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Complex Care 2 > Drugs of the week > Flashcards

Drugs of the week Flashcards

Learn drugs and actions for key pregnancy complexities

1
Q

What are the three phases of the coagulation process?

A
  1. Temporary plug - Platelets adhere to damaged vessels
  2. Fibrin clot - Permanent clot forms
  3. Fibrinolysis - Break down of the clot as the vessel heals.
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2
Q

What are known risk factors for thrombosis?

A

Increased plasma concentration of oestrogens or progesterones - ie ovarian hyperstimulation

Pregnancy - increased clotting factors and decreased fibrinolysis.

Childbirth (LSCS, high instrumental, prolonged labour, grand multips)

AMA
Obesity
Immobility
Trauma and surgery
Dehydration
Haemorrhage
Infection/sepsis
Smoking
Stress
Hypertension
Thrombophilia
Diabetes
Family Hx
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3
Q

What is Virchow’s triad?

A

The three causes of coagulation:

  1. Endothelial injury - trauma/surgery, previous clots, compression, varicose veins, recreational IV drug use
  2. Abnormal blood flow - Narrowed blood vessels (preeclampsia); Venous stasis and sluggish blood flow ie dehydration, immobility, sickle cell disease.
  3. Hypercoagulability - affected by pregnancy, childbirth, infection, inflammation, tissue damage, smoking, inherited conditions, age, pre-existing disease, drugs (ie OCP)
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4
Q

Clomid is the brand name of which drug?

A

Clomiphene citrate

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5
Q

What is Clomid used for, and what is it’s mechanism of action?

A

To stimulate ovulation to achieve pregnancy.

Stimulates increased output of pituitary gonadotrophins which stimulate the maturation of the ovarian follicle and subsequent development of the corpus luteum.

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6
Q

What are contraindications for Clomid?

A

Liver disease
Hormone-dependent tumours or abnormal uterine bleeding
Pregnancy
Ovarian cysts (except PCOS)

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7
Q

How is proteinuria measured?

A

Historically 24 hour urine collection;

Now - spot protein:creatinine ration is a good estimate.

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8
Q

Risk factors for pre-eclampsia?

A 
First pregnancy, or long gap between pregnancies
Renal disease
Rhesus incompatability
Donor eggs
Sickle cell
Young or AMA
Hx 
Multiple gestation
Diabetes
Essential hypertension
Molar pregnancy
Obesity
Clotting disorders.
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9
Q

What is HELLP syndrome?

A

Haemolysis, elevated liver enzymes, low platelets

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10
Q

What is magnesium sulphate used for?

A

Prevent further fits in established eclampsia.

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11
Q

What should you consider/monitor to prevent magnesium toxicity?

A

Magnesium is processed by the kidney’s so if renal function is poor (as it can be with preeclampsia) then there is a risk that it will build up in the blood stream. Dosage should be titrated based on renal function of the individual patient, and a strict fluid balance should be maintained.

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12
Q

What is the antidote to magnesium toxicity?

A

Calcium glutonate

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13
Q

What are the signs of magnesium toxicity?

A

Thirst, warmth, flushing. (Early signs)

Respiratory distress, cardiac failure.

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14
Q

What is the definition of hypertension?

A

> = 140/90
Severe >= 170/110

(As per NSW HEALTH)

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15
Q

What is the first line drug for hypertension in pregnancy?

A

methlydopa

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16
Q

How does Methyldopa work?

A

It is an alpha agonist meaning it stimulates the alpha receptors in the brain which then signals vasodilation, lowering blood pressure.

It opposes the actions of adrenaline and noradrenaline and dopamine, inhibiting the sympathetic nervous system.

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17
Q

Contraindications for methyldopa?

A

Pre-existing or hx of depression

liver or endocrine disease

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18
Q

What type of drug is labetolol?

A

It is an antihypertensive, and a combined alpha & beta-blocker. Also used for thyrotoxicosis.

Method of action: reduces HR and cardiac output by depressing the renin-angiotensin-aldosterene pathway

Better tolerated than methyldopa, and used in 3rd trimester (prior to 3rd will reduce blood flow to fetus - IUGR, bradycardia, hypoglycaemia and resp depression).

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19
Q

Contraindications for labetolol?

A

Asthma - they prevent relaxation of smooth muscle of the bronchioles

Glucose control - impair normal response to hypoglycaemia

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20
Q

What is hydralazine used for?

A

A potent vasodilator used as anti-hypertensive.

Rapid action when used IV in an emergency.

Avoid 1st and 2nd trimesters - sometimes used orally in pregnancy if other drugs not tolerated.

Associated with more adverse effects such as hypotension, LSCS, abruption, low APGAR.

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21
Q

What drugs are used for hypertensive emergencies?

A

IV labetolol
Oral Nifidipine
IV Hydralazine

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22
Q

Side effects of vasodilatory drugs (Hydralazine, nifidepine, labetolol)

A 
Headache,
Flushing
nausea
nasal congestion
tachycardia

Hydralazine - salt and water retention, increased heart rate leading to pulmonary oedema and heart failure.

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23
Q

What are broad-spectrum antibiotics?

A

Those effective against both gram-positive and gram-negative bacteria.

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24
Q

Which type of antibiotic is more effective against gram-positive, and which for gram-negative bacteria?

A

Penicillin - gram-positive

Gentamicin - gram-negative

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25
Q

What is Benzylpenicillin used for?

A

It is effective against gram-positive bacteria only. It is usually used for GBS positive women as prophylaxis.

26
Q

What antibiotic is commonly prescribed for gram-positive bacteria for patients allergic to pencillin?

A

Erythromycin.

27
Q

What are tetracyclines?

A

Broad-spectrum antibiotics. Not prescribed in pregnancy and lactation.

28
Q

What drugs are used to treat bacterial vaginosis?

A

Metronidazole - high doses not recommended in pregnancy. Significant amount passes into breastmilk.

OR

Clindamycin

29
Q

What drug is used to treat Trichomoniasis?

A

Metronidazole.

30
Q

What is used to treat Candidiasis?

A

Clotrimazole - PV suppository or cream

31
Q

What drugs can be used to treat chlamydia?

A

Considered gram-negative:

erythromycin
clindamycin
azithromycin

32
Q

Which common antibiotics are useful for gram-positive bacteria?

A 
Ben Pen
Bacitracin
Vancomycin
Erythromycin
Clindamycin
33
Q

Which antibiotics are useful for gram-negative bacteria?

A

Cephalexin
Ampicillin
Gentamicin

34
Q

Which antibiotics are broad-spectrum?

A 
Tetracycline
Doxycycline
Augmentin
Cephalosporin
Bactrim (trimethoprim/sulfamethoxazole)
35
Q

What is a common first line drug to treat UTIs?

A

Nitrofurantoin - Category B drug.

NOTE - not recommended for pyelonephritis.

Could also be cephalexin (keflex) or amoxycilin

36
Q

What drug is most commonly used to treat syphilis?

A

Ben Pen, or doxycycline if allergic to Penicillin

37
Q

What is aciclovir more commonly known as, and what is used for?

A

Zovirax - used to treat HSV-2 along with analgesia and topical anaesthetic gels.

Note - not in first 20 weeks - tend to use toward end of pregnancy to prevent outbreaks at time of birth.

38
Q

What drug is used to treat toxoplasmosis?

A

spiramycin - to reduce risk of transmission to fetus.

39
Q

Which drugs are used in thromboprophylaxis?

A

Asprin,
Heparin (unfractionated and LMW),
Warfarin

40
Q

What are some differences between unfractionated and LMW heparin?

A

LMW - less adverse effects and equally effective in DVT prevention - now the preferred choice for prophylaxis.

Unfractionated - used in highest risk women. Requires lab monitoring of bloods.

Both are considered safe for the fetus in pregnancy and lactation - but some reports of miscarriage and prem labour.

41
Q

Adverse affects of heparin?

A 
Bleeding,
Thrombocytopenia
hypotension
diuresis
hyperkalaemia (aldosterone inhibition)
LT use:
LFT abnormalities
decreased renal function
Hair loss (reverses)
Osteoprosis
heparin resistance
withdrawal
42
Q

When is LMW heparin discontinued in pregnancy?

A

Usually 24 hours prior to planned delivery, or at onset of labour.

43
Q

How are osteoporosis, pregnancy and heparin related?

A

Osteoprosis can occur in pregnancy due to the increased demand for calcium by the fetus. This process can be compounded by heparin and women with Diabetes are particularly at risk.

Heparin binds to calcium ions and reduces bone formation!

44
Q

Contraindications for heparin?

A 
hypertension (increased risk of stroke)
pre-eclampsia/eclampsia
HELLP
thrombocytopenia
haemorrhagic disorders
active haemorrhage
45
Q

What is given if bleeding occurs with administration of Heparin?

A

The antidote is protamine sulfate - slow IV injection. Safety in pregnancy is unknown.

Side effects:
warmth/flushing
pulmonary vasoconstriction
emesis
BP and HR changes
If given too fast - bradycardia and dangerous hypotension
46
Q

What is warfarin?

A

An oral anticoagulant. High risk of fetal malformations, therefore rarely used in pregnancy.

Can be used postpartum following thromboembolic episodes.

47
Q

How does warfarin prevent thrombosis?

A

It interferes with the action of Vitamin K, a precursor to clotting factors.

48
Q

How does alcohol affect warfarin?

A

It inhibits the bodies ability to clear warfarin, therefore it can build up in the body resulting in haemorrhage.

49
Q

Adverse affects of warfarin?

A

Bleeding - can give Vit K through slow IV, if major bleeding then need to give clotting factors
Skin necrosis - rare

Also - mouth ulcers, GI upset, liver damage, hypersensitivity such as urticaria, fever, nephropathy, decrease in WBC.

50
Q

Effect of warfarin on the fetus?

A

Interferes with bone formation

2/3rd trimesters - fetal intracranial haemorrhage and subsequent malformation

High risk of spontaneous abortion, LBW, abdo and CNS malformation

51
Q

What is clexane?

A

It is a type of LMWH. Generic name is enoxaparin sodium.

MIMS states category C drug.

52
Q

What is fragmin?

A

LMWH - given by sub-cut injection.

53
Q

Which drug is used to stimulate surfactant production in a preterm fetus?

A

Betamethasone - corticosteriod

54
Q

What drug is used in neonatal resuscitation?

A

Adrenaline - 1:10000

Can be given by Umbilical vein catheter or ET tube.

55
Q

What is caffeine citrate used and how is it given?

A

It is used in the prevention of apnoeic episodes in preterm infants.

Can be given orally or by injection.

Generic name: Methylxanthine

Adverse affects: NEC?

56
Q

What is curosurf?

A

Exogenous surfactant given after birth to treat respiratory distress syndrome.

Adverse effects: bradycardia, hypotension, ET tube blockage and oxygen desaturation.

57
Q

What are the effects of opioid use on the fetus?

A

Bradycardia, reduced variability and fetal movements in utero.

Developmental delay, lower IQ, attention deficits and behavioural problems

58
Q

Effects of opioids in pregnancy?

A 
PROM
Abruption
APH
pre-eclampsia
Stillbirth
Prem birth
LBW
anaemia,
resp depression at birth
59
Q

Sudden withdrawal of opioids in pregnancy can result in?

A

Fetal death
PROM
convulsions
uterine contractions / prem labour

60
Q

What are symptoms of opioid withdrawal in the neonate?

A 
irritable and hyperactive
abnormal reflexes
rapid breathing
fever
tremor
diarrhoea
vomiting
convulsions
coma
61
Q

What are the benefits of substitution of methadone and buprenorphine during pregnancy?

A

reduced IUGR

Stable mother

62
Q

Methadone versus buprenorphine?

A

buprenorphine - associated with lower rates of preterm birth and withdrawal symptoms in neonates. BUT shorter half life = more frequent dosing.

Complex Care 2 (15 decks)

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