Antenatal & Perinatal pharm (Fitz)

Question 1

drugs to stimulate fetal lung maturation?

Answer 1

corticosteroids

Question 2

drugs to induce labor?

Answer 2

• Oxytocin

- PGE analogs –> Dinoprostone and Misoprostil

Question 3

drug to maintain a PDA?

Answer 3

Alprostadil

Question 4

drugs to delay labor?

Answer 4

• MgSO4 & Nifedipine (Ca channel antagonists)
• Inomethacin (NSAIDs)
• Salbutamol, Terbutaline, Ritodrine (B agonists)

Question 5

drug to close a PDA?

Answer 5

Indomethacin (NSAIDSs)

Question 6

antihypertensive drugs for pregnancy?

Answer 6

• a-methyldopa (a2 agonist)

- Labetalol (a,B adrenergic receptor blocker)

Question 7

these drugs are given prior to delivery of a pre-term to reduce the incidence of RDS and neonatal death and ventricular hemorrhage

Answer 7

corticosteroids

Question 8

indications for antenatal corticosteroids?

Answer 8

women between 24-34 weeks gestation with any of the following:

• threatened pre-term labor
• antepartum hemorrhage
• preterm rupture of membranes
• conditions requiring C section (Pre-eclampsia, HELLP)

Question 9

corticosteroid drug of choice for fetal cortisol deficit?

Answer 9

betamethasone (12 mg IM, 24 hrs apart)

Question 10

risks of antenatal corticosteroids?

Answer 10

• single course (48 hrs): no significant maternal or fetal adverse effects
• Multiple courses for ~7 days risk side effects –> growth retardation, sepsis, brain developmental delay, adrenal insufficiency, enterocolitis, etc.)

Question 11

contraindications for antenatal corticosteroids?

Answer 11

mother w/systemic infx, TB

Question 12

why not administer cortisol for fetal lung development?

Answer 12

placenta is rich in 11-B-hydroxysteroid dehydrogenase-2 —> less active at glucocorticoid receptor and fetus exposed to cortisone

Question 13

prostaglandins involved in parturition?

Answer 13

PGF2a

PGE2

Question 14

__ is administered intravaginall/intracervically and used for RIPENING OF THE CERVIX. It should be administered w/ the pt in or near a labor and delivery suite

Answer 14

PGE2 (Dinoprostone)

easily removed if uterine hyperstimulation occurs

Question 15

receptors for PGE2? PGF2a?

Answer 15

PGE2 –> EP

PGF2a–> FP

Question 16

Deficit of PGs and birth?

Excess of PGs and birth?

Answer 16

deficit –> delayed

excess–> pre-mature labor, birth

Question 17

once the cervix is ripe, __ is still the favored pharmacological agent for inducing labor

Answer 17

oxytocin

Question 18

__ drugs aim to stop uterine contractions and to prevent neonatal risks associated with prematurity

Answer 18

Tocolytic

Question 19

Ritodrine, Salbutamol, and Terbutaline are what kinds of drugs and used for what?

Complications and adverse?

Answer 19

b2 adrenergic receptor AGONIST

relaxes uterine smooth muscle –> delay labor

-Tachycardia, hypotension, HYPO-K, HYPERGLYCEMIA-mother and fetus

Question 20

Indomethacin is what kind of drug and used for what?

complications and adverse?

Answer 20

NSAID

inhibits uterine COX-1, blocks PGF2a and PGE2 formation

Delay labor. indicated for short-term effect during 2nd trimester

-2nd trimester only. Use at term risks premature in utero closure of ductus arteriosus (fetus) and bleeding risk/ulcer (mother)

Question 21

Nifedipine is what kind of drug and used for what?

complications and adverse?

Answer 21

Ca channel ANTAGONIST

Relaxes uterine smooth muscle

Delay labor

-dizziness, hypotension (mom)

Question 22

MgSO4 is what kind of drug and used for what?

complications and adverse?

Answer 22

competition at Ca channels

delay labor

-Myasthenia gravis: contra-indicated

Question 23

which tocolytic is commonly used to delay labor and why?

Answer 23

MgSO4 –> protects against seizures associated with pre-eclampsia and HELLP

Question 24

What type of drug is Atosiban and its use?

Answer 24

oxytocin pituitary neuropeptide receptor antagonist (europe)

delay labor

Question 25

Maternal risk with NSAID use during 3rd trimester? Fetal risk?

Answer 25

maternal –> prolongation of labor, postpartum hemorrhage, gastric irritation

fetal –> oligohydramnios and intrauterine closure of ductus arteriosus to persistant pulm HTN and fetal death

Question 26

Endoenous __ keeps the ductus arteriosus patent in utero

Answer 26

PGE2

Birth provokes spontaneous closure of DA via metabolic inactivation of PGE2 in the lung

Question 27

Alprostadil is what type of PG? Use?

Answer 27

PGE1

Maintain PDA in congenital heart disorders

Question 28

complications with Alprostadil use?

Answer 28

HYPOTENSION, TACHYCARDIA, APNEA, AND PYREXIA

Question 29

__ inhibitors used to close a PDA in premature infants

Answer 29

COX

Question 30

when are COX inhibitors not effective in closing PDAs?

Answer 30

not effective for PDA in full term baby

Question 31

renal complications of NSAIDs use in neonates?

Answer 31

renal vasoconstriction –> Na and H2O retention (oliguria, edema), reduced creatinine clearance (high serum Cr), mild HTN

Question 32

first line anti-HTN drugs for moderate HTN in pregnancy?

Answer 32

oral a-methyldopa and oral labetalol

Question 33

parental anti-HTN agents used for more severe elevations of BP in pregnancy?

Answer 33

labetalol, hydralazine, and Na nitroprusside

Question 34

caution should be exercised with use of what anti-HTN drug in pregnancy?

Answer 34

Hydralazine –> particularly pts with decreased plasma volume

Question 35

what is the active metabolite of a-methyldopa after its been converted by dopamine B hydroxylase?

Answer 35

a-methylnorepinephrine –> acts primarily within the CNS and renal blood flow well maintained

Question 36

what receptor activity does Labetalol possess?

Answer 36

BOTH a and B blocking activity

Question 37

__ is used extensively in the setting of pre-eclampsia for acute tx of severe HTN

Answer 37

Hydralazine

can cause reflex tachycardia and fluid retention