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WOMEN'S HEALTH > OB PHARM > Flashcards

OB PHARM Flashcards

1
Q

spontaneous abortion treatment

A

misoprostol (cytotec)

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2
Q

what else is misoprostol used for? patti’s lecture

A

for induction of labor - given with prostaglandin E to soften the cervix

then oxytocin given to start contractions

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3
Q

PRODUCTS OF CONCEPTION ARE EVACUATED IN 3 WAYS

A

o Surgical = if pt is unstable, has significant bleeding, has an infection, or just wants immediate treatment

o Medical = those who don’t want to wait for spontaneous passage (expectant) = Misoprostol

o Expectant = will eventually pass naturally (takes days to weeks)

if pt is stable = give them the choice to do surgical, medical, or expectant. if unstable = surgical

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4
Q

surgical evacuation of abortion is done if

A

pt is unstable
has significant bleeding
has an infection
or just wants immediate treatment

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5
Q

medical evacuation of abortion is done in

A

pts who don’t want to wait for spontaneous evacuation (expectant

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6
Q

expectant evacuation of abortion

A

conception products will eventually pass naturally (takes days - weeks to do so)

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7
Q

MISOPROSTOL DOSING

A
  • 400mcg per vagina q4h x 4
  • vaginal administration = highly effective
  • minimizes the risk of SE
  • expulsion rate = 70-90% within 24 hours
  • if during 2nd trimester = more likely to need hospitalization
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8
Q

PRETERM LABOR TREATMENT

A

TOCOLYTICS + CORTICOSTEROIDS

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9
Q

GOAL OF TOCOLYTICS

for preterm labor

A
  • delay delivery by at least 48 hours - to allow the administration of corticosteroids for fetal lung maturity
  • this allows time for transport of the mother to a higher level of care
  • this stops labor to allow the underlying medical condition that stimulated labor to clear
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10
Q

tocolytics shouldn’t be used before _________ weeks, and shouldn’t be used after __________ weeks

A

22 weeks

or after 34 weeks

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11
Q

tocolytics are contraindicated when:

A
  • contraindicated when the baby or mother are unstable
    ⦁ fetal demise, lethal fetal anomaly, nonreassuring fetal status, severe preeclampsia or eclampsia, maternal hemorrhage, intraamniotic infection, or maternal contraindication to tocolytic drug

**CI with preeclampsia/eclampsia because the only tx for those is delivery, so don’t want to delay delivery

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12
Q

tocolytic drugs

to stop preterm labor

A

o NSAIDS = indomethacin
o CCB = nifedipine
o beta adrenergic receptor agonists = terbutaline
o magnesium sulfate

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13
Q

TOCOLYTIC OF CHOICE AT 24-32 WEEKS GESTATION

A

INDOMETHACIN

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14
Q

2ND LINE TOCOLYTIC

A

NIFEDIPINE (CCB)

associated with fewer maternal SE than Magnesium sulfate

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15
Q

MOA OF INDOMETHACIN

to stop preterm labor

A

decreases prostaglandin production through inhibition of COX

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16
Q

MATERNAL SE OF INDOMETHACIN

to stop preterm labor

A 
⦁	nausea
⦁	GE reflux
⦁	gastritis
⦁	emesis
⦁	platelet dysfunction
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17
Q

FETAL SE OF INDOMETHACIN

to stop preterm labor

A

⦁ Constriction of DA (if drug is given > 48 hrs; more likely to occur past 32 weeks)
- prostaglandins maintain PDA, Indomethacin closes DA

⦁ Oligohydramnios - drug decreases fetal urine output –> decreases amniotic fluid volume

⦁ Neonatal complications - bronchopulmonary dysplasia, necrotizing enterocolitis, PDA, periventricular leukomalacia, intraventricular hemorrhage

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18
Q

MATERNAL CI FOR INDOMETHACIN

to stop preterm labor

A 
⦁	platelet dysfunction
⦁	bleeding disorders
⦁	hepatic dysfunction
⦁	GI ulcers
⦁	renal dysfunction
⦁	Asthma if also sensitive to ASA

think platelet dysfunction/bleeding, GI, renal, hepatic

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19
Q

monitoring for indomethacin

to stop preterm labor

A

o if given > 48 hrs = need fetal US to evaluate for oligohydramnios & narrowing of DA

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20
Q

MOA OF NIFEDIPINE

to stop preterm labor

A

CCB –> results in myometrial relaxation & peripheral vasodilation

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21
Q

DO NOT USE NIFEDIPINE WITH

to stop preterm labor

A

magnesium sulfate

can act synergistically to suppress muscle contraction and result in respiratory depression

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22
Q

MATERNAL SE OF INDOMETHACIN

to stop preterm labor

A 
⦁	nausea
⦁	flushing
⦁	headache
⦁	dizziness
⦁	palpitations
⦁	can cause severe hypotension
23
Q

CONTRAINDICATIONS FOR NIFEDIPINE

to stop preterm labor

A

⦁ hypotension
⦁ preload dependent cardiac lesion
⦁ use cautiously in LV dysfunction or CHF

24
Q

tocolytic of choice at 32-34 weeks gestation

to stop preterm labor

A

nifedipine

25
Q

2nd line tocolytic at 32-34 weeks gestation

A

Terbutaline (beta adrenergic receptor agonist)

26
Q

MATERNAL SE OF TERBUTALINE

to stop preterm labor

A 
⦁	tachycardia
⦁	palpitations
⦁	hypotension
⦁	tremor
⦁	SOB
⦁	chest discomfort
⦁	hypokalemia
⦁	hyperglycemia
27
Q

CONTRAINDICATIONS TO TERBUTALINE

to stop preterm labor

A

⦁ tachycardic sensitive cardiac disease (tachycardia / palpitations)

⦁ uncontrolled hyperthyroidism or DM (hyperglycemia)

⦁ Use with caution in placenta previa or abruption - risk of hypovolemia & shock

28
Q

TERBUTALINE MONITORING

to stop preterm labor

A

⦁ I&Os
⦁ Maternal symptoms of SOB, CP (chest pain), tachycardia
⦁ stop drug if maternal HR > 120
⦁ check blood glucose and K+ every 4-6 hours (hypokalemia, hyperglycemia)

29
Q

3rd line therapy for prevention of preterm labor

A

MAGNESIUM SULFATE

30
Q

corticosteroids reduces the incidence of ________ by 50%

A 
⦁	respiratory distress syndrome
⦁	intraventricular hemorrhage
⦁	necrotizing enterocolitis
⦁	sepsis
⦁	neonatal mortality
31
Q

antenatal corticosteroids given for preterm labor

- given at 23-34 weeks

A

o Betamethasone

o Dexamethasone

32
Q

preferred antenatal corticosteroid

for preterm labor

A

o betamethasone

33
Q

dexamethasone has to be ____________ containing, otherwise it can be _________ to the fetus

A

non-sulfite

neurotoxic

34
Q

PREMATURE RUPTURE OF MEMBRANES TREATMENT

A

TREATMENT = ANTIBIOTIC PROPHYLAXIS (polymicrobial)
⦁ Azithromycin 1g on admission
⦁ Followed by Ampicillin IV x 48 hrs
⦁ Followed by Amoxicillin x 5 days

(AAA - azithro / amp / amox

  • If PCN Allergy
    ⦁ Clindamycin IV x 48 hrs + Gentamicin x 48 hrs
    ⦁ Followed by Clindamycin PO x 5 days
  • Tocolytics are often given to delay delivery in the presence of uterine contractions
  • Corticosteroids may be indicated
35
Q

POSTPARTUM HEMORRHAGE = WANT TO USE _____________ DRUGS

A

UTEROTONIC = cause uterus to contract

36
Q

uterotonic drug of choice for postpartum hemorrhage

A

oxytocin

37
Q

drugs to treats postpartum hemorrhage

A

⦁ Oxytocin
⦁ Misoprostol
⦁ Carboprost Tromethamine
⦁ Methylergonovine Maleate

38
Q

SE of Misoprostol (Cytotec)

  • causes uterine contractions
  • given to induce labor, abortion, & PP hemorrhage
A

GI symptoms = diarrhea, constipation, N/V, flatulence, abdominal pain, dyspepsia

CNS = headache

39
Q

which uterotonic drugs = do NOT give IV

A

methylergonovine (methergate)

give IM or intramyometrial

AND

Hemabate (Carboprost tromethamine)
- give IM

40
Q

CI TO METHYLERGONOVINE

  • for PP hemorrhage
A
  • HTN
  • Raynaud’s
  • Scleroderma
41
Q

CI TO HEMABATE

  • for PP hemorrhage
A
  • HTN
  • asthma
  • renal failure
  • reduced CO
42
Q

TREATMENT FOR PREECLAMPSIA - severe HTN - DURING LABOR

A

⦁ IV Labetalol
⦁ IV Hydralazine
⦁ PO NIfedipine

43
Q

All cases of preeclampsia should be treated with ______________ during labor to prevent seizures

A

magnesium sulfate

  • adjust dose with renal insufficiency
44
Q

continue magnesium sulfate x ____ hrs after delivery

A

24

45
Q

MOA OF MAGNESIUM SULFATE

blocks neuromuscular transmission and decreases the amount of ________ at the end plate of the motor neuron impulse

A

acetylcholine

46
Q

TREATMENT FOR TOXIC LEVELS OF MAGNESIUM

A

CALCIUM GLUCONATE

47
Q

ADVERSE EFFECTS OF ELEVATED MAGNESIUM LEVELS

A

⦁ DTRs decrease (plasma level = 4)
⦁ DTRs absent (8-10)
⦁ Respiratory paralysis (10-15)
⦁ Cardiac arrest (20-25)

48
Q

DO NOT USE MAGNESIUM SULFATE WITH

A

CCB (NIFEDIPINE)

49
Q

therapeutic levels of Mag sulfate

A

4.8 - 8.4

50
Q

CI to magnesium sulfate

A

heart block
myocardial damage
myasthenia gravis

51
Q

SE OF MAGNESIUM SULFATE

A

flushing, diaphoresis, warmth, N/V, Headache, muscle weakness, visual disturbance, palpitations

52
Q

induction of labor treatment

A

oxytocin (Pitocin)

53
Q

maternal adverse reactions to oxytocin

A

⦁ CV – arrhythmias, HTN
⦁ GI – nausea, vomiting
⦁ GU – pelvic hematoma, postpartum hemorrhage, uterine hypertonicity, uterine rupture
⦁ Severe water intoxication with seizure, coma and death associated with a slow infusion over 24 hours

54
Q

FETAL ADVERSE RXNS TO OXYTOCIN

A 
⦁	CV – arrhythmia, bradycardia
⦁	CNS – brain damage, seizures
⦁	Hepatic - jaundice
⦁	Ocular – retinal hemorrhage
⦁	Other – death, low Apgar score

WOMEN'S HEALTH (13 decks)

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