Pharmacology Flashcards
<p>What antibiotics can you not give in pregnancy?</p>
<p>Trimethoprim and nitrofurantoin - teratogenic
Tetracyclines (e.g. doxycycline - affects baby's teeth)
Consider treating abx with cefalexin or amoxcillin</p>
<p>What antibiotics should be prescribed for PPROM?</p>
<p>Erythromycin 250mg QDS - prophylaxis to prevent chorioamnionitis
Suspect infection if high WCC, high CRP, maternal temperatures, fatal tachycardia</p>
<p>What antibiotics are given in caesarean sections?</p>
<p>1st gen cephalosporin (cefalexin) / penicillin </p>
<p>What steroids are given for fetal lung maturation and how?</p>
<p>Dexamethasone - 4X 6mg doses given as IM injections 12h apart
Beclametasone - 2X 12mg doses given 24h apart</p>
<p>What should you consider for the treatment of hypertension in pregnancy?</p>
<p>Labetalol 200mg TDS PO
Or Nifedipine 10mg OD-BD
Methyldopa 250mg BD or TDS PO (alpha 2 adrenergic receptor agonist)
IF SEVERE labetalol can be given IV or hydralazine or MgSO4</p>
<p>What can be given to help prevent pre-eclampsia?</p>
<p>Low dose aspirin (75mg)</p>
<p>What else is MgSO4 useful for?</p>
<p>NEUROPROTECTION - should be given to all women in pre-term labour BEFORE 30 weeks</p>
<p>What anti-emetics should be considered in hyperemesis?</p>
<p>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)</p>
<p>What 2 laxatives should be considered in constipation in pregnancy?</p>
<p>BULK-FORMING (e.g. methycellulose)
| OSMOTIC eg. lactulose</p>
<p>What pharmacological treatment could you consider for obstetric cholestasis?</p>
<p>Ursodeoxycholic acid - reduces cholesterol absorption for the intestines helping with the dissolving of cholesterol
8-12mg OD before bed</p>
<p>What pharmacological treatments can be considered for PPH?</p>
<p>SYNTOMETRINE - (syntocinon + ergometrine = contraction of uterus)
CARBOPROST (PG analogue) - helps to contract down uterus 250mcg doses no less than 15mins apart no more than 2mg max
MISOPROSTOL 1000mcg rectal
TRANEXAMIC ACID
If these things fail consider surgical management - Intra-Uterine balloon tamponade, B-lynch sutures, uterine or iliac artery ligation, hysterectomy</p>
<p>When can a termination of pregnancy be managed MEDICALLY?</p>
<p>< 9 weeks</p>
<p>What is the first stage of treatment for a medical TOP?</p>
<p>Mifepristone 200mg - competitive progesterone receptor antagonist
- terminates pregnancy but need help to get it out hence next stage</p>
<p>What is the second stage of management for a TOP?</p>
<p>Misoprostol 800mcg - prostaglandin analogue, stimulates uterine contractions</p>
<p>When can a medical management of an ectopic pregnancy can be considered?</p>
<p>1) <35mm
2) Unruptured
3) No pain
4) BHCG levels are <1500
5) No FHR
6) 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</p>
<p>What can be used to medically manage ectopic?</p>
<p>METHOTREXATE</p>
<p>What treatment options are there for heavy menstrual bleeding?</p>
<p>Tranexamic acid and mefenamic acid</p>
<p>How does tranexamic work? How is it taken?</p>
<p>TXA - is an anti-fibrinolytic
1g PO TDS-QDS
***Still able to take it if you are trying to conceive</p>
<p>How does mefenamic acid work and how is it taken?</p>
<p>NSAID and is one of the most commonly prescribed treatments for HMB
Production of both prostaglandins and thromboxanes are inhibited
500mg PO TDS</p>
<p>What are the high risk factors for VTE in pregnancy and what should be offered?</p>
<p>Previous history of VTE
| LMWH antenatally until 6 weeks post-partum</p>
<p>What are some intermediate risk factors for VTE in pregnancy?</p>
<p>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</p>
<p>What are some low risk factors for VTE in pregnancy and how long would you give prophylaxis for if have: 2/more RF 3/more RF 4/more RF Any hospital admission</p>
<p>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 2/more - LMWH for at least 10 days
If 3/more - LMWH from 28 weeks till 6 weeks postnatal
If 4 OR MORE - LMWH immediately until 6 weeks postnatal
ANY ANTENATAL HOSPITAL ADMISSION = CONSIDER LMWH</p>
<p>If you decide a woman DOES NOT need VTE prophylaxis in pregnancy what advice can you give?</p>
<p>Stay mobile and hydrated</p>
<p>What are some high risk factors for VTE in the post-natal period? What prophylaxis should be given?</p>
<p>Previous VTE LMWH in pregnancy High risk thrombophilia Low risk thrombophilia + FH Give LWMH 4500 for at least 6 weeks</p>
<p>What are some intermediate risk factor for VTE in the post natal period and what prophylaxis should you consider?</p>
<p>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</p>
<p>What are some low risk factors for VTE in the post-natal period and when should you consider prophylaxis?</p>
<p>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</p>
<p>What can Danazol be used to treat?
| How does it work?</p>
<p>Endometriosis
| Anti-androgen</p>
<p>What Abx are used for 3rd/4th perineal tears?</p>
<p>Cefuroxime + Metronidazole</p>
<p>What are is an example of gnrh agonist?
What is it used for?
Mechanism of action
3 SEs</p>
<p>Leuprorelin IM
- Endometriosis
- Ovarian suppression
- hot flashes, headache, osteoporosis</p>
<p>When is oral iron recommended?
| When is IV iron recommended?</p>
<p>T1: Hb <110, T2/3: Hb <105
| Hb <80 at 34 weeks</p>
<p>When is aspirin & how much?</p>
<p>From 12 weeks if high risk
| Usually 75mg, but 150mg in future pregnancies if previously had pre-eclampsia</p>
<p>What medical management is used in urge & stress incontinence?</p>
<p>URGE 1) Anticholinergics - Oxybutynin Inhibit detrusor muscle contraction 2) Beta-3 agonist (alternative for frail older women) - Mirabegron - CI in uncontrolled HTN 3) Vaginal oestrogens
STRESS
1) Duloxetine - SNRI (Strengthens bladder neck)</p>
<p>Misoprostol 3 indications</p>
<p>1) TOP
2) Miscarriage
3) Haemorrhage</p>
<p>When is atosiban used?
| Mechanism of action</p>
<p>Uncomplicated premature labour 24-33wk
| Inhibits oxytocin & relaxes uterus</p>
<p>What 2 topical creams are given for genital warts?</p>
<p>1) Podophyllotoxin
| 2) Imiquimod</p>
