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Endo/Repro II Block 1 > Antenatal and Perinatal Pharm > Flashcards

Antenatal and Perinatal Pharm Flashcards

1
Q

Uterotonic Drug Examples (5)

A 
Misoprostol
Dinoprostone
Carboprost
Oxytocin
Ergot Alkaloids
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2
Q

Misoprostol

Mechanism of Action (2) Indications (4) Adverse Effects (3)

A

PGE1 analog that stimulates uterine contractions

Cervical ripening
Labor Induction
Incomplete abortions
Post-Partum Hemorrhage

Fetal hypoxia
Uterine tachysystole or prolonged contractions
Uterine rupture

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3
Q

Dinoprostone

Mechanism of Action (2) Indications (2) Adverse Effects (5)

A

PGE2 analog that stimulates uterine contractions

Cervical ripening
Pregnancy termination

Fever unresponsive to NSAIDs (during abortion)
Fetal hypoxia
Back pain
Flushing
Dizziness
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4
Q

Carboprost

Mechanism of Action (2), Delivery, Indications (2) Adverse Effects (4)

A

PGF2-alpha analog that stimulates uterine contractions

Deep IM injection

Induce abortions
Refractory post partum hemorrhage

Hypertension
Pulmonary edema
Reduced body temperature
Chills/Shivering

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5
Q

Oxytocin

Mechanism of Action (2), Delivery, Indications (2) Adverse Effect

A

Binds GPCR linked to G-alpha-q to increase force, frequency and duration of uterine contractions

IV infusion pump

Induction of labor
Refractory post partum hemorrhage

Water intoxication

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6
Q

Ergot Alkaloids

Examples (2) Mechanism of Action (3) Effects (2) Indications (2) Adverse Effects (5)

A

Ergonovine
Ethyl-Ergonovine

Stimulates adrenergic, dopaminergic and serotonergic receptors

Prolonged/tonic uterine contractions
Constricts arterioles and veins

Postpartum hemorrhage
Migraine relief

St. Anthony’s Fire: mania, psychosis, vomiting, dry gangrene
Hypertension

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7
Q

Tocolytics

Use and Examples (6)

A

Delay labor (Nifedipine and Indomethacin best choices)

Terbutaline
Indomethacin*
Nifedipine*
MgSO4
Nitroglycerin
Atosiban
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8
Q

Terbutaline

Mechanism of Action (3) Effect (2), Adverse Effects (8)

A

Increases cAMP causing K+ mediated hyperpolarization and myosin light chain dephosphorylation

Delays labor for 2-7 days
FDA says IV/Oral should not be used

Cardiac Arrhythmias
Pulmonary Edema
Myocardial ischemia
Hypotension
Tachycardia
Hyperglycemia
Hyperinsulinema
Altered thyroid function
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9
Q

Nifedipine

Mechanism of Action (2) Indications (2) Adverse Effects (7)

A

Block Ca2+ influx to decrease uterine contraction

Not FDA approved
International guidelines suggest CCB’s are preferable tocolytics

Not fetal side effects
In Mom:
Flushing
Headache
Dizziness
Nausea
Hypotension
Tachycardia
Palpitations
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10
Q

Indomethacin

Mechanism of Action (2) Indications (2) Adverse Effects (5)

A

Block synthesis of PGF2-alpha to decrease contractions

Not FDA approved
International meta analysis says it may be best choice

Constriction of ductus arteriosus
Fetal pulmonary hypertension
Impaired renal function
Hyperbilirubinemia
Necrotizing enterocolitis
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11
Q

Nitroglycerin

Mechanism of Action (2) Indications (2) Adverse Effects (2)

A

Nitric oxide donor causing smooth muscle relaxation

Not FDA approved
Insufficient evidence for use

Headache
Hypotension

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12
Q

Atosiban

Mechanism of Action (2) Indications (2) Adverse Effects (3)

A

Blocks oxytocin to decrease uterine contractions

Not FDA approved
Doesn’t work better than placebo

Headache
Nausea
Allergic reactions

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13
Q

Alprostadil

Mechanism of Action (2) Indications (2) Adverse Effects (4)

A

Parenteral PGE1 analog that maintains the Patent Ductus Arteriosus

Pre-term infants with congenital heart defects
Sustaining systemic and pulmonary blood flow

Pyrexia
Hypotension
Tachycardia
Apnea

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14
Q

Drugs Used to Close PDA

Examples (2) Mechanism of Action, Indication, Adverse Effects (4)

A

Indomethacin
Ibuprofen

Block PGE2

Clinically significant symptomatic PDA

Decreased kidney function:
Oliguria
Edema
Mild hypertension

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15
Q 
Gestational Hypertension Drugs
First Line (2) and Second Line (3) with Mechanisms
A 
Oral alpha-methyldopa (a2 agonist)
Oral labetalol (alpha/beta blocker)

Parenteral labetalol
Hydralazine (arterial dilator)
Sodium Nitroprusside (arterial/venous dilator)

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16
Q

Respiratory Distress Syndrome Treatments

Drugs (2) with Dosing, Mechanism of Action and Indications (6)

A

Betamethasone
Two doses by IM injection at 24 hour intervals

Dexamethasone
Four doses by IM injection at 12 hour intervals

Induces surfactant transcription by type 2 pneumocytes

Women between 24-36 weeks at risk of:
Preterm delivery
Antepartum hemorrhage
Preterm rupture of membranes (PROM)
Pre-eclampsia
HELLP syndrome
17
Q

Magnesium Sulfate

Mechanism of Action, Indications (3) Adverse Effects (5)

A

Inhibit Ach release release at uterine NMJ

Tocolysis
Prevention of eclamptic seizures
Neuroprotective for cerebral palsy

Skin flushing
Palpitations
Headaches
Decreased reflexes
Muscle relaxation

Endo/Repro II Block 1 (6 decks)

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