORN — Erythromycin ophthalmic ointment

ROUTE: Ophthalmic | USE: Prevent gonococcal ophthalmia neonatorum | MOA: Macrolide antibiotic; inhibits bacterial protein synthesis | SIDE EFFECTS: Temporary eye irritation/blurred vision | NURSING: Apply to both eyes after birth; prevents gonococcal—not chlamydial—ophthalmia

NORMAL NEWBORN — Phytonadione (vitamin K₁)

ROUTE: IM | USE: Prevent vitamin K deficiency bleeding (VKDB) | MOA: Supports synthesis of clotting factors II, VII, IX & X | SIDE EFFECTS: Injection-site pain/redness | NURSING: Routine newborn prophylaxis; commonly 1 mg IM within 6 hr of birth for infants >1500 g

NORMAL NEWBORN — Hepatitis B vaccine

ROUTE: IM | USE: Prevent hepatitis B infection | MOA: Stimulates active immunity against HBV | SIDE EFFECTS: Injection-site reaction, mild fever | NURSING: Birth-dose timing depends on maternal HBsAg status and infant weight; if mother is HBsAg-positive, give vaccine + HBIG within 12 hr at separate sites

NORMAL NEWBORN — Nirsevimab

ROUTE: IM | USE: Prevent severe RSV disease in eligible infants | MOA: Long-acting monoclonal antibody; provides passive RSV protection | SIDE EFFECTS: Injection-site reaction, rash | NURSING: Used when maternal RSV vaccine was not given, status is unknown, or infant was born <14 days after maternal vaccination; most infants do not need both