Pregnancy and Urolithiasis Medication

  • Author: Robert O Wayment, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Mar 5, 2012
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Nonsteroidal anti-inflammatory drugs are not recommended during the first 20 weeks of pregnancy. They have been shown to be associated with an 80% increased risk of miscarriage over non-use in a study of 1055 women.[42] NSAID use is also linked to renal congenital abnormalities and fetal pulmonary hypertension[43] and may cause premature closure of the ductus arteriosus[44] .

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Narcotic analgesics

Class Summary

These agents are used to treat pain and provide patient comfort.

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Butorphanol (Stadol)

 

Mixed agonist-antagonist narcotic with central analgesic effects for moderate to severe pain. Causes less smooth muscle spasm and respiratory depression than morphine or meperidine. Weigh advantages against increased cost of butorphanol.

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Meperidine (Demerol)

 

Analgesic with multiple actions similar to those of morphine but may produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine.

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Morphine sulfate (Oramorph, MS Contin, Duramorph)

 

Criterion standard for relief of acute severe pain; may be administered in various ways; commonly titrated until desired effect obtained. IV morphine demonstrates half-life of 2-3 h; however, half-life may be 50% longer in elderly patients.

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Hydromorphone (Dilaudid)

 

A hydrogenated ketone of morphine. Hydromorphone is a narcotic analgesic. Analgesic action of parenterally administered Dilaudid is apparent within 15 min and usually remains in effect for >5 h.

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Analgesics

Class Summary

These agents are used to treat pain and to provide patient comfort.

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Acetaminophen (Tylenol)

 

Inhibits prostaglandin synthesis in the CNS and peripherally blocks pain impulse generation. Produces antipyresis from inhibition of hypothalamic heat-regulating center.

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Alpha-adrenergic blocking agent, oral

Class Summary

These agents relax smooth muscle to facilitate ureteral stone passage.

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Tamsulosin (Flomax)

 

This alpha-1 selective blocker is indicated for the treatment of lower urinary tract symptoms due to prostatic enlargement. An off-label use, as discussed above, is to facilitate passage of ureteral stones. Only short-term therapy (10 d) should be considered for this indication.

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Contributor Information and Disclosures
Author

Robert O Wayment, MD  Resident Physician, Division of Urology, Southern Illinois University School of Medicine

Robert O Wayment, MD is a member of the following medical societies: American Medical Association and American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey B Garris, MD  Chief, Assistant Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Tulane University School of Medicine

Jeffrey B Garris, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Urological Association, Association of Professors of Gynecology and Obstetrics, Louisiana State Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eleanor Lederer, MD  Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa

Disclosure: Dept of Veterans Affairs Grant/research funds Research

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Jong M. Choe, MD, FACS, and previous coauthor Rajesh Prasad, MD, to the development and writing of this article.

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The arrow in this intravenous pyelogram of a gravid female indicates a filling defect at the ureterovesical junction. This finding is most likely consistent with a ureteral stone (distal).
 
 
 
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