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Repro 2 > Antenatal and Perinatal Pharmacology: Fitz > Flashcards

Antenatal and Perinatal Pharmacology: Fitz Flashcards

1
Q

What drugs are used to stimulate fetal lung maturation

A

-corticosteroids:Dexamethasone and betamethasone

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2
Q

What drugs induce Labor?

A
  • Pituitary hormone: oxytocin

- Prostaglandin E analogs: Dinoprostone and Misoprostil

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3
Q

What drugs delay labor?

A
  • Ca channel antagonists: MgSO4 and Nifedipine
  • NSAIDs: indomethacin
  • Beta adrenergic receptors agonists: Salbutamol, Terbutaline, Ritodrine
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4
Q

What drugs are used for antihypertensive pregnancies

A
  • alpha 2 adrenergic receptor agonist: a-methlydopa

- a and b adrenergic receptor blocker: Labetolol

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5
Q

what drug maintains a PDA

A

Alprostadil

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6
Q

What drug closes a PDA

A

Indomethacin

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7
Q

what are the pregnancy categories for drugs

A 
A
B
C
D
X: contraindicated: Warfarin
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8
Q

what are some conditions that are life threatening to the mother and necessitate pre term delivery

A
  • HELLP

- pre-eclampsia

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9
Q

What deficit in immature lungs often leads to respiratory distress syndrome (RDS)

A

surfactant . . affects 40-50% of babies born BEFORE 32 WEEKS

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10
Q

What can be given to reduce the incidence of RDS

A

antenatal corticosteroids

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11
Q

What are the indications for antenatal corticosteroids?

A

women b/t 24 and 34 weeks of gestation with any of the folowing:

  • threatened pre term labor
  • anetpartum hemorrhage
  • Preterm rupture of membranes
  • conditions requiring caesarian delivery like pre eclampsia and HELLP
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12
Q

what is the coricosteroid of choice for antenatal corticosteroids

A

-2 doses of betamethasone

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13
Q

What is the benefit of giving betamethasone over cortisol for antenatal corticosteroids

A

-it has a 20x potency on GCR and no mineralocorticoid receptor effect

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14
Q

what cells in the lung are targeted by the corticosteroids

A

type 2 alveolar pneumocytes

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15
Q

what are the contraindications for antenatal corticosteroid administration?

A
  • mother with systemic infection

- tuberculosis

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16
Q

what is the reason why we don’t administer cortisol for RDS

A

-the placenta is rich in 11b-HSD-2 so will convert it to cortisone which is less active at the GCR

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17
Q

when would you give antenatal cortisol

A

if mother needs treatment for inflammation

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18
Q

Describe the physiology of labor

A
  • Estrogen from the ovaries induces oxytocin receptors on the uterus
  • Stretch nerve impulse as baby gets bigger
  • oxytocin from maternal posterior pituitary induces uterine contraction and the placenta to make PGF2alpha
  • PGF2a also induces uterine contraction
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19
Q

which Cox makes the PGs

A

Cox-1

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20
Q

Pharmacology of labor

A
  • Oxytocin–> uterine contraction

- Dinoprostone and misoprostol –> cervical ripening and uterine contraction

21
Q

Dinoprostone is the same as what PG

A

E2

22
Q

how is Dinoprostone administered

A
  • intravaginally or intracervically for cervical ripening

- easily removed

23
Q

describe the pharmacology of inducing labor

A
  • first ripen the cervix with an PG analog

- next morning oxytocin

24
Q

What does an oxytocin challenge test test for

A

fetal viability

25
Q

what is the name for drugs that delay labor

A

Tocolytic drugs

26
Q

what are the B2 adrenergic receptor agonist that delay labor?
what effect do they have

A
  • Ritodrine, Salbutamol, Terbutaline

- relax uterine smooth muscle

27
Q

what are the NSAIDs for delaying labor?

MOA?

A
  • indomethacin
  • inhibits uterine COX-1 enzyme
  • block PGF2 and PGE2 formation
28
Q

What is the Ca channel antagonist used to delay labor?

this does what?

A
  • Nifedipine
  • block L channesl
  • relaxes uterine smooth muscle
29
Q

What does MgSO4 do

A

competition at Ca channel to delay labor

30
Q

Adverse effects of Ritodrine, Salbutamol, and Terbutaline

A
  • tachy
  • hypotension
  • HYPOKALEMIA
  • HYPERGLYCEMIA

to mother and fetus

31
Q

Adverse effects of indomethacin

A
    • indicated for 2nd trimester only
  • riskd permature in utero closure of ductus arteriosus (fetus)
  • bleeding and ulcer in mother
32
Q

Adverse effects of Nifedipine

A
  • Dizziness
  • hypotension

of mother

33
Q

adverse effects of MgSO4

A

contraindicated in myasthenia gravis

34
Q

what is MgSO5 commonly used for

A

protect against seizures associated with pre-eclampsia and HELLP syndrome

35
Q

what drug antagonized oxytocin receptor

A

Atosiban

36
Q

what are the risks associated with NSAID use in third trimester

A
  • Maternal: prolonged labor, postpartum hemorrhage, gastric irrritation
  • Fetal: from oligohydramnios to intauterine closure of ductus arteriosus to persistent pulmonary HTN and death
37
Q

what keeps the ductus arteriosus patent in utero

A

PGE2

38
Q

what normally happens at birth that makes the ductus arteriosus close

A

maturation of the neonatal lung metabolizes PGE2 and thereby “withdraws” PGE2

39
Q

what drug maintains a PDA and why would you want to do this

A
  • PGE1 . . alprostadil
  • maintains pulmonary blood flow in pre term infants with congenital heart defects allowing them to mature sufficiently to cope with surgery
40
Q

what is the complication to giving alprostadil for maintaining a PDA

A

PYREXIA . . elevating temp

41
Q

failure of PDA closure is common in what babies

A

-premature especially with RDS

42
Q

when is indomethacin not effective in closing a PDA

A

in a full term baby

43
Q

what are complication of Cox inhibitors given to a baby to close a PDA

A
  • renal vasoconstriction –> Na and water retention (edema)
  • high serum creatinine
  • mild HTN
44
Q

what are the first line antihypertensive drugs for moderate HTN

A

oral alpha-methyldopa and oral labetalol

45
Q

Explain the MOA of a-methyldopa

A
  • agonist at pre synaptic a2 adrenergic receptors in thee brainstem
  • reduced adrenergic neuronal outflow through the peripheral nervous system causing vasodilation adn reduced BP
  • renal blood flow and cardiac output are unaltered
46
Q

Side effects of a-methyldopa

A
  • sedation
  • dry mouth
  • impotence
  • galactorrhea
47
Q

difference in onset of action between a-methyldopa and Labetolol

A
  • methyldopa - 3-6 hours

- Labetalol- within 2 hours

48
Q

what is used extensively in the setting of preeclampsia for the acute treatment fo severe HTN

A

Hydralazine

Repro 2 (9 decks)

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