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Endo Repro Exam II > Antenatal & Perinatal Pharmacology > Flashcards

Antenatal & Perinatal Pharmacology Flashcards

1
Q

Describe the changes and expectations associated with the FDA’s Pregnancy and Lactation Labeling Final Rule that became effective June 30, 2015

A

Instead of former letter category indicating risk in pregnancy, now must use narrative sections/subsections for pregnancy (pregnancy exposure registry, risk summary, clinical considerations, data), lactation (risk summary, clinical considerations, data), and females/males of reproductive potential (pregnancy testing, contraception, and infertility)

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2
Q

Strategies for prevention of RDS prior to preterm delivery

A

Corticosteroids are used to promote lung maturation and increase surfactant production (via increased transcription of surfactant proteins in alveolar type 2 pneumocytes)

Options include betamethasone or dexamethasone

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3
Q

Treatment of RDS in newborns

A

CPAP

IPPV (nasal intermittent positive pressure ventilation)

If acidotic or otherwise not improving, intubation and exogenous surfactant administration

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4
Q

5 drugs used to stimulate labor (uterotonics)

A 
Misoprostol
Dinoprostone
Carboprost
Oxytoxin
Ergot alkaloids
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5
Q

MOA of misoprostol

A

Synthetic prostaglandin E1 analog

[Replaces PG loss in stomach during NSAID therapy, induces uterine contractions, and maintains PDA patency]

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6
Q

Clinical indications for misoprostol

A

NSAID-induced gastric ulcer prevention

Termination of intrauterine pregnancy if <70 days gestation — in combo with mifeprestone

Off label: cervical ripening, labor induction, incomplete abortion, post-partum hemorrhage

[contraindications include pregnancy (unless aborting), and previous C-section]

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7
Q

Maternal and fetal side effects of misoprostol

A

Maternal: oral administration may lead to N/V, abd pain, chills; intravaginal administration may lead to tachysystole, prolonged uterine contractions, and uterine rupture

Fetal: hypoxia d/t tachysystole or prolonged uterine contractions

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8
Q

MOA of dinoprostone

A

Synthetic prostaglandin E2 analog

[induces uterine contractions; promotes cervical ripening; can be used for pregnancy termination from 12th through 20th week of gestation]

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9
Q

Maternal and fetal AEs of dinoprostone

A

Maternal: back pain, N/V, diarrhea, chills, abd pain, flushing, dizziness, warm feeling in vagina, and FEVER unresponsive to NSAIDs during abortion

Fetal: hypoxia d/t tachysystole or prolonged uterine contractions during labor/delivery

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10
Q

MOA of carboprost

A

Synthetic prostaglandin F2a analog

[induces uterine contractions, prolonged duration of action]

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11
Q

Clinical indications for carboprost

A

Used to induce abortion by stimulating uterine contractions between 13-20 weeks of pregnancy if failure of another for expulsion of fetus, premature rupture of membranes with previable fetus and inefficient activity

Post-partum hemostasis for refractory bleeding

[contraindications include hypersensitivity, acute PID, active cardiac, pulmonary, renal, or hepatic dysfunction]

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12
Q

AEs of carbaprost

A

Vasoconstricting effects may lead to HTN and pulmonary edema

Can cause chills but tends to reduce body temperature (unlike PGE2)

Also causes dizziness, heartburn, choking sensation, cough, blurred vision, rash, breast tenderness, dysmenorrhea-like pain, perforated uterus or cervix, UTI

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13
Q

Exogenous oxytocin may be given to increase force, frequency, and duration of uterine contractions by binding to GPCRs linked to Ga(q)-dependent pathways. It may also be used for post-partum hemostasis for refractory bleeding. What are the maternal side effects of exogenous oxytocin?

A

Water intoxication

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14
Q

The ergot alkaloids used as uterotonics include ergonovine and ethyl-ergonovine. What is their MOA?

A

Stimulates adrenergic, dopaminergic, and serotonergic receptors

Causes dose-dependent prolonged/tonic uterine contraction as well as constriction of arterioles and veins

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15
Q

Ergot alkaloids could be used to augment labor, but this is not recommended because of prolonged contractions that cause maternal and fetal trauma. What is the primary indication of their use in the setting of labor/delivery?

A

Postpartum use to increase uterine tone and decrease bleeding; administered AFTER delivery

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16
Q

AEs of ergot alkaloids

A

Significant AEs in clinic are rare; may lead to HTN associated with N/V, headache, convulsion, death

Historically St. Anthony’s fire — mania, psychosis, vomiting, dry gangrene

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17
Q

There are currently no FDA-approved drugs available in the US for the suppression of labor (tocolytics). However, there are options that may be used in clinical practice “off-label”. What 5 drugs may be used to delay preterm labor (tocolytics)?

A 
Terbutaline
Indomethacin
Nifedipine
MgSO4
Atosiban
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18
Q

Management of preterm premature rupture of membranes in gestational age <24 weeks

A

Expectant management or induction of labor

Single corticosteroid course may be considered

No consensus on use of tocolytics

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19
Q

Management of preterm premature rupture of membranes in gestational age 24-31 weeks

A

Expectant management

Single corticosteroid use

No consensus on tocolytics

Magnesium sulfate for neuroprotection may be considered

20
Q

Management of preterm premature rupture of membranes in gestational age 32-34 weeks

A

Expectant management

Single corticosteroid course

21
Q

Management of preterm premature rupture of membranes in gestational age >34 weeks

A

Plan delivery; labor induction unless contraindicated

Single corticosteroid course may be considered up to 36 weeks

22
Q

Drug that effectively prevents eclamptic seizures and may decrease risk for cerebral palsy; currently the long-term drug of choice for tocolysis in the US

A

Magnesium sulfate

23
Q

MOA of magnesium sulfate in tocolysis

A

Thought to inhibit ACh release at uterine neuromuscular junctions

24
Q

Maternal and fetal AEs of magnesium sulfate used for tocolysis

A

Maternal: skin flushing, palpitations, headaches, depressed reflexes, respiratory depression, impaired cardiac conduction

Fetal: muscle relaxation, rarely CNS depression

25
Q

Terbutaline mechanism of tocolytic action

A

Beta-2 agonist — Increases cAMP, leads to K+ channel-mediated hyperpolarization, dephosphorylation of myosin light chains

[delays labor for 2-7 days but no evidence of benefit to fetus and mother experiences side effects]

26
Q

Maternal and fetal AEs of terbutaline

A

Maternal: cardiac arrhythmias, pulmonary edema, myocardial ischemia, hypotension, tachycardia, SOB, hyperglycemia, hyperinsulinemia, antidiuresis, altered thyroid function, hypokalemia, tremor, nervousness, N/V

Fetal: tachycardia, hyperinsulinemia, fetal hyperglycemia, neonatal hypoglycemia, hypocalcemia, hypotension, myocardial and septal hypertrophy, myocardial iscemia, ileus

27
Q

Nifedipine mechanism of tocolytic action

A

CCB — Blocks calcium influx through voltage-gated calcium channels

[considered preferable to other tocolytic agents but need more research]

28
Q

Maternal and fetal AEs of nifedipine

A

Maternal: flushing, HA, dizziness, nausea, transient hypotension, transient tachycardia, palpitations

Fetal: none noted

29
Q

Indomethacin mechanism of tocolytic action

A

NSAID/prostaglandin synthetase inhibitor — blocks synthesis of PGF2a (a potent stimulator of uterine contractions)

30
Q

Maternal and fetal AEs with indomethacin

A

Maternal: nausea, heartburn, gastritis, proctitis with hematochezia, impairment of renal function, increased postpartum hemorrhage, HA, dizziness, depression

Fetal: constriction of ductus arteriosus, pulmonary HTN, reversible decrease in renal function with oligohydramnios, intraventricular hemorrhage, hyperbilirubinemia, necrotizing enterocolitis

31
Q

Atosiban mechanism of tocolytic action

A

Oxytocin inhibitor

32
Q

Maternal and fetal AEs with atosiban

A

Maternal: transient HA and nausea, possible allergic rxn

Fetal: none confirmed

33
Q

Use of a tocolytic drug is NOT associated with a clear reduction in perinatal or neonatal mortality/morbidity. Of the available agents, _____ or _____ appear to be the best choices currently available in the US

A

Nifedipine; indomethacin

34
Q

Synthetic PGE1 similar to misoprostol administered parenterally to maintain a patent ductus arteriosus

A

Alprostadil

35
Q

Adverse effects of alprostadil used to maintain PDA

A

Pyrexia, hypotension, tachycardia, apnea

36
Q

2 drugs that may be used to close a PDA

A

Indomethacin

Ibuprofen

37
Q

AEs of NSAIDs used to close PDA

A

Decreased kidney function —> oliguria, edema, mild HTN

38
Q

4 drugs used in management of HTN in pregnancy

A

First line (moderate HTN): alpha-methyldopa, oral labetalol

Second line (severe HTN): parenteral labetalol, hydralazine, sodium nitroprusside

[note: ALL ACEIs and ARBs are contraindicated]

39
Q

MOA of alpha-methyldopa used to tx HTN in pregnancy

A

Alpha-2 agonist

40
Q

MOA of labetalol used to tx HTN in pregnancy

A

Alpha/beta blocker

41
Q

MOA of hydralazine used to tx HTN in pregnancy

A

Arterial vasodilator

42
Q

MOA of sodium nitroprusside used to tx HTN in pregnancy

A

Arterial and venous vasodilator

43
Q

Which of the following would be administered first to induce uterine contractions (prior to cervical dilation)?

A. Carboprost
B. Dinoprostone
C. Ergonovine
D. Misoprostol
E. Oxytocin
A

D. Misoprostol

44
Q

Which of the following is administered to induce uterine contractions after cervical dilation?

A. Carboprost
B. Dinoprostone
C. Ergonovine
D. Misoprostol
E. Oxytocin
A

E. Oxytocin

45
Q

Which of the following rapidly terminates postpartum bleeding?

A. Carboprost
B. Ergonovine
C. Misoprostol
D. Atosiban
E. Terbutaline
A

B. Ergonovine

46
Q

Which of the following could be given to hasten lung development?

A. Beclamethasone
B. Cortisol
C. Cortisone
D. Dexamethasone
E. Mifeprestone
A

D. Dexamethasone

47
Q

Which of the following maintains a PDA until surgical repair?

A. Alprostadil
B. Carboprost
C. Dinoprostone
D. Indomethacin
E. Misoprostol
F. Nifedipine
A

A. Alprostadil

Endo Repro Exam II (28 decks)

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