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MRCOG Part one > Pharmacology non-hormonal therapy in obstetrics > Flashcards

Pharmacology non-hormonal therapy in obstetrics Flashcards

1
Q

How does labetolol work?

A

non-specficic alpha and beta blockade

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2
Q

possible side effects of long term labetolol use?

A

IUGR

Neonatal hypogylaecaemia + bradycardia

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3
Q

How does methyl dopa work?

A

Centrally acting and is metabolised to a-methylnoradrenaline

works on post synaptic a2 agonist reducing central sympathetic flow

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4
Q

Side effects of methyl dopa

A 
rebound HTN
depressed modd
Flatterened CTG
Autoimmune haemolytic anaemia (rare)
raised prolactin
hepatitis
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5
Q

how does nifedipine work?

A

dihydropyridine group and blocks inward flux of calcium though voltage gated calcium channels.
Works on vessels as vasodilator over myocardium
Does also effect myometrium
Not licensed in pregnancy

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6
Q

Side effects of nifedipine

A

acute hypotension if given SL - MR dosing given in pregnancy
peripheral oedema
headache + flushing

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7
Q

When is IV hydrazine used

A

acute hypertension
given slowly over a minimum of 5 minutes, can be repeated every 15 mins
patent vasodilator unknown mechanism

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8
Q

What is MgSo4 role in the treatment of PET?

A

Magpie trial - prevents seizures and reduced mat death

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9
Q

How does MgSo4 work? When do you need to monitor levels?

A

Membrane stabiliser

Monitor if oliguric

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10
Q

Side effects of MgSo4>

A

Hyporeflexia
Resp depression
Cardio-resp arrest

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11
Q

Side effects of ACEi in pregnancy

A

Congenital malformations
Skull defects
Oligohydramnios + impaired fetal renal function
- CI use in pregnancy

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12
Q

Effects of thiazide diuretics

A

neonatal thrombocytopenia

harmful for mother & baby

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13
Q

When are tocolytic agents used?

A

Unwanted uterine activity

  • preterm labour
  • acute hyper stimulation
  • ECV
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14
Q

In which situations should tocolytic agents be used in preterm labour?

A

Under 34/40 to achieve 24 hours for steroids

in-utero transfer for neonatal care

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15
Q

Which drugs are used for tocolysis?

A

NICE guideline

  1. Nifedipine (unliscenced use)
  2. Atosiban (oxytocin antagonist) (nausea tachycardia, hypotension)
  • beta-sympathomimetics (salbutamol/terbutaline), most commonly used
  • MgSO4 - common in USA
  • GTN patch
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16
Q

What are the side effects of beta-sympathomimetics (salbutamol/terbutaline)

A 
Tachycardia 
Hypotension
pulmonary oedema 
hypokalaemia 
hypergylcaemia 
- current NICE say avoid using them
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17
Q

What medication is used for neuroprotection from 24-30 weeks + possibly 30-34 weeks?

A

MgSO4

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18
Q

Which mothers should receive terbutaline prior to ECV?

A

Primips

SE: transient mat tachy and tremor

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19
Q

What drugs is used in hyper stimulation & what is the benefit?

A

Terbutaline IV

improve fetal heart rate patterns and fetal pH

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20
Q

What does of aspirin is given for prevention PET/IUGR and what gestation?

A

75mg OD

12-36 weeks

21
Q

Which women are at high risk of PET and should recieve aspirin?

A

Hypertension disease in previous pregnancy
CKD
autoimmune conditions such as SLE or antiphospholipid syndrome
Type 1 or 2 diabetes
chronic HTN

22
Q

Why is aspirin stopped 2-3 weeks before delivery?

A

Theoretical risk of neonatal haemorrhage due to anti-platelet effects

23
Q

What are the SE of other NSAIDs such as ibuprofen?

A
  • possible increased risk miscarriage
  • fetal renal impairment and oligohydraminios
  • increased risk premature closure of ductus arteriosus
  • small increased risk NEC (necrotising enterocolitis)
  • maternal upper GI symptoms and renal impairment
24
Q

How do opioids work?

A

Activate u opioid receptors reducing cerebral appreciation of pain

25
Q

Side effects of opioids?

A

Sedation
Constipation
N+V
in large quantities - neonatal withdrawal syndrome

26
Q

What is ENTONOX

A

50/50 notorious oxide/oxygen mix. Stage and stable rapid onset
SE nausea and feeling drunk

27
Q

Pethidine IM use and side effects

A

Widely used but little evidence of effective pain relief
Rapid onset + short half life
SE:
N+V
narcosis
resp depression of neonate if used 2 hour of delivary

Morphine less widely used seems safer and more effective

28
Q

What drugs are used in an epidural?

A

Bupivicane (local anaesthetic) and fentynl (opioid)

29
Q

SE of epidrual

A 
Hypotension 
Loss of mobility 
higher chance of assisted delivery 
Dural tap
haematoma 
high blockade
30
Q

How much does active management of 3rd stage prevent PPH

A

50%

31
Q

What is in syntometrine?

A

Ergometrine 500mg

Syntocinon 5IU

32
Q

Side effects of syntometrine

A

Ergo - causes prolonged vasoconstriction
SE N+V
CI HTN pregnancies

Syntocinon - synthetic oxytocin and short term uterine contraction.

33
Q

What other drugs can you used for management PPH

A
  • Ergometrine alone
  • Synto can be used as 40IU in saline individually
  • Misoprostol 800mcg orally/vaginaly/rectally
  • Carboporst
34
Q

How does misoprostol work & SE

A

PGE1 analogue
Diarrhoea
N+V

35
Q

How does carboprost work

A

PGF2a analogue

Caution in HTN CI in asthmatics

36
Q

How does promethazine work? Side effects?

A

Histamine H1-receptor antagonist
Sedation and rare extra-pyramidal neurological SE such as tardtive dyskinesia

1st line

37
Q

How does metoclopramide work? Side effects?

A

Dopamine D2 receptor antagonist
5-HT3 receptor antagonist

Akathisia (restlessness)
tardive kinésie

38
Q

How doe prochlorperazine work? SE?

A

Dopamine D2 receptor antagonist

Sedation and rare extra-pyramidal neurological SE such as tardtive dyskinesia

39
Q

How does ondansetron work? When should it be used?

A

Serotonin 5-HT3 receptor antagonist

Not liscensed in pregnancy - only use as 3rd line

40
Q

What is 4th line treatment for hyperemesis?

A

Corticosteroid - some evidence but not large trials, not shown to be teratogenic

41
Q

Why is heartburn common in pregnancy?

A

Reduced lower oesophageal sphincter tone induced by progesterone

42
Q

What is in gaviscon

A

sodium alginate
calcium carbonate
sodium bicarb

43
Q

What type of drugs is mefanamic acid?

By what % does it reduce menstrual blood loss?

A

Prostalgandin production inhibitor

30%

44
Q

What type of drugs is tranexamic acid?

By what % does it reduce menstrual blood loss?

A

Anti-fibrionyltic
Blocks conversation of plasminogen to plasmin reducing fibrinolysis
40-50%
SE: GI upset and cuation with pre-existing heart disease

45
Q

What types of drugs are tolteridone and oxybutynin?

A 
Muscarinic antagonist (particularly M3 receptor)
60-70% effective at reducing incontinence and irritative symptoms 
SE: dry mouth, dry eyes, constipation, dizziness
46
Q

What type of drugs is duloxetine?
When is it used?
What are its side effects?

A

Balanced serotonin and noradrenaline reptant inhibitor (SNRI)
For stress urinary incontinence, reduces stress incontience by 50%
SE: nausea, dizzy, insomnia occurs in 10-20%

47
Q

what is the response rate to ovarian cancer?

What % relapse?

A

70%

50%

48
Q

Does chemotherapy have a rolle in treating endometrial cancer?

A

Limited

reserved for recurrent or metastatic

MRCOG Part one (28 decks)

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