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part I > pharmacology (non-hormonal) > Flashcards

pharmacology (non-hormonal) Flashcards

1
Q

which % of pregnancies is affected by:

i. HTN
ii. PET

A

i. 10%
ii. 3%

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2
Q

clear indications for rx of raised BP in pregnancy (4):

A

persistant BP >160/110
acute severe HTN
fulminating PET
eclampsia

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3
Q

BP above which we medicate

A

150/100

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4
Q

beta blockers SE:

A

IUGR
neonatal hypoglycaemia and bradycardia (rare)

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5
Q

which BB is sometimes CI as their effect in early and late pregnancy is not known?

A

atenolol

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6
Q

methyldopa
(2nd line)

mechanism of action:

A

centrally acting
is metabolised to α-methylnoradrenaline (it’s active component)
It works as a post-synaptic α2 agonist reducing central sympathetic outflow

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7
Q

methyldopa SE

A
  • rebound HTN
  • depressed mood with LT use
  • Flattened CTG variability
  • Autoimmune haemolytic anaemia (rare)
  • Raised prolactin (outside of pregnancy)
  • Hepatitis
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8
Q

nifedipine
(not licensed in pregnancy but commonly used 2nd line)

  • use MR as acutely can cause hypotension

effects of nifedipine:

A
  • member of the dihydropyridine group and
    blocks inward flux of calcium through voltage
    gated calcium channels
  • has a preferential effect on vessels as a vasodilator rather than the myocardium
  • known effect on the myometrium – it
    may inhibit premature labour (unlicensed use) and
    has been used as a tocolytic agent
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9
Q

nifedipine SE:

A
  • Acute hypotension if given sub-lingually
  • Peripheral oedema
  • Headache + flushing
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10
Q

hydralazine
(iv used for acute HTN)

how is it metabolised and by which organ?

A

by acetyaltion in liver

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11
Q

hydralazine SE:

A
  • acute hypotension if given too fast or often (give over 5 mins at least, up to every 15 mins max)
  • lupus-like syndrome (v rarely - in pts who acetlyate slowly)
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12
Q

magnesium sulphate:

(has rapid onset of action- maintained for 24 hrs post delivery/ fit)

i. how does it work?
ii. in which instances would you require monitoring?

A

i. membrane stabiliser
ii. if oliguric

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13
Q

magnesium sulphate SE:

A
  • hyporeflexia (presents in advance of more serious SE)
  • resp depression
  • cardio-respiratory arrest
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14
Q

antihypertensives to avoid in pregnancy:

A
  • ACEi
  • thiazide diuretics
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15
Q

ACEi associations:

A
  • Congenital malformations – especially CVS
  • Skull defects
  • Oligohydramnios + impaired fetal renal function
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16
Q

effect on neonate with bendroflumethiazde:

A

neonatal thrombocytopaenia

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17
Q

indications for tocolysis:

A
  • To achieve 24 hour steroid latency < 34 weeks
  • to allow for in-utero transfer
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18
Q

drugs used for tocoloysis:

A
  1. nifedipine
  2. atosiban

less commonly:

  1. beta-sympathomimetics (salbutamol, ritodrine,
    terbutaline) NICE recommends avoid
  2. magnesium sulphate - recommended for neuroprotection from 24–30 weeks gestation and possibly 30–34 weeks
  3. GTN patches - no better than ritodrine but less SE
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19
Q

beta-sympathomimetics (salbutamol, ritodrine,
terbutaline)

SE

A

tachycardia
hypotension
pulmonary oedema
hypokalaemia
hyperglycaemia

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20
Q

i. which medication is given prior to ECV (external cephalic version) to improve success rates?

ii. in only which group of women is this done?

iii. SE of this medication

A

i. terbutaline s/c

ii. primagravida

iii. transient maternal tachycardia and tremor

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21
Q

which medication is given as emergency tocolysis in response to hyperstimulation (usually from oxytocin)

A

terbutaline iv

22
Q

which medication should be given to reduce PET risk in high risk pts?

from/to which gestation?

why it stopped in late pregnancy?

A

aspirin 75mg
12 to 36 weeks gestation

theoretical risk of neonatal haemorrhage

23
Q

high risk RF for PET

A
  • hypertensive disease during a previous pregnancy
  • CKD
  • autoimmune disease such as SLE or antiphospholipid
    syndrome
  • type 1 or type 2 diabetes
  • chronic hypertension.
24
Q

risks associated with NSAIDs in pregnancy:

A
  • A possible increase in miscarriage [5]
  • Fetal renal impairment and oligohydramnios
  • Increased risks of premature closure of the ductus
    arteriosus – the evidence for this is actually poor
  • Potential small increased risk in necrotising
    enterocolitis (NEC)
  • They can also cause maternal upper GI symptoms
    and renal impairment over prolonged periods
25
Q

on which receptor do opioids work?

what is the effect of this?

A

μ opioid receptors

reduces cerebral appreciation of pain

26
Q

opioids SE

A
  • Sedation
  • Nausea and vomiting
  • Constipation
  • In large quantities (invariably as drugs of abuse) they
    may cause a neonatal withdrawal syndrome
27
Q

pain relief in labour

A

ENTONOX – 50/50 nitrous oxide / O2 mix. This is
safe, stable and has a very rapid onset and offset. It is
widely used and highly effective for many.
6 Side effects: nausea, “feeling drunk”
6 Pethidine IM is widely used despite little evidence of
effective pain relief.It has a rapid onset and short halflife.
6 Side effects: nausea and vomiting, narcosis,
respiratory depression in the neonate if within
2 hours of delivery.
6 Morphine though less widely used appears to be more
effective and as safe. Both pethidine and morphine
are μ–opioid receptor agonists.
6 Combinations of bupivicaine (local anaesthetic) and
fentanyl (opiate) in epidural administration provide
highly effective pain relief.
6 Side effects: hypotension, loss of mobility, higher
chance of assisted delivery and rarely complications
associated with insertion (dural tap, haematoma, high
blockade).

28
Q

drugs used to manage 3rd stage of labour:

A
  • syntometrine (ergometrine 500mcg/ syntocin 5IU)
  • syntocin (synthetic oxytocin)
  • misoprosotol
  • carboprost
29
Q

syntometrine

i. SE
ii. CI

A

causes prolonged vasoconstriction
i. N+V, HTN
ii. hypertensive disorders

30
Q

syntocin

A

synthetic oxytocin

causes short-term uterine contraction

31
Q

misoprostol

i. class
ii. SE

A

i. PGE1 analogue
ii. diarrhoea/ N&V

32
Q

carboprost

i. class
ii. caution in
iii. avoid in

A

i. PGF2α analogue
ii. HTN
iii. asthmatics

33
Q

hyperemesis gravidarum

i. incidence

A

i. 1-2% of all pregnancies

34
Q

anti-emetics:

1st line

A

1st line:
- Promethazine

2nd line:
- metoclopramide
- prochloperazine

3rd line
- ondansetreon

4th line
- corticosteroids (methylprednisolone or hydrocortisone)

35
Q

promethazine
i. which family of drugs does it belong to?
ii. how does it work? (2)
iii. SE

A

i. phenothiazine family

ii. histamine antagonist (H1), also some anti-muscarinic effect)

iii. sedation
extrapyrimidal neurological effects such as tardive
dyskinesia (rarely)

(prochloperazine is also in this family and has similar SE)

36
Q

metoclopramide

i. class
ii. how does it work?
ii. SE

A

i. dopamine (D2) antagonist and a 5-HT3 antagonist
ii. central anti-emetic effect and increases gastric emptying,
iii. akathisia (restlessness), tardive dyskinesia

37
Q

ondansetron
(3rd line, not licensed in pregnancy)
i. class
ii. SE

A

i. 5-HT3 antagonists
ii. headache, diarrhoes, sedation

38
Q

2 drugs used for menorrhagia (non-hormonal)

A
  • mefenamic acid
  • tranexamic acid
39
Q

mefenamic acid

i. class
ii. how much do they reduce blood loss

A

i. NSAID, prostaglandin inhibitor
ii. 30%

SE = same as for other NSAIDs

40
Q

tranexamic acid

i. class of drug
ii. how does it work
iii. % by which it reduces blood loss
iv. SE
v. caution in which group of pts?

A

i. anti-fibrinolytic
ii. blocks conversion of plasminogen to plasmin and reduces fibrinolysis
iii. 40-50%
iv. mild GI upset
v. pts with cardiac disease

41
Q

urge incontinence

i. type of drug used commonly
ii. examples x2
iii. main receptor
iv. % of pts which see improvement in sx

A

i. anti-muscarinics
ii. tolteridone, oxybutynin
iii. M3 (oxybutanin is less selective than tolteridone)
iv. 60-70%

42
Q

anti-muscarinic SE

A

dry mouth
dry eyes
constipation
dizziness

MR preparations may reduce SE

43
Q

other medications used for urge incontinence:

(than tolteridone and oxybutynin)

A

imipramine (also anti-muscarinic)

Trospium chloride
propiverine
desmopressin

44
Q

drug used for stress incontinence:

i. what class is this?
ii. how does it work?
iii. % of pts it improves sx in
iv. SE
v. % of pts who experience SE

A

duloxetine

i. SNRI
ii. increases urinary sphincter tone
iii. 50%
iv. dissiness, nausea, insomnia
v. 10-20%

45
Q

classes of cytotoxic agents & how they work:

A

Antimetabolites - interfere with DNA and RNA
synthesis e.g. 5-FU, methotrexate (folate antagonist)

Alkylating agents - form covalent bonds with DNA
bases e.g. cyclophosphamide, isofosfamide

Intercalating agents - bind to DNA, thus inhibiting
its replication e.g. cisplatin, carboplatin

Anti-tumour antibiotics - complex mechanisms
leading to inhibition of DNA synthesis e.g.
bleomycin, doxorubicin, etoposide

Drugs directed against spindle microtubules
inhibiting mitosis e.g. paclitaxel, vincristine

46
Q

common regime in ovarian ca

A

platinum based regimes
Carboplatin +/- paclitaxel

47
Q

endometrial cancer

A

chemotherapy usually only in recurrent or metastatic disease

most commin regimes:
carboplatin +/- paclitaxel or
doxorubicin and cisplatin

48
Q

cervical cancer

A

cisplatin & radiotherapy reduce risk of relapse for those undergoing radiotherpay after surgery

cisplatin & methotrexate - for metastatic disease (response rate may be low)

49
Q

vulval ca

A

5-FluUracil (5-FU) +/- cisplatin

+ radiotherapy

used if unfit for surgery or as sole therapy for sx control in metastatic disease

50
Q

trophoblastic disease

A

Methotrexate for simple
trophoblastic disease. EMA-CO (Etoposide,
Methotrexate, Dactimomycin, Cyclophosphamide,
Vincristine) for high risk trophoblastic disease. Both
have cure rates of around 99%

51
Q

SE of chemotherapy:

A

Haematological - bone marrow suppression which
eventually recovers; cellular nadir is around 7-14 days
resulting in neutropenia, anaemia and
thrombocytopenia.
- GI - side effects are due to loss of
epithelial cells:
- Nausea and vomiting are very common with most
agents and are actively prevented with anti-emetics.
- Mucositis: (esp. methotrexate) resulting in ulcers
in mucous membranes especially oral – these
usually resolve spontaneously.
! Diarrhoea is less common and usually transient.
- Alopecia - Taxanes (e.g. paclitaxel), doxorubicin and
etoposide commonly cause temporary hair loss. This
is seen less commonly with carboplatin and cisplatin.
- Neurological – usually dose-related and improve on
dose reduction or stopping:
- Peripheral neuropathy is commonly seen with
paclitaxel and cisplatin
- Tinnitus is associated with cisplatin
- Constitutional - tend to have cumulative effects but
resolve on cessation.
- Lethargy
- Anorexia

part I (12 decks)

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