Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro II Exam II > Drugs During Pregnancy (Linger) > Flashcards

Drugs During Pregnancy (Linger) Flashcards

1
Q

what are a couple drugs used in C-sections

A

(i) Thiopental (barbiturate) is very lipophilic and crosses the placenta almost immediately, causing sedation or apnea in the newborn
(ii) Succinylcholine and tubocurarine (neuromuscular blocking drugs) are highly charged, cross the placenta slowly, and achieve minimal concentrations in the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what if a mother is pregnant and needs anticoagulation drugs…. what should be used and what should be avoided?

A

for pregnant women who need anticoagulation agents, heparin may be given safely (high molecular weight and polar, thus does not cross the placenta) while warfarin is teratogenic, crosses the placenta, and should be avoided during all stages of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what types of drugs cross the placenta more readily

A

lipophilic drugs

low molecular weights

non-polar

unbound proteins (compared to drugs with high protein binding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

viral protease inhibitors and pregnancy

A

these are P-glycoprotein substrates and achieve low fetal concentrations , which may increase the risk of HIV infection transfer from mother to fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how does the fetus metabolize compounds in terms of speed of metabolism compared to children or adults

A

(f) Of note, the fetus metabolizes compounds at a slower rate than children or adults due to a lack of enzyme expression, a reduced activity of metabolic enzymes, or reduced availability of essential endogenous cofactors due to the stage of gestational development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Zidovudine

A

shown to decrease HIV transmission from the mother to the fetus by roughly 60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

female fetus exposure to DES causes increased risk for what?

A

(2) An increased risk for adenocarcinoma of the vagina (with onset after puberty)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the teratogenic mechanisms of drugs

A

(a) Drugs may have a direct effect on maternal tissues with indirect effects on fetal tissues
(b) Drugs may interfere with the passage of oxygen or nutrients through the placenta, affecting the most rapidly metabolizing tissues of the fetus
(c) Drugs may have direct actions on the processes of differentiation in developing tissues
(d) Deficiency of critical substances may play a role in the development of fetal abnormalities (e.g., folic acid deficiency)
(e) Cumulative effects on multiple organs may result from continued exposure to a teratogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

a teratogen has what 3 characteristics

A

(a) The drug results in a characteristic set of malformations, indicating selectivity for certain target organs
(b) The drug exerts its effects at a particular stage of fetal development (see figure below)
(c) The drug shows a dose-dependent incidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what 5 drug classes are used in the treatment of hyperemesis gravidum

A

Pyridoxine (vitamin B6)

Antihistamines (H1 antagonists)

  • doxylamine
  • diphenhydramine
  • dimenhydrinate
  • meclizine

Dopamine Antagonists

  • promethazine
  • prochlorperazine
  • droperidol

Serotonin Antagonists
-ondansetron

Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MOA of pyridoxine

A

(1) MOA: Precursor to pyridoxal, which functions in the metabolism of proteins, carbohydrates, and fats; pyridoxal also aids in the release of liver and muscle-stored glycogen and in the synthesis of GABA (within the central nervous system) and heme
(2) Also used for treatment and prophylaxis of neurological toxicities associated with isoniazid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MOA of antihistamines

A

H1 antagonists

anticholinergic activity thought to help with nausea and vomiting

(3) Doxylamine most commonly used in combination with pyroxidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

dopamine antagonists MOA

A

(1) MOA: antagonists at dopamine receptors
(2) Muscarinic-blocking effect and/or inhibition of dopamine signaling in the chemoreceptor zone may be responsible for antiemetic activity; dopamine receptors in the stomach mediate the inhibition of gastric motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Serotonin Antagonists MOA

A

(1) MOA: selective 5-HT3-receptor antagonist, which blocks serotonin both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone
(2) Common uses include prevention of nausea and vomiting associated with moderately- to highly-emetogenic cancer chemotherapy; radiotherapy;

prevention of postoperative nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

above what level of BP should you treat

A

above 150/100 consistently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what agents can be used for treatment of preeclampsia

A

Labetalol
Hydralazine
Nifedipine and Nicardipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

labetalol MOA

A

(a) MOA: acts as an antagonist of alpha-, beta1-, and beta2-adrenergic receptors
(b) Used to treat moderate to severe hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

hydralazine MOA

A

(a) MOA: dilates arterioles but not veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

nifedipine and nicardipine MOA

A

(a) MOA: inhibits cardiac and smooth muscle L-type calcium channels, producing a relaxation of coronary vascular smooth muscle (vasodilation); increases myocardial oxygen delivery in patients with vasospastic angina; reduces peripheral vascular resistance, producing a reduction in arterial blood pressure

used to treat HTN, angina, arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

if the pt has HTN prior to pregnancy, what medications should be stopped during pregnancy

A

ACE inhibitors
ARB’s
direct renin inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Methyldopa MOA

A

(1) MOA: reduces blood pressure by stimulating central alpha-adrenergic receptors, which results in a decreased sympathetic outflow to the heart, kidneys, and peripheral vasculature

(2) Reduces peripheral vascular resistance with a variable reduction in heart rate and cardiac output
(3) Most common undesired effect is sedation, especially at the onset of treatment
(4) Widely used in the past but now used primarily to treat moderate to severe hypertension during pregnancy

used in pt’s who had pre-existing HTN and now are pregnant

22
Q

toxicities of thiazide diuretics (which are used in pt’s who are pregnant with pre-existing HTN)

A

(2) Toxicities include hypokalemic metabolic alkalosis, impaired carbohydrate tolerance (manifests as hyperglycemia), hyperlipidemia, and hyponatremia among others

23
Q

how do you manage gestational diabetes mellitus

A

Exercise
-increases tissue sensitivity to insulin

Insulin

  • lispro and aspart (fast)
  • improve postprandial excursions compared to human regular insulin and are associated with lower risk of delayed postprandial hypoglycemia
24
Q

what is the leading cause of infant mortality in the US

A

preterm birth

25
Q

what are tocolytics

A

drugs utilized to suppress preterm labor and include beta-adrenergic receptor agonists, magnesium sulfate, calcium channel blockers, and cyclooxygenase (COX) inhibitors

26
Q

MOA of b-adrenergic receptor agonists

A

i) MOA: bind to beta¬2-adrenergic receptors and increase intracellular adenylyl cyclase, which increases cAMP and ultimately decreases myometrial contractility
ii) Target cells eventually become desensitized, thereby limiting efficacy (tachyphylaxis)
iii) Ritodrine is the most evaluated beta agonist used in the inhibition of preterm labor, but is currently unavailable in the US

27
Q

What are the adverse effects of Beta agonists in pregnancy

A

tachycardia, low blood pressure, bronchial relaxation

v) Cardiovascular fetal adverse effects are analogous to the maternal effects

28
Q

what is the proposed action of magnesium sulfate in pregnancy

A

(1) Magnesium competes with calcium at the level of plasma membrane voltage-gated calcium channels
(2) Magnesium hyperpolarizes the plasma membrane and inhibits myosin light-chain kinase activity by competing with intracellular calcium at this site
(3) Interference with the activity of myosin light-chain kinase reduces myometrial contractility

29
Q

what re the adverse maternal and fetal effects of using mag sulfate

A

few!! - diaphoresis, flushing

iv) Maternal therapy causes a slight decrease in baseline fetal heart rate and fetal heart rate variability, which are not clinically significant

30
Q

what are the contraindications for using mag sulfate

A

vi) Contraindicated in pregnant women with myasthenia gravis because it decreases acetylcholine in motor nerve terminals
vii) Use with caution in women with known myocardial compromise or cardiac conduction defects because of its antiinotropic effects (high doses can cause PR and QT elongation and/or heart block) and in women with compromised renal function (magnesium sulfate is eliminated renally)

31
Q

what is the concern in using Calcium Channel blockers for inhibition of preterm labor

A

ii) The primary fetal concern is the potential for reducing uterine and umbilical blood flow

32
Q

most commonly used COX inhibitor used for inhibiting preterm labor

A

indomethacin

33
Q

COX inhibitor MOA in inhibiting preterm labor?

A

ii) Inhibition of COX reduces the formation of prostaglandins and reduces uterine contractions (prostaglandins augment uterine contraction)

34
Q

primary fetal concerns in using COX inhibitors for inhibition of preterm labor

A

iii) The primary fetal concerns with the use of indomethacin and other COX inhibitors are constriction of the ductus arteriosus (may lead to pulmonary hypertension) and oligohydramnios (reduction in amniotic fluid volume)

35
Q

what two therapies are used for the induction of labor?

A

Oxytocin

Intravaginal prostaglandins E2 or E1 (e.g. misoprostol)

36
Q

MOA of oxytocin

A

ii) MOA: stimulates uterine muscle contraction after activating oxytocin receptors (G-protein coupled receptors linked to Gq, phosphoinositide-calcium second-messenger system)

stimulates the release of prostaglandins and leukotrienes that augment uterine contraction

causes contraction of myoepithelial cells surrounding mammary alveoli which leads to milk ejection

37
Q

what are the indications for oxytocin

A

-induction of labor at term

control of post-partum bleeding

adjunctive therapy in management of abortion

38
Q

what are the most popular systemic agents used in management of pain during labor and delivery

A

opioids

  • morphine
  • fentanyl
  • meperidine

or mixed opioid agonists-antagonists

  • nalbuphine
  • butorphanol
39
Q

what are the effects of opioids on the mother and fetus

A

ii) Opioids exert their effects in the maternal brain, although a portion of the dose also crosses the placenta and affects the fetus, which decreases fetal heart rate variability and results in respiratory depression in the neonate

40
Q

what are the most commonly used non-opioid agents used in controlling pain during labor and delivery

A

promethazine (phenothiazine)

hydroxyzine (antihistamine)

used in conjunction with opioids to potentiate analgesia and decrease side effects such as nausea and vomiting

41
Q

nueraxial analgesics

which agents are used?

A

ii) Provide unparalleled pain relief for labor and delivery
iii) Local anesthetics (bupivacaine, ropivacaine), with or without opiates, are typically used in spinal and epidural techniques

42
Q

Class A

A

Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester (and there is no evidence of a risk in late trimesters) and the possibility of fetal harm appears remote.

43
Q

Class B

A

Either animal-reproduction studies have not demonstrated a fetal risk, but there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).

44
Q

Class C

A

Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.

45
Q

Class D

A

There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

46
Q

Class X

A

Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.

47
Q

look at the table regarding drugs which effects on the fetus

A

do it

48
Q

first trimester defects of fetus with warfarin use

A

Hypoplastic nasal bridge, chondrodysplasia

49
Q

second tri defects of fetus with warfarin use

A

CNS malformation

50
Q

third tri defects of fetus with warfarin use

A

Risk of bleeding (discontinue use 1 month before delivery)

Repro II Exam II (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions