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Endo/Repro > Anti/Perinatal Pharmacology > Flashcards

Anti/Perinatal Pharmacology Flashcards

1
Q

What is the MOA of misoprostal?

A
  • Synthetic prostaglandin E1 analog
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2
Q

What are the effects of misoprostal?

A
  • Replacing PG loss in stomach during NSAID therapy
  • Induces uterine contractions
  • Maintains ductus arteriosus
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3
Q

What are the indications of misoprostol?

A
  • NSAID-induced gastric ulcers, prevention
  • Termination of intrauterine pregnancy if use <77 days
  • Off label –> cervical ripening
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4
Q

What are some contraindications of misoprostol?

A
  • Pregnancy unless aborting

- Previous c section

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5
Q

What are some maternal adverse effects of misoprostol?

A
  • Nausea, vomiting, diarrhea, abdominal pain, chills, shivering
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6
Q

What are some fetal adverse effects of misoprostol?

A
  • Hypoxia due to tachysystole or prolonged uterine contractions
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7
Q

What is the MOA of dinoprostone?

A
  • Synthetic prostaglandin E2 drug
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8
Q

What are the effects of dinoprostone?

A
  • Induces uterine contractions

- Promotes cervical ripening

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9
Q

What are the indications of dinoprostone?

A
  • Gel and inserts promote and initiation cervical ripening

- Suppositories: terminate pregnancy from 12th to 20th week gestation

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10
Q

What are the contraindications of dinoprostone?

A
  • Pregnancy unless aborting

- Previous c section

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11
Q

What are some maternal side effects of dinoprostone?

A
  • Back pain
  • Nausea
  • Vomiting
  • Diarrhea
  • Fever
  • Chills
  • Abdominal pain
  • Flushing and dizziness
  • Warm feeling in vagina
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12
Q

What are some fetal side effects of dinoprostone?

A
  • Hypoxia due to tachysystole or prolonged uterine contractions
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13
Q

What is seen in dinoprostone use in abortion?

A
  • Fever unresponsive to NSAIDs which begins around 15 min and lasts around 6 hours
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14
Q

What is the MOA of carboprost?

A
  • Synthetic prostaglandin F2a analog
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15
Q

What is the effect of carboprost?

A
  • Induces uterine contractions, prolonged duration of action
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16
Q

What are the indications of carboprost?

A
  • Used to induce abortion by stimulating uterine contraction between 13-20 weeks
  • Post partum hemostasis for refractory bleeding
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17
Q

What are the contracindicatons of carboprost?

A
  • Hypersensitivity
  • Acute pelvic inflammatory disease
  • Active cardiac, pulmonary, renal or hepatic dysfunction
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18
Q

What are some maternal side effects of carboprost?

A
  • Hypertension and pulmonary edema
  • Chills/shivering but tends to reduce body temp
  • Range of other symptoms
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19
Q

What is the MOA of oxytocin?

A
  • Posterior pituitary hormone
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20
Q

What are the effects of oxytocin?

A
  • Increases force, frequency, and duration of uterine contractions by binding to G protein coupled receptors
  • Also increases milk ejection
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21
Q

What are the indications of oxytocin?-

A
  • Induction of labor

- Post partum hemostasis for refractory bleeding

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22
Q

What are the contraindications for oxytocin?

A
  • Do not induce labor if lungs are note mature or cervix is not ripe
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23
Q

What are some maternal side effects of oxytocin?

A
  • Water intoxication (hyponatremia)
24
Q

What is the MOA of ergot alkaloids?

A
  • Ergonovine or ethyl-ergonovine

- Stimulates adrenergic, dopaminergic, and seratologic receptors

25
Q

What are the effects of ergot alkaloids?

A
  • Extracts used for centuries by midwives
  • Effects on the uterus: dose dependently causes prolonged/tonic uterine contractions
  • Vascular effects: constricts arterioles and veins
26
Q

What are the indications of ergot alkaloids?

A
  • Postpartum use to increase uterine tone and decrease bleeding
  • Augmentation of labor but not recommended because of intense and prolonged contractions that cause mother and fetus trauma
27
Q

What are some contraindications of ergot alkaloids?

A
  • Hypertension

- Hypersensitivity

28
Q

What are some adverse effects of ergot alkaloids?

A
  • Historically St. Anthony’s fire

- Mania, psychosis, vomiting

29
Q

What do prostaglandins work well for?

A
  • Ripening the cervix which is important because it must be ripe before contractions start
30
Q

When is oxytocin most often used?

A
  • During labor and delivery to help induce/normalize contractions
  • Helps limit post-partum bleeding
31
Q

When are ergot alkaloids used?

A
  • As a second choice for limiting postpartum bleeding
32
Q

What does preterm birth heighten the risk of?

A
  • RDS
33
Q

What are corticosteroids used for in preterm delivery?

A
  • Promote lung maturation and increase surfactant production
34
Q

What are some indications for antenatal corticosteroids?

A
  • Women between 24 and <36 weeks of gestation with any of the following:
    1. Threatened preterm labor
    2. Antepartum hemorrhage
    3. Preterm rupture of membranes
    4. Conditions requiring c section
35
Q

What are the two choices over 48 hours of corticosteroids?

A
  1. Betamethasone –> two doses at 24 hour intervals

2. Dexamethasone –> four doses at 12 hour intervals

36
Q

What does magnesium sulfate do?

A
  • Used and does work to prevent eclamptic seizures

- Evidence does support its use for neuroprotection; appears to decrease risk for cerebral palsy

37
Q

What are some maternal adverse effects of magnesium sulfate?

A
  • Flushing
  • Palpitations
  • Headaches
  • Depressed reflexes
  • Respiratory depression
  • Impaired cardiac conduction
38
Q

What are some fetal adverse effects of magnesium sulfate?

A
  • Muscle relaxation

- Rarely CNS depression

39
Q

What is the MOA of terbutaline?

A
  • Increases cAMP, leads to K+ channel mediated hyperpolarization, dephosphorylation of myosin light chains
40
Q

What are some contraindications for terbutaline?

A
  • Tachycardia sensitive cardiac disease
  • Poorly controlled thyroid disease
  • DM
41
Q

What is the recommended us for terbutaline?

A
  • Second choice after nifedipine
42
Q

What is the MOA of nifedipine?

A
  • Blocks calcium channel influx through voltage gated calcium channels, less calcium means less contraction
43
Q

What are some contraindications of nifedipine?

A
  • Cardiac disease
  • Use caution with renal disease and maternal hypotension
  • Avoid concomitant use with magnesium sulfate (can cause lethal cardiovascular collapse)
44
Q

When is nifedipine use?

A
  • Calcium channel blockers are 2nd choice agents for weeks 24-32
  • First choice agents for weeks 32-34
45
Q

What is the MOA of indomethacin?

A
  • Blocks synthesis of PGF2a
46
Q

What are the contraindications of indomethacin?

A
  • Significant renal or hepatic impairment
47
Q

What are the maternal side effects of indomethacin?

A
  • Nausea
  • Esophageal reflux
  • Gastritis
  • Emesis
48
Q

What are some fetal side effects of indomethacin?

A
  • Constriction of ductus arteriosus and reversible decrease in renal function with oligohydramnios
49
Q

When is indomethacin used?

A
  • Drug of choice for 24-32 weeks

- Contraindicated after 32 weeks due to potential ductus arteriosus closure

50
Q

What is the MOA of atosiban?

A
  • Blocks actions of oxytocin
51
Q

What medications are routinely given to neonates?

A
  • Erythromycin eye ointment for prophylactic treatment
  • Vitamin K
  • Umbilical cord care
  • Hep B vaccine
52
Q

What is the MOA of alprostadil?

A
  • Synthetic PGE1 similar to misoprostol for parenteral administration
53
Q

What are the indications of alprostadil?

A
  • Preterm infants with congenital heart defects

- Allows them to mature sufficiently to cope with surgery

54
Q

What are some adverse effects of alprostadil?

A
  • Pyrexia
  • Hypotension
  • Tachycardia
  • Apnea
55
Q

What are the symptoms of a patent ductus arteriosus?

A
  • Poor eating, which leads to poor growth
  • Sweating with crying or eating
  • Persistent fast breathing or breathlessness
  • Easy tiring
  • Rapid heart rate

Endo/Repro (31 decks)

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