2. Antenatal and Perinatal Drugs

Question 1

All of the following have what use during labor and post-partum?
misoprostol
dinoprostone
carboprost
oxytocin
ergot alkaloids

Answer 1

Induction of labor/Control post partum bleeding

Question 2

All of the following are what pregnancy drugs?
Cortisol
Betamethasone
dexamethasone

Answer 2

Corticosteroids

Question 3

All of the following are what pregnancy drugs?
terbutaline
indomethacin
nifedipine
MgSO4
Atosiban

Answer 3

Delay labor = Tocolytics

Question 4

All of the following are what pregnancy drugs?
a-methyldopa
labetalol
hydralazine
sodium nitroprusside

Answer 4

Anti-hypertensives in pregnancy

Question 5

All of the following are what pregnancy drugs?
alprostadil (maintain)
Indomethacin/ibuprofen (close)

Answer 5

Patent ductus arteriosus

Question 6

Instead of using ABCDX category for drugs during pregnancy, they use narrative sections/subsection which include pregnancy risks/clinical considerations/data along with lactation and females and males of?

Answer 6

reproductive potential

Question 7

some drugs are used for Cervical ripening which refers to the process in which collagen and glycoasminoglycans are broken down in the cervix, allowing the cervix to become thin and dilate, as well as inducing/normalizing contractions and controling post partum bleeding….. uterine stimulants are called what?

Answer 7

Oxtocics

Question 8

Drug:
Key Aspects: PGE1 analog, induces uterine contractions and maintains PDA patency, termination of IU preg if combined with mifepristone, off label used for cervical ripening, *cheap, oral, maternal SE: diarrhea, chills, shivering, N/V, Fetal: hypoxia d/t tachysystole or uterine contractions

Answer 8

Misoprostol

Question 9

Drug:
Key Aspects: PGE2 analog, gel = cervical ripening at term, vaginal insert = continue cervical ripening at term, EXPENSIVE, needs refridgerator, contra: preg unless aborting, mat SE: fever chills, fever UNresponsive to NSAIDS, Fetal SE: hypoxia d/t tacysystole

Answer 9

Dinoprostone

Question 10

Drug:
Key Aspects: prostaglandin F2a analog, induces uterine contractions, used to induce abortion or postpartum hemostasis for refractory bleeding, IM injection, expensive, maternal SE: HTN, pulmonary edema, reduce body temp d/t chills shivering

Answer 10

Carboprost

Question 11

Drug:
Key Aspects: posterior pituitary hormone, increases force freq and duration of uterine contraction by binding it Gprotein coupled receptors, INDUCES LABOR, IV admin, do not induce labor if lungs are not mature or cervix is not ripe, mat SE: water intoxication

Answer 11

Oxytocin

Question 12

Drug:
Key Aspects: stimulates adrenergic, dopaminergic, serotonergic receptors, prolonged/ tonic uterine contraction, constricts arterioles and veins, given IV/IM, contraind: HTN and hypersensitivity, st anthonys fire: mania psychosis, + green fingers nose penis and toes

Answer 12

Ergot Alkaloids
(ergonovine or ethylergonovine)

second choice for limiting postpartum bleeding

Question 13

There are many risk factors for preterm births, most miscarriages occur spontaneously due to many reasons. Late preterm is 34-36 weeks, less than 27 weeks birth is?

Answer 13

BAD

*making it to term is important because of less complications

Question 14

What are used in pre term delivery to promote lung maturation and increased surfactant production?

Answer 14

Corticosteroids

Question 15

Indications for corticosteroids (antenatal), include women between 24-36 weeks of gestation with threatened pre term labor, hemorrhage, rupture of membranes or pre-eclampsia/?

Answer 15

HELLP (both require caesarian delivery)

Question 16

Betamethasone is given via IM injection 2 times, in 24 hour intervals, while what is given in 4 doses by IM injection q 12 hours, to induce transcription of surfactant proteins in alveolar type 2 pneumocytes?

Answer 16

Dexamethasone

Question 17

Note: it is important not to adminster cortisol because the placenta inactivates it to cortiSONE, allowing the fetus to be exposed to?

Answer 17

cortisone

Question 18

Drug:
Key Aspects: beat2agonist used for tocolysis (delayed contractions) approved by FDA, SE: severe hallucinations, but withdrawn from market

Answer 18

Ritodrine

Question 19

Drug:
Key Aspects: used a works to prevent eclamptic seizures, neuroprotection- decreases risk for cerebral palsy, *long term drug of choice in US for tocolysis, inhibits Ach release at uterine NMJ, mat SE: flushing, palpitations, headaches, resp depression

Answer 19

Magnesium Sulfate

Question 20

Drug:
Key Aspects: calcium channel blocker, not FDA approved, maternal SE: flushing, HA, dizziness, nausea, Fetal SE: none, calcium channel blockers are preferable to other tocolytic agents (cochran evidence based conclusions)

Answer 20

Nifedipine

Question 21

Drug:
Key Aspects: NSAIDs, prostaglandin synthetase inhibitor, not FDA approved, mat SE: nausea, heartburn, gastritis, proctitis, fetal SE: many, cochrane says there is insufficient evidence new research says this is the best choice drug for tocolysis (along with nifedipine)

Answer 21

Indomethacin

Question 22

Drug:
Key Aspects: not FDA approved, contraindications: headaches, maternal SE: head ache/hypotension, Fetal SE: hypotension, insufficient evidence to support this drug for tocolysis

Answer 22

Nitroglycerin

Question 23

Drug:
Key Aspects: oxytocin inhibitor, stimulates uterine contractions during labor and delivery, not FDA apporved/ NOT avail in US, maternal SE: headache nausea, no fetal SE, may not work better than placebo

Answer 23

Atosiban

Question 24

Labor can often be delayed with tocolytic drugs for somewhere between 2-7 days, but it cannot be STOPPED. There are no animal models, and currently which two drugs are the best choices in the US?

Answer 24

Nifedipine and Indomethicin (*do not combine tocolytics)

Question 25

Ductus arteriosus should close spontaneously within a few days due to constriction caused by increased oxygen tension and decreased circulating PGE2 due to its metabolism in lungs, what drug maintains a patent ductus arteriosus?

Answer 25

Alprostadil (PGE1)

Question 26

Drug:
Key Aspects: PGE 1 similar to misoprostol, but PARENTERAL, indicated for preterm infants w congen heart defects, PGE1 substitutes for PGE2 in circulation, see SE of pyrexia*, hypotension, tachycardia and apnea

Answer 26

Alprostadil (PGE1)

Question 27

A patent ductus arteriosis is common in premature infants and need to close, symptoms include poor eating/growth, sweating, crying, easy tiring, rapid heart rate, usually closed with indomethacin but now more commonly?

Answer 27

Ibuprofen- inhibits PGE2 production

causes oliguria/edema/mild htn = dec kidney function

Question 28

All antiHTN drugs cross the placenta, first line for moderate HTN is oral a-methyldopa (a2agonist), or oral labetalol (a/b blocker), second line or for severe HTN is parenteral labetalol, sodium nitroprusside (A/V vasodilator) and?

Answer 28

Hydralazine (arterial vasodilator only)