Anti/Perinatal Pharmacology Flashcards
What is the MOA of misoprostal?
- Synthetic prostaglandin E1 analog
What are the effects of misoprostal?
- Replacing PG loss in stomach during NSAID therapy
- Induces uterine contractions
- Maintains ductus arteriosus
What are the indications of misoprostol?
- NSAID-induced gastric ulcers, prevention
- Termination of intrauterine pregnancy if use <77 days
- Off label –> cervical ripening
What are some contraindications of misoprostol?
- Pregnancy unless aborting
- Previous c section
What are some maternal adverse effects of misoprostol?
- Nausea, vomiting, diarrhea, abdominal pain, chills, shivering
What are some fetal adverse effects of misoprostol?
- Hypoxia due to tachysystole or prolonged uterine contractions
What is the MOA of dinoprostone?
- Synthetic prostaglandin E2 drug
What are the effects of dinoprostone?
- Induces uterine contractions
- Promotes cervical ripening
What are the indications of dinoprostone?
- Gel and inserts promote and initiation cervical ripening
- Suppositories: terminate pregnancy from 12th to 20th week gestation
What are the contraindications of dinoprostone?
- Pregnancy unless aborting
- Previous c section
What are some maternal side effects of dinoprostone?
- Back pain
- Nausea
- Vomiting
- Diarrhea
- Fever
- Chills
- Abdominal pain
- Flushing and dizziness
- Warm feeling in vagina
What are some fetal side effects of dinoprostone?
- Hypoxia due to tachysystole or prolonged uterine contractions
What is seen in dinoprostone use in abortion?
- Fever unresponsive to NSAIDs which begins around 15 min and lasts around 6 hours
What is the MOA of carboprost?
- Synthetic prostaglandin F2a analog
What is the effect of carboprost?
- Induces uterine contractions, prolonged duration of action
What are the indications of carboprost?
- Used to induce abortion by stimulating uterine contraction between 13-20 weeks
- Post partum hemostasis for refractory bleeding
What are the contracindicatons of carboprost?
- Hypersensitivity
- Acute pelvic inflammatory disease
- Active cardiac, pulmonary, renal or hepatic dysfunction
What are some maternal side effects of carboprost?
- Hypertension and pulmonary edema
- Chills/shivering but tends to reduce body temp
- Range of other symptoms
What is the MOA of oxytocin?
- Posterior pituitary hormone
What are the effects of oxytocin?
- Increases force, frequency, and duration of uterine contractions by binding to G protein coupled receptors
- Also increases milk ejection
What are the indications of oxytocin?-
- Induction of labor
- Post partum hemostasis for refractory bleeding
What are the contraindications for oxytocin?
- Do not induce labor if lungs are note mature or cervix is not ripe
What are some maternal side effects of oxytocin?
- Water intoxication (hyponatremia)
What is the MOA of ergot alkaloids?
- Ergonovine or ethyl-ergonovine
- Stimulates adrenergic, dopaminergic, and seratologic receptors
What are the effects of ergot alkaloids?
- Extracts used for centuries by midwives
- Effects on the uterus: dose dependently causes prolonged/tonic uterine contractions
- Vascular effects: constricts arterioles and veins
What are the indications of ergot alkaloids?
- 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
What are some contraindications of ergot alkaloids?
- Hypertension
- Hypersensitivity
What are some adverse effects of ergot alkaloids?
- Historically St. Anthony’s fire
- Mania, psychosis, vomiting
What do prostaglandins work well for?
- Ripening the cervix which is important because it must be ripe before contractions start
When is oxytocin most often used?
- During labor and delivery to help induce/normalize contractions
- Helps limit post-partum bleeding
When are ergot alkaloids used?
- As a second choice for limiting postpartum bleeding
What does preterm birth heighten the risk of?
- RDS
What are corticosteroids used for in preterm delivery?
- Promote lung maturation and increase surfactant production
What are some indications for antenatal corticosteroids?
- 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
What are the two choices over 48 hours of corticosteroids?
- Betamethasone –> two doses at 24 hour intervals
2. Dexamethasone –> four doses at 12 hour intervals
What does magnesium sulfate do?
- Used and does work to prevent eclamptic seizures
- Evidence does support its use for neuroprotection; appears to decrease risk for cerebral palsy
What are some maternal adverse effects of magnesium sulfate?
- Flushing
- Palpitations
- Headaches
- Depressed reflexes
- Respiratory depression
- Impaired cardiac conduction
What are some fetal adverse effects of magnesium sulfate?
- Muscle relaxation
- Rarely CNS depression
What is the MOA of terbutaline?
- Increases cAMP, leads to K+ channel mediated hyperpolarization, dephosphorylation of myosin light chains
What are some contraindications for terbutaline?
- Tachycardia sensitive cardiac disease
- Poorly controlled thyroid disease
- DM
What is the recommended us for terbutaline?
- Second choice after nifedipine
What is the MOA of nifedipine?
- Blocks calcium channel influx through voltage gated calcium channels, less calcium means less contraction
What are some contraindications of nifedipine?
- Cardiac disease
- Use caution with renal disease and maternal hypotension
- Avoid concomitant use with magnesium sulfate (can cause lethal cardiovascular collapse)
When is nifedipine use?
- Calcium channel blockers are 2nd choice agents for weeks 24-32
- First choice agents for weeks 32-34
What is the MOA of indomethacin?
- Blocks synthesis of PGF2a
What are the contraindications of indomethacin?
- Significant renal or hepatic impairment
What are the maternal side effects of indomethacin?
- Nausea
- Esophageal reflux
- Gastritis
- Emesis
What are some fetal side effects of indomethacin?
- Constriction of ductus arteriosus and reversible decrease in renal function with oligohydramnios
When is indomethacin used?
- Drug of choice for 24-32 weeks
- Contraindicated after 32 weeks due to potential ductus arteriosus closure
What is the MOA of atosiban?
- Blocks actions of oxytocin
What medications are routinely given to neonates?
- Erythromycin eye ointment for prophylactic treatment
- Vitamin K
- Umbilical cord care
- Hep B vaccine
What is the MOA of alprostadil?
- Synthetic PGE1 similar to misoprostol for parenteral administration
What are the indications of alprostadil?
- Preterm infants with congenital heart defects
- Allows them to mature sufficiently to cope with surgery
What are some adverse effects of alprostadil?
- Pyrexia
- Hypotension
- Tachycardia
- Apnea
What are the symptoms of a patent ductus arteriosus?
- Poor eating, which leads to poor growth
- Sweating with crying or eating
- Persistent fast breathing or breathlessness
- Easy tiring
- Rapid heart rate
