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O&G > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Name some tocolytics

A 
'It's Not My Time'
Indomethecin (NSAID)
Nifedipine (Ca2+ channel blocker)
MgSO4
Terbutaline (beta-blocker)
Atosiban (oxytocin antagonist)
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2
Q

What drugs cross the placenta?

A

Assume all do

Unless high molecular weight (insulin, heparin)

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3
Q

What drug doses need to change in pregnancy?

A

If they have a narrow therapeutic window, due to the change in volume of distribution. Monitoring of phenytoin, carbamazepine and digoxin is therefore recommended

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4
Q

Define teratogen

A

An agent that cause or contribute to a malformation, or abnormal physiological function or affect neurological development of the exposed fetus during pregnancy or following birth.
Dose dependent

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5
Q

What is the worst time for teratogenicity?

A

The most vulnerable time is the 1st trimester (first 17 days will lead to miscarriage or replacement of cells and a normal pregnancy)

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6
Q

Give 7 common examples of teratogenic drugs

A
  • ACEi and Ang-II antagonists (lung and kidney hypoplasia, hypocalvaria)
  • Antiepileptics (neural tube, cardiac, facial and limb defect, mental retardation)
  • Cytotoxic agents (miscarriage)
  • Sex hormones progesterone and oestrogen (virilisation of female, feminisation of male)
  • Lithium (cardio defects, congenital goitre, prematurity, fetal macrosomia, floppy infant syndromes)
  • Thalidomide (limb defects, central facial naevus, cleft palate, CV, neuro development, GI and urogenital problems)
  • Warfarin (nasal hypoplasia, chondrodysplasia punctata)
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7
Q

What pharmacokinetics change in pregnancy?

A

Decreased GI motility, plasma protein

Increased lung function, skin blood circulation, plasma volume, body water, liver activity and GFR

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8
Q

Risks of antiepileptics in pregnancy

A
  • Up to 10% risk of an abnormal baby
  • Heart defects, cleft palate, neural tube and GU malformations
  • Dose related
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9
Q

How is risk of antiepileptics in pregnancy reduced?

A

Avoid them for neuropathic pain and mood
Epilepsy: take lowest dose possible
Take folic acid 5mg for first 12 weeks
Carbamazepine is safest

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10
Q

How is diabetes treated differently in pregnancy?

A
  • Oral hypoglycaemic agents should be stopped in pregnancy, apart from metformin
  • Insulin should be started instead, if required
  • Statins should be stopped in pregnancy
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11
Q

How is hypertension treated differently in pregnancy?

A
  • NO ACEi or Ang-II antagonists
  • Labetalol is 1st line (unless asthmatic)
  • Nifedipine and methyldopa are alternatives
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12
Q

What are NSAIDs used for in O and G?

A

Pain relief
Menorrhagia (antiprostaglandin & pain relief)
Tocolysis (antiprost, reduced contractility of uterus)

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13
Q

Name an antifibrinolytic and action

SE?

A

Tranexamic acid
Inhibits plasminogen-> plasmin
SE: thrombosis

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14
Q

What is atosiban? SE

A

Oxytocin receptor antagonist
Tocolytic
Headache

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15
Q

SE of indomethacin

A

NSAID used in tocolysis
Blocks prostaglandin production
Headaches
May close ductus arteriosus prematurely and cause reduced renal function and oligohydramnios

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16
Q

Name 2 GnRH agonists, also called?

A

Gonadorelin analogues
Goserelin
Triptorelin

17
Q

What are GnRH agonists used for? 4 uses

A

In menorrhagia due to fibroids
-> correct anaemia due to reversible menopause
Used before fibroid surgery
-> deceases size of fibroids and reduces surgical blood loss
Endometriosis
Precocious puberty

18
Q

Action of GnRH agonists

A

Suppress hypo-pituitary-ovarian axis
Causes reversible menopause
Used for 3-6 months at a time

19
Q

What is danazol? SE?

A

testosterone derivative
Causes hypo-oestrogen and hypoprogesterone state (pseudomenopause)
SE: deep voice

20
Q

What is danazol used for?

A

Endometriosis

Causes endometrial regression and atrophy

21
Q

What is oxybutynin?

A

Antimuscarinic

Used in detrusor overactivity (in urinary incontinence)

22
Q

How does oxybutynin work?

A

Delays initial drive to void
Decreases detrusor strength
Decreases frequency of detrusor contractions

23
Q

SE of oxybutynin

A 
Anticholinergic:
dry mouth
constipation
blurred vision
drowsiness
24
Q

What is solifenacin?

A

Antimuscarinic used for urge incontinence

25
Q

Name 3 antimuscarinic drugs used in urinary incontinence

A

Oxybutynin
Solifenacin
Trospium

26
Q

Name a psychiatric drug used in urinary incontinence

A

Duloxetine
SNRI
Used in stress incontinence

27
Q

Name 2 psychiatric drugs used menopause

A

SSRIs (vasomotor and depression)

Gabapentin (vasomotor)

28
Q

What is clonidine used for in O&G?

A

Alpha agonist

Used for vasomotor symptoms of menopause

29
Q

Name 4 drugs that can be used for osteoporosis in menopause

A

Calcium
Vitamin D
Bisphosphonates
SERM (selective oestrogen modulators) Tamoxifen

30
Q

What is labetalol? Who should avoid it?

A

Alpha and beta blocker
1st line for PET and hypertension in pregnancy
Decreases peripheral vascular resistance
Asthmatics should avoid it

31
Q

What is nifedipine? SE

A

Calcium channel blocker
Causes arterial dilation
Used in tocolysis and for hypertension in pregnancy
SE: headaches, flushing, tremor

32
Q

What is methyldopa? SE

A

Alpha agonist
Prevents vasoconstriction
Treatment for hypertension in pregnancy
Stop 2 days before delivery due to risk of post natal depression

33
Q

What is hydralazine? SE

A

IV antihypertensive used in pregnancy
Vasodilation
Rapid hypotension

34
Q

What is chlorphenamine?

A

Sedating antihistamine

Used for itching in obstetric cholestasis

35
Q

What is ursodeoxycholic acid?

A

UCDA
Alters bile acid pool balance
Decreased hydrophobic bile acids
Used in obstetric cholestasis

36
Q

What is ulipristal acetate?

A

Progesterone receptor modulator
For pre op and intermittent treatment of fibroid symptoms
3 months at a time
NOT used with hormonal contraceptives

37
Q

What is GTN used for in pregnancy?

A

Tocolytic
Relaxation of myometrium
Transdermal patch

38
Q

What analgesia is available in labour?

A 
Entonox (O2, nitrous oxide)
Pethidine IM
Pudendal block (for operative delivery)
Perineal infiltration (for episiotomy/suturing)
Epidural anaesthesia
Spinal (operative delivery)
39
Q

What anaesthesia can be used for operative deliveries?

A

Spinal (subarachnoid space bupivocaine)

Pudendal block

O&G (12 decks)

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