Pharma Flashcards
Nifedipine + Mg sulphate ?
Retrospective studies show no harm to combine nifedipine and Mg sulphate on pregnant mother and Ca level but remember to monitor heart rate during that
Methotrexate anti-dote
Folinic acid
treatment option for trichomonal vaginal infection
Single oral dose (2g) Metronidazole and Tinidazole are effective treatment options for women who have trichomonal vaginal infection and their partner
Cetrotide® (cetrorelix acetate) 0.25 mg
GnRH antagonist
The most common cause of erythema nodusum
OCP
What is “Mirabegron”, uses, S.E., contraindications?
Beta 3 agonist
Indication:
-for Pt with OAB Who can’t tolerate anti-musculanic or have dry mouth or constipation due to other medical conditions
S.E.: may increase BP
CI: in uncontrolled Hypertension
SGLT2 inhibitors
side effect
Increase viscosity > increase the risk of thrombosis
Oxytocin (Syntocinon )dose:
10-20 IU IM (with 3 mins) or in 500 ml of NS IV infusion @ 1 hr [@40-60 drops /min] ( IV Bolus risk of marked transient fall in BP, Abrupt increase in CO, MI, chest pain)
in William’s obs: 20U in 1000 ml crystalloid Solution IV at rate of 10 ml/min for a dose of 200 mU/min
Max: 96 units
CI of methylergometrine:
Mnemonic: TOPER
Twin pregnancy
Organic heart disease
Preeclampsia
Eclampsia
Rh negative female
Cabertocin (uterotonic more effective than oxytocin) its dose:
100 mcg IV
15-methyl PGF2α (Carboprost) dose:
250 mcg (0.25 mg) IM or intramyometrially (repeated every 15-90 min for max 8 doses)
Carboprost PGF2α (Hemabate) side effects:
Diarrhoea and vomiting
Hypertension
Pyrexia and Flushing
Tachycardia
CI in BA, Suspected pt of Amniotic fluid embolism
Relative CI: Renal and liver and cardiac dis
Misoprostol - cytotec- (PGE1) dose for prevention /treatment of PPH:
600-1000 mcg (rectally or sublingual or orally)
SE:
- hyperpyrexia
- safe in asthma
Source: William ACOG17
Dinoprostone (PGE2) off- label PPH dose:
20 mg per rectum or per vagina every 2 hrs
SE:
Diarrhoea
CI in hypotension
Sulprostone is an Intravenous form of PGE2
Tranexamic acid dose:
500 mg IV or IM
The most potent drug to control PPH:
Carboprost
Misoprostol dose in abortion:
5-13 wks:
800 mcg vaginally or orally
Max dose: 400/ 3-4 hrs
14-24 wks:
400 mcg vaginally or sublingual
Max: 5 doses < 1/2 dose in prev C/S
In cervical preparation before surgical evacuation:
Up to 14 wks:
400 mcg vaginally 3 hrs prior or sublingual 2-3 hr
- if didn’t pass tissue give 600 or 800 single dose
- if actively bleeding give ASAP
Opioids anti-dote
Naloxone ( except pethidine it’s respiratory depression cann’t be reversed by it)
Syntometrine dose:
5IU
Oxytocin is structurally similar to anti-diuretic hormone (ADH, vasopressin) and both are released from the posterior pituitary, Commonest side effects:
The most common side effect is hypotension
Prolonged infusions can result in water retention and hyponatremia due to cross reactivity with the vasopressin receptor, giving rise to water intoxication.
PROPESS
containing 10 mg dinoprostone (Prostaglandin E2)
Actinomycin-D side effects:
- serious myelosuppression
- black stool discolouration
Mgso4 S.E.
Uterine atony > examine if uterus contracted post- delivery
ACOG 2009 Abx recommendation Preoperative Abx
Single Preoperative dose of 1 gm IV injection cefazolin half-an-hour prior to CS or 3 doses 8 hourly can be given for high risk cases or suspected infection x 24 hrs
IOL regimen by prosten and propess:
Prosten (PGE2 tab or gel): one dose followed by 2nd dose after 6-8 hrs (Max: 3 doses)
Propess (controlled release pessary): one dose over 24 hrs.< for PG, singleton, cephalic, normal CTG
If Bishop’s score < 6, IOL started at Antenatal ward
Terbutaline/ Ritodrine MOA
Bind to B-adrenoreceptors that increase Adenylyl Cyclase, elevated levels of cAMP, and myometrial cell relaxation.
How does mifesprostone prevent pregnancy?
Prevents ovulation (progesterone agonist)
Syntometrine is combination of
Oxytocin/ergometrine
Why the use of nitrofurantoin is contraindicated near term (38 to 42 weeks’ gestation)
because of the potential for the induction of hemolytic anemia in the neonate, which is caused by low levels of red blood cell glutathione
should not be used at term because of the risk of neonatal haemolysis - during the last few weeks may precipitate haemolytic anaemia due to glucose-6-phosphate dehydrogenase deficiency in the newborn.
Hemolytic reactions to nitrofurantoin in patients with glucose-6-phosphate dehydrogenase deficiency.
This drug may rarely cause an acute pulmonary reaction that dissipates on its withdrawal
Ondansetron withdrawal S.E.
Prolonged QT interval and serotonin syndrome
Cabergoline dose (dopamine agonist D2 specific ligand)
For hyperptolactinemia cessation. 0.25 mg twice weekly
For breastfeeding cessation 1mg ORALLY given within 24 to 27 h of delivery
Methergine (methylergonovine) dose In PPH
0.2 mg IM/IV Q2-4hrs for 24-48 hrs (Not to exceed 5 doses maximum)
IV Labetalol initial dose:
20 mg bolus over 2 min
If BP > 160/110, then repeat 10 min later with 40 mg IV, and 10 min later 80mg IV (the maximum IV daily dose is 300 mg)
if BP remain >160/110 shift to hydralazine.
(labetalol not given to asthmatic women)
MgSo4 dose in severe PET or eclampsia
4-6 g IV loading dose of Mgso4 diluted in 100ml IV fluid over 15-20 min followed by maintenance cont. infusion of 2 g/hr in 100 ml IV fluid
MgSo4 antidote
Calcium gluconate or calcium chloride 1gm IV over 3 min
Implanon
etonogestrel
SSRIs for Premenstrual Dysphoric Disorder, SSRI Effective Doses:
Fluoxetine hydrochloride:
20 mg/day
Sertraline hydrochloride
50-150 mg/day
Paroxetine hydrochloride
20-30 mg/day
Paroxetine controlled release (CR)
25 mg/day
Citalopram
20-30 mg/day
Escitalopram
10-20 mg/day
toxic complication of NSAID use
is nonoliguric renal failure. Because it is more likely to occur with NSAID use associated with severe dehydration, the agent should be discontinued if severe diarrhea is present and should not be used with diuretics.
Hydralazine initial dose and maintenance?
Initial dose: 5-10 mg IV over 2 min
After 20 min if BP remain >160/110, repeat with 10 mg IV
In PET: Nifedipine dose
10-20 mg PO repeat every 30 min if BP> 160/110,
Also you may give 10-20 mg PO Q2-6 hrs for management.
(Nifedipine given sublingually is no longer recommended. This route is associated with dangerously rapid and extensive effects.)
Oxytocin is never given as an undiluted
bolus dose because
serious hypotension or cardiac arrhythmias can develop
Tranexamic Acid serious association
Its use has been associated with a higher incidence of renal cortical necrosis (Frimat, 2016)
Anti-D dose
50μg given IM for pregnancies ≤12 weeks and 300 μg for ≥13 weeks.
This is administered immediately following surgical evacuation. For planned medical or expectant management, the injection is given within 72 hours of pregnancy failure diagnosis.
the most widely accepted regimen for medical abortion
regimen is mifepristone, 200 mg given orally on day 0 and followed in 24 to 48 hours by misoprostol 800 μg, administered by a vaginal, buccal, or sublingual route
(Acog, 2016c).
During medical abortion, the uterine rupture rate is
0.4 percent with one prior cesarean delivery.
the rate may reach 2.5 percent with two or more prior cesarean deliveries.
methotrexate precautions:
bound primarily to albumin, and its displacement by
other medications such as phenytoin, tetracyclines, salicylates, and sulfonamides can increase MTX serum drug levels.
renal clearance of MTX may be impaired by nonsteroidal antiinflammatory drugs including aspirin, probenecid, orpenicillins. Last, vitamins containing folic acid may lower MTX efficacy.
the most common side effects of methotrexate
The most common were liver involvement—12 percent; stomatitis—6 percent; and gastroenteritis—1 percent.
Mgso4 monitoring:
measure serum mg+ level at 4-6 hrs and adjust infusion to maintain levels btw 4-7 mEq/L (4.8 -8.4mg/dL)
Patellar reflexes disappear when the plasma magnesium level reaches
10 mEq/L—about 12 mg/dL—presumably because of a curariform action.
NSAIDS contraindicated in 3rd trimester it may cause:
- early closure of PDA.
- oligohydramnious
- fetal pulmonary HTN
medications may predispose to QT prolongation
such as azithromycin, erythromycin, and clarithromycin
to treat hypertension in pregnancy methyldopa (adrenergic-blocking drugs act centrally by reducing sympathetic outflow to effect a generalized decreased vascular tone) or (α-/ β-receptor blocking agent) labetalol.doses
methyldopa: 250mg BID max 1 gm
Labetalol: 200
thiazide diuretics are considered safe in
pregnancy. But for preeclampsia treatment, they are considered to be ineffective
Webster and colleagues (2017) found labetalol and nifedipine to be equally effective for chronic hypertension in pregnant women.
vasodilator treatment (hydralazine) not that effective alone for chronically hypertensive women was associated with a twofold rise in rates of low-birthweight and growth-restricted neonates
T
Anti-hypertensive meds in pre-eclampsia
