Pregnancy and Urolithiasis Medication

Updated: Jul 23, 2018
  • Author: Robert O Wayment, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Medication

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. [51] NSAID use is also linked to renal congenital abnormalities and fetal pulmonary hypertension [52] and may cause premature closure of the ductus arteriosus [53] .

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Narcotic analgesics

Class Summary

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

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.

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.

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.

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.

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.

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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