Pharmacology non-hormonal therapy in obstetrics Flashcards by Anna Hay

How does labetolol work?

non-specficic alpha and beta blockade

How well did you know this?

Not at all

Perfectly

possible side effects of long term labetolol use?

IUGR

Neonatal hypogylaecaemia + bradycardia

How well did you know this?

Not at all

Perfectly

How does methyl dopa work?

Centrally acting and is metabolised to a-methylnoradrenaline

works on post synaptic a2 agonist reducing central sympathetic flow

How well did you know this?

Not at all

Perfectly

Side effects of methyl dopa

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

How well did you know this?

Not at all

Perfectly

how does nifedipine work?

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

How well did you know this?

Not at all

Perfectly

Side effects of nifedipine

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

How well did you know this?

Not at all

Perfectly

When is IV hydrazine used

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

How well did you know this?

Not at all

Perfectly

What is MgSo4 role in the treatment of PET?

Magpie trial - prevents seizures and reduced mat death

How well did you know this?

Not at all

Perfectly

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

Membrane stabiliser

Monitor if oliguric

How well did you know this?

Not at all

Perfectly

Side effects of MgSo4>

Hyporeflexia
Resp depression
Cardio-resp arrest

How well did you know this?

Not at all

Perfectly

Side effects of ACEi in pregnancy

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

How well did you know this?

Not at all

Perfectly

Effects of thiazide diuretics

neonatal thrombocytopenia

harmful for mother & baby

How well did you know this?

Not at all

Perfectly

When are tocolytic agents used?

Unwanted uterine activity

preterm labour
acute hyper stimulation
ECV

How well did you know this?

Not at all

Perfectly

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

Under 34/40 to achieve 24 hours for steroids

in-utero transfer for neonatal care

How well did you know this?

Not at all

Perfectly

Which drugs are used for tocolysis?

NICE guideline

Nifedipine (unliscenced use)
Atosiban (oxytocin antagonist) (nausea tachycardia, hypotension)

beta-sympathomimetics (salbutamol/terbutaline), most commonly used
MgSO4 - common in USA
GTN patch

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

MgSO4

How well did you know this?

Not at all

Perfectly

Which mothers should receive terbutaline prior to ECV?

Primips

SE: transient mat tachy and tremor

How well did you know this?

Not at all

Perfectly

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

Terbutaline IV

improve fetal heart rate patterns and fetal pH

How well did you know this?

Not at all

Perfectly

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

75mg OD

12-36 weeks

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

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

Why is aspirin stopped 2-3 weeks before delivery?

Theoretical risk of neonatal haemorrhage due to anti-platelet effects

What are the SE of other NSAIDs such as ibuprofen?

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

How do opioids work?

Activate u opioid receptors reducing cerebral appreciation of pain

Side effects of opioids?

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

What is ENTONOX

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

Pethidine IM use and side effects

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

What drugs are used in an epidural?

Bupivicane (local anaesthetic) and fentynl (opioid)

SE of epidrual

``` Hypotension Loss of mobility higher chance of assisted delivery Dural tap haematoma high blockade ```

How much does active management of 3rd stage prevent PPH

50%

What is in syntometrine?

Ergometrine 500mg | Syntocinon 5IU

Side effects of syntometrine

Ergo - causes prolonged vasoconstriction SE N+V CI HTN pregnancies Syntocinon - synthetic oxytocin and short term uterine contraction.

What other drugs can you used for management PPH

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

How does misoprostol work & SE

PGE1 analogue Diarrhoea N+V

How does carboprost work

PGF2a analogue | Caution in HTN CI in asthmatics

How does promethazine work? Side effects?

Histamine H1-receptor antagonist Sedation and rare extra-pyramidal neurological SE such as tardtive dyskinesia 1st line

How does metoclopramide work? Side effects?

Dopamine D2 receptor antagonist 5-HT3 receptor antagonist Akathisia (restlessness) tardive kinésie

How doe prochlorperazine work? SE?

Dopamine D2 receptor antagonist Sedation and rare extra-pyramidal neurological SE such as tardtive dyskinesia

How does ondansetron work? When should it be used?

Serotonin 5-HT3 receptor antagonist Not liscensed in pregnancy - only use as 3rd line

What is 4th line treatment for hyperemesis?

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

Why is heartburn common in pregnancy?

Reduced lower oesophageal sphincter tone induced by progesterone

What is in gaviscon

sodium alginate calcium carbonate sodium bicarb

What type of drugs is mefanamic acid? | By what % does it reduce menstrual blood loss?

Prostalgandin production inhibitor | 30%

What type of drugs is tranexamic acid? | By what % does it reduce menstrual blood loss?

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

What types of drugs are tolteridone and oxybutynin?

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

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

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

what is the response rate to ovarian cancer? | What % relapse?

70% | 50%

Does chemotherapy have a rolle in treating endometrial cancer?

Limited | reserved for recurrent or metastatic