Exam 3: Uterus, Thyroid, And Osteo Flashcards
What is the DOC for inducing labor at term?
Oxytocin
What can cause strong contractions in the second trimester?
Prostaglandins
What is the first line treatment in postpartum hemorrhage?
Massage
What is oxytocin?
Cyclic octapeptide stored in posterior pituitary normally released in response to suckling and cervical pressure
What are the indications for Oxytocin?
- DOC to induce labor at term
- prevention of hemorrhage (IM route preferred)
- Stimulation of milk let-down reflex
What are the adverse effects of oxytocin?
- Water intoxication with convulsions
- Uterine rupture
- Anaphylaxis
- Sinus bradycardia
What are the contraindications fo oxytocin?
- Malpresentation
- cephalopelvic disproportion
- complete placenta prevails
- uterine scar from previous C section
- unengaged head
- cervical scarring
What is the MOA of Ergot Alkaloids?
Contraction of uterine smooth muscle through activation of serotonin and alpha-adrenergic receptors
What are the indications to use Ergot Alkaloids?
-After completion of labor and the delivery of the placenta to produce firm uterine contractions to decrease uterine bleeding (2nd line after oxytocin and massage have failed)
What are the adverse effects of Ergot alkaloids?
- Transient hypertension
- Angina, MI
What are the contraindications to Ergot Alkaloids?
- Should never be used to induce labor (will cause fetal hypoxia)
- Peripheral vascular disease or CAD
What are the 3 prostaglandin drugs?
Dinoprostone, Carboprost Tromethamine, and misoprostol
What are the indications to use prostaglandins?
- Expulsion of the uterine contents after miscarriage/abortion
- cervical ripening prior to delivery at term
- postpartum bleeding due to uterine atony (3rd line)
What are the adverse effects of prostaglandins?
- GI disturbances, vomiting, DIARRHEA (BLACK BOX)
What are the 5 drugs known to cause significant diarrhea?
Metformin Quinidine Dinoprostone Erythromycin Colchicine
“Many quality drugs expel crap”
When should prostaglandins not be used for cervical ripening?
If there is problems with the mother or fetus such as fetal distress or history of difficult deliveries or C section
What are the contraindications to prostaglandins?
- Acute cardiac, pulmonary, renal, or hepatic diseases
- Asthma, HTN, anemia, jaundice, or epilepsy
What kind of drug is Tranexamic acid?
- Non-uterotonic drug
- Anti-fibrinolytic, inhibits plasminogen activation
What are the indications of Tranexamic acid?
- Reduced death due to bleeding in women with postpartum hemorrhage
- uterine bleeding when hormonal therapy is not wanted or C/I
How is tranexamic acid administered?
IV, alongside standard uterotonic therapy
** should not be regarded as alternative therapy
What are the adverse effects of tranexamic acid?
-May cause intravascular thrombosis
What are tocolytics and what is their goal?
- Uterine relaxants
- Prevent premature labor or delay premature labor until term or until fetus has matured sufficiently for survival
If delivery of a baby happens before the 37th week, what should be administered?
Corticosteroids to cause production of surfactant in the lungs
What are the 4 tocolytic drugs?
Magnesium sulfate, Nifedipine, indomethacin, and progesterone
What is the MOA of magnesium sulfate?
Relax the uterus probably by a direct effect, unknown mechanism
What are the indications for magnesium sulfate?
- Considered first line (no FDA approved first line)
- can prevent convulsions in pre-eclampsia and treat eclampsia
How is magnesium sulfate administered?
Slow IV, may cause hypotension or asystole is too fast)
What are the adverse effects of magnesium sulfate?
- Flushing, diaphoresis, hypotension
- Depressed DTRs, muscle paralysis, weakness
- Circulatory collapse, respirator depression
What is the MOA of Nifedipine?
-CCB
What is the MOA of indomethacin?
Inhibits COX enzyme (reduction of PG synthesis)
What are the adverse effects of Indomethacin?
- possible partial closure of fetal ductus arteriosus, impaired fetal renal function, and persistent PAH in the neonatal period
- Maternal GI irritation, peptic ulceration, thrombocytopenia
What are the indications to using progesterone as a tocolytic?
- More effective than placebo in maintaining length of pregnancy when given prophylactically from the 16th-37th week
- Not effective for acute treatment
What are the signs and symptoms of hypothyroidism (myxedema)?
- Slow metabolic rate, weight gain, hypothermia
- fatigue, depression
- bradycardia
- High TSH
- Possible goiter
What is the DOC for hypothyroidism?
Levothyroxine sodium
How is Levothyroxine dosed?
It must be carefully titrations to the individual
What are the 3 drugs used for hypothyroidism?
Levothyroxine, Liothyronine sodium , and dessicated thyroid
When is liothyronine used?
Used for initial therapy of hypothyroid, not maintenance
When would you use dessicated thyroid?
Patients with deficiency in peripheral deiodinase enzyme
What are the causes of hyperthyroidism?
- Graves disease
- Toxic adenoma
- toxic multinodular goiter
What are the 4 options of treating hyperthyroidism?
- Surgical removal of the gland
- destroy the gland with 131I
- decreased T3 and T4 (thioamides, iodide)
- Block the symptoms with b blockers
What are the 2 thioamide drugs?
Propylthiouracil and methimazole
What is the MOA of Thioamides?
Inhibits synthesis of T4 (methimazole is more potent)
-PTU blocks conversation of T4 to T3
What is the first line treatment for Graves’ disease?
Thioamides
What is the black box warning for PTU?
Severe liver injury, acute liver failure
Is Methimazole or PTU DOC in most causes of graves? What are the exceptions?
Methimazole is DOC, except for in cases of allergy or pregnancy
What are the side effects common with methimazole and PTU?
- Itching/rash (most common)
- Granulocytopenia and agranulocytosis
- Goiter
What is the MOA of iodide?
-Rapidly decreases synthesis and release of T4/T3
What are the indications for iodide?
- decreases vascularity and thyroid content of gland
- used 7-10 days before surgery to decreased likelihood of thyroid storm
- radioactive emergencies
What is the MOA of radioactive iodide (131I)?
Taken into the gland specifically
- Small dose is diagnosis
- Large amount destroys the gland
What are the indications to radioactive iodide (131I)?
- Used in elderly patients and those with HD
- Definitive treatment for Graves, but thioamides preferred
- preferred treatment for toxic nodular goiter
What are the adverse effects of radioactive iodide (131I)?
- usually causes hypothyroidism over time
- thyroid storm risk (decrease risk by use of thioamide prior to treatment)
What is the C/I to radioactive iodide?
Pregnancy, nursing, or mothers who lack childcare
How do Beta blockers treat hyperthyroid?
Propranolol inhibits the conversion of T4 to T3
What are the indications of Beta blockers in hyperthyroidism?
- Decreased many of the symptoms of hyperthyroid
- used to prepare for surgery while waiting for thioamides or 131I to take effect
What are the contraindications to B blockers?
Asthma, but CCB instead
What is key to osteoporosis treatment and fracture prevention?
Decreasing bone resorption
What is the DOC for treatment of osteoporosis?
Bisphosphonates
What are the 4 treatment options of osteoporosis?
- Calcium and vitamin D
- HRT (estrogen inhibits bone resorption)
- Calcium regulating hormones (PTH, calcitonin)
- Bisphosphonates (DOC)
Can calcium and vitamin D treat osteoporosis alone?
NO
What are the adverse effects of calcitonin?
- nasal rhinitis/sinusitis
- nausea and vomiting
- allergy
What are the indications of calcitonin?
- Osteoporosis (not first line)
- pagets disease
What is the MOA of calcitonin?
- Decrease bone resorption of Ca
- antagonizes PTH
What are the 3 PTH drugs?
Teriparatide, abaloparatide, and rhPTH (1-84)
What are the adverse effects of Teriparatide and Abaloaparatide?
- Hypercalcemia and hypercalciuria
- dizziness, leg cramps
- Abaloparatide causes hyperuricemia
What is the black box warning for Teriparatide and abaloparatide?
-May cause osteosarcoma
What kind of drug is Denosumab?
Antibody against receptor activator of nuclear factor kappa beta ligand (RANKL)
What is the MOA of Denosumab?
- Inhibits bone resorption
- inhibits RANKL (factor make by osteoblasts that is necessary for the formation of mature osteoclasts)
What are the indications of Denosumab?
- Osteoporosis in men and postmenopausal women at high risk for fractures
- Increase bone mass and strength in both cortical and trabecular bone
What are the contraindications of Denosumab?
- Hypocalcemia
- pregnancy
What are the precautions of Denosumab?
- CKD
- Patients at risk for serious infections
What are the 4 bisphosponate drugs?
Alendronate, Risedronate, Ibandronate, and Zoledronic acid
What bisphosphonates are given orally? Which are IV?
Orally: Aledronate, risedronate, and ibandronate
IV: Ibandronate and zoledronic acid
What is the MOA of Bisphosphonates?
P-C-P bond binds analogs of pyrophosphate
- substitutes for PO4 in Ca binding (incorporates into bone)
- inhibits osteoclast activity and bone resorption
What are the indications of Bisphosphonates?
- DOC for post-menopausal osteoporosis
- Paget’s disease
- osteopenia
How are bisphosphonates administered?
- Orally, absorption is poor
- must be taken on an empty stomach and stay upright for 30 minutes after
- other preparations are IV only
What are the adverse effects of bisphosphonates?
- Abdominal pain, esophageal ulceration, diarrhea, flatulence, N/V
- IV may cause renal tox if given too quickly
- osteonecrosis of the jaw
What are the contraindications of Bisphosphonates?
- oral: Inability to stand/sit upright or esophageal disease
- IV: renal disease
