Obstetrics

Question 1

spontaneous abortion drugs

Answer 1

misprostol (cytotec)

this drug is used to prevent ulcers so make sure don’t give to woman of child bearing age to prevent ulcers

Question 2

3 ways can evacuate spontaneous abortion

Answer 2

surgical
medical
expectant

Question 3

preterm labor meds

Answer 3

tocolytics

steroids

Question 4

Drug of choice for preterm labor between 24-32 weeks

Answer 4

Indomethacin
maternal side effects- nausea, gastric esophageal reflux, gastritis, emesis, platelet dysfunc
fetal side effects- closure of PDA, oligohydraminos

Question 5

contraindications to indomethacin

Answer 5

Platelet dysfunction
Bleeding disorders
Hepatic dysfunction
GI ulcers
Renal dysfunction
Asthma if also sensitive to ASA (samters triad)
If give >48 hrs then need to monitor fetus w/ US to make sure PDA is open and oligohydraminos

Question 6

Drug of choice for preterm labor between 32-34 weeks

Answer 6

Nifedipine
side effects- nausea, flushing, hypotension, HA, dizziness, palpitations
2nd line-terbutaline (beta agonist)
side effects-Tachycardia, palpitations, hypotension, tremor, shortness of breath, chest discomfort, hypokalemia, hyperglycemia

Question 7

contraindications to nifedipine

Answer 7

hypotension, LV dysfunction or CHF, preload dependent cardiac lesion (right side of heart)
DO NOT use in conduction w/ magnesium sulfate cause work synergistically and can depress respiratory

Question 8

what to monitor w/ nifedipine and terbutaline

Answer 8

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
`

Question 9

antenatal steroids

Answer 9

bethamethasone (preferred)

dexamethasone (2nd line non sulfite containing one)

Question 10

indications for abx prophylaxis of Group B strep

Answer 10

positive culture
had previous child w/ group b strep
group b strep bacteriuria during current pregnancy
or:  maternal fever >100.4
preterm labor 18 hrs

Question 11

do you need to give group b strep prophylaxis to woman who is having c section

Answer 11

no unless membranes rupture

Question 12

abx prophylaxis for premature rupture of membranes

Answer 12

1 g Azithromycin at admission
followed by ampicillin
followed by amoxicillin
OR if pcn allergy
clindamyacin + gentamycin followed again by clindamycin

Question 13

post partum hemorrhage

Answer 13

oxytocin- DOC
add misoprostol (stimulates uterine contractions)
add carboprost tromethamine (hemabate)
add methylergonovine maleate

Question 14

contraindications for methylergonovine

Answer 14

HTN, raynauds, scleroderma (this drug is a vasoconstrictor)

Question 15

contraindications of hemabate

Answer 15

asthma, HTN, renal failure, reduce cardiac output

Question 16

severe HTN during labor

Answer 16

IV labetelol
or IV hydralazine
or PO nifedipine

Question 17

seizure prophylaxis

Answer 17

magnesium sulfate

all cases of preeclampsia should be treated w/ this to prevent seizures

Question 18

reversal of magnesium sulfate

Answer 18

calcium gluconate

Question 19

how to check magnesium sulfate levels

Answer 19

plasma level 4- DTR decreased
level 8-10- DTR absent
10-15 respiratory paralysis
20-25 cardiac arrest

therapeutic level 4.8-8.4

Question 20

contraindications to magnesium sulfate

Answer 20

heart block, myasthenia gravis, myocardial damage

Question 21

induction of labor

Answer 21

pitocin (oxytocin)- stimulate uterine contractions

contraindications are things that you wouldn’t want to induce labor yet

Question 22

tx of diarrhea

Answer 22

oral rehydration and diet changes is first line

can use loperamide ONLY if symptoms are disabling

Question 23

constipation

Answer 23

1st line is increase dietary fiber and fluids
2nd line bulk forming agents- psyllium (metamucil), methyl cellulose (citrucel), fibercon, benefiber
refractory cases-lactulose or dulcolax; can use milk of magnesia too

Question 24

gerd

Answer 24

lifestyle modifications (elevate bed, don’t eat late, antacids)
next line- sulcrafate
3rd line- h2 blockers- cimetidine (tagamet) or rantadine (zantac)
then ppi- omeprazole (prilosec), pantoprazole (protonix), lansoprazole (prevacid)

Question 25

cold sxs

Answer 25

tylenol
saline spray
rhinorhea- ipratropium bromide (atrovent)
nasal congestion- pseudoephidrine (avoid in 1st trimester)
cough- robitussin or inhaled air, mucinex