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EndoRepro 2 Exam 1 > Pharm Antenatal and Perinatal - Wolff > Flashcards

Pharm Antenatal and Perinatal - Wolff Flashcards

1
Q
  • misoprostol
  • dinoprostone
  • carboprost
  • oxytocin
  • ergot alkaloids
A

labor induction/control post-partum hemorrhage

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2
Q
  • cortisol
  • betamethasone
  • dexamethasone
A

corticosteroids

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3
Q
  • terbutaline
  • indomethacin
  • nifedipine
  • MgSO4
  • atosiban
A

tocolytics (delay labor)

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4
Q

what drugs are used to keep the ductus arteriosus open?

A

alprostadil, misoprostol

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5
Q

what drugs are used to close a PDA?

A

indomethacin, ibuprofen

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6
Q
  • a-methyldopa
  • labetalol
  • hydralazine
  • Na-nitroprusside
A

anti-hypertensives in pregnancy

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7
Q

what are the key factors thought to regulate phase 1 of parturition (labor)?

A

nitric oxide, hCG, progesterone

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8
Q

what are the key factors thought to regulate phase 2 of labor?

A

gap junction receptors, prostaglandins, hyaluronan

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9
Q

what are the key factors thought to regulate phase 3 of labor?

A

oxytocin, estrogen

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10
Q

what are the key factors thought to regulate phase 4 of labor?

A

inflammatory cell activation

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11
Q

process in which collagen and glycosaminoglycans are broken down in the cervix by matrix metallo-proteinases
- cervix becomes thin (effacement) and dilates

A

cervical ripening

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12
Q

synthetic prostaglandin E1 analog

  • induces uterine contractions
  • used to terminate intrauterine pregnancy if <70 days (in combination with mifepristone)
  • off-label cervical ripening
  • stable at room temp, cheap!
A

misoprostol

- causes NVD, can cause hypoxia in fetus

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13
Q

what are the contraindications of misoprostol?

A

pregnancy (unless aborting)

previous c-section (disrupts uterine scar -> rupture!)

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14
Q

synthetic prostaglandin E2 analog

  • induces uterine contractions AND promotes cervical ripening
  • available as gel, vaginal insert, or suppositories
  • much more expensive than miso, needs to be refrigerated
A

dinoprostone

  • causes NVD, fever (not responsive to NSAIDs)
  • can cause hypoxia in fetus d/t tachysystole
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15
Q

synthetic prostaglandin F2a analog

  • induces uterine contractions
  • used to induce abortion b/w 13-20wks (if other methods don’t work)
  • also used for post-partum hemostasis for refractory bleeding
  • given IV, is expensive
A

carboprost

  • causes HTN and pulmonary edema, is a potent vasoconstrictor (unlike PGE2)
  • tends to reduce body temp (unlike PGE2)
  • dizziness, gagging, heartburn, cough… lots of other side effects
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16
Q

posterior pituitary hormone

  • increases force, frequency, and duration of uterine contractions (both induction and augmentation, but should be used with caution)
  • administered IV, is cheap
A

oxytocin
- can cause water intoxication (rare) because structure is similar to ADH
NOTE: only works in uterus AT TERM (cervix needs to be ripe before uterus contract, otherwise it can rupture)

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17
Q

stimulates adrenergic, dopaminergic and serotogenic receptors

  • causes prolonged tonic uterine contractions (not good for fetus)
  • constricts arterioles and veins
  • used POST-PARTUM to increase uterine tone and stop bleeding
  • oral, IV or IM admin
A

ergot alkaloids (constrictor from rye fungus)

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18
Q

what are the contrindications of ergot alkaloids?

A

HTN, hypersensitivity

- very rarely can cause psychosis or convulsions (the whole witchcraft thing)

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19
Q

what drug class works well for cervical ripening, and can cause uterine contractions at any time during pregnancy (used for abortions)?

A

PGE analogs (prostaglandins)

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20
Q

what drug is used during labor and delivery to help induce AND augment contractions
- also helps limit post-partum bleeding

A

oxytocin

21
Q

what is the second choice for limiting post-partum bleeding?

A

ergot alkaloids

22
Q

what is the best tx for preeclampsia?

A

deliver that baby!

23
Q

what are the two most common obstetrical complications associated with preterm birth?

A
  • spontaneous labor (45%)

- spontaneous rupture of membranes (35%)

24
Q

what is the trend that Wolff wants us to know about birth outcomes?

A

making it to term matters

- the later in gestational age, the better chance the baby has of surviving to 1 year

25
Q

what is the management of PPROM if > 34 weeks?

A
  • GBS prophylaxis

- single corticosteroid course

26
Q

what is the management of PPROM if 32 - 34 weeks?

A
  • GBS prophylaxis
  • single corticosteroid course
  • antimicrobials to prolong latency
27
Q

what is the management of PPROM if 24 - 32 weeks?

A
  • GBS prophylaxis
  • single corticosteroid course
  • (no consensus on tocolytics)
  • antimicrobials to prolong latency
  • MgSO4 for neuroprotection
28
Q

what is the management of PPROM if <24 weeks?

A
  • GBS prophylaxis NOT RECOMMENDED
  • single corticosteroid course
  • (no consensus on tocolytics)
29
Q

what heightens the risk of RDS?

A

preterm birth

  • affects 40-50% of babies born before 32 weeks
  • caused by surfactant deficit in immature lungs
30
Q

what drugs are used in pre-term delivery to promote lung maturation and increase surfactant production?

A

corticosteroids

31
Q

what are the indications for antenatal corticosteroids?

A

women between 24-36 weeks gestation with:

  • threatened preterm labor
  • antepartum hemorrhage
  • preterm rupture of membranes
  • conditions requiring c-section (preeclampsia, HELLP)
32
Q

fluorinated steroid that hastens fetal lung development

- given in TWO doses IM in 24hr intervals (48hrs total)

A

betamethasone

33
Q

fluorinated steroid that hastens fetal lung development

- given in FOUR doses IM in 12hr intervals (48hrs total)

A

dexamethasone

34
Q

what is the MOA of endogenous fetal cortisol?

A

induces transcription of surfactant proteins in alveolar type 2 pneumocytes

35
Q

why not administer cortisol to mom?

A

the placenta metabolizes/inactivates to CORTISONE (via 11b-hydroxy steroid dehydrogenase-2), so it doesn’t affect baby

NOTE: this means you can give cortisol if mom needs it for something and it won’t harm baby

36
Q

which drugs should you use to delay contractions?

A

currently NO FDA approved drugs in US…
- nifedipine or indomethacin seem to be best choices currently available in US

NOTE: recommendation is to NOT combine tocolytics

37
Q

calcium channel blocker

  • MOA: blocks calcium influx thru voltage-gated channels (less calcium=less contraction)
  • NOT FDA approved, but CCB’s are preferable to other comparative tocolytics
A

nifedipine

  • causes flushing, headaches, dizziness
  • no fetal side effects
38
Q

what are the contraindications of nifedipine?

A

cardiac dz, maternal hypotension, avoid concomitant use with MgSO4

39
Q

prostaglandin synthesase inhibitor

  • MOA: blocks synthesis of PGFa2 (a potent stimulator of uterine contractions)
  • NOT FDA approved
A

indomethacin

  • causes nausea, heartburn, gastritis, proctitis, hematochezia, impaired renal function
  • fetal side effects: constrics ductus arteriosus, pulmonary HTN, reversable decrease in renal function with oligohydramnios
40
Q

what are the two main contraindication of indomethacin

A

significant renal or hepatic impairment

41
Q

which tocolytic has been found to delay labor for 2-7 days?

  • there is no evidence of benefit to fetus
  • mother experience side effects: cardiac arrhythmias, pulmonary edema, myocardial ischemia, hypotension, tachycardia, SOA, hyperglycemia, hyperinsulinemia, tremor, NV)
A

terbutaline (beta-2 agonist)

42
Q

what drug is used to prevent eclamptic seizures

  • MOA: inhibits ACh release at uterine NMJ
  • evidence does support its use for neuroprotection (appears to decrease risk for cerebral palsy)
  • is a long-term drug of choice for tocolysis in US (but rarely used elsewhere)
A

magnesium sulfate

  • in mom: causes skin flushing, palpitations, headaches, depressed reflexes, respiratory depression, impaired cardiac function
  • in baby: muscle relaxation, rarely CNS depression
43
Q

which b2-agonist used for tocolysis was approved by FDA in 1980, but was taken off the market in 1998?

A

ritodrine

- causes severe hallucinations

44
Q

oxytocin inhibitor what is NOT available in the US?

A

atosiban

  • causes maternal headaches, nausea
  • no fetal side effects
45
Q

synthetic PGE1 analog (similar to misoprostol) that MAINTAINS a patent ductus arteriosus

  • indicated in pre-term infants with congenital heart defects
  • infusion of PGE1 substitutes for and complements with PGE2
A

alprostadil

- adverse effects: hypotension, tachycardia, apnea

46
Q

what drugs can be used to CLOSE a ductus arteriosus?

- signs of a PDA: baby isn’t eating well, is listless, breathes too fast and seems to be sweating too much

A

NSAIDs!

  • indoemthacin
  • recently, more likely ibuprofen
47
Q

what drugs classes are contraindicated for HTN in pregnancy?

A

ALL ACE INHIBITORS/ARBs!!!

- they are lethal during 2nd/3rd trimesters

48
Q

what is the first line tx for moderate HTN in pregnancy?

A
  • oral a-methyldopa (a2 agonist)

- oral labetalol (a/b blocker)

49
Q

what is the second line tx for severe HTN in pregnancy?

A
  • parenteral labetalol
  • hydralazine (arterial vasodilator)
  • sodium nitroprusside (arterial/venous vasodilator)

EndoRepro 2 Exam 1 (25 decks)

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