Pharmacology Flashcards
What antibiotics can you not give in pregnancy?
Trimethoprim and nitrofurantoin - teratogenic
Tetracyclines (e.g. doxycycline - affects baby’s teeth)
Consider treating abx with cefalexin or amoxcillin
What antibiotics should be prescribed for PPROM?
Erythromycin 250mg QDS - prophylaxis to prevent chorioamnionitis
Suspect infection if high WCC, high CRP, maternal temperatures, fatal tachycardia
What antibiotics are given in caesarean sections?
Co-amoxiclav commonly given
What steroids are given for fetal lung maturation and how?
Dexamethasone - 4X 6mg doses given as IM injections 12h apart
Beclametasone - 2X 12mg doses given 24h apart
What should you consider for the treatment of hypertension in pregnancy?
Labetalol 100mg TDS PO
Or Nifedipine 10mg TDS or QDS
Methyldopa 250mg BD or TDS PO
IF SEVERE labetalol can be given IV or hydralazine or MgSO4
What can be given to help prevent pre-eclampsia?
Low dose aspirin (75mg)
What else is MgSO4 useful for?
NEUROPROTECTION - should be given to all women in pre-term labour BEFORE 30 weeks
What anti-emetics should be considered in hyperemesis?
Cyclizine 50mg TDS PO
Prochlorperazine 10mg TDS
Promethiazine 25mg TDS
Chlorpromazine 10-25mg
THEN
Metaclopramide (5-10mg) or ondansetron
THEN
Corticosteroids e.g. hydrocortisone (consultant decision)
What laxatives should be considered in constipation in pregnancy?
BULK-FORMING (e.g. methycellulose)
LACTULOSE is also commonly given
What pharmacological treatment could you consider for obstetric cholestasis?
Ursodeoxycholic acid - reduces cholesterol absorption for the intestines helping with the dissolving of cholesterol
8-12mg OD before bed
What pharmacological treatments can be considered for PPH?
SYNTOMETRINE - (syntocinon and ergometrine for contraction of uterus)
CARBOPROST (PG analogue) - helps to contract down uterus 250mcg doses no less than 15mins apart no more than 2mg max
If these things fail consider surgical management - Intra-Uterine balloon tamponade, B-lynch sutures, uterine or iliac artery ligation, hysterectomy
When can a termination of pregnancy be managed MEDICALLY?
TOP can only be managed medically if the woman is less than 9 weeks
What is the first stage of treatment for a medical TOP?
Mifepristone - competitive progesterone receptor antagonist
- this terminates the pregnancy but then the woman requires some assistance to pass the pregnancy and this is when the next stage is given
What is the second stage of management for a TOP?
Misopristol. This is a prostaglandin analogue that helps the woman’s body to pass the terminated pregnancy
When can a medical management of an ectopic pregnancy can be considered?
- if pregnancy has not ruptured
- If woman has no symptoms or pain
- If woman BHCG levels are <1500
- If there is no fetal heart beat
- If intra-uterine pregnancy has been effectively ruled out
**if a woman does not fulfil these criteria should consider surgical management of the ectopic either with salpingectomy or salpingostomy
What can be used to medically manage a top?
METHOTREXATE
What treatment options are there for heavy menstrual bleeding?
Tranexamic acid and mefenamic acid
How does tranexamic work? How is it taken?
TXA - is an anti-fibrinolytic
It has a very short half life and so should be taken as 1g PO TDS-QDS
***Still able to take it if you are trying to conceive
How does mefenamic acid work and how is it taken?
Mefenamic acid is an NSAID and is one of the most commonly prescribed treatments for HMB
NSAIDS inhibit the cyclo-oxygenases meaning the production of both prostaglandins and thromboxanes are inhibited
500mg PO TDS
What are the high risk factors for VTE in pregnancy and what should be offered?
Previous history of VTE
Offer 4500U tinzaparin
What are some intermediate risk factors for VTE in pregnancy and what should be offered?
Hospital admission
Single prev VTE related to major surgery
High risk thrombophilia
High risk co-morbidities (SLE, heart failure, cancer, T1DM, IBD, arthropathy, sickle cell disease, IVDU)
Surgical procedure
CONSIDER Tinzaparin 4500
What are some low risk factors for VTE in pregnancy and what would make you consider prophylaxis?
BMI >30 Age >35 Parity of 3 or more Smoker Gross varicose veins Immobility FH of unprovoked or oestrogen provoked VTE Current pre-eclampsia Low risk thrombophilia Multiple pregnancy IVF/ART
***if 4 OR MORE of these factors exist consider 4500 tinzaparin
If you decide a woman DOES NOT need VTE prophylaxis in pregnancy what advice can you give?
Stay mobile and hydrated
What are some high risk factors for VTE in the post-natal period? What prophylaxis should be given?
Previous VTE LMWH in pregnancy High risk thrombophilia Low risk thrombophilia + FH Give LWMH 4500 for at least 6 weeks
What are some intermediate risk factor for VTE in the post natal period and what prophylaxis should you consider?
C-section
BMI >40
Re-admission or prolonged admission (>3 days) in puerperium
Surgery in puerperium apart from immediate perineal repair
Medical comorbidities (cancer, SLE, nephrotic syndrome, T1DM, sickle cell disease, IBD and arthropathy)
Give AT LEAST 10 days prophylactic LMWH
What are some low risk factors for VTE in the post-natal period and when should you consider prophylaxis?
Age >35 Obesity. BMI >30 Parity of 3 or more Smoker Elective c-section FHx VTE Low risk thrombophilia Gross varicose veins Systemic infection Immobility Current pre-eclampsia Multiple pregnancy Pre-term delivery in this pregnancy Still birth in this pregnancy Mid cavity rotation or operative delivery Prolonged labour >24h PPH >1L blood transfusion
IF 2 OR MORE RFx - 7-10 days LMWH
If less than 2 advise mobility and hydration
