Antenatal and Perinatal Pharm Flashcards
A woman between 23 and 34 weeks of gestation has threatened pre term labor, antepartum hemorrhage, preterm rutpure of membranes, PREECLAMPSIA or HELLP - what is indicated?
Antenatal CS - Betamethasone** or dexamethasone
Dose timing for betamethasone
two doses, 4 hrs apart, IM
Dose timing for dexamethasone
four doses, 12 hours apart, IM
Antenatal CS prior to delivery reduce incidence of what in newbron?
Respiratory Distress Syndrome, ventricular hemorrhage, neonatal death
Want a CS that directly afects what receptor?
Glucocorticoid receptor only (not mineralocorticoid)
Mom has systemic infection or TB. What drugs are contraindicationed?
betamethasone or dexamethasone
How long was mom on antenatal CS for if her baby has growth retardation, sepsis, brain developmental delay, adrenal insufficiency, enterocolitis…
Multiple course for ~7 days (v. a single 48 hr course = no AE)
Why is betamethasone or dexamethasone used instead administering cortisol to mom?
Placental metabolizes cortisol to cortisone, which is less active at GC-R. Cortisol converted to cortisone by 11B-HSD-2)
What drugs mimic PGE2? Why give?
Dinoprostone (or misoprostol) to mimic PGE2’s cervical ripening effects.
Name the two functions of oxytocin.
- Induction of labor (once cervix is ripe)
2. Oxytocin challenge test - assess fetal heart/distressed state
Mom needs to a drug to relax uterine smooth muscle to delay delivery until transport to NICU (she has preeclampsia or HELLP) - give what?
MgSO4 - it relaxes uterine smooth muscle and protects against seizures.
Relaxation of myometrium (delay uterine contractions): drug that inhibits the COX-1 enzyme, blocking PGF2alpha and PGE2 formation
Indomethacin (NSAIDs)
Relaxation of myometrium (delay uterine contractions): A drug that competes at Ca channels
MgSO4
Relaxation of myometrium (delay uterine contractions): a drug that blocks oxytocin pituitary neuropeptide receptor.
Atosiban (***Know that this is an oxytocin NP-R antagonist)
Relaxation of myometrium (delay uterine contractions): three drugs that are B2-adregergic receptor agonists
Ritodrine, salbutamol, terbutaline
Woman give a tocolytic drug and she/fetus presents with tachycardia, hypoT, HYPOKALEMIA, HYPERGLYCEMIA. What class and drugs were given?
B2-Receptor agonists - ritodrine, salbutamol, terbutaline
Woman give a tocolytic drug and her fetus has in utero closure of ductus arteriosus. Mom has bleeding risk and ulcers. What drug was given and why did this happen?
Indomethacin. She was given it at an incorrect time in at term. Should only be administered in 2nd trimester.
Mom given tocolytic drug and presents with dizziness and hypotension. What drug was given and when should this be used with caution?
Nifedipine - used with caution in women with compromised CV conditions, at risk of pulmonary edema and CF.
Mom has myasthemnia gravis. Never give what tocolytic drug.
MgSO4
Relaxation of myometrium (delay uterine contractions): what drug is a Ca channel antagonist?
Nifedipine
Risks associated with NSAID use in 3rd trimester.
Maternal complicaitons - prolongation of labor, postpartum hemorrhage, and gastric irritation.
Fetal AE - intrauterine closure of DA.
PGE1 drug that maintains PDA. Use for what condition?
Alprostadil. Use for Congenital heart disorders/defects
***Complications of PGE1 drugs (aloprostadil).
hypotension, tachycardia, apnea, PYREXIA
What AE limits the amount of aloprostadil that can be given to a baby?
fever/pyrexia
What drug facilitates closure of a PDA in a PREEMATURE BABY
NSAIDs - indomethacin
Indomethacin is ineffective in facilitating closure of a PDA unless the child is…
Premature
Infants less than what age must have dosage of renal-cleared drugs change?
If the infant is less than 6 months - has reduced renal function.
Infants less than what age must have dosage of hepatic-cleared drugs change? Why?
Sulfnamides (Sulfamethoxazole) - Glucouronidation begins at 60 days.
A baby presents with neonatal encephalopathy (BR excess in brain). What drug?
SMX - this is kernicterus. Poor BR clearance
A baby presents with abdominal distension, diarrhea, vomiting, dusky gray color, circulatory collapse & death. What is this? Why?
Gray baby Syndrome - bc impaired glucronidation in neontates.
SMX is CI in (mom?) what type of neonate
term/breast fed.
What ab are generally safe for mom to take if neonate has infection?
B-lactams - cephalosporins, penicillins
What three classes of ab are not safe for mom to take if neonate is sick?
- Class C: Fluoroquinolone, trimethoprim (birth defect risk)
- Class D: tetracycline (fatty liver hepatotox)
Peds conditions - do not admin fluoroquinolones (~cipro/moxi/levo-floxacin) before age __ because ____.
Before 18 yo because of cartilage erosion.
Peds conditions - do not admin tetracyclines before age __ because ____.
Before 8 years old because of bone and teeth deposits.
Why does trimethoprim cause birth defects?
Bc it is a DHF-Reductase Inhibitor and mo2-3 in utero requires a lot of folate.
