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Pharmacology II > L&D > Flashcards

L&D Flashcards

1
Q

What effect does calcium play in uterine contractions?

A

muscle contraction

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2
Q

What effect does stimulation of ATP-sensitive potassium channels?

A

inhibits muscle contraction

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3
Q

3 reasons for promotion of uterine contractions?

A
  1. Cervical ripening (thinning and softening)
  2. Control of postpartum hemorrhage
  3. Pregnancy termination
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4
Q

Name 5 drugs that promote uterine contractions

A
  1. Oxytocin
  2. Prostaglandin E2
  3. Carboprost
  4. Mifepristone
  5. Methylergonovine
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5
Q

Oxytocin: indications

A
  • induce labor
  • promote cervical ripening
  • control post partum hemorrhage
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6
Q

Prostaglandin E2: indications

A

-promote cervical ripening and contractions

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7
Q

Carboprost: indications

A

-postpartum hemorrhage

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8
Q

Mifepristone: indication

A

terminate pregnancy

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9
Q

Methylergonovine: indication

A

-postpartum hemorrhage

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10
Q

Which drugs are indicated for controlling postpartum hemorrhage?

A
  1. Oxytocin (IV)
  2. Carboprost (IM)
  3. Methylergonovine (IM)
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11
Q

What complications can come from giving too much Oxytocin too fast?

A
  • *excessive uterine contractions
  • Uterine rupture
  • fetal distress (robs O2 from baby)
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12
Q

What forms does prostaglandin E2 come in? What are each used for?

A
  1. PGE2 gel
  2. Vaginal insert

**cervical ripening + uterine contractions

  1. Vaginal suppository
    * *termination of pregnancy (weeks 12-20) [higher dose]
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13
Q

Prostaglandin side effects

A
  • Nausea, vomiting, (sometimes fever)

- Hypertension and hypotension

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14
Q

What is carboprost used for?

A
  • postpartum hemorrhage (IM)

- induce uterine emptying at 13-20 weeks with non-viable infant (but not for elective abortion)

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15
Q

When is it contraindicated to give a women Carboprost?

A

asthma (gives bronchospasm)

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16
Q

Carboprost side effects

A
  • Bronchospasm**
  • HTN
  • Diarrhea, vomiting
  • “choking”
17
Q

Mifepristone uses

A

-terminate pregnancy up through 49 days gestation

18
Q

Why is methylergonovine given IM?

A

given IM after delivery to lessen postpartum bleeding

IV use not recommended due to increased risk of severe hypertension (if given too rapidly)

19
Q

What do tocolytic agents do?

A
  • suppress uterine contractions

- suppress labor so baby isn’t born prematurely (can delay 48hrs to a week)

20
Q

If you need to accelerate fetal lung maturity what drugs to you give?

A
  1. Betamethasone IM
  2. Dexamethasone IM

-give to women between 24 and 34 weeks gestation at risk for giving birth in the next 7 days

21
Q

Name the 4 drugs that suppress uterine contractions (Tocolytics)

A
  1. Terbutaline (beta-2 agonist)
  2. Nifedipine (CCB)*
  3. NSAIDs
  4. Magnesium sulfate
22
Q

Terbutaline

A
  • beta 2 agonist
  • causes uterine smooth muscle relaxation
  • oral, SQ, or IV
23
Q

Terbutaline: side effects

A
  • syndrome of tachycardia
  • pulmonary edema
  • hypokalemia
  • metabolic acidosis
  • hypotension
24
Q

Terbutaline: black box warning

A

Oral and prolonged IM, or IV use (more than 48-72hrs) due to maternal cardiotoxicity and death

25
Q

Magnesium sulfate

A
  • DO NOT use for more than 5-7 days –> may lead to in utero exposure may lead to hypocalemia, increased risk of osteopenia and bone fractures in newborns
  • category D (according to FDA: evidence of human fetal risk)
26
Q

In what way is magnesium sulfate protective in premature infants?

A

neuroprotective, decreases occurrence of moderate to severe cerebral palsy

27
Q

Magnesium sulfate: side effects/toxicity

A

High serum levels:

  • weakness
  • paralysis
  • respiratory failure
  • hypotension
28
Q

What type of patient do you need to use caution for Magnesium sulfate?

A

-Renal patients

if insufficiency body won’t eliminate and may predispose to toxicity –> hemodialysis may be needed to correct

29
Q

Nifedipine

A
  • CCB
  • relaxes uterine smooth muscle and vascular muscle

Side effects: constipation

30
Q

NSAIDs

A

ex. indomethacin, Ibuprofen
- 2nd or 3rd line agent

Side effects:

  1. decrease GFR in baby
  2. narrowing/closure of fetal ductus arteriosis
31
Q

Hydroxyprogesterone caproate

A
  • Maintains pregnancy (improves action of progesterone)

- Given IM weekly (starting at 16 weeks) if hx of recurrent miscarriage at greater than 20 weeks

Pharmacology II (31 decks)

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