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ENRP Exam 1 > Wolff Ante- and Perinatal Pharm > Flashcards

Wolff Ante- and Perinatal Pharm Flashcards

1
Q

What drugs are used for the induction of labor and control of post partum bleeding?

A
  • Misoprostol
  • Dinoprostone
  • Carboprost
  • Oxytocin
  • Ergot alkaloids
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2
Q

What drugs are used to maintain and close a patent ductus arteriosus?

A
  • Maintain: Alprostadil
  • Close:
    • indomethacin
    • ibuprofen
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3
Q

What are the Tocolytics used to delay labor?

A
  • terbutaline
  • Indomethacin
  • Nifedipine
  • MgSO4
  • Atosiban
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4
Q

What are the anti hypertensives used in pregnancy?

A
  • a-methyldopa
  • labetalol
  • hydralazine
  • sodium nitroprusside
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5
Q

Misoprostol MOA?

A
  • synthetic prostaglandin E1 analog
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6
Q

Misoprostol indications

A
  • Termination of uterine pregnancy if <77 days in combo with mifepristone
  • off label for cervical ripening to induce labor and help control post partum bleeding
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7
Q

Contraindications to misoprostol?

A
  • Pregnancy unless being used for abortion
  • Previous C-section
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8
Q

Pharmacokinetics of Misoprostol?

A
  • Stable at room temperature
  • oral
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9
Q

AE’s of Misoprostol?

A
  • n/v diarrhea
  • chills shivering
  • abd. pain
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10
Q

Dinoprostone MOA?

A
  • Prostaglandin E2 analog
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11
Q

Dinoprostone Indications?

A
  • Induces uterine contractions and cervical ripening
  • off label for abortions at later stages
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12
Q

Dinoprostone pharmacokinetics?

A
  • Comes in a gel and an insert or suppository
    • needs refridgeration
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13
Q

AE’s of dinoprostone?

A
  • Back pain
  • n/v diarrhea
  • fever chills
  • warm feeling in vagina
  • during an abortion can have fever unresponsive to NSAIDs
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14
Q

Carboprost MOA?

A

Synthetic prostaglandin F2alpha analog

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15
Q

Indications for Carboprost?

A
  • used to induce abortion btw 13 and 20 weeks
  • post partum hemostasis for refractory bleeding
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16
Q

Contraindications for Carboprost?

A
  • acute PID
  • active cardiac pulmonary renal or hepatic dysfunction
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17
Q

Carboprost AE’s?

A
  • Htn and pulonary edema
  • chills/shivering (reduces body temp)
  • dizzy
  • heartburn, gagging, diarrhea
  • choking sensation
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18
Q

Carboprost pharmacokinetics?

A

Deep IM injection

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19
Q

Oxytocin MOA?

A

Posterior pituitary hm

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20
Q

Oxytocin indications?

A
  • Induce labor
  • post partum hemostasis for refractory bleeding
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21
Q

Oxytocin pharmacokinetics

A

IV

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22
Q

Oxytocin AEs?

A
  • water intoxication-hyponatremia
    • rare
23
Q

Oxytocin contraindications?

A
  • DON’T induce labor if:
    • lungs are not mature
    • cervix is not ripe, it could lead to rupture
24
Q

Ergot Alkaloids MOA?

A
  • Ergonovine or ethyl ergonovine
  • stimulates adreneerrgic, dopaminergic, and serotonergic receptors
25
Q

Ergot Alkaloid effects?

A
  • on the uterus it can cause prolonged tonic uterine contractions
  • Vascular effects are that it constricts arterioles and veins
26
Q

Ergot Alkaloids indications?

A
  • Increase uterine tone and decrease bleeding
    • given after delivery
27
Q

Pharmacokinetics of ergot alkaloids?

A

Oral, IV, IM

28
Q

Ergot alkaloids AE’s?

A
  • rare significant AE’s
  • historically St. Anthony’s Fire
    • mania psychosis vomiting
    • dry gangrene affecting poorly vascularized areas
29
Q

Ergot Alkaloids contraindication?

A

Hypertension and hypersensitivity

30
Q

How do we attempt to reduce RDS risk in a premie?

A
  • corticosteroids are used in pre term delivery to promote lung maturation and increase surfactant production
31
Q

Indications for Antenatal Corticosteroids?

A
  • Between 24 weeks and 36 weeks with:
  • threatened pre term labor
  • antepartum hemorrhage
  • preterm rupture of membranes
  • conditions that require C-sections
    • pre-eclampsia and HELLP
32
Q

How are betamethasone and dexamethasone given and what for?

A
  • Betamethasone: two IM injections over 24 hr intervals
  • Dexamethasone: four IM injections over 12 hr intervals
  • used to induce transcription of surfactant proteins in alveolar type 2 pneumocytes
33
Q

How do you treat RDS in premature infants?

A

CPAP, IPPV or intubation

34
Q

Ritodrine MOA and AE’s and historical use?

A
  • beta 2 agonist
  • severe hallucinations
  • previously FDA approved as a tocolytic, but no longer approved or on market
35
Q

MgSO4 uses?

A
  • used and works to prevent eclamptic seizures
  • long term drug of choice for tocolysis in the US
36
Q

Magnesium Sulfate unique protection?

A

Evidence for neuroprotection, decreases risk for cereberal palsy

37
Q

AE’s of Magnium Sulfate?

A
  • maternal:
    • flushing, palpitations, HA, depressed reflexes and respiration,
  • Fetal: muscle relaxation and rarely CNS depression
38
Q

Terbutaline tocolytic MOA?

A
  • increases cAMP leading to K channel mediated hyperpolarization and dephosphorylation of myosin light chains
39
Q

Terbutaline contraindications?

A
  • tachycacrdia sensitive cardiac disease
  • poor controlled thyroid disease or DM
40
Q

Maternal AE of Terbutaline?

A
  • cardiac arrrhythmia
  • pulm edema
  • myocardial ischemia
  • hypotension, tachycardia, SOB
  • Hyperglycemia
41
Q

Are there FDA approved Tocolytics?

A

No

42
Q

Terbutaline use according to up to date?

A

Second choice to Nefidipine btw 32 and 34 weeks when NSAIDs are contraindicated

43
Q

How is Terbutaline given?

A
  • Off label as a subcutaneous injection
  • should not be given for prevention or prolonged treatment longer than 48-72 hrs
  • NO oral use
44
Q

Contraindications to Nifedipine use as a tocolytic?

A
  • cardiac disease and renal and hypotension
  • avoid using magnesium sulfate as same time as it can cause cardiovascular collapse
45
Q

What choice agent is nifedipine?

A

2nd choice for 24-32 weeks and first choice for 32-34 weeks

46
Q

When is Indomethacin chosen as a tocolytic?

A

1st choice for 24-32 weeks Nifedipine is second choice

contraindicated after 32 wks due to potential ductus arterosus closure

47
Q

What is erythomycin eye ointment used for?

A

Prophylaxis against gonococcal conjunctivitis, it is not effective against C. trachomatis

48
Q

What is Vitamin K given to a neonate for and how is it administered?

A

IM dose given to prevent vitamin K deficient bleeding

49
Q

When is hepatitis B vaccine given to neonates?

A

Within 24 hours of delivery and more rapidly if mother has Hep B

50
Q

What is Alprostadil and its AE’s ?

A
  • Synthetic PGE1 simiilar to misoprostol given parenterally to maintain patent ductus arteriosus
  • Pyrexia, hypotension, tachycardia, apnea
51
Q

How do we close a patent ducturs arteriosus?

A

Indomethacin classically, but now ibuprofen

52
Q

What are the two first line antihypertensive drugss used in pregnancy and do they cross the placenta?

A
  • Oral alpha-methyldopa (alpha 2 agonist)
  • Oral labetalol (alpha/beta blocker)
  • ALL anti hypertensives cross the placenta
53
Q

Second line anti-hypertensives ued for severe hypertension?

A
  • Parenteral labetalol
  • hydralazine
  • sodium nitroprusside
54
Q

ACE/ARBS in pregnancy?

A

Absolute contraindication, can lead to death of baby

ENRP Exam 1 (7 decks)

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