Reprouctive Pharmacology Flashcards
Rhogam (Rho(D) immune globulin)
Rh antibodies that are injected within 72 hours after birth to prevent sensitization in the rh- mother who has had a fetal maternal transfusion of rh+ fetal blood. Prevent hemolytic disease in next newborn
Indications. For rhogam
At 28 weeks rh_ mom to prevent sensitization. Can be give phorpholactically, or after any type of exposure risk that occurs after 28 weeks of gestation (amniocentesis, second trimester, miscarriage or abortion
What does rhogam do
Suppres antibody production in mom. Following delivery, preg termination, any abdominal trauma, ectopic preg, version, or after procedures such as amniocentesis or chorionic Billy’s sampling
MOE rhogam
Causes lysis of the fetal RBS from a rh-positive infant that may have entered the rh negative mothers bloodstream. By destroying the fetal RBC the mother does not form antibodies against them. Protect from becoming sensitized in future pregnancies
Side effects rhogam
Myalgia and lethargy
Coombs test
Blood test indicates the whether the mother has already been sensitized and has the presence of antibodies
Positive Coombs test
Mom sensitized
Negative Coombs est
Mom hasn’t been sensitized so can give rhogam
Does of rhogam 300 mcg given to mom. Not infant.
Standard
Microdose 50 mcg coombs
After 1st trimester miscarriage or abortion, ectopic preg or following chorionic villus sampling
Why need to watch for allergic responses with rhogam
Considered a blood product
Magnesium sulfate
CNS depressant inhibits the release of acetylcholine at neuromuscular junctions . Preventing skeletal and uterine muscle contraction.
Indication for magnesium sulfate
Preterm labor contractions and the treatment of pressclampsia
Side effects magnesium sulfate
Warm feeling, hypotension, decreased DTR, decreased respiratoy rate, decreased urine output, paralytic ileus
Antidote for magnesium sulfate
Calcium gluconate
MOS magnesium sulfate
Muscle relaxant and depresses CNS by stopping the release of ach
Decreased neuromuscular irritability and cardiac conduction
Also decrease hyperreflexia and preven t onset of seizure from eclampsia
Indications for magnesium sulfate
Preterm labor contractions and preeclampsia
Side effects magnesium sulfate
Warn feeling, hypotension, DTrS decreased respiratory rebate, decreased urine output, paralytic ileus,
Why get warm feeling with magnesium sulfate
Vasodilator
Get flushing
Why get hypotension from magnesium sulfate
Vasodilator
Can get pulmonary edema or headache
Why get decreased DTR with magnesium sulfate
Relaxes the CNS
Why get decreased urine output with magnesium sulfate
Renal perfusion decreases as a result of lowered bp and cardiac output.
Antidote to magnesium sulfate
Calcium gluconate
Magnesium toxicity
Cardiac arrest and respiratory depression.
Effect of calcium glucoronate
Increases muscle contraction
Leuprolide
Gonadotropin releasing hormone agonist
MOA leuprolide when given in a pulsating manor
Stimulates GnRH receptors in the anterior pituitary resulting ins timulation of LH and FSh which then stimulate the ovaries and testes to produce sex steroids
MOA of leuprolide when given in a Continuous manor
Potent inhibitor of gonadotropin secretion when administered continuously resulting in suppression of ovarian and testicular production of sex steroids
Down regulation LH FSH
What is pulsation use of leuprolide used o treat
Infertility
What is continuous leuprolide used to treat
Prostate cancer, precocious puberty, uterine fibroids, and endometriosis
Side effects of continuous leuprolide
*inhibit sex steroid-antiandrogenic
Decreased libido, nausea/vomiting and symptoms of menopause like amenorrhea and hot flashes
Upregulation of FSH LH
Bind to receptors on the Sertoli cells (males) and the leydig cells (females) and granula cells and theca internal cells in females
Downregulatoin FSH LH
Constant stimulation of GnRH receptors in anterior pituitary
How does pulsating leuprolide help fertility
Increase FSH LH. Stimulates leydig cells to produce testosterone and increases sperm production
Indications for continuous leuprolide
Palliative treatment of advanced prostate cancer, breast cancer
Uterine fibroids and leuprolide
Continuous
Decrease e and p which temporarily puts patient in a postmenopausal state. Shrinks fibroids and the cessation of menstruation
Endometriosis and continuous leuprolide
(Cells lining the uterus appear to flourish outside the uterine cavity0in membrane lining the abdominal cavity, peritoneum)
Decrease in e
Helps control symptoms in endometriosis
Side effects leuprolide
Antiandrogenic effects such as decreasing testosterone in men andesterogen in women. Manifests as decreased libido, nausea/vomiting, as well as hot flashes and amenorrhea
Methylegonovine (methergine) and ergotamine (ergot alkaloids) examples
Methylergovine, ergotamine, dihydroergotamine
What do ergot alkaloids do
Produce strong powerful contractions and are used to control postpartum hemorrhage and treat migraine
Indication for ergot alkaloids
Migraine, postpartum hemorrhage, as second line after treatment with oxytocin
MOA ergot alkaloids
Smooth muscle contraction-causes uterine contractions
Vasoconstriction-treat migraines but can cause hypertension
Side effects ergot alkaloids
Nausea, vomiting, severe hypertension, tachycardia
Why are ergot alkaloids used as second line treatment
Effects are often delayed
Why are ergot alkaloids not recommended for inducing labor
Delayed onset of contractions and should only be used for postpartum hemorrhage after the use of oxytocin
Why do ergot alkaloids help migrain
Constrict dilated blood vessels
Oxytocin
Synthetic analog of the hormone produced in the hypothalamus that is stored and released int he posterior pituitary
Function of oxytocin
Stimulate uterine contractions and initiate milk ejects from the nipple during breastfeeding
Indication for oxytocin
Induce labor and control hemorrhage after delivery
Why should oxytocin be give in lowest possible dose
Increased risk of side effects
When cant u administer oxytocin
Alone or without confirming cervical ripening in a pregnant patient
MOA oxytocin (pitocin)
Increased uterine contractions by stimulating receptors on the uterine muscle wall. Also stimulates milk ejection from nipple
Indications for oxytocin
Labor induction
Control postpartum hemorrhage
Side effects oxytocin
Uterine rupture, water intoxication
Why risk of rupturing uterine wall with oxytocin
Strength of muscle contractions
*higher risk if have previous uterine scarring (multi parity) bc weakened uterine walls
Contradictions to oxytocin
Fetal lung immaturity*before 20 was gestation
Cervix not ripened *may cause fetal or maternal injuries
Active genital herpes infection *TORCH need cesarean
Why must give oxytocin in IV
GI system destroys it
Carboprost (hemabate)
Synthetic prostaglandin used to treat postpartum hemorrhage by inducing uterine contractions.
What is postpartum hemorrhage
When after birth uterus doesn’t contract and stop bleeding
Indications for carboprost (hemabate)
Post partum hemorrhage
Abortion
Side effects carboprost
Hypertension, fever, bronchoconstriction, nausea, vomiting, diarrhea
MOA carboprost
Prostaglandin F2 alpha analog
Smooth muscle contraction-cause intense uterine contractions to stop. Postpartum bleeding
Side effects carboprost (hemabate)
GI distress (SM contraction), hypertension (vasoconstrict), fever, bronchioconstriction (caution with asthma history)
Consideration carboprost with fever
Fever common cause of fever must be identified (drug induced or other, such as endometriosis)
Dinoprostone and misoprostol
Prostaglandin medications tat both act to ripen the cervix.
Dinoprostone (prepidil, cervidil)
Only used topically as a gel or vaginal insert
Induce abortion or ripen the cervix to induce labor
Misoprostol (cytotoxic)
Also used as energy contraception and to prevent GI ulcers
Also used topically as a gel or vaginal insert
Induce abortion or ripen cervix to induce labor
MOA dinoprostone and misoprostol
Stimulate contraction and ripening of the cervix to stimulate induction of labor or the induction of abortion
MOA ddinprostons is also known as a ___, while misoprostol is a _____
Prostaglandin E2 (PGE2) Prostaglandin E1 (PGE1)
Indications for dinoprostone and misoprostol
Promote cervical ripening(breakdown of colalgen)
Prevent GI ulcers(stimulates secretion of mucus and bicarbonate, maintains submucosal gastric perfusion and suppresses secretion of gastric acid)
Protecting against NSAID induced ulcers (misoprostol serves as a replacement for endogenous prostagladins)medical abortion (stimulate uterine contractions to expel fetus)
Misoprostol emergency contraception
Yup
Side effects misoprostol and dinoprostone
Fetal distress
Hyperstimuation of uterus
Why give prostagladins before induction of labor or initiation of oxytocin
Softening and ripening of cervix which should occcur before the induction of labor or use of oxytocin
