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Top Drawer Medications > OB > Flashcards

OB Flashcards

1
Q

Methergine causes arterial vasoconstriction by ___ stimulation and inhibition of ___ release.

A

alpha

endothelial derived relaxation factor

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2
Q

This drug used for blood pressure control in parturients is a combined alpha and beta antagonist with rapid onset and few neonatal complications (might see bradycardia).

A

Labetalol

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3
Q

Magnesium Sulfate
dose:
Onset:
Duration:

A

4 grams over 20 min, or 2-3 grams/hr infusion
onset: immediate
duration: 20-30 mins with good renal perfusion

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4
Q

Magnesium Sulfate – effects on anesthesia-related drugs:

A

Potentiates nondepolarizing and depolarizing NMBs (probably not enough to alter dose) (the inhibition of ACh release at the NMJ causes this)

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5
Q

In which order do we choose drugs for use in a hypertensive emergency for parturients?

A

labetalol –> hydralazine –> nipride

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6
Q

Misoprostol
dose:
onset:
half-life:

A

1-2 tablets buccal (in cheek) (200 mcg each) – can be given rectally and vaginally(by OB)
onset: rapid
half life: 20-40 mins

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7
Q

This drug used for blood pressure control in parturients is a potent vasodilator that decreases (preload/afterload), peripheral resistance (especially when used with volume repletion), maternal BP, and uterine vascular resistance to increase uterine blood flow.

Limiting side effects of this drug include maternal (bradycardia/tachycardia) (reflex sympathetic response to direct vasodilation), vomiting, and tremors.

A

Hydralazine

afterload

tachycardia

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8
Q

This drug is used in parturients as a venodilator. It decreases cardiac filling pressures by acting on capacitance vessels, and you may get reflex tachycardia.

A

Nitroglycerin

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9
Q

Methergine
dose:
onset:
duration:

A

0.2 mg IM every 2-4 hrs (max 5 doses)
onset: 2-5 mins
duration: ~3 hrs

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10
Q

Between Nipride and Nitro, which drug is preferred for use in parturients?

A

Nipride is preferred; Nitro may cause hypotensive “overshoot”

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11
Q

Which drug causes an increase in temperature that might initially lead the healthcare team to think the patient is experiencing MH?

A

Hemabate –> increases temperature possibly by 2 degrees (possibly due to effect on hypothalamic thermoregulation)

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12
Q

This drug is used in parturients for acute hypertensive crisis. It is a potent arteriolar dilator with a rapid onset and short duration. Maternal and fetal cyanide toxicity is a concern, but at low doses (5-10 mcg/kg/min) it is unlikely.

A

Nipride (Sodium nitroprusside)

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13
Q

Pitocin
dose
onset
DOA

A

10-40 U in 1000cc (1L) LR
onset: Immediate
duration: within 1 hr

WE NEVER GIVE IV BOLUS

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14
Q

What is our primary goal with the administration of Magnesium Sulfate in parturients?

What is a beneficial side effect?

A

Primary goal = prevent seizures

Beneficial side effect = decreased BP

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15
Q

Hemabate
dose
onset
DOA

A

250 mcg IM repeated every 15-45 mins (max 8 doses)
onset: immediate
duration: 2 hrs

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16
Q

How do you treat Magnesium Sulfate-induced magnesium toxicity?

A

Calcium gluconate 1 gram (given over 2 mins)
fluids
diuresis
O2

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17
Q

How does volume repletion help in the treatment of severe pre-eclampsia?

A

Intravascular repletion can improve the low CO.

When right and left cardiac filling pressures normalize, CI improves, maternal HR and SVR decrease, and fetal circulation improves.

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18
Q

why do we use Methergine?

A

1) Helps induce labor (by increasing motor activity/tone of the uterus) >arterial vasoconstriction)
2) Then helps the uterus stop bleeding post-delivery (alpha stimulation –> arterial vasoconstriction)Why do we give methergine?

19
Q

Magnesium Sulfate effects:

A
  • Mild vasodilator that decreases uterine activity to increase uterine blood.
  • Decreases SVR
  • Pulmonary Edema
  • Dilates liver beds and kidneys to increase function,
20
Q

Methergine (____________)

A

___ (Methylergonovine)

21
Q

Pitocin (___)

A

___ (Oxytocin)

22
Q

Hemabate (___)

A

___ (Carboprost)

23
Q

Magnesium Sulfate s/e:

A

Can cause pulmonary edema, may be some correlation with chorioamnionitis

magnesium toxicity (monitor Mag levels, treat toxicity with calcium gluconate 1 gram over 2 min, fluids, diuresis, O2)

Crosses the placenta, so neonate may show signs of respiratory depression, apnea, and decreased tone

24
Q

Magnesium plasma level that causes:
normal levels

A
25
Q

Magnesium plasma level that causes:
therapeutic levels

A
26
Q

Magnesium plasma level that causes:
ECG changes,prolonged PR, widened QRS

A
27
Q

Magnesium plasma level that causes:
decreased tendon relfexes, respiratory depression

A
28
Q

Magnesium plasma level that causes:
respiratory arrest, ECG changes (SA/AV conduction)

A
29
Q

Magnesium plasma level that causes:
cardiac arrest

A
30
Q

Hemabate drug class and MOA:

A

Synthetic analogue of prostaglandin F2
Stimulates uterine contraction,
Increases myometrial calcium,
Stimulates smooth muscle of GI tract to cause diarrhea

31
Q

Methergine C/I:

A
  • severe HTN (alpha stimulation of drug further increases BP)
  • pregnancy-induced hypertension (PIH)
  • cardiac disease
32
Q

Pitocin uses:

A

induction of labor; control uterine bleeding postpartum and after suction D&C

33
Q

Methergine MOA:

A

increases motor activity of uterus by acting directly on smooth muscle of the uterus to increase tone, rate, and amplitude of contraction
causes arterial vasoconstriction by ALPHA STIMULATION and inhibition of endothelial derived relaxation factor release

34
Q

Methergine drug class:

A

Semisynthetic ergot alkaloid

35
Q

Misoprostol (___)

A

___ (Cytotec)

36
Q

Pitocin C/Is:

A

fetal distress, unfavorable fetal positions, previous uterine rupture

37
Q

Misoprostol drug class:

A

Synthetic prostaglandin E1

38
Q

Magnesium Sulfate (MgSO4) uses:

A

Used to prevent eclamptic seizures (decreases incidence of seizure by 50 %);

also to stop premature labor (tocolytic effect)

39
Q

Hemabate s/e:

A
  • Temperature –> possibly d/t effect on hypothalamic thermoregulation (can increase 2 degrees)
  • Airway constriction and wheezing,
  • Heart: Increased CO, BP, and PVR –> d/t constriction of vascular smooth muscle
  • Diarrhea –> d/t stimulation of smooth muscle in GI tract
40
Q

Pitocin s/e:

A

flushing, brady/tachycardia, hyper/hypotension (especially when given rapidly)

41
Q

Misoprostol uses:

A

Indicated for uterine atony, abortions, cervical ripening, peptic ulcer disease

42
Q

Magnesium Sulfate MOA:

A

Inhibition of acetylcholine release at NMJ

43
Q

Pitocin MOA:

A
  • Indirectly increases intracellular calcium
  • directly stimulates the oxytocin receptor on the myometrium
  • some antidiuretic properties

Top Drawer Medications (13 decks)

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