Drugs Flashcards
MOA/Adverse Effects
NSAIDS
MOA/Dose/A/E
CIN
block cyclooxegenase (Cox), reduce prostaglandin levels (higher levels have been associated in women who experience excessive menstrual blood loss)
CIN: hypersensitivity, active GI ulcer, CKD and CLD, bleeding disorders
Omeprazole
MOA/Dose
A/E
CIN
MOA: PPI in gastric parietal cells
Dose: 20 mg qD
A/E: HA, abdominal pain, GI upset
CIN: hypersenstiivity to drug
Valtrex
MOA/Dose/A/E
Primary outbreak
Recurrent outbreak
Pregnancy suppression
CIN
MOA: anti-viral that inhibits DNA synthesis and replication
Primary outbreak: 1 gram BID x 7-10 days
Recurrent: 500 BID x 3 days
Pregnancy suppression: 500 BID
CIN: hypersensitivity
Metrondiazole
MOA/Dose/A/E
CIN
MOA: inhibits nucleic acid synthesis, bateriocidal/trichomonacidal
Dose: 500 BID x 7 days
A/E: GI upset, hypersensitivity, metallic taste
CIN: caution history heart failure or hepatic failure, renal disease
Ceftriaxone
MOA/Dose/A/E
MOA: third gen cephalisporin, broad specrtrum gram negative
Dose: 500 mg IM (if <150 kg)
Dose: 1 grams qd (pyelonephritis)
A/E: injection pain, eosinophilia
Fentanyl
synthetic opioid
PTU
MOA: blocks synthesis of T4/T3
Dose: 100 TID
A/E: concerns for hepatic toxicity
Methimazole
MOA: blocks oxidation of iodine
Dose: 20 mg QD
A/E: aplasia cutis, esophageal atresia
Glyburide
MOA/Dose/A/E
Caution
MOA: increases insulin secretion by pancreases
Dose: 2.5 daily then BID
A/E: allergy sx
Caution: hypoglycemia (maternal and neonatal)
Crosses placenta freely
ursodiol
MOA/Dose/A/E
CIN
MOA: reduces cholesterol and hydrophilic bile acids (toxic)
Dose: 300 TID
Improvement in 1-2 weeks, bile acids improve 3-4 weeks
A/E: GI upset, back pain, dizziness
CIN: hypersensitivity
metformin
MOA/Dose/A/E
CIN
MOA: inhibits gluconeogenesis in liver and stimulates glucose uptake in peripheral tissue
Dose: 500 mg x 1 week then increased to BID
A/E: GI upset, diarrhea
CIN: chronic renal disease (check Cr)
Counseling: absent long term data on neonate, readily crossest placenta, lack of superiority to insulin
Tranxexamic Acid
-MOA
-Dosing
-CIN
plasmin inhibitor, stabilizes fibrin matrix
1 gram IV in 100 ml solution, given over 10 minutes
CIN: history of color blindness, VTE, concomitant use of COCP
Nifedipine
MOA/Dose/A/E
CIN
MOA: CCB
Dose: 30 mg loading, then 10 mg q 4-6 hrs
Maternal AE: dizziness, flushing, suppression of heart rate, contractility
Fetal AE: none
CIN: HYPOTENSION, AORTIC INSUFFICIENCY (or other preload dependent lesions)
Terbutaline
MOA/Dose/A/E
CIN
MOA: beta 2 adrenergic receptor agonist- relaxation of smooth muscle found in bronchial, vascular and uterine tissues
Dose: 0.25 mg subQ every 20 min to 30 hours
Maternal A/E: tachycardia, HYPOTENSION, tremor, palpitations, SOB, pulmonary edema, hypokalemia, hyperglycemia
Fetal A/E: tachycardia
CIN: tachycardia sensitive cardiac disease, poorly controlled DM
Indocin
MOA/Dose/A/E
CIN
MOA: NSAID
Dose: if < 32 weeks
50-100 mg po loading then half q 4-6 hours
Maternal: nausea, GERD, gastritis, emesis, plt dysfunction
Fetal: contracted ductus arterioles, olighydramnios, NEC, PDA, especially if used > 2 days
CIN: bleeding or plt disorder, hepatic or renal dysfunction, GI ulcerative disease, asthma (if hypersensitivity to ASA)
Magnesium
MOA/Dose/A/E
CIN
Toxicity values: 9/12/30
Cautions
MOA: reduces calcium in uterine muscle, thus relaxes muscle
Dose: 4 grams followed by 1 gram per hour
Maternal A/E: flushing, diaphoresis, nausea, toxicity
Fetal A/E: neonatal depression
CIN: myasthenia Travis
When used with Nifedipine: suppressed heart rate and decreased LVP, neuromuscular blockade
When used with Terb: caution
Labetalol
MOA/Dose/A/E
CIN
MOA: beta agonist
Dose: 200 BID
20/40/80 IV push over 2 min, check BP every 10 min
Onset: minutes
Max daily dose: 300 mg
CIN: asthma, heart disease (MI/heart block), bradycardia
If not working… switch to Hydralazine 10 mg
Nifedipine po
MOA
Dose
A/E
CIN
MOA: CCB
Dose: 10 mg PO
Repeat BP in 20 min, Can give 20 mg if elevated
Max dose: 180 mg daily
Onset: 10 min
A/E: reflex tachycardia, maternal HA
CIN: concomitant use with rifampin, phenobarbital (CYP)
Clindamycin
MOA: suppresses protein synthesis by binding to 50S ribosomal unit
Dose: 900 IV
A/E: C difficile
Caution: nephrotoxic
Bactrim
MOA/Dose/CIN
MOA:blocks two steps in nucleic acid and protein synthesis
Dose: 160/800 mg
CIN: pregnancy - congenital malformations
Macrobid
MOA
MOA: alters bacterial ribosomal proteins thus blocking cell wall synthesis
Dose: 100 BID X 5-7 days
Keflex
MOA
Dose
MOA: blocks bacterial cell wall synthesis
Dose: 500 QID x 5-7 days UTI
Clotrimazole
MOA: alters fungal cell membrane, fungistatic/cidal
A/E: abnormal LFT’s, local burning/pain
CIN:caution if liver disease
Diflucan
MOA
Dose
A/E
CIN
MOA: alters fungal cell membrane
Dose: 150 mg, repeat 72 hours
A/E: HA, GI upset
CIN: hypersenstiivty, caution with erythromycin… CYP interaction
Clobetasol
Dose
A/E
0.5% Clobetasol
A/E: hypopigmentation, skin atrophy, dry skin
GNRH Agonist (Depot Lupron)
Dose
Duration
3.75 mg q mo or 11.25 q 3 mo
Fibroids/Endo: up to 12 months (need add back after 6)
Add back: Estrogen 0.625 + Norethindrone 0.5 mg
Norethindrone: helps with BMD loss
RX CA 1000 mg rx
GNRH Antagonist (Orlissa)
Duration
Dose: 300 BID + Estradiol 1 mg + Norethindrone 0.5 mg
Fibroids: up to 2 yrs with add back
Vasopressin
MOA
Dose
Moa: vasoconstrictor
Dose: 20 units in 100 ml
Dicloxacillin
MOA/Dose/A/E
CIN
MOA: penicillin
Dose: 500 mg QID x 10 days
A/E: GI upset
CIN: hypersensitivity, live bacterial vaccines,
Oxytocin Labor
Dose
Where is it made?
Dose: 1-2 mill unit every 30 minutes
MOA: increases calcium levels in uterine muscle, stimulates prostaglandin
Produced in hypothalamus, and stored in the posterior pituitary
Prostaglandin- cytotec
MOA: prostaglandin E1
Dose: 25 mcg q 4 hours
A/E tachysystole
CIN: prior uterine scar > 28 weeks
Methotrexate
MOA
Dose
CIN
MOA: blocks DNA synthesis by inhibiting dehydrate folate reductase
Dose: 50 mg/m2, 50 mg/BSA which is comprised of height and weight
CIN: IUP pregnancy also, ruptured ectopic, breast feeding, active liver/peptic disease, unreliable to follow up
Acyclovir Dosing
Primary
Recurrent
Prophylaxis
Primary 400 TID X 7-10 days
Recurrent: 400 TID x 5 days
Suppression: 400 TID
PPROM Antibiotics
Total treatment x 7 days
Amp 2 grams IV x 48 hours + Azithromycin 1 gram po
Amoxicillin 500 po 8 hrs x 5 days
3hr GTT Cut offs
180/155/140/95
*two elevated = GDM
GDM PP follow up
2 hr GTT 6 weeks pp, then q 3 yrs
Hydralazine
MOA/Dose/AE
CIN
MOA: vasodilator thus reduced BP
Dose: 5/5/10 mg , check BP in 20 minutes
Max dose: 20 mg
Onset: 10-20 min
A/E: maternal HA, hypotension, FHR abnormalities
CIN: CAD, rheumatic heart disease of mitral valve
Lorazepam
Dose
4 mg over 2 min push
Phenytoin Dose
400 mg IV
Magnesium sulfate
Dose
How to draw up the solution
4 grams over 15 minutes
Use 20 ml syringe, draw up 4 grams MgSo4 50%, (8 ml) + 12 ml sterile saline = (20% solution).
Aspirin
MOA for pre-e prevention
CIN
reducing productions of thromboxane on platelets and acts as an anti-inflamattory
Thromboxane essentially promoted vasoconstriction and platelet aggregation.
CIN: allergy to ASA or NSAIDS, nasal polyps with risk of bronchospasm or asthma associated with bronchospasm, active peptic ulcer
Cardinal Movements of Labor
ED FIRE REX
engangement
descent
flexion
IR
extension
restitution
expulsion
