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Pharm II Unit III > 3 Uterine Thyroid Osteoporosis > Flashcards

3 Uterine Thyroid Osteoporosis Flashcards

(60 cards)

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1
Q

Hormones that cause uterine contraction

A

Estrogens
Prostaglandins
Oxytocin
Stretching

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2
Q

Hormones that cause uterine relaxation

A

Beta-adrenergic drugs (not used any more)
Progesterone
Alcohol
MgSO4

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3
Q

______ and ______ of oxytocin receptors in the uterus increase just prior to labor and delivery

A

Number and sensitivity

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4
Q

DOC for inducing labor at term

A

Oxytocin

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5
Q

Why are prostaglandins useful in inducing abortion?

A

Uterus is generally resistant to stimulation during the second trimester but prostaglandins can cause strong labor-like contractions during this time

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6
Q

Major cause of delivery-associated deaths

A

Postpartum hemorrhage (4-20% of deliveries have PPH)

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7
Q

________ is the cause of 80% of all postpartum hemorrhage

A

Uterine atony

Uterus doesn’t have enough contractility after delivery

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8
Q

First line treatment for postpartum hemorrhage

A

Uterine massage

WHY? Causes release of oxytocin —> constriction of the uterine arteries

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9
Q

Cyclic octapeptide store in posterior pituitary normally released in response to suckling and cervical pressure

A

Oxytocin (Pitocin, Syntocin)

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10
Q

Indications/therapeutic effects of Oxytocin

A

DOC to induce labor at term if indicated

  • uterine dysfunctional inertia
  • causes timed contractions (more physiological)
  • IV infusion used

For prevention of postpartum hemorrhage (IM route preferred)

For stimulation of milk let-down reflex (NASAL application via cotton pledget)

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11
Q

Adverse effects of Oxytocin

A

Water intoxication (ONLY AT LARGE DOSES) - b/c of ADH like effect of oxytocin

UTERINE RUPTURE with large dose

Allergy

Anaphylaxis

Sinus bradycardia of the fetus —> Caesarian

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12
Q

Contraindications for Oxytocin

A

Basically, if it’s not time to deliver, don’t administer

Malpresentation
Cephalopelvic disproportion
Complete placenta Previn
Uterine scar form previous Caesarian 
Unengaged head
Cervical scarring
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13
Q

What drugs are ergot alkaloids

A

Ergonovine maleate

Methylergonovine maleate

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14
Q

MOA for ergot alkaloids

A

Contraction of uterine smooth muscle through activation of serotonin and alpha-adrenergic receptors - powerful vasoconstrictors

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15
Q

Indications for the use of ergot alkaloids

A

After completion of labor and the delivery of the placenta, to produce firm uterine contractions and to decrease uterine bleeding

2nd line after massage and oxytocin have failed for PPH

To produce contractions following suction abortion

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16
Q

Adverse effects of ergot alkaloids

A 
Transient hypertension (b/c it contracts all smooth muscle)
Angina, MI
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17
Q

Contraindications for Ergot alkaloids

A

Should NEVER be used to induce labor - only AFTER DELIVERY (because it causes the wrong kind of contractions, will cause fetal hypoxia)

Peripheral vascular or coronary artery disease - increases BP

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18
Q

Dinoprostone is a synthetic ________ indicated for the expulsion of uterine contents

A

Prostaglandin

Used in cases of intrauterine fetal dearth, missed abortion (miscarriage), and elective abortions

Can also cause cervical ripening prior to delivery at term

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19
Q

How is Dinoprostone administered?

A

For abortion: one suppository in the vagina (woohoo)

For cervical ripening: apply gel to cervix

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20
Q

Adverse effects of Dinoprostone

A

GI disturbances - vomiting, DIARRHEA** (black box)

Fever, chills, H/A

Many common but not serious (use correct dose)

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21
Q

Contraindications for Dinoprostone

A

Fetal distress, history of difficult deliveries

For abortions, should not be used in patients with:

  • Acute pelvic inflammation
  • Acute cardiac, pulmonary, renal, or hepatic diseases
  • Asthma, HTN, anemia, jaundice, or epilepsy
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22
Q

What is Carboprost tromethamine?

A

A prostaglandin (PGF2a derivative) used for the induction of abortion in 13th to 20th week (2nd trimester) or for postpartum bleeding due to uterine atony

Administered IM

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23
Q

Adverse effects of carboprost tromethamine

A

Not serious if used properly, systemic PG actions often diagnosed as anaphylactic shock

Vomiting and diarrhea in >60%

Fever and rashes

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24
Q

Contraindications for carboprost tromethamine

A

Should not be used in patients with
ACUTE PELVIC INFLAMMATION
Acute cardiac, pulmonary, renal, or hepatic disease
Asthma, HTN, anemia, jaundice or epilepsy

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25
Anti-fibrinolytic agent used to reduce death due to bleeding in women with postpartum hemorrhage
Tranexamic acid Given IV along with standard uterotonic therapy (should NOT be regarded as an alternative therapy)
26
First line drug for prevent premature labor
Magnesium Sulfate Can also prevent convulsions in pre-eclampsia and treat eclampsia
27
Why must MgSO4 be administered slowly?
Significant hypotension or asystole if too fast
28
How is Nifedipine used during pregnancy?
To prevent pre-term labor (tocolytic agent) Inhibitors Ca2+ influx (and smooth muscle contractions) Becoming the 1st line agent
29
Why should you never give Nifedipine with MgSO4?
CV collapse due to severe hypotension
30
_________ is an anti-inflammatory drug that has been investigated for its ability to delay preterm labor
Indomethacin Trials show reduced frequency of delivery within 48 hours and within 7-10 days from the beginning of treatment
31
How does Indomethacin work as a tocolytic agent?
Inhibits COX enzyme —> reduction in prostaglandin synthesis (and prostaglandins cause contractions, so that’s that)
32
Adverse effects of indomethacin as a tocolytic agent
Maternal GI irritation Partial closure of the fetal ductus arteriosus
33
How is progesterone used in preventing preterm birth?
More effective than placebo in maintaining the length of pregnancy when GIVEN PROPHYLACTICALLY from the 16th-37th week of pregnancy or until delivery Not effective for acute treatment Recommended for women at high risk with a history of preterm birth Approved for use in ART to maintain the luteal phase following IVF or ICSI
34
How is nitroglycerin used in pregnancy?
EMERGENCY USE ONLY in case of uterine rupture
35
What was used historically to inhibit premature labor?
Ethanol. Yup. Works though, if you have NOTHING ELSE Direct relaxant effect on the myometrium and inhibits oxytocin release
36
Agents used in the past for premature labor but no longer due to the overwhelming cardiac problems associated with its tocolytic use
B2 adrenergic agents - Terbutaline and Ritodrine
37
Drug of choice for hypothyroidism
Levothyroxine sodium - T4 replacement
38
What do you need to know about Levothyroxine
Drug levels must be carefully titrations to the individual and vary brand to brand - monitor TSH levels and patient Sx 4-6 weeks for stead state
39
How is Liothyronine sodium (Cytomel) used?
T3 - used for initial therapy (quicker steady state levels) but not for maintenance in thyroid replacement MYXEDEMA COMA
40
Side effects of Levothyroxine
Similar to hyperthyroidism Reduce dose or stop for a few days and resume at a lower dose
41
Treatment for hyperthyroidism
Remove the gland via surgery Destroy the gland with I-131 Reduce T4/T3 with thiazides/iodide Block symptoms - BETA BLOCKERS
42
First line treatment for Grave’s disease
Thioamides - Propylthiouracil or Methimazole Inhibit synthesis of T4 PTU only - blocks conversion of T4 to T3
43
What is the black box warning for PTU?
Severe liver injury, acute liver failure Thus Methimazole is preferred unless allergies or PREGNANCY
44
DOC for Graves in pregnancy
Propylthiouracil (PTU) - doesn’t cross placenta as well
45
Why do you need to watch for sore throat and do blood tests on thioamides?
Risk of granulocytopenia and agranulocytosis
46
How is iodide used in the treatment of hyperthyroid?
Rapidly decreases synthesis and release of T4/T3 - good for short-term effect Used for 7-10 days before surgery to decrease likelihood of thyroid storm Can be used in radioactive emergencies
47
How is radioactive iodine (I-131) used in hyperthyroidism?
Small amounts diagnostic (uptake and scan) Large amounts destroy gland Used in elderly patients and those with heart disease for definitive treatment of Graves’ disease (but thioamides preferred)
48
Preferred treatment for toxic nodular goiter
Radioactive Iodine (I-131)
49
Contraindications for Radioactive Iodine use
PREGNANCY, nursing, or mothers who lack childcare
50
How is Propranalol used in hyperthyroidism?
Non-specific beta blocker, but it specifically inhibitors the peripheral conversion of T4 to T3 in addition to helping with the symptoms of hyperthyroidism Used to prepare for surgery and for those waiting for other treatments to take effect
51
What is always given in conjunction with other treatments for osteoporosis?
Calcium and Vitamin D
52
DOC for osteoporosis
Bisphosphonates + Calcium and Vit D +/- HRT +/- Calcium regulating hormones (PTH, calcitonin)
53
How is Calcitonin used in treatment of osteoporosis?
Reduces bone resorption of Ca2+ and antagonizes parathyroid hormone Indicated for Osteoporosis (though not first line) DOC for Paget’s disease
54
What drugs are the only anabolic drugs for osteoporosis?
Parathyroid drugs, b/c RG receptor activation can stimulate formation of new bone Examples: Teriparatide, Abaloparatide, rhPTH
55
Adverse effects of parathyroid drugs
Hyperkalemia and hypercalciuria Contraindicated in OSTEOSARCOMA (b/c rats)
56
Antibody against receptor activator of nuclear factor kappa-beta ligand (RANK-L)
Denosumab Inhibits bone resorption RANK-ligand is the factor made by osteoblasts that is necessary for the formation of mature osteoclasts —> inhibitors resorption
57
Indications for Denosumab
Osteoporosis in men and postmenopausal women at high risk for fractures, esp those with cancer Increases bone mass and strength in both cortical and trabecular bone
58
MOA for bisphosphanates
Substitutes for PO4 in Ca2+ binding —> incorporates into bone —> inhibition of osteoclasts activity and bone resorption
59
First line treatment for post-menopausal osteoporosis
Bisphosphonates
60
What are the special pharmacokinetics of bisphosphonates?
Absorption is very poor Must be taken on an empty stomach with exactly 1/2 glass of water and stay upright for 30 min after taking to decrease esophageal irritation

Pharm II Unit III (4 decks)

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