OB Pharmacology Flashcards
What should we treat spontaneous abortion with?
Misoprostol (Cytotec)
SPONTANEOUS ABORTION: Products of conception are evacuated in 3 ways?
- Surgical
Unstable, significant bleeding, infection or want immediate treatment - Medical
Those who do not want to wait for spontaneous passage - Expectant
Will eventually pass naturally (days to weeks)
MISOPROSTOL IS THE MAIN DRUG FOR MEDICAL MANAGEMENT
- MOA?
- For which type of abortions? 2
- Off label use? 2
- Prostaglandin E1 analog and induces uterine contractions
- For missed abortion
- For incomplete abortion
- Unlabeled uses
- Cervical ripening (intravaginally)
- Treatment of post partum hemorrhage
PRETERM LABOR
What drugs should we use? 2
- Tocolytics
2. Corticosteroids
GOALS OF TOCOLYTICS
3
- Delay delivery by at least 48 hours to allow the administration of corticosteroids for fetal lung maturity
- Provide time for transport of the mother to a higher level of care
- Stop labor to allow the underlying medical condition that stimulated labor to clear
BENEFITS OF TOCOLYTICS NEED TO OUTWEIGH THE RISKS
1. Used on what timeline?
2. Contraindications? (main one?)
9
- Generally not used past 34 weeks of gestation and controversial use any earlier than 22 weeks
- -Contraindicated when the baby or the mother are unstable**
Review of contraindications
-Fetal demise,
-lethal fetal anomaly,
-nonreassuring fetal status,
-severe preeclampsia or
-eclampsia,
-maternal hemorrhage,
-intraamniotic infection,
-maternal contraindication to the tocolytic drug
WHAT IS THE DOC AT 24-32 WEEKS GESTATION for preterm labor?
INDOMETHACIN
INDOMETHACIN
- MOA?
- Maternal SE? 5
- Decreases prostaglandin production through inhibition of cyclooxygenase
Maternal side effects
- Nausea,
- GE reflux,
- gastritis,
- emesis
- Platelet dysfunction
- FETAL SIDE EFFECTS OF INDOMETHACIN
2. Neonatal complications associated with use? 5
- Constriction of ductus arteriosus
- Oligohydramnios
- -Bronchopulmonary dysplasia,
-necrotizing enterocolitis,
-PDA,
-periventricular leukomalacia,
-intraventricular hemorrhage
Data is conflicting
INDOMETHACIN
- Constriction of ductus arteriosus if drug is given when?
- More likely to occur in what gestational week?
- What is Oligohydramnios?
- If drug given > 48 hrs
- More likely to occur past 32 weeks
- Drug decreases fetal urine output therefore decreasing amniotic fluid volume
INDOMETHACIN
1. Maternal contraindications? 6
- Monitoring: If given > 48 hours then need what?
- Maternal contraindications
- Platelet dysfunction
- Bleeding disorders
- Hepatic dysfunction
- GI ulcers
- Renal dysfunction
- Asthma if also sensitive to ASA - fetal US to evaluate for oligohydramnios and narrowing of the ductus arteriosus
What is second line therapy for preterm labor?
NIFEDIPINE FOR SECOND LINE THERAPY
- NIFEDIPINE MOA?
- Associated with what?
- Maternal SE? 6
- Calcium channel blocker which results in myometrial relaxation and peripheral vasodilation
- Associated with fewer maternal side effects compared to magnesium sulfate
- Maternal side effects
- Nausea,
- flushing,
- headache,
- dizziness,
- palpitations
- Can cause severe hypotension
NIFEDIPINE
1. Contraindications? 4
- Precaution? 1
- Contraindications
- Hypotension,
- preload dependent cardiac lesion,
- use cautiously in LV dysfunction -CHF - Precaution
Do not use in conjunction with magnesium sulfate as they can act synergistically to suppress muscle contraction and result in respiratory depression
NIFEDIPINE PHARMACOKINETICS
- Half life?
- Peak plasma concentration?
- Metabolized and excreted through what?
- Half life 2-3 hours
- Peak plasma concentrations in 30-60 minutes
- Metabolized through the liver and excreted by the kidneys
32-34 WEEKS GESTATION (preterm labor)
- DOC?
- Second line?
- Maternal SE? 8
- Nifedipine is the DOC
- Second line therapy is a Beta-adrenergic receptor agonist
- Terbutaline is the most commonly used in the US - Maternal side effects
- Tachycardia,
- palpitations,
- hypotension,
- tremor,
- shortness of breath,
- chest discomfort,
- hypokalemia,
- hyperglycemia
BETA ADRENERGIC RECEPTOR AGONISTS
- Contraindications? 3
- Do not use longer than what?
Contraindications
- Tachycardia sensitive cardiac disease
- Uncontrolled hyperthyroidism or DM
- Use with caution in placenta previa or abruption due to risk of hypovolemia and shock
- Do not use longer then 48-72 hours
MONITORING in preterm labor?
4
- I/O’s
- Maternal symptoms of shortness of breath, CP, tachycardia
- Stop drug if maternal HR > 120
- Check blood glucose and K+ every 4-6 hours
OTHER TOCOLYTICS
Third line treatment?
Magnesium sulfate
CORTICOSTEROIDS
Reduces the incidence of the following by 50%?
5
- respiratory distress syndrome
- intraventricular hemorrhage
- necrotizing enterocolitis
- sepsis
- neonatal mortality
ANTENATAL CORTICOSTEROIDS
- Used in which weeks?
- Whats preferred?
- Other option?
- 23-34 weeks
- Betamethasone (preferred)
12 mg IM q 24 hrs X 2 - Dexamethasone (use non-sulfite containing suspension otherwise neurotoxicity of fetus)
6 mg IM q 12 hrs X 4
INDICATIONS FOR ABX PROPHYLAXIS for Group B strep
4
- Positive rectovaginal culture
- Positive history of birth of an infant with early onset GBS disease
- GBS bacteriuria during current pregnancy
- Unknown culture status AND
- Maternal fever ≥ 100.4 OR
- Preterm labor less than 37 weeks OR
- Prolonged rupture of the membranes ≥ 18 hours
GROUP B STREP
Don’t give abx prophylaxis for GBS positive patient undergoing what?
planned c-section unless their membranes rupture
ANTIBIOTIC REGIMEN
Group B Strep? 2
- Penicillin G
5 million U IV then 2.3-3 million U q 4 hours until delivery - OR Ampicillin
2 g IV followed by 1g q 4 hours until delivery