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Lindsey's LC Unit 2 > Drugs in Prego and Lactation > Flashcards

Drugs in Prego and Lactation Flashcards

1
Q

Which oral phosphodiesterase inhibitor (PDEI) has a delayed onset but prolonged action?

A

Tadalafil (Cialis)

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2
Q

Drugs with m.w. _____ cross the placenta easily; drugs of ______ m.w. cross with more difficulty, while those with m.w. > ____ cross very poorly.

A

250-500 = easy 500-1000 = moderate > 1000 = poor

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3
Q

What is Terbutaline? How does it work? What is it used for?

A

a β2 Adrenergic Agonist relaxes smooth muscle contraction through adenylate cyclase dependent pathways to suppress contractions and treating premature labor ONLY IF THE CERVIX HASN’T DILATED AND MEMBRANES HAVE NOT RUPTURED

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4
Q

Drugs that cross the placenta will enter the fetal circulation via the ____.

A

umbilical vein

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5
Q

______ drugs will diffuse readily across the placenta and enter the fetal circulation and can produce pharmacologic effects.

A

Highly lipophilic

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6
Q

The uterus is insensitive to _____ until 20-36 weeks gestation, when its receptor number increases progressively to 80-fold above baseline levels, plateaus, and increases again to 200-fold over baseline during early labor.

A

oxytocin

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7
Q

Drugs that inhibit prostaglandin synthesis such as _____ and _____ will delay the onset of labor and prolong gestation.

A

NSAIDs (e.g., aspirin, ibuprofen, naproxen) or COX-2 selective inhibitors (celecoxib)

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8
Q

Name a β2 Adrenergic Agonist used as a tocolytic agent.

A

Terbutaline

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9
Q

_____ given orally is effective at inducing uterine contractions, while vaginal preparations are now being tested with positive results on cervical ripening.

A

Misoprostol

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10
Q

______ strongly contract uterine smooth muscle and promote formation of gap junctions between cells (potentiating oxytocin-induced contractions).

A

Prostaglandins

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11
Q

_____ increases the number of oxytocin receptors in myometrial and decidual tissue of pregnant women.

A

Estrogen

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12
Q

Name 3 oral phosphodiesterase inhibitors (PDEIs).

A

Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis)

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13
Q

Oxytocin receptors are coupled to phospholipase C and increase intracellular _____ levels.

A

Ca++

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14
Q

Prostaglandins are poorly tolerated when administered _____ , producing intestinal cramping, diarrhea and nausea.

A

systemically

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15
Q

What are Ergonovine and methylergonovine used for?

A

control of late uterine bleeding and should never be given before delivery

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16
Q

Prostaglandins E2 and F2α (synthesis via ______) play a critical role in the initiation of labor.

A

COX-2

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17
Q

What protects the fetus from high levels of maternal hormones, like cortisol?

A

placental enzymes

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18
Q

______, as a very large and polar molecule, does not cross the placenta and is the drug of choice for anticoagulation in pregnancy.

A

Heparin Heparin keeps the baby Happy!

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19
Q

Name the drug: an anticonvulsant, antihypertensive agent blocks Ca++ actions –> sedation and depression of smooth muscle contractions to prevent sz’s and intracranial hemorrhage (eclampsia) in pregnancy related to HELLP syndrome

A

Magnesium Sulfate

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20
Q

What does a tocolytic agent do?

A

inhibits labor/delay delivery

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21
Q

Oxytocin is probably NOT involved in the initiation of labor but may help _____.

A

maintain labor

22
Q

______ is the most commonly used agent for labor induction after cervical ripening.

A

Oxytocin (Pitocin)

23
Q

What is HELLP syndrome?

A

hemolysis, elevated liver enzymes, low platelet count

24
Q

Uterine smooth muscle is inactive throughout most of pregnancy, possibly due to actions of ________.

A

progesterone

25
Q

Fetal pH is ______ than maternal pH (7.35).

A

lower (7.25)

26
Q

What kind of drug are Ergonovine and methylergonovine?

A

ergot alkaloids

27
Q

What are the SEs for Terbutaline?

A

increased heart rate, palpitations, unpleasant jitteriness and intestinal symptoms, hypokalemia, hyperglycemia, hypotension, and pulmonary edema

28
Q

Tadalafil (Cialis) use is associated with back and muscle pain (7-30%) that may relate to its inhibition of _____ in skeletal muscle.

A

PDE-11

29
Q

Name the drug: a β2 Adrenergic Agonist relaxes smooth muscle contraction through adenylate cyclase dependent pathways to suppress contractions and treating premature labor ONLY IF THE CERVIX HASN’T DILATED AND MEMBRANES HAVE NOT RUPTURED

A

Terbutaline

30
Q

Prostaglandins strongly contract uterine smooth muscle and promote formation of gap junctions between cells (potentiating ______-induced contractions).

A

oxytocin

31
Q

Prostaglandins E2 and F2α (synthesis via COX-2) play a critical role in ______.

A

the initiation of labor

32
Q

Sildenafil (Viagra) causes increased light sensitivity, blurred vision, or loss of blue-green color discrimination due to inhibition of _____ in photoreceptor cells in the retina, especially higher doses.

A

PDE-6

33
Q

Misoprostol given orally is effective at inducing _____, while vaginal preparations are now being tested with positive results on _____.

A

oral = uterine contractions vaginal = cervical ripening

34
Q

Oxytocin receptors are coupled to ______ and increase intracellular Ca++ levels.

A

phospholipase C

35
Q

Cervical dilatation is dependent upon ______.

A

prostaglandins

36
Q

Postpartum hemorrhage is controlled by continued contraction of the uterus via ______.

A

oxytocin

37
Q

______ drugs (e.g., succinylcholine or tubocurarine) used in cesarean sections cross the placenta slowly and produce negligible plasma levels in the newborn.

A

Highly ionized

38
Q

What is Magnesium Sulfate? How does it work? What is it used for?

A

an anticonvulsant, antihypertensive agent blocks Ca++ actions –> sedation and depression of smooth muscle contractions to prevent sz’s and intracranial hemorrhage (eclampsia) in pregnancy related to HELLP syndrome

39
Q

What is an ADR for Oxytocin (Pitocin)?

A

water intoxication (note structural similarity to ADH) –> coma, convulsions, and death; uterine rupture and impaired fetal oxygenation

40
Q

Pregnant women are exposed to 3-5 prescription drugs during pregnancy and as a rule of thumb: drugs with ______ will readily cross the placenta.

A

good oral bioavailabilty

41
Q

____ is the only PDEI that DOES NOT decrease BP.

A

Tadalafil (Cialis)

42
Q

Cervical effacement is inhibited by _____ and stimulated by ______.

A

inhibited = progesterone stimulated = descent of the fetal head and prostaglandin synthesis

43
Q

_____ causes increased light sensitivity, blurred vision, or loss of blue-green color discrimination due to inhibition of PDE-6 in photoreceptor cells in the retina, especially higher doses.

A

Sildenafil (Viagra)

44
Q

What is the most commonly used tocolytic agent and how does it work?

A

Nifedipine, a Ca++ channel blocker –> relax uterine smooth muscle

45
Q

_____ block cGMP breakdown –> enhance vascular relaxation –> ↑ blood flow

A

PDEIs

46
Q

______ use is associated with back and muscle pain (7-30%) that may relate to its inhibition of PDE-11 in skeletal muscle.

A

Tadalafil (Cialis)

47
Q

Uterine contractions are stimulated by _____ and _____.

A

prostaglandins and oxytocin

48
Q

Prostaglandins strongly contract uterine smooth muscle and promote formation of ______ (potentiating oxytocin-induced contractions).

A

gap junctions between cells

49
Q

Uterine smooth muscle also expresses ______ receptors that, when stimulated, lead to relaxation.

A

β2-adrenergic

50
Q

______ and ______ (synthesis via COX-2) play a critical role in the initiation of labor.

A

Prostaglandins E2 and F2α

51
Q

What is the max amount of time that Terbutaline can be used?

A

48-72 hours

52
Q

What is the leading cause of infant mortality?

A

prematurity

Lindsey's LC Unit 2 (10 decks)

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