Ante and Perinatal Pharm (Wolff) Flashcards
Misoprostol
prostaglandin E1 analog; termination of intrauterine pregnancy; contraindicated in pregnancy unless aborting; stable at room temp; maternal side effects - n/v, pain, chills, shivering
Dinoprostone
prostaglandin E2 analog; cervical ripening agent; can also be used to terminate a pregnancy; much more expensive than misoprostol and needs refrigeration; contraindicated in pregnancy unless aborting; ** during abortion watch for a fever that is unresponsive to NSAIDs
Carboprost
prostaglandin F2alpha analog; used to induce abortion; controls postpartum bleeding; deep IM injection; many many maternal side effects; contraindicated in PID, cardiac, pulmonary, renal or liver dysfxn
Oxytocin
posterior pituitary hormone; induction of labor; contraindicated if fetal lungs are not mature; watch for water intoxication in mom (hyponatremia)
ergot alkaloids
contractor from a rye fungus; prolonged/tonic uterine contraction; constricts arterioles and veins; decrease postpartum bleeding; history side effect of St. Anthony’s fire - mania, psychosis, vomiting, gangrene of distal tissues
Tocolytics (stop uterine contractions)
- Indomethacin
- Nifedipine
- Ritodrine - FDA approved but not available
- Terbutaline
- Magnesium sulfate
Corticosteroids
- Bethamethasone - 2 doses by IM
- Dexamethsaone - 4 does by IM
PGE1 (alprostadil)
given to preterm infants with cardiac defects; adverse effects pyrexia (fever)
First line treatments for HTN in pregnancy
**oral alpha-methyldopa
oral labetalol
oral nifedipine
Treatment for severe HTN in pregnancy
*labetalol
*hydralazine
esmolol and/or nicardipine
sodium nitroprusside
HTN meds contraindicated in pregnancy
ACEi and ARBs; spironolactone
FDA teratogenic categories
a: possibility of fetal harm
b. studies have NOT demonstrated fetal risk
c. animal studies have revealed adverse effects on the fetus; no clinical studies available
d. positive evidence of human fetal risk; benefits may outweigh risks
x. risks clearly outweighs any benefits
The 5 induction of labor agents
- misoprostol
- dinoprostone
- carboprost
- oxytocin
- ergot alkaloids
The 5 tocolytics
to delay labor (PTL or PROM)
1. indomethacin
2. nifedipine
3. terbutaline
4. magnesium sulfate
5. atosiban
Agent used to maintain the patent ductus arterioles in newborns
alprostadil
Agents used to close the patent ductus arterioles in newborns
indomethacin
ibuprofen
FDA teratogenic category x
x. risks clearly outweighs any benefits
Bottom line with cervical ripening/induction agents
- prostaglandins work well for ripening cervix, but cervix must be ripe before contractions are induced; can cause contractions at anytime during pregnancy (abortions)
- oxytocin used during L&D to induce/normalize contraction
- ergot alkaloids are second choice for limiting postpartum bleeding (after oxytocin)
Indomethacin
tocolytic; blocks synthesis of PGF2aalpha (potent stimulator of uterine contractions); contraindicated in renal or liver impairment; agent of choice from 24-32 weeks (nifedipine is 2nd)
What is the agent of choice for a tocolytic from 24 - 32 weeks?
Indomethacin; (nifedipine is 2nd)
Nifedipine
tocolytic; calcium channel blocker; blocks calcium influx (less calcium, less contractions); contraindicated in cardiac and renal disease and maternal hypotension; ** do not admin with magnesium sulfate can cause lethal cardiovascular “collapse”
Ritodrine
FDA approved but not available; beta2 agonist tocolytic; maternal side effects of severe hallucinations
Terbutaline
beta 2 agonist tocolytic; increase cAMP, hyperpolarization, dephosphorylation of myosin light chains; NOT FDA approved; but second choice after nifedipine between 32 - 34 weeks when NSAIDs are contraindicated
Magnesium sulfate
prevents eclamptic seizures; neuroprotection (cerebral palsy); long term choice for tocolysis; MOA unknown but somehow competes with Ca+ channels
Medications routinely given to neonates
- erythromycin eye ointment - effective against gonococcal conjunctivitis but NOT C. trachomatis
- Vitamin K
- umbilical cord care - topical antiseptics to reduce infections
- hepatitis B vaccine - first dose w/I 24 hrs of delivery
