GOSH drugs Flashcards
Indications for antenatal steroids
24+0 - 36+6 weeks
Pre-term labour
P-PROM
Expected preterm birth
Give IM
Purpose of antenatal steroids
Hasten the maturation of foetal lungs in anticipation of premature delivery.
Reduce likelihood of infant respiratory distress syndrome
Reduce mortality
Syntocinon MOA and indications
Synthetic oxytocin = Stimulates uterine contractions
Inducing labour (IV)
Augmentation of labour if hypotonic uterus (IV)
During C section (IV)
Prevention of PPH after delivery of placenta = active management (IV)
Treatment of PPH (IV)
Miscarriage
SE and CI of syntocinon
SE:
- arrhythmias
- headache
- nausea and vomiting
- uterine hyperstimulation (can cause foetal distress)
- water intoxication
CI when labour/SVD inadvisable (e.g. placenta praevia, or foetal malposition)
Ergometriene MOA and indications
Ergot alkaloid = contracts uterine and vascular smooth muscle
PPH caused by uterine atony (given in 3rd stage of labour)
Ergometriene SE and CI
SE:
- abdominal pain
- arrythmias
- coronary vasospasm
- hypertension
- dizziness, headache
- dysponea
- vasoconstriction
CI:
- eclampsia/hypertension
- first/second stage of labour
- vascular disease
- sepsis
Tocolytics MOA and indications
MOA: myometrial relaxants
Indications:
- to postpone premature labour so that antenatal corticosteroids can be given
- 24-33 weeks
Tocolytics of choice
1st line = nifedipine (Ca2+ channel blocker)
2nd line = atosiban (oxytocin receptor antagonist) if nifedipine CI
SE and CI of atosiban
SE:
- dizziness/headache
- hot flush
- hyperglycaemia
- hypotension
- N+V
- tachycardia
CI:
- abnormal foetal HR
- antepartum haemorrhage
- eclapsia
- itra-uterine foetal death
SE and CI nifedipine
SE:
- constipation
- oedema
- vasodilation
CI:
- acute angina
- aortic stenosis
- within 1 month of MI
Atosiban MOA and indications
Oxytocin receptor antagonist = competitively inhibits oxytocin (and vasopressin), providing a dose-dependent inhibition of uterine contractility.
Given as a tocolytic in premature labour to delay delivery until antenatal steroids can be given
Antenatal aspirin dose/indications
75-150mg from 12 weeks
If 1 high risk factor of developing pre-eclampsia:
- HTN in previous pregnancy
- chronic HTN
- chronic kidney disease
- T1/T2 DM
- Autoimmune disease
If 1+ moderate risk factor of developing pre-eclampsia
- BMI >35
- Age >40
- first pregnancy
- pregnancy interval >10 years
- FH of pre-eclampsia
- multiple foetal pregnancy
Indications and MOA for tranexamic acid
PPH (>500ml after vaginal delivery)
Prevention of PPH after C section in high risk women
Heavy menstrual bleeding
MOA = anti-fibrinolytic
Indications and MOA of mefenamic acid
Dysmenorrhoea
NSAID = decreases prostaglandin synthesis, reduces pain
Misoprostol MOA and indications
MOA = prostaglandin analouge, softens cervix and stimulates uterine contractions.
Can be given vaginally or orally
Indications
- medical management of miscarriage
- termination of pregnancy (+ mifepristone)
- induction of labour (vaginal)
Misoprostol SE and CI
SE:
- heavy bleeding
- pain
- diarrhoea/vomiting
CI
- Caution in patients with CVD
Indications for IM methotrexate
Medical management of ectopic pregnancy
If serum hCG 1500-5000 and surgical criteria not met
Treatment of BV
Metranidazole PO (first line even in pregnancy and breastfeeding)
Clindamycin (2nd line) but can weaken condoms
Treatment of vulval candida infection (thrush)
Clotrimazole pessargy 500mg STAT OR Clotrimazole cream OR Fluclonazole 150mg PO STAT (avoid in pregnancy)
Treatment of trichomonas vaginalis
400mg Metranidazole PO BD for 5-7 days
Treatment of chlamydia
100mg Doxycycline PO BD for 7 days
If pregnant azithromycin (1g day 1, 500mg day 2 and 3)
Treatment of gonorrhea
1mg ceftriaxone IM STAT
Oral cefixime + oral azithromycin if injection refused
GnRH analogues (e.g. goserelin (zoladex)) MOA and indications
MOA = inhibit oestrogen production
- by inhibiting LH and FSH production
- induce menopause (inhibit ovulation)
Indications
- endometriosis
- fibroids
- severe PMS
- first stage IVF (inhibit natural menstrual cycle)
SE and CI of GnRH analogues
SE:
- Initial worsening of symptoms (initially cause LH/FSH surge)
- Menopause like symptoms (low oestrogen state) = HRT can be given alongside
- Osteoporosis
CI:
- Undiagnosed vaginal bleeding
Progesterones MOA and indications
MOA
- opposes the endometrial proliferative actions of oestrogen.
Indications
- HMB
- Endometrial hyperplasia
Progesterone SE and CI:
SE:
- menstrual irregularities
- headache
CI:
- breast cancer
- acute porphyrias
when is oestrogen only HRT indicated
ONLY if the uterus is absent
Continuous combined HRT indications and MOA
Indications: established menopause
- >1 year since LMP
- >54
(will cause bleeding/spotting if younger/pre-menopausal)
MOA:
- Continuous oestrogen and progesterone
- No bleeding (endometrium becomes atrophied)
Sequential combined cyclical HRT indications and MOA
Indications: <1 year since LMP
MOA:
- Oestrogen daily
- Progesterone for last 10-14 days
- withdrawal bleed monthly (stimulates menstrual bleeding)
Sequential long cyclical HRT
- Oestrogen daily for 3 months
- Progesterone last half of 3rd month
- Bleed every 3 months
Tibolone MOA
Synthetic steroids with oestrogen, progesterone and androgen properties
- helps boost libido
- no bleeding
Risks of HRT
- endometrial hyperplasia (always oppose oestrogen with progesterone)
- breast cancer
- VTE
NO RISK IF TAKING DUE TO PREMATURE MENOPAUSE (as only returning no normal levels)
Antibiotic Tx of PID
- Stat IM 1g ceftriaxone (gonorrhoea).
- Doxycycline 100mg BD PO for 14days (chlamydia)
- metronidazole 400mg BD for 7-14days (anaerobes)
Metranidazole considerations
AVOID ALCOHOL
Give in pregnancy if risks outweight benefits
Safe in breastfeeding but may affect taste.
Treatment of vaginal thrush
- Clotrimazole pessary (500mg)
- Vaginal clotrimazole cream
- Fluconazole 150 PO (AVOID IN PREGNANCY)
Doxycycline SE and CI
SE:
- GI discomfort (take with glass of water)
- diarrhoea
CI:
- pregnancy
- breast feeding (teeth discoloration)
Co-amoxiclav in prengnancy
AVOID
can cause NEC in baby
