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OB Pharmacology Flashcards

1
Q

3 Ways Products of Conception are Evacuated

A

Surgical
medical
Expectant

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2
Q

Reasons for Surgical Removal of Product of Conception

A

Unstable
Significant bleeding
Infection
Want immediate treatment

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3
Q

Reason for Medical Removal of Products of Conception

A

Do not want to wait for spontaneous passage

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4
Q

Define Expectant Evacuation of Products of Conception

A

Will eventually pass naturally

Days to weeks

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5
Q

Main Drug for Medical Management of Spontaneous Abortion

A

Misoprostol

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6
Q

Uses of Misoprostol

A

Missed abortion
Incomplete abortion
Cervical ripening (unlabeled use)
Postpartum hemorrhage (unlabeled use)

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7
Q

What is misoprostol?

A

Prostaglandin E1 analog

Induces uterine contractions

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8
Q

Route of Misoprostol Administration

A

Vaginally

Every 4 hours x 4

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9
Q

Medication Classes for Preterm Labor

A

Tocolytics

Corticosteroids

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10
Q

Goals of Tocolytics

A

Delay delivery by at least 48 hours
Provide transport time for mother
Stop labor to clear underlying medical condition

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11
Q

Benefits need to Outweigh Risks for Administration of Tocolytics

A

NOT for >34 weeks

Controversial

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12
Q

Contraindications for Tocolytics

A 
Baby or mother unstable
Fetal demise
Lethal fetal anomaly
Non-reassuring fetal status
Severe pre-eclampsia or eclampsia
Maternal hemorrhage
Intra-amniotic infection
Maternal contraindication to drug
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13
Q

Drug of Choice for 24-32 Weeks of Gestation (Preterm Labor)

A

Indomethacin

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14
Q

MOA of Indomethacin

A

Decreases prostaglandin production through inhibition of cyclooxygenase

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15
Q

Administration of Indomethacin

A

PO

PR

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16
Q

Maternal SE of Indomethacin

A 
Nausea
GE reflux
Gastritis
Emesis
Platelet dysfunction
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17
Q

Fetal SE of Indomethacin

A

Constriction of ductus arterioles
Oligohydramnios
Neonatal complications

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18
Q

When does indomethacin constrict the ductus arteriosus?

A

If given for >48 hours

Give past 32 weeks

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19
Q

Why oligohydramnios with use of indomethacin?

A

Decreases fetal urine output

Decreasing amniotic fluid volume

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20
Q

Neonatal Complications with Indomethacin Use

A 
Bronchopulmonary dysplasia
Necrotizing enterocolitis
PDA
Periventricular leukomalacia
Intraventricular hemorrhage
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21
Q

Maternal Contraindications of Indomethacin

A 
Platelet dysfunction
Bleeding disorders
Hepatic dysfunction
GI ulcers 
Renal dysfunction
Asthma if sensitive to ASA
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22
Q

Second Line Therapy of Tocolytics

A

Nifedipine

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23
Q

MOA of Nifedipine

A

Myometrial relaxation

Peripheral vasodilation

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24
Q

Maternal SE of Nifedipine

A 
Nausea
Flushing
Headache
Dizziness
Palpitations
Can cause severe hypotension
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25
Q

Contraindications of Nifedipine

A

Hypotension
Preload dependent cardiac lesion
Cautious with LV dysfunction or CHF

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26
Q

Precaution with Nifedipine

A

Do not use with magnesium sulfate

Act synergistically & result in respiratory depression

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27
Q

Pharmacokinetics of Nifedipine

A

Half life: 2-3 hours
Peak plasma concentrations: 30-60 minutes
Metabolized: liver
Excreted: kidney

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28
Q

Drug of Choice for 32-34 Weeks Gestation (Preterm Labor)

A

Nifedipine

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29
Q

2nd Line Therapy for 32-34 Weeks Gestation (Preterm Labor)

A

Beta-adrenergic receptor agonists

Terbutaline

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30
Q

Maternal SE of Terbutaline

A 
Tachycardia
Palpitations
Hypotension
Tremor
SOB
Chest discomfort
Hypokalemia
Hyperglycemia
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31
Q

Contraindications of Beta Adrenergic Receptor Agonists

A

Tachycardia sensitive cardiac disease
Uncontrolled hyperthyroidism or DM
Caution in placenta previa or abruption due to hypovolemia & shock

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32
Q

Administration Routes of Terbutaline

A

SubQ

IV

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33
Q

Monitoring with Terbutaline

A

I/Os
Maternal symptoms: SOB, CP, tachycardia
Stop drug if maternal HR >120
Blood glucose & K+ every 4-6 hours

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34
Q

Why do we need to check potassium with terbutaline?

A

Potassium moves intra-cellularly

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35
Q

3rd Line Therapy for Prevention of Preterm labor

A

Magnesium sulfate

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36
Q

Corticosteroids Reduces Incidence of What in the Neonate?

A 
Respiratory distress syndrome
Intraventricular hemorrhage
Necrotizing enterocolitis
Sepsis
Neonatal mortality
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37
Q

Antenatal Corticosteroids

A

Betamethasone**

Dexamethasone

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38
Q

When can you give mom antenatal corticosteroids to help lung development of the fetus?

A

23-34 weeks

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39
Q

Indications for Antibiotic Prophylaxis for Group B Strep

A

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 18 hours)

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40
Q

Antibiotic Regimen for Group B Strep

A

Penicillin G or Ampicillin

PCN Allergy: cephazolin (Ancef), clindamycin, or vancomycin

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41
Q

Antibiotic Prophylaxis of Premature Rupture of Membranes

A

Azithromycin on admission
+ ampicillin x 48 hours
+ amoxicillin x 5 days
PCN allergy: clindamycin x48 hours + gentamicin x48 hours + clindamycin x5 days

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42
Q

Additional Medical Therapy for Premature Rupture of Membranes

A

Tocolytics: delay delivery

Corticosteroids as indicated

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43
Q

Medications for Postpartum Hemorrhage

A

Oxytocin
Misoprostol
Carboprost tromethamine
Methylergonovine maleate

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44
Q

Oxytocin Routes of Administration

A

IV

IM

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45
Q

Response time of IV Oxytocin

A

1 minute

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46
Q

Response time of IM Oxytocin

A

3-5 minutes

47
Q

Half life of Oxytocin

A

1-6 minutes

48
Q

MOA of Misoprostol (Cytotec)

A

Stimulates uterine contraction

49
Q

Adverse Reactions of Misoprostol (Cytotec)

A 
Diarrhea
Abdominal pain
Constipation
Dyspepsia
Flatulence
N/V
Headache
50
Q

MOA of Methylergonovine (Methergine)

A

Acts on smooth muscle & increases uterine tone & strength & frequency of contractions

51
Q

Routes of Administration of Methylergonovine (Methergine)

A

IM

Intramyometrial

52
Q

Contraindications of Methylergonovine (Methergine)

A

HTN
Raynaud’s
Scleroderma

53
Q

Route of Administration of Carboprost Tromethamine (Hemabate)

54
Q

Contraindications of Carboprost Tromethamine (Hemabate)

A

Asthma
HTN
Renal failure
Reduced cardiac output

55
Q

Signs/Symptoms of 500-1000 mL Blood Loss in Postpartum Hemorrhage

A

Palpitations
Light headedness
Tachycardia

56
Q

Signs/Symptoms of 1000-1500 mL Blood Loss in Postpartum Hemorrhage

A

Weakness
Sweating
Tachycardia

57
Q

Signs/Symptoms of 1500-2000 mL Blood Loss in Postpartum Hemorrhage

A

Restlessness
Confusion
pallor
Oliguria

58
Q

Signs/Symptoms of 2000-3000 mL Blood Loss in Postpartum Hemorrhage

A

Lethargy
Air hunger
Anuria
Collapse

59
Q

Medications to Treat Severe HTN During Labor

A

IV lebetalol
IV hydralazine
PO nifedipine

60
Q

Seizure Prophylactic Medication in Pre-Eclampsia

A

Magnesium sulfate

61
Q

MOA of Magnesium Sulfate

A

Blocks neuromuscular transmission & decreases amount of acetylcholine at the end plate of the motor neuron impulse

62
Q

Adverse Effects of Magnesium Serum Levels at 4 mEq/L

A

Deep tendon reflexes decrease

63
Q

Adverse Effects of Magnesium Serum Levels Between 8-10 mEq/L

A

Deep tendon reflexes absent

64
Q

Adverse Effects of Magnesium Serum Levels Between 10-15 mEq/L

A

Respiratory paralysis

65
Q

Adverse Effects of Magnesium Serum Levels Between 20-25 mEq/L

A

Cardiac arrest

66
Q

What medication can treat magnesium toxicity?

A

Calcium gluconate

67
Q

Other SE of Magnesium Sulfate

A 
Flushing
Diaphoresis
Warmth
N/V
Headache
Muscle weakness
Visual disturbance
Palpitations
68
Q

Contraindications of Magnesium Sulfate

A

Heart block
Myocardial damage
Myasthenia graves

69
Q

What class of medications should you not use with magnesium sulfate?

A

Calcium channel blockers

70
Q

Medication for Induction of Labor

A

Oxytocin (Pitocin)

71
Q

MOA of Oxytocin (Pitocin)

A

Stimulates uterine contractions by activation of G-protein-coupled receptors that trigger increased intracellular calcium levels
Increases prostaglandin production

72
Q

Contraindications of Oxytocin (Pitocin)

A

Conditions to avoid vaginal delivery

73
Q

Maternal Adverse Reactions of Oxytocin (Pitocin)

A 
Arrhythmias
HTN
N/V
Pelvic hematoma
Postpartum hemorrhage
Uterine hypertonicity
Uterine rupture
Severe water intoxication with seizure, coma & death (infusion over 24 hours)
74
Q

Fetal Adverse Effects of Oxytocin (Pitocin)

A 
Arrhythmia
Bradycardia
Brain damage
Seizures
Jaundice
Retinal hemorrhage
Death
Low Apgar scores
75
Q

Common Disorders to Treat with Pregnancy

A 
Diarrhea
Constipation
GERD
Cough & cold symptoms
Analgesics
76
Q

Pregnancy Category of Loperamide

A

Category C

77
Q

Treatment of Diarrhea in Pregnancy

A

Oral rehydration*
Dietary changes*
Loperamide (only if symptoms are disabling)

78
Q

Treatment of Constipation in Pregnancy

A

Increase dietary fiber*
Increase fluids*
Bulk forming laxatives

79
Q

Bulk Forming Laxatives Used in Pregnancy

A

Psyllium (Metamucil)
Methylcellulose (Citrucel)
Calcium polycarbofil (Fibercon)
Wheat dextrin (Benefiber)

80
Q

Treatment of Refractory Cases of Constipation in Pregnancy

A

Lactulose
Bisacodyl (Dulcolax)
Magnesium hydroxide

81
Q

Medications to Avoid when Treating Constipation in Pregnancy

A

Castor oil

Mineral oil

82
Q

Pregnancy Category of Lactulose

A

Category B

83
Q

Why avoid castor oil in the treatment of constipation in pregnancy?

A

Stimulates contractions

84
Q

Why avoid mineral oil in the treatment of constipation in pregnancy?

A

Interferes with vitamin absorption

85
Q

Lifestyle Modifications in the Treatment of GERD in Pregnancy

A

Elevation of the head of the bed, dietary modification, antacids PRN

86
Q

Preferred Agent After Failure of Lifestyle & Antacids in the Treatment of GERD During Pregnancy

A

Sulcralfate

87
Q

H2 Receptor Blockers to Treat GERD in Pregnancy

A

Ranitidine (Zantac)

Cimetidine (Tagamet)

88
Q

Pregnancy Category of Ranitidine (Zantac)

A

Category B

89
Q

Pregnancy Category of Cimetidine (Tagamet)

A

Category B

90
Q

PPI’s Used to Treat GERD in Pregnancy

A

Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Omeprazole (Prolisec)

91
Q

Pregnancy Category of Lansoprazole (Prevacid)

A

Category B

92
Q

Pregnancy Category of Pantoprazole (Protonix)

A

Category B

93
Q

Pregnancy Category of Omeprazole (Prilosec)

A

Category C

94
Q

Treatment of Cold Symptoms in Pregnancy

A

Heated, humidified air: congestion
Acetaminophen: sore throat, fever, headache
Saline nasal spray or irrigation
Ipratropium bromide (Atrovent) nasal spray: rhinorrhea
Pseudoephedrine (Sudafed): nasal congestion

95
Q

Pregnancy Category of Ipatropium bromide (Atrovent) Nasal Spray

A

Category B

96
Q

Pseudoephedrine (Sudafed) for Nasal Congestion in Pregnancy

A

Avoid in 1st trimester

97
Q

Treatment of Cough in Pregnancy

A

Inhalation of warm, humidified air
Dextromethorphan (Robitussin)
Guaifenesin (Mucinex)

98
Q

Pregnancy Category for Dextromethorphan (robitussin)

A

Category C

99
Q

Pregnancy Category for Guaifenesin (Mucinex)

A

Category C

100
Q

Analgesics in Pregnancy

A

Acetaminophen (Tylenol)

101
Q

Pregnancy Category of Acetaminophen (Tylenol)

A

Category C

102
Q

Acetaminophen use in Pregnancy Lead to an Increased Risk of What Diseases

A

ADD behavior

Wheezing & asthma

103
Q

Considerations for Treatment with Acetaminophen

A

Weigh risks vs. benefits when treating fever

104
Q

What analgesics should be avoided?

105
Q

Pregnancy Category of NSAIDs Prior to 30 Weeks Gestation

A

Category C

106
Q

Pregnancy Category of NSAIDs After 30 Weeks Gestation

A

Category D

107
Q

Fetal SE of NSAIDs Prior to 30 Weeks Gestation

A

May cause miscarriage
CV anomalies
Cleft lip/palate

108
Q

Fetal SE of NSAIDs After 30 Weeks Gestation

A

Premature closure of the ductus

Many other significant abnormalities

109
Q

Drugs that Stimulate Ovulation

A

Clomiphene (Clomid)

Metformin (Glucophage)

110
Q

MOA of Clomiphene (Clomid)

A

Inhibits normal estrogenic negative feedback

Increased pulsatile GnRH secretion

111
Q

Class in which Clomiphene (Clomid) Belongs

A

Ovulation stimulator

Selective estrogen receptor modifier

112
Q

Class in which Metformin (Glucophage) Belongs

113
Q

Metformin (Glucophage) Associated With What

A

Increased menstrual cyclicity
Improved ovulation
Reduction in circulating androgen levels

114
Q

Benefits of Metformin (Glucophage)

A

Reduction in insulin

Stimulate weight loss

OB/GYN (12 decks)

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