Ante and Perinatal Pharm (Wolff)

Question 1

Misoprostol

Answer 1

prostaglandin E1 analog; termination of intrauterine pregnancy; contraindicated in pregnancy unless aborting; stable at room temp; maternal side effects - n/v, pain, chills, shivering

Question 2

Dinoprostone

Answer 2

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

Question 3

Carboprost

Answer 3

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

Question 4

Oxytocin

Answer 4

posterior pituitary hormone; induction of labor; contraindicated if fetal lungs are not mature; watch for water intoxication in mom (hyponatremia)

Question 5

ergot alkaloids

Answer 5

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

Question 6

Tocolytics (stop uterine contractions)

Answer 6

1. Indomethacin
2. Nifedipine
3. Ritodrine - FDA approved but not available
4. Terbutaline
5. Magnesium sulfate

Question 7

Corticosteroids

Answer 7

1. Bethamethasone - 2 doses by IM
2. Dexamethsaone - 4 does by IM

Question 8

PGE1 (alprostadil)

Answer 8

given to preterm infants with cardiac defects; adverse effects pyrexia (fever)

Question 9

First line treatments for HTN in pregnancy

Answer 9

**oral alpha-methyldopa
oral labetalol
oral nifedipine

Question 10

Treatment for severe HTN in pregnancy

Answer 10

*labetalol
*hydralazine
esmolol and/or nicardipine
sodium nitroprusside

Question 11

HTN meds contraindicated in pregnancy

Answer 11

ACEi and ARBs; spironolactone

Question 12

FDA teratogenic categories

Answer 12

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

Question 13

The 5 induction of labor agents

Answer 13

1. misoprostol
2. dinoprostone
3. carboprost
4. oxytocin
5. ergot alkaloids

Question 14

The 5 tocolytics

Answer 14

to delay labor (PTL or PROM)
1. indomethacin
2. nifedipine
3. terbutaline
4. magnesium sulfate
5. atosiban

Question 15

Agent used to maintain the patent ductus arterioles in newborns

Answer 15

alprostadil

Question 16

Agents used to close the patent ductus arterioles in newborns

Answer 16

indomethacin
ibuprofen

Question 17

FDA teratogenic category x

Answer 17

x. risks clearly outweighs any benefits

Question 18

Bottom line with cervical ripening/induction agents

Answer 18

1. prostaglandins work well for ripening cervix, but cervix must be ripe before contractions are induced; can cause contractions at anytime during pregnancy (abortions)
2. oxytocin used during L&D to induce/normalize contraction
3. ergot alkaloids are second choice for limiting postpartum bleeding (after oxytocin)

Question 19

Indomethacin

Answer 19

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)

Question 20

What is the agent of choice for a tocolytic from 24 - 32 weeks?

Answer 20

Indomethacin; (nifedipine is 2nd)

Question 21

Nifedipine

Answer 21

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”

Question 22

Ritodrine

Answer 22

FDA approved but not available; beta2 agonist tocolytic; maternal side effects of severe hallucinations

Question 23

Terbutaline

Answer 23

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

Question 24

Magnesium sulfate

Answer 24

prevents eclamptic seizures; neuroprotection (cerebral palsy); long term choice for tocolysis; MOA unknown but somehow competes with Ca+ channels

Question 25

Medications routinely given to neonates

Answer 25

1. erythromycin eye ointment - effective against gonococcal conjunctivitis but NOT C. trachomatis
2. Vitamin K
3. umbilical cord care - topical antiseptics to reduce infections
4. hepatitis B vaccine - first dose w/I 24 hrs of delivery