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Endo Final Pharm > Pregnancy Pham > Flashcards

Pregnancy Pham Flashcards

1
Q

What are the two drugs to give for moderate hypertension in a pregnant woman?

A

Alpha methyldopa

Labetalol

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2
Q

What three drugs are given for severe hypertension during pregnancy?

A

Labetalol
Hydralazine (arterial VD)
Sodium nitroprusside (arterial and venous VD)

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3
Q

What two drug classes are contraindicated in pregnant women?

A

ACE inhibitors and ARBS

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4
Q

What two clinical conditions do we see a patent ductus arteriosus?

A

Respiratory distress syndrome

Low birth weight/pre mature

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5
Q

What 2 drugs do we give for patent ductus arteriosus?

A

NSAIDS.
Indomethacin
Ibu

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6
Q

What is the organ system affected by the NSAID use and what are the three symptoms?

A

Kidneys.
Oliguria
Edema
Mild HTN

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7
Q

When are babies at risk for getting RDS and what is the most common cause of a baby being born with RDS?

A

Before 32 weeks

Surfactant deficiency in immature lungs

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8
Q

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?

A

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.

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9
Q

Why don’t we give cortisol to babies to mature their lungs?

A

Because the placenta metabolizes/inactivates cortisol to cortisone because it has a ton of 11 beta hsd2

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10
Q

What is the message for treating acute respiratory distress syndrome in a little guy?

A

Give artificial surfactant if they are not doing well.

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11
Q

What 4 conditions indicate corticosteroids during weeks 24-36 of pregnancy?

A

Threatened pre term labor
Antepartum hemorrhage
Preterm rupture of membranes
Conditions requiring C sections

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12
Q

Talk about the role of prostaglandins during early pregnancy, late pregnancy, and delivery?

A

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

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13
Q

What is the feedback loop for normal baby lung maturation?

A

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.

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14
Q

What is the target agent to increase to maintain uterine relaxation and what is the effect of that agent?

A

CAMP

Dephosphorylate myosin light chain

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15
Q

What is the agent of focus to maintain uterine contraction and what is the effect of that agent?

A

Decrease levels of cAMP which will lead to DAG and IP3 and calcium and contraction.

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16
Q

What is unique about uterine tissue cells that allows it to contract over large areas of uterus at the same time?

A

They have gap junctions called connexins

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17
Q

What is the MOA for misoprostol and what are the 3 effects after giving it?

A

Prostaglandin E1 analog

Replacing PG loss in stomach during NSAID use, causes the uterus to contract, and maintains a patent ductus arteriosus

18
Q

2 clinical indications of using misoprostol?

A

NSAID induced gastric ulcer

Terminate intrauterine pregnancy less than 70 days with mifepristone

19
Q

What is the MOA for dinoprostone and what are the two effects of the drug?

A

Prostaglandin E2 analog

Uterine contraction and cervical ripening

20
Q

2 clinical uses of dinoprostone?

A

Cervical ripening and terminating pregnancy 12-20 weeks

21
Q

Mechanism of action of carboprost and 1 effect ?

A

Prostaglandin F2 alpha analog.

Uterine contractions

22
Q

2 clinical uses of carboprost?

A

Abortion from week 12-20

Post-partum bleeding

23
Q

When using dinoprostone, what is the clinical condition that can cause a maternal adverse effect and what is the effect?

A

During abortion, a fever that is unresponsive to NSAIDS

24
Q

2 effects of oxytocin?

A

Increased force and frequency of uterine contraction

Milk ejection

25
Q

2 clinical uses of oxytocin?

A

Induction of labor

Post partum hemostasis

26
Q

Mechanism of action of ergot alkaloids?

A

Stimulates adrenergic, dopaminergic and serotonergic receptors

27
Q

What are the two main effects of using ergot alkaloids?

A

Prolonged uterine contraction

Vasoconstrictor

28
Q

2 clinical uses of ergot alkaloids?

A

Used after delivery to increase uterine tone and stop bleeding
Migraine relief due to dilating vessel

29
Q

2 contraindications for ergot alkaloids?

A

HTN and hypersensitivity

30
Q

Off label use of misoprostol and what is the big time contraindication of it?

A

Induce labor

Pregnancy

31
Q

Big picture, what are two things we want to do with prostaglandins? 2 things with oxytocin? 1 Ergot alkaloids?

A

Great for cervical ripening, and this has to happen before contractions. Contractions anytime during pregnancy, so abortion.
Induce contractions during labor and limits post partum bleeding
Second choice for limiting post partum bleeding

32
Q

MOA for ritodrine, clinical use, and 1 adverse effect?

A

Beta 2 agonist, stop uterine contraction/prolong labor, severe hallucinations

33
Q

Mechanism of action for magnesium sulfate and 3 clinical uses?

A

Block Ach release at the uterine neuromuscular junction
Prevent eclampsia
Neuro-protection for baby
Long term drug of choice for tocolysis

34
Q

MOA for terbutaline, clinical indication, and big time adverse effect?

A

Beta 2 agonist
Stop labor
Maternal heart problems and death

35
Q

MOA of nifedipine, clinical use, how does it compare to using a beta 2 agonist for tocolytic action, 1 contraindication?

A

Calcium channel blocker, tocolysis, preferred over beta 2, cardiac disease

36
Q

MOA of indomethacin, clinical use, and 2 contraindications?

A

Prostaglandin synthesis inhibitor, tocolysis, and renal and hepatic impairment

37
Q

MOA and clinical use of atosiban?

A

Blocks action of oxytocin

Tocolysis

38
Q

What are the two tocolytic drugs he said would be preferred above all the others?

A

Nifedipine or indomethacin but only one at a time and not recommending to combine any drugs. Just one at a time.

39
Q

MOA for alprostadil, clinical use, 4 adverse effects?

A

PGE1 analog
Sometimes pre term infants have congenital heart problems and need their patent ductus arteriosus to stay open to provide pulmonary and systemic blood flow
Fever, hypotension, tachycardia, and apnea

40
Q

3 indications to use uterotonics?

A

Cervical ripening, induce contractions, control post partum bleeding

Endo Final Pharm (7 decks)

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