OBGYN Drugs

Question 1

When give Progesterone?

Answer 1

1st pregnancy preterm (<27 weeks)
Give 17-hydroxyprogesterone to reduce recurrence of preterm delivery.
Give between 16-36 weeks gestation

Question 2

Best antiviral for Hep B in pregnancy?

Answer 2

Tenofovir or Telbivudine

- continue to give b/c pregnancy may push pt into acute liver failure or chronic liver cirrhosis.

Question 3

Woman has seizure disorder, then pregnant, what problem and why?

Answer 3

Neural tube defects

• Valproate
• Carbamazepine

Question 4

hCG can stimulate __ in what trimester?

Answer 4

hCG acts like TSH stimulating the thyroid gland in the 1st trimester to secrete more thyroxine and triiodothyronine. Increased total T4 and T3 are normal in pregnancy. Bound T3 and T4 is also increased due to increased SHBG due to elevated estrogen levels.

Question 5

Drug for use in pregnancy for Asthma exacerbation?

Answer 5

Albuterol - beta agonist for acute asthma

Budesonide: mild persistent asthma
- low dose inhaled corticosteroid

Salmeterol/fomoterol: moderate persistent asthma; long-acting beta agonist

Question 6

Major side effect of Fluoxetine (Prozac)?

Answer 6

Insomnia / sleep disturbance

Question 7

Side effect of Fluoxetine (Prozac) in infant?

Answer 7

Agitation / difficulty feeding
Agitation, abnormally increased or decreased muscle tone, tremor, sleepiness, severe difficulty breathing, and difficulty in feeding.

Question 8

Treat toxo in pregger?

Answer 8

Spiramycin
- a protozoan

Toxoplasmosis is a TORCHES infection

Question 9

What drug and what procedure to help in case of spontaneous abortion (<20 weeks)?

Answer 9

Misoprostol - hasten process of evacuation

Dilation & curettage - removal of products of conception

Question 10

What abx given w/ routine c-s?

Answer 10

Cefazolin: give w/in 60 mins of start
- C/s much higher risk infection than vaginal birth
- want narrow spectrum
- want good safety profile
- 1st gen cephalosporin
- covers anaerobes + gram negative bacilli, GBS and enterococcal species
Benefit = reduction surgical site infection

Question 11

Treat HIV mom when preg?

Answer 11

IV zidovudine during Labor & Delivery

Newborn gets 6+ weeks oral zidovudine for prophaylaxis

Question 12

Metoclopramide SE’s?

Answer 12

Hyperprolactinemia

- cause amenorrhea & galactorrhea

Question 13

Sertraline SE’s?

Answer 13

Decreased libido

Question 14

How treat HSV infection in preg?

Answer 14

Acyclovir

Question 15

How treat Hep B in preg?

Answer 15

Tenofovir
(can also treat HIV)
Safe in all stages of pregnancy

Question 16

Which is elevated in PCOS? FSH or LH?

Answer 16

LH levels eLevated

Question 17

Misoprostol:

• abortion
• ectopic pregnancy

Answer 17

Abortion: hemodynamically stable pt after incomplete abortion (1st Tri used w/ mifepristone)

Ectopic pregnancy: NOT used

Question 18

Urinary symptoms

• ___ & ___
• ___
• other??

Answer 18

Amp + Gent: acute pyelonephritis
(gent = IV, reserved for complicated infections requiring hospitalization & often multiple medical therapies).

Nitrofurantoin: uncomplicated UTI in pregnancy

Cephalexin: asymptomatic bacteriuria

Question 19

How reduce risk mother-fetal transmission of Hep B when it’s in mom’s blood?

Answer 19

Neonatal therapy

• hep B immune globulin
• hep B vaccine
• **both immediately after parturition

Treat mom w/ tenofovir when serum viral load > 1 million IU/mL

Question 20

All these can be used for uterine atony. When can each not be used?
PGF2 alpha: carboprost
Methylergonovine
Misoprostol

Answer 20

PGF2a carboprost - can’t use w/ asthma
Methylergonovine - can’t use w/ HTN / Pre-eclampsia
Misoprostol - no contraindications
(a PGE1 analog - constriction of vasculature by uterine SM contraction)

Question 21

PROM, start what abx? What is a backup?

Answer 21

Ampicillin + Gentamicin

- if penicillin allergy, substitute clindamycin