Pharm Flashcards
Medication for spontaneous abortion?
- MOA
- what types of abortions?
- unlabled uses
- how long until expulsion of fetal remnants?
- route of administration
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
What 3 ways are the products of conception evacuated in spontaneous abortion?
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)
Preterm labor:
- medication classes (2)
- MOA of each of the drug classes
Meds: tocolytics and corticosteroids
Tocolytics:
MOA: delay delivery by at least 48hrs to allow for adminstration of corticosteroids for fetal lung maturity.
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
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.
Tocolytics:
- 2nd line medication 24-32wks gestation
- -MOA
- -maternal SE
- -CI
- -precaution
What is the DOC weeks 32-34 gestation? 2nd line?
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.
Tocolytics Terbutaline:
- maternal SE
- CI
- monitoring
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
What tocolytic is 3rd line therapy for prevention of preterm labor?
Magnesium sulfate.
Corticosteroids:
-which medication is used 23-34wks
betamethasone***
Dexamethasone
Group B Strep:
- indications for abx prophylaxis
- are prophylactic abx given to mother undergoing c-section?
- Abx regimen
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
Premature rupture of membranes:
- abx regimen
- additional medical therapy
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.
Post partum Hemorrhage:
-stepwise approach to tx
first massage the uterus, then give oxytocin(DOC), then misoprostol, then carboprost tromethamine (Hemabate), then methylergonovine maleate, then possible surgery for uterine artery embolization.
What is the response time of oxytocin IV and IM?
IV 1min response, IM 3-5min response.
POSTPARTUM HEMMORHAGE: Misoprostol (Cytotec)
- MOA
- adverse rxns
MOA: synthetic prostaglandin that stimulates uterine contractions.
Adverse rxns:
- diarrhea
- abd pain
- constipation
- dyspepsia
- n/v
- HA
POSTPARTUM HEMORRHAGE: Methylergonovine (Methergine)
- MOA
- CI
MOA: acts directly on smooth muscle and increases uterine tone and strength and frequency of contractions
CI:
-HTN, raynauds, scleroderma
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)
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
Preeclampsia
- meds for severe HTN during labor
- prophylactic seizure medication
- -how long is the patient on this medication?
- -what are normal magnesium levels?
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
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?
- 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
Magnesium Sulfate:
- SE
- CI
- do not use with what other medication?
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.
Induction of labor:
- which medication?
- -effects on the uterus?
- -CI
- -maternal adverse SE
- -fetal adverse SE
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
Tx of Diarrhea
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.
Tx Constipation
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)
Tx of GERD
- 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)
Tx of Cold sx
- 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
Drugs stimulating Ovulation:
-medication names
Meds: clomiphene (Clomid)
Metformin (Glucophage)
Clomiphene (Clomid)
- MOA
- when to have sex to ensure pregnancy?
- how often can you take this?
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.
Metformin (Glucophage)
- MOA
- class
- what population is this medication most directed towards?
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
