Pharm

Question 1

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

Answer 1

misoprostol

Question 2

Unlabeled uses of misoprostol

Answer 2

cervical ripening and post partum hemorrhage

Question 3

Dosing of misoprostol

Answer 3

400mcg intravaginally q 4hrs x 4

Question 4

Past what week of gestation are tocolytics generally not used

Answer 4

34 wks

Question 5

Contraindication to tocolytics

Answer 5

mother/fetal instability

Question 6

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

Answer 6

Indomethacin

Question 7

Dosage of indomethacin to stop preterm labor

Answer 7

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

Question 8

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

Answer 8

constriction of ductus arteriosus

Question 9

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

Answer 9

oligohydramnios

Question 10

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

Answer 10

nifedipine

Question 11

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

Answer 11

magnesium sulfate

Question 12

Contraindication and side effect of nifedipine

Answer 12

hypotension

Question 13

Drug of choice for preterm labor at 32-34 wks

Answer 13

nifedipine

Question 14

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

Answer 14

terbutaline

Question 15

Dosage of nifedipine to stop preterm labor

Answer 15

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

Question 16

CI to beta adrenergic receptor agonists

Answer 16

tachycardia, uncontrolled hyperthyroidism/DM, placenta previa/abruption

Question 17

3rd line therapy for prevention of preterm labor.

Answer 17

magnesium sulfate

Question 18

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

Answer 18

corticosteroids

Question 19

Preferred antenatal corticosteroid at 23-34 wks and its dosage

Answer 19

betamethasone. 12mg IM q 24hrs x 2

Question 20

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

Answer 20

ruptured membranes

Question 21

Abx regimen for group B strep

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

clindamycin or vancomycin 1g IV q 12 hrs until delivery

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

Uterotonic drug of choice for post partum hemorrhage

Answer 26

oxytocin

Question 27

Added on to oxytocin if hemorrhage continues post partum

Answer 27

misoprostol (cytotec)

Question 28

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

Answer 28

methyergonovine (methergine)

Question 29

last ditch pharm effort to stop post partum hemorrhage

Answer 29

carboprost tromethamine (hemabate)

Question 30

dosage of oxytocin for post partum hemorrhage

Answer 30

40 U in 1L saline IV or 10 U IM

Question 31

onset of action for oxytocin

Answer 31

IV-one minute. IM: 3-5 minutes

Question 32

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

Answer 32

methylergonovine (methergine)

Question 33

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

Answer 33

carboprost tromethamine (hematabate)

Question 34

Tx for severe HTN during labor

Answer 34

IV labetalol, hydralazine, or PO nifedipine

Question 35

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

Answer 35

magnesium sulfate

Question 36

Normal magnesium plasma levels

Answer 36

1.5-2.5mEq/L

Question 37

Result of Mg levels at 4mEg/L

Answer 37

decreased deep tendon reflexes

Question 38

At what level of Mg do tendon reflexes disappear

Answer 38

8-10mEq/L

Question 39

Result of Mg levels at 10-15mEq/L

Answer 39

respiratory paralysis

Question 40

At what level of Mg does cardiac arrest occur?

Answer 40

20-25mEq/L

Question 41

Contraindications include heart block, myocardial damage, myasthenia gravis

Answer 41

magnesium sulfate

Question 42

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

Answer 42

oxytocin (pitocin)

Question 43

Associated with slow infusion of oxytocin over 24hrs

Answer 43

severe water intoxication

Question 44

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

Answer 44

loperamide

Question 45

First line treatment for constipation of pregnancy

Answer 45

increased dietary fiber and fluids

Question 46

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

Answer 46

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

Question 47

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

Answer 47

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

Question 48

CI for constipation during pregnancy

Answer 48

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

Question 49

Preferred agent for GERD if lifestyle modifications and antacids fail

Answer 49

sulcralfate 1g PO TID

Question 50

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

Answer 50

Ranitidine (zantac) or cimetidine (Tagamet)

Question 51

Nasal spray safe to use during pregnancy. Category B

Answer 51

ipatropium bromide (atrovent)

Question 52

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

Answer 52

sudafed

Question 53

Category C cough suppressants

Answer 53

dextromethrophan (robitussin) and guaifesin (mucinex)

Question 54

Still DOC for maternal pain and fever

Answer 54

acetaminophen

Question 55

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

Answer 55

NSAIDS