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Repro 2 > Antenatal and Perinatal Pharmacology: Fitz > Flashcards

Antenatal and Perinatal Pharmacology: Fitz Flashcards

(48 cards)

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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

Study These Flashcards
A
  • Oxytocin–> uterine contraction

- Dinoprostone and misoprostol –> cervical ripening and uterine contraction

21
Q

Dinoprostone is the same as what PG

22
Q

how is Dinoprostone administered

Study These Flashcards
A
  • intravaginally or intracervically for cervical ripening

- easily removed

23
Q

describe the pharmacology of inducing labor

Study These Flashcards
A
  • first ripen the cervix with an PG analog

- next morning oxytocin

24
Q

What does an oxytocin challenge test test for

Study These Flashcards
A

fetal viability

25
what is the name for drugs that delay labor
Tocolytic drugs
26
what are the B2 adrenergic receptor agonist that delay labor? what effect do they have
- Ritodrine, Salbutamol, Terbutaline | - relax uterine smooth muscle
27
what are the NSAIDs for delaying labor? | MOA?
- indomethacin - inhibits uterine COX-1 enzyme - block PGF2 and PGE2 formation
28
What is the Ca channel antagonist used to delay labor? | this does what?
- Nifedipine - block L channesl - relaxes uterine smooth muscle
29
What does MgSO4 do
competition at Ca channel to delay labor
30
Adverse effects of Ritodrine, Salbutamol, and Terbutaline
- tachy - hypotension - HYPOKALEMIA - HYPERGLYCEMIA to mother and fetus
31
Adverse effects of indomethacin
- - indicated for 2nd trimester only - riskd permature in utero closure of ductus arteriosus (fetus) - bleeding and ulcer in mother
32
Adverse effects of Nifedipine
- Dizziness - hypotension of mother
33
adverse effects of MgSO4
contraindicated in myasthenia gravis
34
what is MgSO5 commonly used for
protect against seizures associated with pre-eclampsia and HELLP syndrome
35
what drug antagonized oxytocin receptor
Atosiban
36
what are the risks associated with NSAID use in third trimester
- Maternal: prolonged labor, postpartum hemorrhage, gastric irrritation - Fetal: from oligohydramnios to intauterine closure of ductus arteriosus to persistent pulmonary HTN and death
37
what keeps the ductus arteriosus patent in utero
PGE2
38
what normally happens at birth that makes the ductus arteriosus close
maturation of the neonatal lung metabolizes PGE2 and thereby "withdraws" PGE2
39
what drug maintains a PDA and why would you want to do this
- PGE1 . . alprostadil - maintains pulmonary blood flow in pre term infants with congenital heart defects allowing them to mature sufficiently to cope with surgery
40
what is the complication to giving alprostadil for maintaining a PDA
PYREXIA . . elevating temp
41
failure of PDA closure is common in what babies
-premature especially with RDS
42
when is indomethacin not effective in closing a PDA
in a full term baby
43
what are complication of Cox inhibitors given to a baby to close a PDA
- renal vasoconstriction --> Na and water retention (edema) - high serum creatinine - mild HTN
44
what are the first line antihypertensive drugs for moderate HTN
oral alpha-methyldopa and oral labetalol
45
Explain the MOA of a-methyldopa
- 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
Side effects of a-methyldopa
- sedation - dry mouth - impotence - galactorrhea
47
difference in onset of action between a-methyldopa and Labetolol
- methyldopa - 3-6 hours | - Labetalol- within 2 hours
48
what is used extensively in the setting of preeclampsia for the acute treatment fo severe HTN
Hydralazine

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