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Repro Pharm > Antenata and perinatal pharmacology > Flashcards

Antenata and perinatal pharmacology Flashcards

1
Q

drugs to stim fetal lung maturation

A
  • betamethasone

- dexamethasone

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2
Q

drugs to induce labor

A
  • oxytocin (pit H)

- Dinoprostone, Misoprostil- PGE analogs

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3
Q

drugs to maintain or close a PDA

A
  • maintain- Alprostadil

- close- Indomethacin (NSAIDs)

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4
Q

drugs to delay labor

A
  • MgSO4, Nifedipine (Ca channel antagonists)

- salbutamol, terbutaline, ritodrine (B adrenergic R agonists)

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5
Q

Antihypertensive drugs for pregnancy

A
  • alphaMethylDOPA (alpha2 R agonist)

- Labetalol (alpha,B R Blocker)

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6
Q

pregnancy categories for dugs

A
  • A and B- no risk
  • C- risk evident in animal studies
  • D- risk evident in human studies
  • X- contraindicated (ex- Warfarin)
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7
Q

drug used to promote lung maturation

A

corticosteroids

  • betamethasone- drug of choice- 2 doses, 24 hrs apart
  • dexamethasone
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8
Q

preterm birth- risk of RDS

A
  • surfactant deficient- leads to RDS

- RDS affects 50% of babies born < 32 wks!!

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9
Q

Indications for antenatal corticosteroids

A
  • b/w 24-34 wks of gestation with:
  • pre-term labor
  • antepartum hemorrhage
  • conditions requiring C-delivery- pre-eclampsia, HELLP!!!
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10
Q

corticosteroid- moa

A
  • GCR binding
  • dissociation
  • dimerization
  • translocation
  • transcription of surfactant proteins!! (alveolar type 2 pneumocytes)
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11
Q

risks of antenatal corticosteroids, contraindications

A
  • single course- no significant maternal or fetal adverse effects
  • contraindications- mother with systemic infection, TB
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12
Q

Why cant we just administer cortisol?

A 
placenta metabolizes (inact) cortisol!!
-11B-HSD2 in placenta- converts cortisol to cortisone
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13
Q

physiology of labor

A
  • estrogen- induce oxytocin Rs on uterus
  • stretch N impulse- stim release of oxytocin (post pit)
  • oxytocin:
  • uterine contraction
  • placenta- prod PGF2alpha- uterine contraction (and + feedback)
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14
Q

PGfalpha- made how

A

-COX-1

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15
Q

drug for cervical ripening and uterine contraction

A
  • Dinoprostone (PGE2)- easily removed if uterine hyperstim occurs
  • Misoprostol
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16
Q

Prostaglandins- moa

A
  • PGE2- EP Rs
  • PGF2alpha- FP Rs
  • dilate the cervix, contract the uterus
  • deficit of PGs- delayed birth
  • excess of PGs- premature labor, birth
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17
Q

labor induction- drug

A

oxytocin

-once cervix is ripe!!

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18
Q

Oxytocin challenge test

A
  • controlled stress test to test fetal viability!!!

- provokes contractions- follow fetal heart rate

19
Q

drugs to delay labor

A

Tocolytic drugs

  • B R agonist
  • inhibit COX-1
  • CA channel antagonist
  • competition at Ca channels
  • oxytocin R antagonist
20
Q

B R agonist- drugs, SE’s

A

(relax uterine smooth m)

  • Ritodrine
  • Salbutamol
  • Terbutaline
  • hypokalemia, hyperglycemia
21
Q

inhibits uterine COX-1- drug, SE’s

A

(blocks PGF2alpha and PGE2 formation)

  • indomethacin (NSAIDs)
  • 2nd trimester only!!
  • use at term risks premature in utero closure of ductus arteriosus- fetus
  • bleeding risk, ulcer- mother
22
Q

Ca channel antagonist- drug, SE’s

A

(relax uterine smooth m)

  • nifedipine
  • dizziness, hypotension- mother
23
Q

competition at Ca channels- drug, SE’s

A
  • MgSO4

- MG- contraindicated

24
Q

oxytocin R antagonist- drug

A

-atosiban

25
Q

Tocolytic drugs- how long is long enough?

A

-useful to delay delivery for hrs/days (not to delay indefinitely!!)

26
Q

used to protect against seziures assoc with pre-eclampsia and HELLP syndrome

A

-MgSO4

27
Q

indomethacin- indicated when?

A

second trimester of pregnancy

28
Q

ifedipine- use with caution when?

A

-used with caution in pts with compromised CV condition at risk of pulm edema and cardiac failure

29
Q

selective B2 R agonists- use

A
  • SE’s of hypokalemia, hyperglycemia

- leads to discontinuation and choosing alternative tocolytic drugs

30
Q

NSAID use- risks assoc in 3rd trimester

A
  • maternal- prolongation of labor, postpartum hemorrhage

- fetal- intrauterine closure of ductus arteriosus

31
Q

ductus arteriosus- what happens at birth

A
  • birth provokes closure of DA via metabolic inact of PGE2 in lung
  • maturation of neonatal lung- metabolizes PGE2
32
Q

drug to keep PDA in utero- indication

A

Endogenous PGE1- alprostadil

-pre-term infants with congenital heart defects

33
Q

Alprostadil- indication

A

(PGE1)

-maintains a PDA in congenital heart disorders

34
Q

Alprostadil- complications

A

-pyrexia

35
Q

PDA- in who

A

premature infants

36
Q

drugs to close ductus arteriosus

A

NSAIDS- indomethacin (COX inhibitors)

-less PGE2- closure

37
Q

Indomethacin- indications

A
  • premature infants!!- close DA

- not effective for PDA in full term baby!!!

38
Q

complications of NSAIDs in infants

A

-inhibit COX-1/2- deficit of PG2- renal vasoconstriction- Na and H2O retention, reduced creatinine clearance, mild HTN

39
Q

HTN in pregnancy- drugs

A

-alpha-methyldopa
-labetalol
(oral)

40
Q

Methyldopa- moa

A

centrally acting

  • converted to alpha-methylnorepinephrine- stim alpha2 Rs- reduces symp outflow from CNS!!
  • BP falls due to dec in peripheral resistance
41
Q

Adrenergic R blockers

A

-safety in pregnancy is controversial

42
Q

Labetalol- moa

A

-alpha and B blocking activity!!!

43
Q

used for acute tx of severe HTN

A

-IV hydralazine

Repro Pharm (5 decks)

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