Prescribing and contraception Flashcards

Question

Entonox what is it, Contraindications

Answer 1

50% nitrous oxide, 50% oxygen passes though placenta contraindiction- fentanyl / haemolytic disease

Answer 2

Rapid acting local anaesthetic dose- 1% 20ml (200mg) - 2-5MINS EFFECT Administer- SC, slowly with aspiration to prevent intravascular injection (can cause systemic toxic effect)

Answer 3

WHERE: Before Spinal cord - into "lumbar epidural space" (between dura mater and ligamentum (lumber)

Answer 4

effect- analgesia + hypotension comparsion- faster / shorter acting. goes directly into CSF.

Answer 5

calcium gluconate

Answer 6

effect- anti-coagulant - prevents DVT/ pulmonary embolism indication- risk of VTE dose 40 mg contraindicated- Ibuprofen hematuria, ecchymosis (bruise), epistaxis (nose bleed) antagonist- protamine sulphate

Answer 7

Indication - heart burn (only if diet changes haven't worked) use combination calcium / magnesium based antacids (these neuralise stomach acid) avoid aluminium containing antacids (these can cause constipation / diarrhoea) * CAUTION * Consider PE * interactions- can bind with other medications so take >1hr away from iron + other meds

Answer 8

indication- reflux effect- reduces amount of acid stomach makes

Answer 9

paracetamol 1g PR diclofenac 100mg

Answer 10

AKA Nausicalm indication- anti-emetic

Answer 11

AKA B6 indication - anti-emetic Effect- nausea prophylactic dose 25mg TID safe throughout pregnancy. can be taken with other anti-emetics

Answer 12

indication - antiemetic - antenatal- <5 days (risk of abnormal movements) - intrapartum- use with opioids (instead of ondansetron, which may cause SST)

Answer 13

indication - anti-emetic NOT first line treatment avoid 1st trimester (cleft palate)

Answer 14

nifidipine pyridoxine (b6) magnesium + keep nipples warm

Answer 15

flucloxacillin 500mg

Answer 16

Nitrofuratoin - NOT after 36wks (risk of haemolytic anaemia / lactating mothers >1mth postpartum) not for parent/baby with G6PD Don't take urine alkaliniser (drug is more effective in acidic environment) Trimethoprim - NOT 1st trimester (interferes with folate metabolism)

Answer 17

indication- risk of PTL effect- uterine quiescence Take up to 34 wks

Answer 18

Flucloxacillin 500mg

Answer 19

Asymptomatic (benzylpenicillin IV 1.2g, then 0.6g q4h) Symptomatic (amoxicillin

Answer 20

what is it - yeast infection (lactobacilli)- may be caused by various Candida species (usually candida albicans) physiology develops when there is change in vaginal flora risk factors- 2nd half pregnancy, antibiotics, diabetes, UTI's, anaemia, HIV NOT A STI symptoms vaginal irritation (itching / irritation/ redness), burning or stinging with PU, PV dx (thick / white/ thin / watery) swelling / splits in skin risks in pregnancy may be associated with PTL so best to get treated management treat only if symptomatic send swab for culture before commencing treatment (confirm which type of candida) Clotrimazole !% (36g)- 6-7 day course

Answer 21

dose 5IU oxytocin +0.5mg ( 500mcg) ergometrine (1ml IM) Can repeat after 2hrs (max 3ml in 24hrs) onset - acts within 2-3mins lasts- 2-4hrs side effects- nausea / vomiting/ headache contraindications- hypertensive disorders (incl PE), cardiac disease, asthma (ergometrine can result in vasospasm)

Answer 22

dose- 5IU (1ml) IV onset- 1min, lasts 15-30mins side effect- nausea / vomiting cautions- oversaturation of oxygen receptors / max 100 IU / 24hrs

Answer 23

uterotonic dose: 10 IU (1ml) IV onset- 2-3mins, lasts 30-60mins side effects nausea + vomiting caution- oversaturation of oxytocin receptors max in 1hr- 100IU

Answer 24

dose- 40 IU / 500ml (4hrs) ONLY AFTER BIRTH OF PLACENTA!!

Answer 25

effect-"antifibrinolytic"- reduces bleeding by stopping breakdown of fibrogen / fibrin dose- 1g IV (slow push to avoid hypotension) contraindicatd- if woman has coagulopathy

Answer 26

effect- uterotonic indication- PPH - use after oxytocin, ergometrine side effect- nausea, vomiting, diarrhea, fever Contraindication- asthma, cardiac/ pulmonary/ renal / PID

Answer 27

Primary- toxic to sperm / stops transports secondary- inflmmatory effect on endometrium when- <48hrs postpartum, or after 4-6 wks postpartum (risk of expusion >48wks-<4wks) no hormonal side effects likely to cause heavier / painful bleeding

Answer 28

mechanism of action progesteogen released into uterine cavity- causes cervical mucous thickening and alters composition of endometrial fluid Does not interfere with breastfeeding when can you start?- if not breastfeeding, can be inserted within first 48hrs or after 4wks (high risk of expusion >48hrs- 4wks) if breastfeeding- wait 4 wks (avoid interfering wtih breastfeeding) side effects lighter bleeding

Answer 29

Drugs that delay birth preferred- Nifipine (calcium channel blocker) contraindications - - >34wks gestation -risk to mum / baby to delay birth ( significant bleeding / infection / abnormal HR/ fetus not compatible with life) maternal refusal

Answer 30

dose- IM ~80-100mg qid (max 300mg / day) (maternal Weight dependent) Route- IM time to peak effect 15-30mins Setting- primary unit (1 only/ consider transfer) + tertiary

Answer 31

what is it- "Jadelle" 2 Rods SC Implanted into upper arm lasts for 1-5 years what is mechanism of action- rod releases progestogen primary - thins endometrium / affects cervical mucous secondary - inhibit ovulation through suppressing LH surge when can you start? immediately postpartum side effects variable/ unpredictable bleeding headache, acne, weight gain, mood changes rapidly reversible BF minute amounts ingested via breastmilk contraindications- anti-epileptic meds, St johns wart, Antivirals for TB + HIV

Answer 32

what is it oestrogen + progesterone pill take within 24hrs of each other what is mechanism of action inhibits LH/ FSH inhibit endometrium dev side effects oestrogen- Increased risk of VTE disrupts lactogenesis III Weight gain / acne /mood increases risk of stroke when can you start? not breastfeeding -3 wks post partum ( avoid risk of VTE) Breastfeeding- 6wks post partum but ideally wait for 6mths impact on breastmilk minute amount of hormone in breastmilk- but viewed as safe overall Contraindications breast cancer (family hx of certain genetic mutations that increase risk of breast cancer) known genetic mutations family hx of VTE risk factors for stroke (BMI>30, >35 years, >smoking / >diabetes / Hypertension >taking medications that induce CYP3A4 liver system (reduce efficacy of contraceptive)

Answer 33

21days postpartum

Answer 34

contraception via breastfeeding prolactin inhibits GnRH --> FSH/LH 98% effective 3 Criteria must be met <6mths exclusively/ near fully BF (no long intervals (<4hrs during day, <6hrs night) no period effectiveness reduced with expressing

Answer 35

what is it Progesterone only everyday -take within 3hr window (no inactive day)- if you miss a 3hr window, wait 48hrs what is mechanism of action * primary- block passage of sperm through thickening mucous + decreasing endometrial rceptivity * varying effect on ovulation when can you start?- anytime post partum effect on Breastfeeding doesn't seem to reduce volume minute amounts pass through breastmilk Contraindications current breast cancer (but ok if you are old / smoking/ clotting risk) if mum is taking medication that affects CYP3A4 liver system medical assessment req if hypertensive, cancers, previous ectopic pregnancy, cysts,)

Answer 36

what is it aka depo provera 3mth injection medroxyprogesterone (doesn't contain oestrogen) what is mechanism of action primary- suppress ovulation (suppress FSH/ LH) Secondary- thickens mucous / thins endometrium side effects can take 1 year to return of fertilty reduced bone density variable effect on bleeding when can you start? Anytime post partum- but bleeding may be heavier in first 6wks no evidence it affects breast milk

Answer 37

10 IU in 500ml NacL (With 1000ml Nacl)

Answer 38

indication- BV / trichomonal infection pregnancy- recommended to treat BV/ trichomonas in all trimesters breastfeeding -metranidazole crosses placenta + is excreted in breast milk- ideally avoid during breastfeeding / at least wait 12-24hrs after single dose regimen

Answer 39

Indication- prophylaxis of seziures for women with severe pre-eclampsia treatment of eclamptic convulsions side effect nausea, vomiting, diarrhoea, thirst, flushing, hypotension, respiratory depression, loss of reflexes

Answer 40

indication- anti-emetic antihistamine

Answer 41

Anti hyperintensives contraindicated in pregnancy

Answer 42

mum- micronazole baby- nystatin

Answer 43

how drugs are absorbed / distributed / metabolised / eliminated

Answer 44

how drugs act on the body

Answer 45

what is it acute + severe systemic reaction after exposure to antigen mast cells / basophils cause immune response usually occurs seconds-minutes to exposure range from mild-very severe signs / symptoms * tachycardia, sweating, dizzy, fainting, unconscious, wheezing, chest tightness, difficulty breathing, swelling lips / tongues/ eyes * nausea / vomiting/ diarrhoea * throat swelling treatment *stop any IV treatment * call for Emergency help * Commence Resus * Adrenaline

Answer 46

Antiviral increase healing rate + decrease pain of herpes lesions

Answer 47

Contraindicated for breatfeeding women- neonatal toxicity as some women quickly metabolise codeine which creates risk of opioid toxicity

Answer 48

-breastfeeding * concurrent use of SSRI antidepressants (Serotonin toxicity)

Answer 49

ultraproct contains steroids that have anti-inflammatory vasoconstrictor effect + local anaesthetic Don't use extensively (large amounts/ long duration) in pregnancy contraindications- ultraproct in Trimester 1

Answer 50

treatment of constipation (often used prophylactically for women with haemarroids /perineal tear/ operative birth) time to effect 24-72hrs after oral administration how it works * shortens transit time of intestinal contents (by increasing fluid in intestine which increases peristalsis) * promotes natural bowel flora safe + effective in pregnancy / breastfeeding

Answer 51

indication- anti-emetic effect- sedating anti-histamine

Answer 52

indication: Vit d insufficiency (<50) / deficiency (<25) Risks maternal- risk of GDM / PE neonatal- bone health / birth weight/ teeth / acute respiratory infection Risk factors - dark skin tone -live south of nelson (winter/ spring) -spend limited time outdoors Prescribe maternal - 400-800 IU colecalciferol 188mcg /ml (1-2drops) - anyone with > 1 risk factor Testing not routinely recommended Can test if people have known hx of vit d deficiency, or all 3 risk factors

Answer 53

indication- partially / exclusively breastfed prescribe 400 IU 188mcg /ml (1 drop ) / day- from 1mth - 1year don't go into sun

Answer 54

AB - contraindicated in pregnancy (rare maternal acute fatty liver necrosis)

Answer 55

Indication: for baby at high risk of Turburculosis Country : >40casees / 100k population Risk factors - live with someone who has been In country with tb risk for last 5 years, for over 6mths - baby going to high risk country for 3mths Administration -MW refer for vaccine -Burwood contact- give before 5yrs

Answer 56

metronidazole crosses placenta + is excreted in breastmilk- NZF says avoid high single dose when breastfeeding

Answer 57

placental insufficiency (Excess iron poisons organs) should always recheck bloods after starting iron supplements 2-4wks later

Answer 58

hormonal- safe to take postpartum, doesn't effect lactation but mum should not breastfeed for 1wk copper iud (no effect on BF)

Answer 59

fluoxetine (slower clearance)- avoid unless used in pregnancy generally benefit of BF outweighs risk

Answer 60

possible risk of congenital cardiac malformation PPH (active mgmt) small but increased risk of persistent pulmonary hypertension of NB- look for cyanosis poor neonatal adaption -investigate other possible causes

Answer 61

Lithium Lithum toxicity -if mum BF's, requires lose monitoring

Answer 62

Indication- treat anxiety / PTSD risks - neonatal breathing difficulty + neonatal abstinance (symptoms may not present for several day after birth) --> consider tapering/ stopping close to term - caution with breastfeeding, as associated with adverse afefts (sedation, jaundice, apnoea)

Answer 63

risks- miscarriage, PTL, FGR, placental abruption, oligohydramnios neonatal abstinance syndrome DON'T suddenly withdrawal--> Risk of stillbrith mgmt minimise stimulation (swaddling / sucking/ skin to skin/ dark / quiet) opioid substitution treatment ( morphine / methadone)

Answer 64

Rotavirus pertussis (whooping cough, diphtheria, tetanus) polio, hep B, Hib pneumococcal

Answer 65

>40/ 100k people