Fitzy: Ante- and Perinatal pharmacology

Question 1

What do the pregnancy categories for drugs not take into account?

Answer 1

-the risks from pharmaceutical agnets or their metabolites in breast milk

Question 2

What are corticosteroids used in pre=term delivery for?

Answer 2

-to promote lung maturation

Question 3

What is the last organ system to mautre sufficiently to support extra-uterine life?

Answer 3

the lungs!

Question 4

What does antenatal corticosteroids prior to delivery reduce?

Answer 4

the indicence of RDS

• neonatal death
• ventricular hemorrhage

Question 5

Who gets these antenatal corticosteroids?

Answer 5

• women between 24 and 34 weeks of gestation with any of the following
• threatened pre-term labor
• antepartum hemorrhage
• preterm rupture of membranes
• conditions requiring Caesarian delivery

Question 6

What drives lung maturation?

Answer 6

-endogenous fetal cortisol

Question 7

What do we usually give to fill the cortisol deficit at weeks 24-34?

Answer 7

-Betamethasone!.. 2 doses, 24 hours apart

Question 8

What receptor does Betamethasone get?

Answer 8

-Glucocorticoid receptor GCR

Question 9

What genes does betamethasone drive up?

Answer 9

-surfactant proteins

Question 10

What cells does this all happen in (surfactant production)?

Answer 10

-alveolar type 2 pneumocytes

Question 11

Contraindications of Betamethasone/dexamethasone?

Answer 11

-mother with systemic infection, tuberculosis

Question 12

Why don’t we just administer cortisol?

Answer 12

• if mom gets it, the fetus will be exposed to cortisone… less active at GCR
• this is a built in protective system so that the stress on mom doesn’t always kill the baby
• so if mom is having an inflammatory crisis, go ahead and use cortisol! It will be great

Question 13

Which cycoloxygenase enzyme make the prostaglandin H2 (PGH2)

Answer 13

cycoloxygenase 1

-then that gets converted into PGF2a and PGE2

Question 14

What do we give before we give them oxytocin to induce delivery?

Answer 14

• Dioprostone and Misoprosto.l

- they ripen the cervix

Question 15

If there is a deficit of PG’s what will happen

Answer 15

delay of birth

Question 16

PG excess?

Answer 16

premature birth

Question 17

What do we give to drive the contractions after the cervix is ripened by dioprostone or misoprostol

Answer 17

Oxytocin

Question 18

what is used in the contraction stress test?

Answer 18

oxytocin

Question 19

What is the most important Tocolytic drug?

Answer 19

-MgSO4

Question 20

What are Tocolytic drugs?

Answer 20

-they aim to stop uterine contractions na dto prevent neonatal risks associated with prematurity

Question 21

MOA for Ritodrine, Salbutamol, Terbutaline?

Answer 21

• B2 adrenergic receptor agonist

- relaxes uterine smooth muscle

Question 22

MOA for Indomethacin

Answer 22

• inhibits uterine COX-1 enzyme

- blocks PGF2a and PGE2 formation

Question 23

Nifedipine MOA

Answer 23

• Ca2+ channel antagonist

- relaxes uterine smooth muscle

Question 24

MgSO4 MOA

Answer 24

-competition at Ca2+ channels

Question 25

Atosiban MOA

Answer 25

-Oxytocin pituitary neuropeptide receptor antagonist

Question 26

Adverse effects for Ritodrine, Salbutamol, and Terbutaline?

Answer 26

- Tachycardia, hypotension | - hypokalemia, hyperglycemia for mother and fetus

Question 27

Indomethacin adverse effectrs?

Answer 27

- 2nd trimester only... use at term risks premature in utero closure of the ductus arteriosus (fetus) - Bleeding risk, ulcer (mother)

Question 28

Nifedipine adverse effects?

Answer 28

-Dizziness, hypotension (mother)

Question 29

MgSO4 adverse effects?

Answer 29

-Myasthenia gravis: contra-indicated

Question 30

Are Tocolytic drugs useful to delay pre term labor indefinitely?

Answer 30

no | -it's useful to delay delivery for hours/days to allow transport of mother to a hospital with a NICU/MICU/SICU

Question 31

What is the most commonly used Tocolytic drug?

Answer 31

- MgSO4 - protects against seizures associated with pre-eclampsia and HELLP syndrome - the other drugs don't do this

Question 32

What do Tocolytic drugs do to uterine smooth muscle?

Answer 32

-relaxes dat shit

Question 33

What does Indomethacin and Ibuprofen do

Answer 33

- inhibit COX enzyme | - stops uterine contraction

Question 34

What does Nifedipine and MgSO4 block?

Answer 34

-Ca2+ channels

Question 35

When do we use Indomethacin?

Answer 35

- 2nd trimester of pregnancy! | - if we take NSAIDs in the 3rd semester, then we stop the PG's that we need! (ductus arteriosus)

Question 36

What keeps the ductus arteriosus open?

Answer 36

-PGE2!

Question 37

When birth happens, how is the ductus arterosus close?

Answer 37

-inactivation of PGE2 in the lung

Question 38

What do we use to maintain a ductus arteriosus?

Answer 38

-PGE1 (alprostadil)

Question 39

Complications of PGE1?

Answer 39

-hypotension, tachycardia, apnea, PYREXIA

Question 40

What is used to inhibit the PDA in premature infants?

Answer 40

- COX inhibitors - Indomethacin - NSAID

Question 41

Is the Indomethacin and NSAID effective for PDA in full term baby?

Answer 41

-no!

Question 42

What organ system will have adverese effects with NSAIDs?

Answer 42

-the renal system!

Question 43

What are the first-line antihypertensive drugs for moderate hypertension ?

Answer 43

-oral alpha methyldopa and oral labetalol

Question 44

What does Methyldopa do?

Answer 44

- acts cetnrally to prevent neurotransmitter release - alpha-methylnorepinephrine (from the methyldopa), is released from adrenergic neurons and stimulates central alpha 2 adrenergic receptors - this reduces the sympathetic outflow from the central nervous system - blood pressure falls as a result of decrease in peripheral resistance

Question 45

What is used extensively in the setting of preeclampsia for the acute treatment of severe hypertension?

Answer 45

-Hydralazine