Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm II Unit III > 3 Uterine Thyroid Osteoporosis > Flashcards

3 Uterine Thyroid Osteoporosis Flashcards

1
Q

Hormones that cause uterine contraction

A

Estrogens
Prostaglandins
Oxytocin
Stretching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hormones that cause uterine relaxation

A

Beta-adrenergic drugs (not used any more)
Progesterone
Alcohol
MgSO4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

______ and ______ of oxytocin receptors in the uterus increase just prior to labor and delivery

A

Number and sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DOC for inducing labor at term

A

Oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why are prostaglandins useful in inducing abortion?

A

Uterus is generally resistant to stimulation during the second trimester but prostaglandins can cause strong labor-like contractions during this time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Major cause of delivery-associated deaths

A

Postpartum hemorrhage (4-20% of deliveries have PPH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

________ is the cause of 80% of all postpartum hemorrhage

A

Uterine atony

Uterus doesn’t have enough contractility after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

First line treatment for postpartum hemorrhage

A

Uterine massage

WHY? Causes release of oxytocin —> constriction of the uterine arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cyclic octapeptide store in posterior pituitary normally released in response to suckling and cervical pressure

A

Oxytocin (Pitocin, Syntocin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Indications/therapeutic effects of Oxytocin

A

DOC to induce labor at term if indicated

  • uterine dysfunctional inertia
  • causes timed contractions (more physiological)
  • IV infusion used

For prevention of postpartum hemorrhage (IM route preferred)

For stimulation of milk let-down reflex (NASAL application via cotton pledget)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Adverse effects of Oxytocin

A

Water intoxication (ONLY AT LARGE DOSES) - b/c of ADH like effect of oxytocin

UTERINE RUPTURE with large dose

Allergy

Anaphylaxis

Sinus bradycardia of the fetus —> Caesarian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Contraindications for Oxytocin

A

Basically, if it’s not time to deliver, don’t administer

Malpresentation
Cephalopelvic disproportion
Complete placenta Previn
Uterine scar form previous Caesarian 
Unengaged head
Cervical scarring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What drugs are ergot alkaloids

A

Ergonovine maleate

Methylergonovine maleate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MOA for ergot alkaloids

A

Contraction of uterine smooth muscle through activation of serotonin and alpha-adrenergic receptors - powerful vasoconstrictors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indications for the use of ergot alkaloids

A

After completion of labor and the delivery of the placenta, to produce firm uterine contractions and to decrease uterine bleeding

2nd line after massage and oxytocin have failed for PPH

To produce contractions following suction abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Adverse effects of ergot alkaloids

A 
Transient hypertension (b/c it contracts all smooth muscle)
Angina, MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Contraindications for Ergot alkaloids

A

Should NEVER be used to induce labor - only AFTER DELIVERY (because it causes the wrong kind of contractions, will cause fetal hypoxia)

Peripheral vascular or coronary artery disease - increases BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dinoprostone is a synthetic ________ indicated for the expulsion of uterine contents

A

Prostaglandin

Used in cases of intrauterine fetal dearth, missed abortion (miscarriage), and elective abortions

Can also cause cervical ripening prior to delivery at term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is Dinoprostone administered?

A

For abortion: one suppository in the vagina (woohoo)

For cervical ripening: apply gel to cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Adverse effects of Dinoprostone

A

GI disturbances - vomiting, DIARRHEA** (black box)

Fever, chills, H/A

Many common but not serious (use correct dose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Contraindications for Dinoprostone

A

Fetal distress, history of difficult deliveries

For abortions, should not be used in patients with:

  • Acute pelvic inflammation
  • Acute cardiac, pulmonary, renal, or hepatic diseases
  • Asthma, HTN, anemia, jaundice, or epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Carboprost tromethamine?

A

A prostaglandin (PGF2a derivative) used for the induction of abortion in 13th to 20th week (2nd trimester) or for postpartum bleeding due to uterine atony

Administered IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Adverse effects of carboprost tromethamine

A

Not serious if used properly, systemic PG actions often diagnosed as anaphylactic shock

Vomiting and diarrhea in >60%

Fever and rashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Contraindications for carboprost tromethamine

A

Should not be used in patients with
ACUTE PELVIC INFLAMMATION
Acute cardiac, pulmonary, renal, or hepatic disease
Asthma, HTN, anemia, jaundice or epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Anti-fibrinolytic agent used to reduce death due to bleeding in women with postpartum hemorrhage

A

Tranexamic acid

Given IV along with standard uterotonic therapy (should NOT be regarded as an alternative therapy)

26
Q

First line drug for prevent premature labor

A

Magnesium Sulfate

Can also prevent convulsions in pre-eclampsia and treat eclampsia

27
Q

Why must MgSO4 be administered slowly?

A

Significant hypotension or asystole if too fast

28
Q

How is Nifedipine used during pregnancy?

A

To prevent pre-term labor (tocolytic agent)

Inhibitors Ca2+ influx (and smooth muscle contractions)

Becoming the 1st line agent

29
Q

Why should you never give Nifedipine with MgSO4?

A

CV collapse due to severe hypotension

30
Q

_________ is an anti-inflammatory drug that has been investigated for its ability to delay preterm labor

A

Indomethacin

Trials show reduced frequency of delivery within 48 hours and within 7-10 days from the beginning of treatment

31
Q

How does Indomethacin work as a tocolytic agent?

A

Inhibits COX enzyme —> reduction in prostaglandin synthesis (and prostaglandins cause contractions, so that’s that)

32
Q

Adverse effects of indomethacin as a tocolytic agent

A

Maternal GI irritation

Partial closure of the fetal ductus arteriosus

33
Q

How is progesterone used in preventing preterm birth?

A

More effective than placebo in maintaining the length of pregnancy when GIVEN PROPHYLACTICALLY from the 16th-37th week of pregnancy or until delivery

Not effective for acute treatment

Recommended for women at high risk with a history of preterm birth

Approved for use in ART to maintain the luteal phase following IVF or ICSI

34
Q

How is nitroglycerin used in pregnancy?

A

EMERGENCY USE ONLY in case of uterine rupture

35
Q

What was used historically to inhibit premature labor?

A

Ethanol. Yup.

Works though, if you have NOTHING ELSE

Direct relaxant effect on the myometrium and inhibits oxytocin release

36
Q

Agents used in the past for premature labor but no longer due to the overwhelming cardiac problems associated with its tocolytic use

A

B2 adrenergic agents - Terbutaline and Ritodrine

37
Q

Drug of choice for hypothyroidism

A

Levothyroxine sodium - T4 replacement

38
Q

What do you need to know about Levothyroxine

A

Drug levels must be carefully titrations to the individual and vary brand to brand - monitor TSH levels and patient Sx

4-6 weeks for stead state

39
Q

How is Liothyronine sodium (Cytomel) used?

A

T3 - used for initial therapy (quicker steady state levels) but not for maintenance in thyroid replacement

MYXEDEMA COMA

40
Q

Side effects of Levothyroxine

A

Similar to hyperthyroidism

Reduce dose or stop for a few days and resume at a lower dose

41
Q

Treatment for hyperthyroidism

A

Remove the gland via surgery
Destroy the gland with I-131
Reduce T4/T3 with thiazides/iodide
Block symptoms - BETA BLOCKERS

42
Q

First line treatment for Grave’s disease

A

Thioamides - Propylthiouracil or Methimazole

Inhibit synthesis of T4

PTU only - blocks conversion of T4 to T3

43
Q

What is the black box warning for PTU?

A

Severe liver injury, acute liver failure

Thus Methimazole is preferred unless allergies or PREGNANCY

44
Q

DOC for Graves in pregnancy

A

Propylthiouracil (PTU) - doesn’t cross placenta as well

45
Q

Why do you need to watch for sore throat and do blood tests on thioamides?

A

Risk of granulocytopenia and agranulocytosis

46
Q

How is iodide used in the treatment of hyperthyroid?

A

Rapidly decreases synthesis and release of T4/T3 - good for short-term effect

Used for 7-10 days before surgery to decrease likelihood of thyroid storm

Can be used in radioactive emergencies

47
Q

How is radioactive iodine (I-131) used in hyperthyroidism?

A

Small amounts diagnostic (uptake and scan)
Large amounts destroy gland

Used in elderly patients and those with heart disease for definitive treatment of Graves’ disease (but thioamides preferred)

48
Q

Preferred treatment for toxic nodular goiter

A

Radioactive Iodine (I-131)

49
Q

Contraindications for Radioactive Iodine use

A

PREGNANCY, nursing, or mothers who lack childcare

50
Q

How is Propranalol used in hyperthyroidism?

A

Non-specific beta blocker, but it specifically inhibitors the peripheral conversion of T4 to T3 in addition to helping with the symptoms of hyperthyroidism

Used to prepare for surgery and for those waiting for other treatments to take effect

51
Q

What is always given in conjunction with other treatments for osteoporosis?

A

Calcium and Vitamin D

52
Q

DOC for osteoporosis

A

Bisphosphonates

+ Calcium and Vit D

+/- HRT

+/- Calcium regulating hormones (PTH, calcitonin)

53
Q

How is Calcitonin used in treatment of osteoporosis?

A

Reduces bone resorption of Ca2+ and antagonizes parathyroid hormone

Indicated for Osteoporosis (though not first line)

DOC for Paget’s disease

54
Q

What drugs are the only anabolic drugs for osteoporosis?

A

Parathyroid drugs, b/c RG receptor activation can stimulate formation of new bone

Examples: Teriparatide, Abaloparatide, rhPTH

55
Q

Adverse effects of parathyroid drugs

A

Hyperkalemia and hypercalciuria

Contraindicated in OSTEOSARCOMA (b/c rats)

56
Q

Antibody against receptor activator of nuclear factor kappa-beta ligand (RANK-L)

A

Denosumab

Inhibits bone resorption

RANK-ligand is the factor made by osteoblasts that is necessary for the formation of mature osteoclasts —> inhibitors resorption

57
Q

Indications for Denosumab

A

Osteoporosis in men and postmenopausal women at high risk for fractures, esp those with cancer

Increases bone mass and strength in both cortical and trabecular bone

58
Q

MOA for bisphosphanates

A

Substitutes for PO4 in Ca2+ binding —> incorporates into bone —> inhibition of osteoclasts activity and bone resorption

59
Q

First line treatment for post-menopausal osteoporosis

A

Bisphosphonates

60
Q

What are the special pharmacokinetics of bisphosphonates?

A

Absorption is very poor

Must be taken on an empty stomach with exactly 1/2 glass of water and stay upright for 30 min after taking to decrease esophageal irritation

Pharm II Unit III (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions