Pharm Flashcards
what medication is used to induce ovulation?
clomiphene citrate
what is the MOA of clomiphene?
induces ovulation as its a selective estrogen receptor modulator
it blocks estrogen’s negative effects on the hypothalamus leading to inc. GnRH
what pharmicokinetic changes of drugs cause higher fetal concentrations?
lipophilic, low molecular wt, high Pka, not affected by protein binding
what drug can cause significant renal failure in infants?
ACEIs
what drugs can cause neonatal abstinence syndrome
opiods
what can cause spina bifida?
dec. folic acid in diet
what does thalidomide do to a fetus? when are they most at risk?
causes limb malformations (phocomelia)
4-7 weeks gestation
what shows the following symptoms: low nasal bridge, small head and jaw, thin upper lip, epicanthal folds, poor growth, heart defects, delayed development?
fetal alcohol syndrome
what causes intrauterine growth retardation, stillbirth, risk for SIDs, neurobehavioral def?
tobacco use/nicotine`
what is the first line treatment for GBS?
penicillin
what is the second line treatment for GBS if there is no significant reaction to penicilin?
cefazolin
what do you treat GBS with if a patient is highly allergic to penicillin?
clindamycin and vacnomycin
what is used for a 1st trimester abortion?
misoprostol + mifepristone
what is the moa of mifepristone?
progesterone receptor antagonist
leads to endometrial decay
what is the MOA of misoprostol?
PGE1 analogue that causes uterine contractions
what do you use for a missed abortion/intrauterine fetal death?
dinoprostone (PGE2 analogue)
what is used for PPH due to uterine antony?
carboprost (hemabate)
PGF2 alpha analogue
what are the various obstetrical uses for misoprostol?
abortificant, ripen cervix, induce labor, treat PPH
what HTN drugs do you avoid in pregnancy?
prils and sartans
what drugs do you use for acute and chronic control of HTN in pregnancy?
methyldopa, hydralazine, labetalol, nifedipine
MOA of methyldopa
stimulates the central inhibitory alpha-2-adrenergic receptors, leading to a reduction in sympathetic tone, total peripheral resistance, and blood pressure
moa of hydralazine
Direct acting arterial vasodilator
moa of labetalol
Selective Alpha-1- blocker = vasodilate
Non selective Beta-1 block = decreased CO
moa of nifedipine
Calcium Channel Blocker = arterial vasodilator
Fast release gel caps for acute, slow release tabs for chronic
Explain the rationale for using magnesium sulfate in treating preeclampsia and eclampsia
prevents seizures with eclampsia
Describe how magnesium sulfate is administered
Given as an IV loading dose followed by a constant IV infusion
Explain the mechanisms of action of magnesium sulfate’s anticonvulsant effects
Unique calcium antagonist, an anticonvulsant: It inhibits calcium movement through its channels in a variety of tissues
Relaxes smooth muscle, also has the ability to decrease platelet aggregation and increase release of NO.
Increase the seizure threshold by inhibiting NMDA receptors, thereby limiting the effect of glutamate
Recognize the signs of magnesium toxicity
N, warmth, flushing, somnolence, double vision, slurred speech, weakness, loss of patellar reflexes muscular paralysis, respiratory arrest, cardiac arrest
identify a magnesium antidote
calcium gluconate
Therapeutic use of misoprostol
cervical ripening
induction of labor
abortificient
PPH (prevent/treat)
ADRs of misprostol
Diarrhea
shivering
MOA of methylergonovine
ergot alkaloid
alpha 1 adrenergic, dopaminergic, agonist at serotonin receptors. induces uteronic effect and dec. blood loss
MOA of oxytocin
stimulates uterine contractions
stimulates PG release
therapeutic use of methylergonovine
prevent and treat PPH, not inducement of labor
ADRs of methylergonovine
diarrhea
N/V
*hallucinations, abortifacient vasospasm for toxicity
Treatments for PPH
Oxytocin
methylergonovine
carboprost
dinoprostone
therapeutic use of oxytocin
Dilute: IOL after ripening via PGs
PPH
ADRs of oxytocin
hyperstimulation of uterine contractions
activation of vasopressin receptors -> excessive fluid retention (hyponatremia, HF, seizures, or death)
MOA of dinoprostone, misoprostol, and carboprost
bind PG receptors and inc. intracellular Ca leading to inc. adenylyl cyclase
ADRs of carboprost
N/V
diarrhea
therapeutic use of carboprost
PPH due to uterine atony
therapeutic use of dinoprostone
cervical ripening (most common)
IOL
cervidil is sustained release
contraindication to misoprostol use
women attempting vaginal birth w/ prior C/S
what PG analogue is misoprostol
PG E1
what PG analogue is dinoprost
PGE2
what PG analogue is carboprost
PGF2alpha
contraindications for dinoprostone
HTN, hepatic and renal dysfunction, glaucoma
ADRs for dinoprostone
uterine hyperstimulation
uterine rupture w/wo fetal heart rate changes
contraindications to carboprost
hypersensitivity
active renal, hepatic, or cardiac dz
contraindications to methylergonovine
obstructive vascular dz
collagen dz
contraindications for oxytocin
fetal distress
premi
abnormal fetal presentation
