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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
Q

IV dose of methergine?

A

0.02 mg

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26
Q

If you give an IM dose the IV route for methergine what can it cause?

A

severe HTN

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27
Q

2nd line agent after methergine to stim muscle contractions?

A

hemabate

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28
Q

Hemabate must always be given this route?

A

IM

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29
Q

Typical dose, how often, and max of hemabate?

A

250 mcg, q 15-30 min, max of 1 mg

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30
Q

Side effects of hemabate

A

N/V, bronchospasm if given IV

31
Q

Also known as synthetic prostaglandin F or Carboprost?

32
Q

What does hemabate do?

A

dose dep increase in uterine tone

33
Q

What is cytotec?

A

prostaglandin

34
Q

Dose of cytotec?

A

400-800 mcg rectally

35
Q

Are there CV effects from cytotec?

36
Q

Side effect of cytotec?

A

hyperuterine stim can occur

37
Q

Why is ephedrine the gold standard for hypotension in mom?

A

it’s an indirect agent thought to cause less of a decrease in uteroplacental blood flow than phenylephrine

38
Q

Why is phenylephrine used more now?

A

causes less fetal acidosis than once thought

39
Q

What kind of med is hydralazine? And does?

A

direct alpha antagonist, 5 mg IV q5 min, use slowly and cautiously

40
Q

Typical dose of labetolol? Alpha and beta activity?

A

5-10 mg IV, yes both

41
Q

This med to lower BP causes rapid and profound uterine hypotension?

A

nitroglycerin

42
Q

Why is esmolol typically avoided in pregnant person?

A

fetal bradycardia

43
Q

Why is nitroprusside avoided in pregnant woman?

A

fetal acidosis/hypoxia

44
Q

What do calcium channel blockers do to the pregnant woman?

A

tocolytic effect

45
Q

Goal of tocolysis?

A

stop labor long enough (18-48 hours) to get neonatal corticosteroid therapy

46
Q

4 conditions neonatal corticosteroid therapy helps prevent?

A

RDS, death, intraventricular hemorrhage, necrotizing enterocolitis

47
Q

6 agents used to stop premature labor?

A

B adrenergic receptor agonists, nitric oxide donors, Mg sulfate, CCBs, prostaglandin synthesis inhibitors, oxytocin antagonists

48
Q

Typical dose of Mg?

A

4g followed by 2g/h

49
Q

Side effects of Mg?

A

cutaneous vasodilation w flushing, HA, dizziness, N, muscle weakness, depression of DTRs, resp depression, ECG changes

50
Q

When does Mg infusion stop?

A

24 hours after tocolysis achieved

51
Q

Mg is therapeutic at what levels?

52
Q

Terbutaline is what type of drug?

A

beta agonist

53
Q

Side effects of terbutaline?

A

potent bronchodilator, cerebral vasospasm, CP/tightness/MI, glu intolerance, hypokalemia, ileus, N, palpitations, pulmonary edema, restlessness, tremor, ventricular arrythmias

54
Q

SQ dose terbutaline?

A

0.25mg into lat deltoid, 0.25 mg 15-30 min later if needed

55
Q

oral dose of terbutaline?

A

2.5-7.5 mg q6 h

56
Q

Why is nifedipine a good first line agent?

A

route (po), low side effects, efficacy in reducing neonatal complications

57
Q

How does nifedipine work?

A

inhibits flux of Ca ions thru cell mem and release of ICF Ca from SR. decrease in ICF Ca results in uterine relaxation

58
Q

This has been proven superior to Mg sulfate in delaying delivery?

59
Q

Most drugs cross placenta by?

A

simple diffusion

60
Q

4 factors that determine how freely drugs cross?

A

fetal acid base status, degree of free drug, lipid sol, molecular weight

61
Q

4 characteristics that will help a drug cross readily to the placenta?

A

poorly protein bound, unionized, lipid sol, small molecular weight

62
Q

6 factors that influence fetal effects of med?

A

route of admin, dose, timing, fetal gestation, liver development, lung maturity

63
Q

All local anesthetics are what pH?

A

weak basic

64
Q

2 highly protein bound local anesthetics that limit placental transfer?

A

bupivacaine and ropivacaine

65
Q

2 benefits of ropivacaine?

A

less motor blockade and less cardiotoxicity

66
Q

This amide is less protein bound than ropiv or bupiv and therefore has higher degree of transfer?

67
Q

This local anesthetic is an esther that has the least transfer r/t rapid breakdown from plasma cholinesterase?

A

chloroprocaine

68
Q

This local anesthetic you have to be careful w if the person has a pseudocholinesterase def bc it will last forever?

A

chloroprocaine

69
Q

If fetal acidosis is present, the excess H ion can cause what?

A

binding to non ionized drug and result in trapping

70
Q

This opioid causes the least fetal depression?

71
Q

This opioid is favored in obstetrics for the least fetal resp depression d/t mu receptor antagonists

A

nalbuphine/nubain; butorphanol/stadol

72
Q

This opioid has less fetal depression than w morphine but has delayed fetal depression (1-3 hours)?

A

meperedine

73
Q

Dose dependent but greatest fetal depression opioid?

74
Q

Epidural or IT admin of opioids: does that cause resp depression in fetus?

6903 (12 decks)

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