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OBGYN 2 > Pharm > Flashcards

Pharm Flashcards

1
Q

Medication for spontaneous abortion?

  • MOA
  • what types of abortions?
  • unlabled uses
  • how long until expulsion of fetal remnants?
  • route of administration
A

Med: misoprostol (cytotec)

MOA:
-prostaglandin E1 analog and induces uterine contractions

Abortions:

  • missed
  • incomplete

Unlabled uses:

  • cervical ripening (intravagiinally)
  • tx of post post partum hemorrhage

expulsion of fetal remnants within 24hrs

route: intravaginally

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2
Q

What 3 ways are the products of conception evacuated in spontaneous abortion?

A

surgical: unstable, significant bleeding, infection or want immediate tx
medical: those who do not want to wait for spontaneous passage
expectant: will eventually pass naturally (days to weeks)

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3
Q

Preterm labor:

  • medication classes (2)
  • MOA of each of the drug classes
A

Meds: tocolytics and corticosteroids

Tocolytics:
MOA: delay delivery by at least 48hrs to allow for adminstration of corticosteroids for fetal lung maturity.

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4
Q

Tocolytics:

  • up to how many weeks gestation can these be used? minimum weeks gestation?
  • what is the DOC at 24-32wks gestation?
  • -MOA of this drug
  • -maternal SE
  • -fetal SE
  • -maternal CI
  • -monitoring
A

Generally not used before 22wks or past 34wks of gestation.

DOC 24-34wks: INDOMETHACIN

MOA indomethacin:
-decreases prostaglandin production through the inhibition of cyclooxygenase

Mother SE: Nausea, GE reflux, gastritis, emesis, platelet dysfunction

Fetal SE:

  • constriction of ductus arteriosus
  • oligohydramnios (decreases fetal urine output therefore decreasing amniotic fluid volume)

CI:

  • platelet dysfunction
  • bleeding disorders
  • hepatic dysfunction
  • GI ulcers
  • renal dysfunction
  • asthma if also sensitive to ASA

Monitoring:
-if given greater than 48hrs then need fetal US to evaluate for oligohydramnios and narrowing of the ductus arteriosus.

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5
Q

Tocolytics:

  • 2nd line medication 24-32wks gestation
  • -MOA
  • -maternal SE
  • -CI
  • -precaution

What is the DOC weeks 32-34 gestation? 2nd line?

A

2nd line: Nifedipine (Ca channel blocker)

MOA:
-calcium channel blocker which results in myometrial relaxation and peripheral vasodilation

Maternal SE:
-nausea, flushing, HA, dizziness, palpitations, severe hypotension

CI:
-hypotension, preload dependent cardiac lesion, LV dysfunction or CHF

Precaution:
-DO NOT use in conjunction with magnesium sulfate as they act synergistically to suppress muscle contraction and result in resp depression.

Nifedipine is the DOC 32-34wks gestation.

Terbutaline is 2nd line therapy 32-34wks.

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6
Q

Tocolytics Terbutaline:

  • maternal SE
  • CI
  • monitoring
A

Maternal SE: tachycardia, palpitations, hypotension, tremor, SOB, chest discomfort, hypokalemia, hyperglycemia

CI:

  • tachycardia cardiac dz
  • uncontrolled hyperthyroidism or DM
  • use with caution in placenta previa or abruption d/t risk of hypovolemia and shock

Monitoring:

  • I/Os
  • stop if maternal HR greater than 120
  • check blood glucose and K+ q4-6hrs
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7
Q

What tocolytic is 3rd line therapy for prevention of preterm labor?

A

Magnesium sulfate.

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8
Q

Corticosteroids:

-which medication is used 23-34wks

A

betamethasone***

Dexamethasone

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9
Q

Group B Strep:

  • indications for abx prophylaxis
  • are prophylactic abx given to mother undergoing c-section?
  • Abx regimen
A

abx prophylaxis:

  • positive rectovaginal culture
  • positive hx of birth of an infant with early onset GBS
  • GBS bacteriuria during current pregnancy
  • unknown culture status AND:
  • -maternal fever greater than 100.4F OR
  • preterm labor less than 37wks OR
  • prolonged rupture of the membranes greater than 18hrs

No, only give abx if their membranes rupture.

Abx:

  • PCN G or Ampicillin q4hrs until delivery
  • if PCN allergic:
  • cephazoline (Ancef) q8hrs until delivery
  • clindamycin or vancomycin q12hrs until delivery
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10
Q

Premature rupture of membranes:

  • abx regimen
  • additional medical therapy
A

Abx:
-1g azithromycin on admission followed by ampicillin IV followed by amoxicillin PO

  • if PCN allergic:
  • clindamycin IV plus gentamycin followed by clindamycin.

Medical therapy:
-tocolytics given to delay delivery in presence of uterine contractions

-corticosteroids may be indicated.

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11
Q

Post partum Hemorrhage:

-stepwise approach to tx

A

first massage the uterus, then give oxytocin(DOC), then misoprostol, then carboprost tromethamine (Hemabate), then methylergonovine maleate, then possible surgery for uterine artery embolization.

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12
Q

What is the response time of oxytocin IV and IM?

A

IV 1min response, IM 3-5min response.

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13
Q

POSTPARTUM HEMMORHAGE: Misoprostol (Cytotec)

  • MOA
  • adverse rxns
A

MOA: synthetic prostaglandin that stimulates uterine contractions.

Adverse rxns:

  • diarrhea
  • abd pain
  • constipation
  • dyspepsia
  • n/v
  • HA
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14
Q

POSTPARTUM HEMORRHAGE: Methylergonovine (Methergine)

  • MOA
  • CI
A

MOA: acts directly on smooth muscle and increases uterine tone and strength and frequency of contractions

CI:
-HTN, raynauds, scleroderma

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15
Q

BP, Signs and Sx of each of the following levels of blood loss:

  • 10-15% (500-1000ml)
  • 15-25% (1000-1500ml)
  • 25-35% (1500-2000ml)
  • 35-45% (2000-3000)
A

10-15: normal BP, palpitations, lightheadedness, tachycardia

15-25: slightly low BP, weakness, sweating, tachycardia

25-35: BP 70-80mmHg; restlessness, confusion, pallor, oliguria

35-45%: BP 50-70mmHg: lethargy, air hunger, anuria, collapse

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16
Q

Preeclampsia

  • meds for severe HTN during labor
  • prophylactic seizure medication
  • -how long is the patient on this medication?
  • -what are normal magnesium levels?
A

Severe HTN during labor:

  • IVLebetalol
  • IV hydralazine
  • PO Nifedipine

Seizure: Magnesium sulfate

  • -continue for 24hrs after delivery
  • -normal magnesium plasma levels are 1.5-2.5
17
Q

What are the adverse effects of elevated magnesium at each of the following plasma concentrations?

  • 4mEq/L
  • 8-10mEq/L
  • 10-15mEq/L
  • 20-25mEq/L

-antidote?

A
  • 4mEq/L = DTR decreased
  • 8-10mEq/L = DTR absent
  • 10-15mEq/L = respiratory paralysis
  • 20-25mEq/L = cardiac arrest

-antidote = calcium gluconate 1g over 10minutes

18
Q

Magnesium Sulfate:

  • SE
  • CI
  • do not use with what other medication?
A

SE:
-flushing, diaphoresis, warmth, nausea, vomiting, HA, muscle weakness, visual disturbance, palpitations

CI: 
-heart block 
-myocardial damage 
-myasthenia gravis 
(*B/c this med affects Ach)

DO NOT use in conjunction with calcium channel blockers b/c they potentiate each others effects.

19
Q

Induction of labor:

  • which medication?
  • -effects on the uterus?
  • -CI
  • -maternal adverse SE
  • -fetal adverse SE
A

Oxytocin (Pitocin)

Effects: stimulates uterine contractions, increases prostaglandin production

CI:
-conditions in which you would want to avoid vaginally delivery.

Maternal SE:

  • CV: arrhythmias, HTN
  • GI: nausea, vomiting
  • GU: pelvic hematoma, postpartum hemorrhage, uterine hypertonicity, uterine rupture
  • severe water intoxication with seizure, coma, and death associated with a slow infusion over 24hrs

Fetal SE:

  • CV: arrhythmias, bradycardia
  • CNS: brain damage, seizures
  • hepatic: jaundice
  • ocular retinal hemorrhage
  • other: death. low apgar score
20
Q

Tx of Diarrhea

A

Oral rehydration and dietary changes are best.
* Loperamide (immodium) preg cat C, should only be used in small amounts and only if sx are disabling and if conservative measures have not worked.

21
Q

Tx Constipation

A

first line is increase dietary fiber and fluids

bulk forming laxatives are the preferred treatment as they are not absorbed

  • psyllium (metamucil)
  • methylcellulose (citrucel)
  • calcium polycarbofil (Fibercon)
  • Wheat Dextrin (Benefiber)

Tx for refractory cases:

  • Lactulose (Preg B)
  • Bisacodyl (Dulcolaz)
  • Magnesium hydroxide (MOM)
22
Q

Tx of GERD

A
  • elevate HOB, dietary modification, antacids prn
  • sulfralfate* (preferred agent after failure of lifestyle and antacids)

H2 Blockers:

  • Ranitidine* (Zantac)
  • Cimetiddine (Tagamet(

PPI:

  • Lansoprazole (Prevacid)
  • Pantoprazole (Protonix)
  • Omeprazole (Prilosec)
23
Q

Tx of Cold sx

A
  • heated, humidified air for congestion
  • acetaminophen for sore throat, fever, or HA
  • saline nasal spray or irrigation
  • Rhinorhea:
  • -ipatropium bromide (atrovent) nasal spray
  • Nasal congestion:
  • -may only use single doses in 3rd trimester.

Cough suppressant: inhale warm humidified air

  • dextromethorphan (Robitussin; Cat C)
  • guaifenesin (Mucinex, cat C)

NSAIDS should be avoided

24
Q

Drugs stimulating Ovulation:

-medication names

A

Meds: clomiphene (Clomid)

Metformin (Glucophage)

25
Q

Clomiphene (Clomid)

  • MOA
  • when to have sex to ensure pregnancy?
  • how often can you take this?
A

MOA: ovulation stimulator. inhibits estrogens negative feedback on GnRH so it continues to secrete FSH and LH leading to growth of the ovarian follicle followed by ovulation.

Time intercourse 5-10days after completion of the 5 day course.

If needed, the 5 day cycle may be repeated as early at 30days after the previous one, up to 6 cycles.

26
Q

Metformin (Glucophage)

  • MOA
  • class
  • what population is this medication most directed towards?
A

MOA: helps decrease androgens, by decreasing androgens this allows for FSH and LH to increase and stimulate ovulation.

  • insuline stimulates ovarian theca cell anddrogen production and secretion
  • suppresses the hepatic production of sex hormone binding globulin.

Class: Biguanide

Population: those with PCOS

OBGYN 2 (9 decks)

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