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Hannah's Intersystem > Obstetric Pharmacology > Flashcards

Obstetric Pharmacology Flashcards

1
Q

List some circumstances in which the inclusion of pregnant women in clinical studies would be considered ethically appropriate

A 
Where there are no other available effective therapies for treatment of a serious or life-threatening condition (e.g. in pregnant women with drug resistance, intolerance, contraindication or allergy)
Where pregnant women are already using the drug or class of drugs in the post-marketing setting, plus an established safety profile
Where the drug is being developed specifically to treat pregnancy-related conditions
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2
Q

List 2 primary factors relating to the distribution of a drug within a pregnant woman and foetus

A

Ability to cross capillary membranes

Ability to cross lipid membranes

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3
Q

List 4 secondary factors relating to the distribution of a drug within a pregnant woman and foetus

A

Blood flow
pH differences between the 2 compartments
Protein binding
Binding of other tissue components

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4
Q

What is important to consider in terms of drug excretion in a lactating woman?

A

The drug may be excreted via breast milk, and will then be absorbed, distributed, metabolised and excreted by the neonate or infant
Need to consider whether the drug will be safe in its excreted form

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5
Q

List 7 important cardiovascular changes in pregnancy

A 
Increased SV
Increased HR
Increased CO (by ~40%)
Decreased TPR
Decreased MAP
Increased blood volume
Increased O2 consumption
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6
Q

Which 8 other symptoms besides cardiovascular are affected in pregnancy?

A 
Respiratory
Haematology and coagulation
Immune
GI (including liver)
Renal
Endocrine
Nervous
Musculoskeletal
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7
Q

List 6 maternal factors that determine transfer of drugs to the foetus

A 
Drug dose
Route of administration
Maternal metabolism and excretion
Maternal protein binding
Maternal pH and ionisation of the drug
Uterine blood flow
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8
Q

What is the general formula for flow?

A

Pressure differential/resistance

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9
Q

What is the formula for uterine blood flow (UBF)?

A

UBF = (uterine artery pressure - uterine venous pressure)/uterine vascular resistance

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10
Q

List 4 factors that decrease UBF

A

Decreased BP
Hypovolaemia
Aortocaval compression
Vasoconstrictors (endogenous/exogenous)

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11
Q

What are the 4 main functions of the placenta?

A

Transport of substances, gases (especially O2 and CO2), nutrients, waste products and drugs
Immunological
Metabolic including inactivation of drugs
Endocrine

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12
Q

What are 3 drug characteristics influencing placental transfer of any drug?

A

Molecular weight
Lipid solubility
Degree of ionisation

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13
Q

What 3 aspects of foetal physiology which are relevant to the way the foetus deals with a particular drug?

A

Foetal uptake (absorption) of drug
Foetal distribution of drug (dependent on blood flow)
Foetal metabolism of drug (immature organ systems may not be able to adequately metabolise certain drugs)

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14
Q

What are the 3 principles of prescribing a drug to a lactating woman?

A

Minimising the amount of drug in the milk
Minimising disruption to breastfeeding
Effectively treating the woman’s condition

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15
Q

What is teratogenicity and what is required for teratogenicity?

A

Any significant postnatal change in function or form after prenatal treatment; includes morphological, biochemical and behavioural changes
Teratogenicity occurs when the teratogenic dose is administered at the teratogenic time in gestation with a teratogenic agent of the correct species

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16
Q

List 4 classes of human teratogens and give examples of each

A

Environmental and physical agents (e.g. nuclear radiation, radioiodine, hyperthermia)
Infection (e.g. rubella, CMV, herpes)
Maternal metabolic imbalance (e.g. diabetes, obesity, folic acid deficiency)
Drugs and chemicals (e.g. ACEI, warfarin, tetracyclines, valproic acid, diethylstilbestrol)

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17
Q

List the 7 categories used in Australia for prescribing medications in pregnancy

A

A - taken by a large number of pregnant women without causing malformations or harm to the foetus
B1 - taken by only a limited number of pregnant women without causing malformations or harm to the foetus (studies in animals have not shown increased foetal damage)
B2 - taken by only a limited number of pregnant women without causing malformations or harm to the foetus (studies in animals are lacking/inadequate but available data does not show increased foetal damage)
B3 - taken by only a limited number of pregnant women without causing malformations or harm to the foetus (studies in animals have shown increased foetal damage but the significance is uncertain in humans)
C - drugs which have caused or are suspected to cause increased harmful effects on the foetus without causing malformations (damage may be reversible)
D - drugs which have caused or are suspected to cause increased foetal malformations or irreversible damage
X - drugs which have such a high risk of causing permanent damage to the foetus that they should not be used in pregnancy or when there is a possibility of pregnancy

18
Q

What are the main causes of maternal mortality?

A 
Cardiac disease
Indirect neurological conditions
Sepsis
Pre-eclampsia and eclampsia
Thrombosis and thromboembolism
Amniotic fluid embolism
Psychiatric causes
Early pregnancy deaths
Haemorrhage
Anaesthesia
19
Q

What are 5 direct causes of maternal mortality in developing countries?

A 
Haemorrhage
Pre-eclampsia/eclampsia
Infection
Unsafe abortion
Obstructed labour
20
Q

What is the risk of severe maternal morbidity?

A

1 in 200 women

21
Q

What % of all causes of developmental defects in humans is caused by drug administration in pregnant women?

A

2%

22
Q

What are the 9 conditions mentioned specifically in the WHO list of priority life-saving medicines for women and children?

A 
Post-partum haemorrhage
Severe pre-eclampsia and eclampsia
Maternal sepsis
Provision of safe abortion services and/or management of incomplete abortion and miscarriage
STIs
Management of preterm labour
Maternal HIV/AIDS and malaria
Prevention of tetanus in mother and newborn
Contraception
23
Q

What % of maternal death is caused by haemorrhage?

A

25% (most common cause)

24
Q

What are the 3 goals of acute management of obstetric haemorrhage?

A

Control the bleeding
Restore adequate O2-carrying capacity
Maintain adequate tissue perfusion

25
Q

What is the mechanism of action, route of administration and side effects of oxytocin?

A

Used to stimulate uterine contraction in obstetric haemorrhage
Administered via IV or IM
Side effects include hypotension, tachycardia, H20 intoxication

26
Q

What is the mechanism of action, route of administration and side effects of ergometrine?

A

Used to stimulate uterine and vascular smooth muscle contraction in obstetric haemorrhage
Administered via IV or IM
Side effects include hypertension, nausea and vomiting

27
Q

What kind of IV fluid therapy is administered in obstetric haemorrhage?

A

0.9% isotonic NaCl

28
Q

What is delivered in a blood transfusion for obstetric haemorrhage?

A

Packed RBCs
Coagulation factors
Platelets

29
Q

What technique can be used to monitor women with obstetric haemorrhage? What are its benefits?

A

Rapid Obstetric Screening Echocardiography Scan (ROSE Scan)
Provides structural and functional information in real time at the bedside; non-invasive and safe, liked by pregnant women

30
Q

What is pre-eclampsia?

A

Hypertension occurring in pregnant women with multi-organ system involvement

31
Q

What % of pregnant women does pre-eclampsia affect?

A

5-8%

32
Q

When does pre-eclampsia generally occur and when does it resolve by?

A

Occurs at >20 weeks gestation

Resolves by 3 months post-partum

33
Q

List 5 long term complications of pre-eclampsia

A

Same as for general population: IHD, cerebrovascular disease, HF, CKD, PVD

34
Q

List some ways in which pre-eclampsia can cause maternal mortality

A 
Cerebral complications
Cardiorespiratory failure
Multiple organ failure
DIC
Renal failure
Hypovolaemic shock
35
Q

How is severe pre-eclampsia defined?

A

BP >140/90
And 1 or more symptoms affecting cardiorespiratory, haemotalogical, GI or renal systems, CNS, or uteroplacental/foetal circulation (symptomatic disease is severe disease; abnormal biochemistry or haematology is usually severe disease)

36
Q

What are the 6 general principles of treating severe pre-eclampsia?

A

Early senior and multi-disciplinary involvement
Standardised guidelines
Regular review and awareness of complications
Control of hypertension with anti-hypertensives
Prevention and treatment of seizures with MgSO4
Meticulous fluid balance

37
Q

Should ergometrine be administered to a pregnant woman with severe pre-eclampsia? Why/why not?

A

No, will cause vascular smooth muscle contraction and exacerbate hypertension

38
Q

At what BP threshold is pre-eclampsia considered a medical emergency?

A

SBP >180mmHg is classed as a medical emergency

39
Q

What is the mechanism of action, route of administration and side effects of MgSO4?

A

Used to treat and prevent seizures in women with pre-eclampsia
Involved in production and utilisation of ATP, reduces IC [Ca2+] and Mg acts as a weak Ca2+ channel antagonist regulating Ca2+ influx via NMDA receptor (may inhibit ischaemic neuronal damage caused by anion flux)
Administered via IV or IM
Side effects include cardiorespiratory depression

40
Q

How can toxicity with MgSO4 be reversed?

A

With Ca2+ gluconate

41
Q

What is the mechanism of action and route of administration of labetalol?

A

Competitive non-selective B-adrenoceptor antagonist and competitive a1-adrenoceptor antagonist; also has membrane-stabilising properties at higher doses (used to treat hypertension)
Administered orally or via IV

Hannah's Intersystem (16 decks)

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