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OB pharm Flashcards

1
Q

gold standard for induction

A

propofol

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2
Q

old gold standard for induction, which is still fine

A

thiopental

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3
Q

safe alternative to prop or thiopental but not well established in lit

A

etomidate

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4
Q

Is ketamine a good choice for induction?

A

it depends. isn’t first line, but acceptable and safe. bronchodilator which is good, avoid in preeclampsia

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5
Q

Why do you want to avoid ketamine in preeclampsia?

A

catecholamines cause uterine vasoconstriction, BUT an increase in uterine blood flow is seen

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6
Q

Neonatal depression is seen w how much of ketamine dose?

A

1mg/kg

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7
Q

Why do opioids cross rapidly in to the placenta?

A

small and lipid sol

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8
Q

How soon after giving IV opioid is it detected in the fetal circulation?

A

one minute

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9
Q

What effects are seen from fentanyl?

A

depressant effects including beat to beat variation

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10
Q

Appropriate dose of fentanyl?

A

50-100 mcg/hr

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11
Q

Higher incidence of fetal suppression with this opioid and not used much any more?

A

morphine

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12
Q

This sedative medication is definitely contraindicated in the first trimester and usually not given after that either?

A

benzos

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13
Q

What common anesthetic medication is not acceptable for induction?

A

NMDRs

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14
Q

All volatile agents cause what to the uterus?

A

dose dep reduction in uterine blood flow and uterine relaxation

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15
Q

What % MAC inhalation depresses uterine contractility 25%? It is thought that pitocin can overcome this

A

2/3

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16
Q

Is NO an absolute no in pregnant person?

A

nope, debated heavily

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17
Q

How quickly after pitocin is given does it start working?

A

1 min

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18
Q

Pitocin should be given immediately after?

A

delivery of placenta

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19
Q

What does pitocin do?

A

stimulate muscle contractions

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20
Q

Typical pit dose and emergent pit dose?

A

20 u; 40 u

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21
Q

What can rapid admin of pit result in?

A

hypotension, tachycardia d/t preservative in pit

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22
Q

What is the drug class of methergine?

A

ergot alkaloid

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23
Q

What does methergine do?

A

causes intense and prolonged uterine contraction via smooth muscle stimulation

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24
Q

Dose and onset of methergine?

A

0.2mg IM 3-5 min

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25
IV dose of methergine?
0.02 mg
26
If you give an IM dose the IV route for methergine what can it cause?
severe HTN
27
2nd line agent after methergine to stim muscle contractions?
hemabate
28
Hemabate must always be given this route?
IM
29
Typical dose, how often, and max of hemabate?
250 mcg, q 15-30 min, max of 1 mg
30
Side effects of hemabate
N/V, bronchospasm if given IV
31
Also known as synthetic prostaglandin F or Carboprost?
hemabate
32
What does hemabate do?
dose dep increase in uterine tone
33
What is cytotec?
prostaglandin
34
Dose of cytotec?
400-800 mcg rectally
35
Are there CV effects from cytotec?
no
36
Side effect of cytotec?
hyperuterine stim can occur
37
Why is ephedrine the gold standard for hypotension in mom?
it's an indirect agent thought to cause less of a decrease in uteroplacental blood flow than phenylephrine
38
Why is phenylephrine used more now?
causes less fetal acidosis than once thought
39
What kind of med is hydralazine? And does?
direct alpha antagonist, 5 mg IV q5 min, use slowly and cautiously
40
Typical dose of labetolol? Alpha and beta activity?
5-10 mg IV, yes both
41
This med to lower BP causes rapid and profound uterine hypotension?
nitroglycerin
42
Why is esmolol typically avoided in pregnant person?
fetal bradycardia
43
Why is nitroprusside avoided in pregnant woman?
fetal acidosis/hypoxia
44
What do calcium channel blockers do to the pregnant woman?
tocolytic effect
45
Goal of tocolysis?
stop labor long enough (18-48 hours) to get neonatal corticosteroid therapy
46
4 conditions neonatal corticosteroid therapy helps prevent?
RDS, death, intraventricular hemorrhage, necrotizing enterocolitis
47
6 agents used to stop premature labor?
B adrenergic receptor agonists, nitric oxide donors, Mg sulfate, CCBs, prostaglandin synthesis inhibitors, oxytocin antagonists
48
Typical dose of Mg?
4g followed by 2g/h
49
Side effects of Mg?
cutaneous vasodilation w flushing, HA, dizziness, N, muscle weakness, depression of DTRs, resp depression, ECG changes
50
When does Mg infusion stop?
24 hours after tocolysis achieved
51
Mg is therapeutic at what levels?
4-8 g/dL
52
Terbutaline is what type of drug?
beta agonist
53
Side effects of terbutaline?
potent bronchodilator, cerebral vasospasm, CP/tightness/MI, glu intolerance, hypokalemia, ileus, N, palpitations, pulmonary edema, restlessness, tremor, ventricular arrythmias
54
SQ dose terbutaline?
0.25mg into lat deltoid, 0.25 mg 15-30 min later if needed
55
oral dose of terbutaline?
2.5-7.5 mg q6 h
56
Why is nifedipine a good first line agent?
route (po), low side effects, efficacy in reducing neonatal complications
57
How does nifedipine work?
inhibits flux of Ca ions thru cell mem and release of ICF Ca from SR. decrease in ICF Ca results in uterine relaxation
58
This has been proven superior to Mg sulfate in delaying delivery?
NO donor
59
Most drugs cross placenta by?
simple diffusion
60
4 factors that determine how freely drugs cross?
fetal acid base status, degree of free drug, lipid sol, molecular weight
61
4 characteristics that will help a drug cross readily to the placenta?
poorly protein bound, unionized, lipid sol, small molecular weight
62
6 factors that influence fetal effects of med?
route of admin, dose, timing, fetal gestation, liver development, lung maturity
63
All local anesthetics are what pH?
weak basic
64
2 highly protein bound local anesthetics that limit placental transfer?
bupivacaine and ropivacaine
65
2 benefits of ropivacaine?
less motor blockade and less cardiotoxicity
66
This amide is less protein bound than ropiv or bupiv and therefore has higher degree of transfer?
lidocaine
67
This local anesthetic is an esther that has the least transfer r/t rapid breakdown from plasma cholinesterase?
chloroprocaine
68
This local anesthetic you have to be careful w if the person has a pseudocholinesterase def bc it will last forever?
chloroprocaine
69
If fetal acidosis is present, the excess H ion can cause what?
binding to non ionized drug and result in trapping
70
This opioid causes the least fetal depression?
fentanyl
71
This opioid is favored in obstetrics for the least fetal resp depression d/t mu receptor antagonists
nalbuphine/nubain; butorphanol/stadol
72
This opioid has less fetal depression than w morphine but has delayed fetal depression (1-3 hours)?
meperedine
73
Dose dependent but greatest fetal depression opioid?
morphine
74
Epidural or IT admin of opioids: does that cause resp depression in fetus?
minimal

6903 (12 decks)

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