GOSH drugs Flashcards
What is the other name given to Syntocinon?
Synthetic Oxytocin
What are the indications for Oxytocin?
- Induction of labour for medical reasons
- Stimulation of labour in hypnotic uterine inertia
- C-Section
- Prevention & treatment of (severe) postpartum haemorrhage after delivery of the placenta
- Induction of labour in incomplete/inevitable/missed miscarriage/abortion
- Augmentation of labour
What are the contraindications to using Syntocinon?
- Spontaneous labour inadvisable
- Vaginal delivery inadvisable
- Fetal distress
- Hypertonic uterine contractions
- Severe CVD
- Severe pre-eclampsia
What are the side effects of Oxytocin?
Arrhythmia
Headache
N&V
RARE: Anaphylaxis, DIC, hypoN, uterine hyperstimulation/spasm
What are the indications for tranexamic acid?
- Local/general fibrinolysis
- Menorrhagia
- Epistaxis
- Prevent/treat significant haemorrhage following trauma
What are the contraindications for tranexamic acid?
- Fibrinolytic conditions following DIC
- Thromboembolic disease
- Hx of convulsions
What are the cautions needed to be taken into account when prescribing tranexamic acid?
- Oral contraceptives (inc risk of VTE)
- Irregular menstrual bleeding
- Massive haematuria (risk ureteric obstruction)
What are the side effects caused by tranexamic acid?
- Diarrhoea
- N&V
- Uncommon: Dermatitis
- RARE: Impaired colour vision, VTE, visual disturbance
What are the drug interactions with tranexamic acid?
-Methotrexate
-Tamoxifen
-Thalidomide
All inc risk of VTE
What are the indications for Mefenamic acid?
- Acute pain inc dysmenorrhoea, menorrhagia
- Pain & inflammation in RA/OA
What are the contraindications of Mefenamic acid?
- Active GI bleeds
- Active GI ulcer
- Hx of GI bleed related to NSAIDs
- IBD
- Severe HF
What are the side effects of Mefenamic acid?
- Diarrhoea
- Rashes
- Stomatitis
- Uncommon: Paresthesia, fatigue
- RARE: Alveoli’s, aplastic anaemia, bronchospasm, colitis, photosensitivity
What are the drug interactions of Mefenamic acid?
- Alteplase
- Apixaban
- Beclometasone
- Bendroflumethiazide
- Betamethasone
- Budesonide
- Ciprofloxacin
- Dabigatran
- Dexamethasone
- Enoxaparin
- Fludrocortisone
- Fondaparniux
- Glucose
- Heparin
- Hydrocortisone
- Lithium
What are the allergy contraindications for Mefenamic acid?
Hx of hypersensitivity to aspirin/NSAID
Those in whom asthma attacks, angioedema, urticaria, rhinitis precipitated by aspirin/NSAIDs
What are the drug interactions of Ergometrine?
- Atenolol/Bisoprolol/Labetalol
- Clarithromycin
- Diltiazem
- Dopamine
- Erythromycin
- Fluconazole
- Itra/ketoconazole
- NorA
- Verapamil
What are the indications of ergometrine?
Postpartum haemorrhage caused by uterine atony
What are the contraindications of Ergometrine?
- Eclampsia
- 1st & 2nd stage of labour
- Induction of labour
- Sepsis
- Severe cardiac disease
- Severe hypertension
What are the side effects of ergometrine?
- Abdo & chest pain
- Arrhythmia/bradycardia/ palpitations
- Headache
- Hypertension
- Pulmonary oedema
- VasoC
- Tinnitus
- RARE: MI
What are the indications of Misoprostol?
-Termination of pregnancy following Mifepristone (gestation up to 49days, 50-63days, 9-13weeks, 13-24weeks)
How long after Mifepristone is Misoprostol given?
24-48hours
What type of drug is Misoprostol?
Prostaglandin E1
What are the side effects of Misoprostol?
- Diarrhoea
- IMB/menorrhagia
- Postmenopausal bleeding
- Abdo pain
In what state is Misoprostol contraindicated?
1st trimester of pregnancy (teratogenic risk)
Avoid-potent uterine stimulant
Name the main GnRH analogues
Goserelin
Leuprorelin
What are the indications of Goserelin?
- Endometriosis
- Endometrial thinning before intra-uterine surgery
- Before surgery in women who have anaemia due to uterine fibroids
- IVF related
What are the contraindications for Goserelin/Leuprorelin?
Undiagnosed vaginal bleeding
Use >6months in endometriosis (do not repeat)
What are the side effects of Goserelin?
- RARE: HyperCa
- Tumour flare in use as cancer treatment
Can Goserelin/Leuprorelin be used in pregnancy or breast-feeding?
NO
What are the directions for use of Goserelin?
Rotate injection site to prevent atrophy and nodule formation
What are the indications for Leuprorelin?
- Same as Goserelin
- Reduction of size of uterine fibroids & associated bleeding before surgery
What VTE medication can be used in pregnancy?
LMWH (Tinzaparin)
Unfractionated Heparin
What VTE should not be used in pregnancy? Why?
Warfarin
Inc risk of stillbirth & prematurity
What is Syntometrine made up of?
Oxytocin & Ergometrine
What is the brand name of Leuprorelin?
Prostap
In pregnancy, which medications can & can’t be used to control blood pressure?
CAN: Labetalol, Nifedipine
CAN’T: ACE/ARB
In pregnancy, which medications can & can’t be used to control seizures?
CAN: Magnesium Sulphate
CAN’T: Valproate (risk of neural tube defects)
What are tocolytics used for? Name the main ones used
Aim to holt/slow down premature labour
- Beta mimetic: Terbutaline (22-37weeks)
- CCB: Nifedipine
What are contraindications of tocolytics?
T: Pre-eclampsia
N: Acute angina, CardioShock, aortic stenosis, 1month post-MI
What are the contraindications specific to premature labour use of Terbutaline?
- Placenta praaevia
- Placental abruption
- Antepartum haemorrhage
- Eclampsia
- Hx of intra-uterine fetal death/infection
What antibiotics can be given to a pregnant woman with a UTI?
Cephalosporins
Penicillins
Why can Co-Amoxiclav not be given to pregnant women?
Increased risk of necrotising enterocolitis
Why can Trimethoprim, Tetracyclines & Nitrofurantoin not be given to pregnant women?
N: 3rd trimester increases risk of neonatal haemolysis
T: 1st trimester= anti-folate inc risk of neural tube defects
Tetra: Neonatal tooth discolouration
Which antibiotic should be prescribed in PPROM and why?
Erythromycin
Prophylaxis for chorioamnionitis
What is used to treat chorioamnionitis?
Cefotaxime & Metronidazole
What are the indications for Mifepristone?
- Cervical ripening before mechanical cervical dilatation for TOP <84days
- Labour induction in fatal death in utero
- mTOP <49days/50-63days
- mTOP 13-24weeks w/prostaglandin
What are the contraindications of Mifepristone?
Acute porphyria
Ectopic
Uncontrolled severe asthma
What are the side effects of Mifepristone?
- GI cramps, uterine contractions, vaginal bleeding
- RARE: TSS, chills, fever, hypoT, headache, hot flushes
What are the indications of maternal corticosteroids?
Accelerate fatal lung maturation
When should maternal corticosteroids be considered?
-24-35
weeks preterm labour
