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Top Drawer > Common OB Medications > Flashcards

Common OB Medications Flashcards

1
Q

What is the trade name of oxytocin?

A

Pitocin

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2
Q

What is oxytocin used for?

A
  • induction of labor
  • control postpartum uterine bleeding
  • after suction D & C
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3
Q

What is the mechanism of action of oxytocin?

A
  • indirectly increases intracellular calcium
  • directly stimulates the oxytocin receptor on the myometrium
  • some antidiuretic effect
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4
Q

In what cases is oxytocin contraindicated?

A
  • fetal distress
  • unfavorable fetal positions
  • previous uterine rupture
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5
Q

What are the side effects of oxytocin?

A
  • flushing
  • brady/TACHYCARDIA
  • hyper/hypotension
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6
Q

Oxytocin Dosing

A

10-40 units in 1000 ml LR

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7
Q

Oxytocin onset and duration

A

Onset: immediate
Duration: within 1 hour

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8
Q

Oxytocin causes uterine contraction or relaxation?

A

uterine contraction

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9
Q

How many weeks of gestation does oxytocin work?

A

does not work until 12-14 weeks of pregnancy

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10
Q

What is the trade name of methylergonovine?

A

Methergine

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11
Q

Methylergonovine dosing and frequency

A

0.2 mg IM q 2-4 hours
MAX OF 5 DOSES

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12
Q

Methylergonovine onset and duration

A

Onset: 2-5 min
Duration: about 3 hours

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13
Q

T/F: methylergonovine can be given IV or IM

A

false
- methylergonovine can only be given IM, NEVER IV!!!

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14
Q

What drug class does methylergonovine fall under?

A

semisynthetic ergot alkaloid

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15
Q

How does methylergonovine work?

A

increases motor activity of the uterus (contraction) by acting directly on smooth muscle to increase tone, rate, and amplitude of contraction

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16
Q

What is the mechanism of action of methylergonovine?

A
  • arterial vasoconstriction by alpha stimulation
  • inhibition of endothelial derived relaxation factor release
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17
Q

When is methylergonovine contraindicated?

A
  • severe HTN
  • pregnancy induced hypertension (PIH)
  • cardiac disease
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18
Q

Methylergonovine causes uterine contraction or relaxation?

A

uterine contraction

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19
Q

What is the trade name of carboprost?

A

Hemabate

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20
Q

What are the side effects of carboprost?

A
  • airway constriction and wheezing
  • increased CO, BP, PVR (peripheral vascular constriction)
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21
Q

When is carboprost contraindicated?

A

asthma
- causes airway constriction and wheezing

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22
Q

Carboprost causes increased or decreased temperature? How does this happen?

A
  • increased temperature
  • effect on hypothalamic thermoregulation
  • can increase temp by 2 degrees
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23
Q

Carboprost can increase temperature by _____ degrees

A

2 degrees

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24
Q

What is the mechanism of action of carboprost?

A
  • synthetic analogue of prostaglandin F2 that stimulates uterine contraction
  • increase of myometrial calcium, stimulates smooth muscle of GI tract to cause diarrhea
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25
Q

How does carboprost stimulate uterine contraction?

A

it is a synthetic analogue of prostaglandin F2

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26
Q

Carboprost increases ______________ , which stimulates smooth muscle of the GI tract to cause diarrhea

A

myometrial calcium

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27
Q

Carboprost dosing and frequency

A

250 mcq IM q 15-45 min
MAX OF 8 DOSES

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28
Q

Carboprost onset and duration

A

Onset: immediate
Duration: 2 hours

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29
Q

What is the trade name of misoprostol?

A

Cytotec

30
Q

What drug class is misoprostol?

A

synthetic prostaglandin E1

31
Q

What is misoprostol indicated for?

A
  • uterine atony
  • abortions
  • cervial ripening
  • peptic ulcer disease
32
Q

Misoprostol Dosing

A

1-2 tablets buccal (200 mcq each)

33
Q

What are the possible routes of administration of misoprostol?

A
  • buccally
  • rectally
  • vaginally (by OB)
34
Q

Misoprostol onset and half time

A

Onset: rapid
Half life: 20-40 min

35
Q

Misopostol has potential to cause __________

A

diarrhea

36
Q

What is magnesium sulfate (MgSO4) used for in OB?

A
  • prevent eclamptic seizures (decreases incidence by 50%)
  • stop premature labor (tocolytic)
37
Q

What effect does magnesium sulfate have at the NMJ?

A

inhibits release of acetylcholine

38
Q

How does magnesium sulfate work?

A
  • mild vasodilator that decreases uterine activity to increase uterine blood
  • dilates liver beds and kidneys to increase function
  • decreases SVR
39
Q

Magnesium sulftate causes uterine contraction or relaxation?

A

uterine relaxation

40
Q

Magnesium sulfate potentiates ___________ and _______________

A

nondepolarizers and depolarizers

41
Q

What respiratory side effect comes with administering magnesium sulfate?

A

pulmonary edema
- may be some correlation with chorioamnionitis

42
Q

Magnesium sulfate dosing

A
  • 4 grams over 20 min
  • 2-3 grams/hr infusion
43
Q

Magnesium sulfate onset and duration

A

Onset: immediate
Duration: 20-30 min (assuming good renal perfusion)

44
Q

What do we have to check when administering magnesium sulfate?

A
  • magnesium levels
  • deep tendon reflexes
45
Q

How do you treat magnesium toxicity?

A
  • 1 gram calcium gluconate over 2 min
  • fluids
  • diuresis
  • O2
46
Q

Magnesium sulfate _____________ (crosses/does not cross) the placenta

A

crosses the placenta

47
Q

What effect does magnesium sulfate have on the fetus/neonate?

A
  • respiratory depression
  • apnea
  • decreased tone
48
Q

Magnesium sulfate may cause muscle relaxation or contraction?

A

muscle relaxation (weakness)

49
Q

What are therapeutic magnesium sulfate levels for use in OB?

A

4-8 mg/dL

50
Q

At magnesium level of 5-10 mg/dl, what would you see?

A
  • ECG
  • prolonged PR
  • widened QRS
51
Q

What magnesium level would you begin to see decrease in deep tendon reflexes and respiratory depression?

A

10 mg/dl

52
Q

What would you expect to see at a magnesium level of 10 mg/dl?

A
  • decreased deep tendon reflexes
  • respiratory depression
53
Q

What would you expect to see in an OB patient with magnesium levels between 4-8 mg/dl?

A

therapeutic effects

54
Q

At what magnesium level would you begin to see respiratory arrest and ECG changes from SA/AV conduction?

A

15 mg/dl

55
Q

At what magnesium level would you expect cardiac arrest?

A

25 mg/dl

56
Q

What treatments may you consider for blood pressure control in parturients?

A
  • labetalol
  • hydralazine
  • nipride
  • nitroglycerine
  • volume repletion (decrease ECF)
57
Q

Labetalol is a _____________ antagonist

A

alpha and beta antagonist

58
Q

What effects does labetalol have on the neonate if administered?

A
  • possibly bradycardia
  • typically few neonatal complications
59
Q

Labetalol has a _________ onset

A

rapid

60
Q

How does hydralazine work?

A

potent vasodilator that decreases afterload, PVR, maternal BP, and uterine vascular resistance to increase uterine blood flow

61
Q

When would you most see decrease in PVR with hydralazine administration?

A

volume repletion

62
Q

What are potential side effects of hydralazine?

A
  • maternal tachycardia (reflex sympathetic response to vasodilation)
  • vomiting
  • tremors
63
Q

What is nipride used for in OB?

A

acute hypertensive crisis

64
Q

How does nipride decrease blood pressure?

A

potent arteriolar dilator

65
Q

Nipride has ______ onset and _______ duration

A

rapid onset and short duration

66
Q

Maternal/fetal _________________ is a concern with nipride, but can be prevented with low doses at ________________

A
  • cyanide toxicity
  • 5-10 mcg/kg/min
67
Q

What dose should you keep nipride at for OB patients?

A

5-10 mcg/kg/min

68
Q

How does nitroglycerine lower blood pressure?

A

venodilator to decrease cardiac filling pressures by acting on capacitance vessels

69
Q

The patient may get reflex _______________ when nitroglycerine is used to lower blood pressure

A

reflex tachycardia

70
Q

When would volume repletion be considered in OB?

A

severe pre-eclampsia

71
Q

How would intravascular volume repletion be beneficial in OB?

A
  • improve the low CO
  • normalize right/left cardiac filling pressures
  • improve CI
  • decrease maternal HR
  • decrease SVR and BP
  • improve fetal circulation

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