Pregnancy Pham Flashcards
What are the two drugs to give for moderate hypertension in a pregnant woman?
Alpha methyldopa
Labetalol
What three drugs are given for severe hypertension during pregnancy?
Labetalol
Hydralazine (arterial VD)
Sodium nitroprusside (arterial and venous VD)
What two drug classes are contraindicated in pregnant women?
ACE inhibitors and ARBS
What two clinical conditions do we see a patent ductus arteriosus?
Respiratory distress syndrome
Low birth weight/pre mature
What 2 drugs do we give for patent ductus arteriosus?
NSAIDS.
Indomethacin
Ibu
What is the organ system affected by the NSAID use and what are the three symptoms?
Kidneys.
Oliguria
Edema
Mild HTN
When are babies at risk for getting RDS and what is the most common cause of a baby being born with RDS?
Before 32 weeks
Surfactant deficiency in immature lungs
So, lets say we have a baby with respiratory problems and its over 48 hours before delivery. What can we give to help with the maturation of the lungs and why?
Betamethasone, 2 doses IM, every 24 hours or dexamethasone, 4 doses IM, every 12 hours.
Induces transcription of surfactant proteins in type 2 lung cells.
Why don’t we give cortisol to babies to mature their lungs?
Because the placenta metabolizes/inactivates cortisol to cortisone because it has a ton of 11 beta hsd2
What is the message for treating acute respiratory distress syndrome in a little guy?
Give artificial surfactant if they are not doing well.
What 4 conditions indicate corticosteroids during weeks 24-36 of pregnancy?
Threatened pre term labor
Antepartum hemorrhage
Preterm rupture of membranes
Conditions requiring C sections
Talk about the role of prostaglandins during early pregnancy, late pregnancy, and delivery?
Early pregnancy, PGDH levels are high so prostaglandin levels are low.
Late pregnancy PGDH levels are low so prostaglandins are higher and can lead to uterine contraction.
During delivery, PGDH levels are low so prostaglandins can contribute to membrane rupture and uterine contractions
What is the feedback loop for normal baby lung maturation?
Placental CRH goes to both the baby pituitary gland and adrenal glands to produce fetal cortisol to mature the lungs. That cortisol has a positive feedback response to the placenta to produce more placental CRH which continues to do its thing.
What is the target agent to increase to maintain uterine relaxation and what is the effect of that agent?
CAMP
Dephosphorylate myosin light chain
What is the agent of focus to maintain uterine contraction and what is the effect of that agent?
Decrease levels of cAMP which will lead to DAG and IP3 and calcium and contraction.
What is unique about uterine tissue cells that allows it to contract over large areas of uterus at the same time?
They have gap junctions called connexins
What is the MOA for misoprostol and what are the 3 effects after giving it?
Prostaglandin E1 analog
Replacing PG loss in stomach during NSAID use, causes the uterus to contract, and maintains a patent ductus arteriosus
2 clinical indications of using misoprostol?
NSAID induced gastric ulcer
Terminate intrauterine pregnancy less than 70 days with mifepristone
What is the MOA for dinoprostone and what are the two effects of the drug?
Prostaglandin E2 analog
Uterine contraction and cervical ripening
2 clinical uses of dinoprostone?
Cervical ripening and terminating pregnancy 12-20 weeks
Mechanism of action of carboprost and 1 effect ?
Prostaglandin F2 alpha analog.
Uterine contractions
2 clinical uses of carboprost?
Abortion from week 12-20
Post-partum bleeding
When using dinoprostone, what is the clinical condition that can cause a maternal adverse effect and what is the effect?
During abortion, a fever that is unresponsive to NSAIDS
2 effects of oxytocin?
Increased force and frequency of uterine contraction
Milk ejection
