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Gross but true (OBGYNE) > Pharm > Flashcards

Pharm Flashcards

1
Q

Main drug for medical treatment of spontaneous abortion. Is a prostaglandin E1 analog that induces uterine contractions.

A

misoprostol

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2
Q

Unlabeled uses of misoprostol

A

cervical ripening and post partum hemorrhage

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3
Q

Dosing of misoprostol

A

400mcg intravaginally q 4hrs x 4

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4
Q

Past what week of gestation are tocolytics generally not used

A

34 wks

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5
Q

Contraindication to tocolytics

A

mother/fetal instability

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6
Q

Drug of choice to stop preterm labor at 24-32 weeks. Decreases prostaglandin production through inhibition of cyclooxygenase

A

Indomethacin

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7
Q

Dosage of indomethacin to stop preterm labor

A

50-100mg loading dose PO/PR. 25mg q 4-6hrs

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8
Q

Fetal side effect of indomethacin more likely to occur if given past 32 wks and longer >48hrs

A

constriction of ductus arteriosus

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9
Q

Fetal side effect of indomethacin that results from decreased fetal urine output

A

oligohydramnios

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10
Q

Second line therapy to stop preterm labor between 24-32 wks. Results in myometrial relaxation and peripheral vasodilation

A

nifedipine

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11
Q

What should not be used in conjunction with nifedipine due to synergistic effect that results in respiratory depression?

A

magnesium sulfate

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12
Q

Contraindication and side effect of nifedipine

A

hypotension

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13
Q

Drug of choice for preterm labor at 32-34 wks

A

nifedipine

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14
Q

Second line therapy for preterm labor at 32-34 wks that is a beta-andrenergic receptor agonist

A

terbutaline

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15
Q

Dosage of nifedipine to stop preterm labor

A

20mg PO. Repeat in 90 minutes for up to 72 hrs

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16
Q

CI to beta adrenergic receptor agonists

A

tachycardia, uncontrolled hyperthyroidism/DM, placenta previa/abruption

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17
Q

3rd line therapy for prevention of preterm labor.

A

magnesium sulfate

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18
Q

Reduces incidence of the following by 50%: respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neonatl mortality

A

corticosteroids

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19
Q

Preferred antenatal corticosteroid at 23-34 wks and its dosage

A

betamethasone. 12mg IM q 24hrs x 2

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20
Q

Under what condition should you give prophylactic abx for GBS positive patient undergoing a planned c-section?

A

ruptured membranes

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21
Q

Abx regimen for group B strep

A

PCN G 5 million U IV. Then 2-3 million U q 4hrs until delivery

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22
Q

Abx regimen for group B strep in PCN allergic patients with low risk of anaphylaxis

A

cephazolin (Ancef) 2g IV. Then 1g q 8hrs until delivery

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23
Q

Abx regimen for group B strep in PCN allergic patients with high risk of anaphylaxis

A

clindamycin or vancomycin 1g IV q 12 hrs until delivery

24
Q

Abx regimen for suspected infection as cause of premature rupture of membranes

A

1g azithromycin on admission. Followed by ampicillin 2g IV q 6hrs x 48 hrs. Followed by amoxicillin for 5 days

25
Q

Abx regimen for suspected infection as cause of premature rupture of membranes in patient with PCN allergy

A

clindamycin 900mg IV q 8hrs for 48hrs plus gentamycin 7mg/kg. followed by clindamycin 300mg q 8hrs for 5 days

26
Q

Uterotonic drug of choice for post partum hemorrhage

A

oxytocin

27
Q

Added on to oxytocin if hemorrhage continues post partum

A

misoprostol (cytotec)

28
Q

added on if hemorrhage continues post partum and oxytocin/misoprostol fails

A

methyergonovine (methergine)

29
Q

last ditch pharm effort to stop post partum hemorrhage

A

carboprost tromethamine (hemabate)

30
Q

dosage of oxytocin for post partum hemorrhage

A

40 U in 1L saline IV or 10 U IM

31
Q

onset of action for oxytocin

A

IV-one minute. IM: 3-5 minutes

32
Q

Given 200mcg IM or intramyometrial (DO NOT GIVE IV). Contraindicated with HTN, Raynaud’s, scleroderma

A

methylergonovine (methergine)

33
Q

Given 250mcg IM q 15-90 min. Max 8 doses. Contraindicated in asthma, HTN, renal failure, and reduced cardiac output

A

carboprost tromethamine (hematabate)

34
Q

Tx for severe HTN during labor

A

IV labetalol, hydralazine, or PO nifedipine

35
Q

blocks neuromuscular transmission and decreases amount of acetylcholine at the end plate of motor neuron impulse

A

magnesium sulfate

36
Q

Normal magnesium plasma levels

A

1.5-2.5mEq/L

37
Q

Result of Mg levels at 4mEg/L

A

decreased deep tendon reflexes

38
Q

At what level of Mg do tendon reflexes disappear

A

8-10mEq/L

39
Q

Result of Mg levels at 10-15mEq/L

A

respiratory paralysis

40
Q

At what level of Mg does cardiac arrest occur?

A

20-25mEq/L

41
Q

Contraindications include heart block, myocardial damage, myasthenia gravis

A

magnesium sulfate

42
Q

Stimulates uterine contractions by activation of G protein coupled receptors that trigger increased intracellular Ca+ levels. Also increases prostaglandin production

A

oxytocin (pitocin)

43
Q

Associated with slow infusion of oxytocin over 24hrs

A

severe water intoxication

44
Q

Drug that is category C and can be used during pregnancy for diarrhea that’s refractory to oral rehydration and dietary changes

A

loperamide

45
Q

First line treatment for constipation of pregnancy

A

increased dietary fiber and fluids

46
Q

What do the following have in common: psyllium (metamucil), methylcellulose (citrucel), calcium polycarbofil (fibercon), and wheat dextrin (benefiber)

A

bulk forming laxatives that are preferred tx for pregnant women as they aren’t absorbed

47
Q

Tx for refractory cases of constipation that are category B with minimal absorption

A

lactulose, bisacodyl (dulcolax), magnesium hydroxide (milk of magnesia)

48
Q

CI for constipation during pregnancy

A

castor oil (stimulates contractions) and mineral oil (interferes w/vitamin absorption)

49
Q

Preferred agent for GERD if lifestyle modifications and antacids fail

A

sulcralfate 1g PO TID

50
Q

Can be used if failure of sulcralfate for GERD. Category B

A

Ranitidine (zantac) or cimetidine (Tagamet)

51
Q

Nasal spray safe to use during pregnancy. Category B

A

ipatropium bromide (atrovent)

52
Q

Avoid in 1st trimester for nasal congestion, but okay in 3rd trimester

A

sudafed

53
Q

Category C cough suppressants

A

dextromethrophan (robitussin) and guaifesin (mucinex)

54
Q

Still DOC for maternal pain and fever

A

acetaminophen

55
Q

If used prior to 30wks associated with miscarriage, CV anomalies, cleft lip. After 30 wks closure of ductus.

A

NSAIDS

Gross but true (OBGYNE) (17 decks)

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