Antenatal and Perinatal Pharm

Question 1

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?

Answer 1

Antenatal CS - Betamethasone** or dexamethasone

Question 2

Dose timing for betamethasone

Answer 2

two doses, 4 hrs apart, IM

Question 3

Dose timing for dexamethasone

Answer 3

four doses, 12 hours apart, IM

Question 4

Antenatal CS prior to delivery reduce incidence of what in newbron?

Answer 4

Respiratory Distress Syndrome, ventricular hemorrhage, neonatal death

Question 5

Want a CS that directly afects what receptor?

Answer 5

Glucocorticoid receptor only (not mineralocorticoid)

Question 6

Mom has systemic infection or TB. What drugs are contraindicationed?

Answer 6

betamethasone or dexamethasone

Question 7

How long was mom on antenatal CS for if her baby has growth retardation, sepsis, brain developmental delay, adrenal insufficiency, enterocolitis…

Answer 7

Multiple course for ~7 days (v. a single 48 hr course = no AE)

Question 8

Why is betamethasone or dexamethasone used instead administering cortisol to mom?

Answer 8

Placental metabolizes cortisol to cortisone, which is less active at GC-R. Cortisol converted to cortisone by 11B-HSD-2)

Question 9

What drugs mimic PGE2? Why give?

Answer 9

Dinoprostone (or misoprostol) to mimic PGE2’s cervical ripening effects.

Question 10

Name the two functions of oxytocin.

Answer 10

1. Induction of labor (once cervix is ripe)

2. Oxytocin challenge test - assess fetal heart/distressed state

Question 11

Mom needs to a drug to relax uterine smooth muscle to delay delivery until transport to NICU (she has preeclampsia or HELLP) - give what?

Answer 11

MgSO4 - it relaxes uterine smooth muscle and protects against seizures.

Question 12

Relaxation of myometrium (delay uterine contractions): drug that inhibits the COX-1 enzyme, blocking PGF2alpha and PGE2 formation

Answer 12

Indomethacin (NSAIDs)

Question 13

Relaxation of myometrium (delay uterine contractions): A drug that competes at Ca channels

Answer 13

MgSO4

Question 14

Relaxation of myometrium (delay uterine contractions): a drug that blocks oxytocin pituitary neuropeptide receptor.

Answer 14

Atosiban (***Know that this is an oxytocin NP-R antagonist)

Question 15

Relaxation of myometrium (delay uterine contractions): three drugs that are B2-adregergic receptor agonists

Answer 15

Ritodrine, salbutamol, terbutaline

Question 16

Woman give a tocolytic drug and she/fetus presents with tachycardia, hypoT, HYPOKALEMIA, HYPERGLYCEMIA. What class and drugs were given?

Answer 16

B2-Receptor agonists - ritodrine, salbutamol, terbutaline

Question 17

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?

Answer 17

Indomethacin. She was given it at an incorrect time in at term. Should only be administered in 2nd trimester.

Question 18

Mom given tocolytic drug and presents with dizziness and hypotension. What drug was given and when should this be used with caution?

Answer 18

Nifedipine - used with caution in women with compromised CV conditions, at risk of pulmonary edema and CF.

Question 19

Mom has myasthemnia gravis. Never give what tocolytic drug.

Answer 19

MgSO4

Question 20

Relaxation of myometrium (delay uterine contractions): what drug is a Ca channel antagonist?

Answer 20

Nifedipine

Question 21

Risks associated with NSAID use in 3rd trimester.

Answer 21

Maternal complicaitons - prolongation of labor, postpartum hemorrhage, and gastric irritation.
Fetal AE - intrauterine closure of DA.

Question 22

PGE1 drug that maintains PDA. Use for what condition?

Answer 22

Alprostadil. Use for Congenital heart disorders/defects

Question 23

***Complications of PGE1 drugs (aloprostadil).

Answer 23

hypotension, tachycardia, apnea, PYREXIA

Question 24

What AE limits the amount of aloprostadil that can be given to a baby?

Answer 24

fever/pyrexia

Question 25

What drug facilitates closure of a PDA in a PREEMATURE BABY

Answer 25

NSAIDs - indomethacin

Question 26

Indomethacin is ineffective in facilitating closure of a PDA unless the child is…

Answer 26

Premature

Question 27

Infants less than what age must have dosage of renal-cleared drugs change?

Answer 27

If the infant is less than 6 months - has reduced renal function.

Question 28

Infants less than what age must have dosage of hepatic-cleared drugs change? Why?

Answer 28

Sulfnamides (Sulfamethoxazole) - Glucouronidation begins at 60 days.

Question 29

A baby presents with neonatal encephalopathy (BR excess in brain). What drug?

Answer 29

SMX - this is kernicterus. Poor BR clearance

Question 30

A baby presents with abdominal distension, diarrhea, vomiting, dusky gray color, circulatory collapse & death. What is this? Why?

Answer 30

Gray baby Syndrome - bc impaired glucronidation in neontates.

Question 31

SMX is CI in (mom?) what type of neonate

Answer 31

term/breast fed.

Question 32

What ab are generally safe for mom to take if neonate has infection?

Answer 32

B-lactams - cephalosporins, penicillins

Question 33

What three classes of ab are not safe for mom to take if neonate is sick?

Answer 33

• Class C: Fluoroquinolone, trimethoprim (birth defect risk)

- Class D: tetracycline (fatty liver hepatotox)

Question 34

Peds conditions - do not admin fluoroquinolones (~cipro/moxi/levo-floxacin) before age __ because ____.

Answer 34

Before 18 yo because of cartilage erosion.

Question 35

Peds conditions - do not admin tetracyclines before age __ because ____.

Answer 35

Before 8 years old because of bone and teeth deposits.

Question 36

Why does trimethoprim cause birth defects?

Answer 36

Bc it is a DHF-Reductase Inhibitor and mo2-3 in utero requires a lot of folate.