Obs and Gynae Pharmacology

Question 1

definition of hyperemesis gravidarum?

Answer 1

loss of 5% of body weight
dehydration
electrolyte disturbance

Question 2

first line anti-emetics in hyperemesis gravidarum?

Answer 2

cyclizine
promethazine
antihistamines

Question 3

how are anti-emetics given in hyperemesis gravidarum?

Answer 3

IV
(but be careful with cyclizine IV as it can make people v dizzy esp if dehydrated)
can give IM if they dont have IV access

Question 4

second line anti-emetics in hyperemesis gravidarum?

Answer 4

metoclopramide
ondansetron
(generally try metoclopramide before ondansetron as ondansetron can cause cleft palate)

Question 5

is there any risks with metoclopramide?

Answer 5

extra-pyramidal side effects

Question 6

dose of cyclizine?

Answer 6

50mg

Question 7

other drugs which can be given alongside anti-emetics in hyperemesis gravidarum?

Answer 7

thiamine/pabrinex
folic acid
PPI/ranitidine

Question 8

fluid prescribing in hyperemesis gravidarum?

Answer 8

1L saline with 20mmol K+ over 2 hrs (twice)

maybe? not sure? might be wrong who knows

Question 9

what analgesia can be given in pregnancy?

Answer 9

paracetamol usually first line

can also give codeine 2nd line

Question 10

what analgesia should you not prescribe in pregnancy and why?

Answer 10

NSAIDs

risk of closing ductus arteriosus causes neonatal pulmonary hypertension

Question 11

what analgesia is safe in breastfeeding eg for pain after C-section?

Answer 11

paracetamol
NSAIDs
dihydrocodeine
can also give lactulose to help as most women are constipated after C-section

Question 12

codeine before/after birth?

Answer 12

antenatal = codeine
post-natal = dihydroceodeine

Question 13

how long do you need to stop methotrexate for before pregnancy?

Answer 13

3 months

Question 14

management of UC in pregnancy?

Answer 14

5-ASA (mesalazine) is safe to use but should be taking folic acid alongside
some DMARDs are safe
steroids fine
biologics (eg infliximab) ok but try to avoid in 3rd trimester

Question 15

what DMARDs are safe in pregnancy?

Answer 15

sulfasalazine

hydroxychloroquine

Question 16

is metronidazole safe in pregnancy?

Answer 16

yes

Question 17

antibiotics for PID?

Answer 17

doxycycline
metronidazole
ceftriaxone

Question 18

what should doxycycline should be swapped for if pregnant in PID?

Answer 18

erythromycin

Question 19

management of anaphylaxis due to antibiotic allergy?

Answer 19

stop antibiotic and press button on wall for help
oxygen
fluids (stat)
anti-histamine
steroids (IV hydrocortisone)
0.5mg IM adrenaline

Question 20

when can COCP be started after a C-section?

Answer 20

21 days (if not breastfeeding and no thrombo risk factors)
need to wait 6 weeks if breastfeeding

Question 21

when can POP be started after C-section?

Answer 21

immediately

Question 22

management of heavy vaginal bleeding?

Answer 22

tranexamic acid
mefenamic acid (try to avoid if trying to conceive)
mirena coil (probs first choice if not wanting to conceive)
COCP

Question 23

how is tranexamic acid taken?

Answer 23

take 1g 3X daily for 3-4 days during period

Question 24

can ACEi be taken in pregnancy?

Answer 24

no

should change to methydopa/nifedipine/labetolol

Question 25

can lithium be taken in pregnancy?

Answer 25

probs shouldnt be but dont come off it if thats the only thing that manages mental health