Antenatal and Perinatal Pharm

Question 1

Drugs to to induce labor/control postpartum bleeding (Uterotonics)

Answer 1

Misoprostol (PGE1)
Dinoprostone (PGE2)
Carboprost (PGF2a)
Oxytocin
Ergot Alkaloids

Question 2

Tocolytics

Answer 2

Terbutaline (B2-agonist) 
Indomethacin (NSAID)
Nifedipine (Ca2+ channel blocker)
MgSO4
Atosiban

Question 3

Which arachidonic acid derivative maintains a patent ductus arteriosus?

Answer 3

Prostaglandins

Question 4

What can be given to close a PDA?

Answer 4

NSAIDs

Question 5

How does the placenta stop circulating Prostaglandins from initiating premature labor?

Answer 5

Secretion of PGDH which inactivates PGE2 from acting on the myometrium

Question 6

Describe the placental-fetal adrenal cascade in late pregnancy that increases steroid hormone production.

Answer 6

Placental CRH stimulates fetal release of cortisol and DHEA

Cortisol stimulates release of placental CRH, and a positive feedback loop occurs

Question 7

If a uterine smooth muscle cell has increased cAMP and low Ca2+ levels, is it in a relaxed or contracted state?

Answer 7

Relaxed. cAMP–>PKA–> phosphodiesterase activity–> dephosphorylation of MLCK

Question 8

What is cervical ripening?

Answer 8

Breakdown of collagen fibers in the cervix by metalloproteases to increase compliance.

Question 9

Misoprostol

Answer 9

PGE1 analog
Stimulates contractions
Cervical Ripening
Maintains PDA

Question 10

Dinoprostone

Answer 10

PGE2 analog
Stimulates contractions
Cervical Ripening

SE: Pyrexia unresponsive to NSAIDs

Question 11

Carboprost

Answer 11

PGF2a analog
Stimulates Contractions/Stops Refractory Bleeding
Induces abortion between 13-20 weeks
Given via IM

Question 12

Oxytocin

Answer 12

Increases frequency, force, and duration of uterine contractions
Induces Labor and controls postpartum bleeding

Question 13

Ergot alkaloids

Answer 13

prolonged/tonic uterine contraction

Increases uterine tone postpartum

Question 14

Maternal conditions that necessitate a preterm birth

Answer 14

HELLP syndrome
Pre-eclampsia/Eclampsia
Threat to fetus

Question 15

At what week of gestation is there a significant increase in 1 year survival rate, and decreased disability?

Answer 15

Week 22 to week 23

Question 16

What infection is it recommended to prophylactically treat for in PPROM?

Answer 16

Strep B

Question 17

What can be given to help speed along lung and brain development?

Answer 17

Corticosteroids

Question 18

Babies born prior to what week are at increased risk for RDS?

Answer 18

32 weeks

Question 19

Antenatal Corticosteroid indications

Answer 19

24-36w gestation with:
threatened labor
hemorrhage
PROM

Question 20

Corticosteroids of choice for lung maturation

Answer 20

Betamethasone

Dexamethasone

Question 21

What is MgSO4 used for in the US?

Answer 21

Prevent eclamptic seizures

Question 22

Terbutaline

Answer 22

B2-agonist used as a tocolytic

2nd choice after Nifedipine between 32-34w

Question 23

How does Nifedipine work as a tocolytic?

Answer 23

blocks Ca2+ influx, decreasing contraction

Question 24

Indomethacin MOA

Answer 24

blocks PGF2a synthesis (decreased contraction)
1st choice 24-32w
CONTRAINDICATED after 32w due to PDA closure

Question 25

What medications are often given to a newborn postpartum?

Answer 25

Erythromycin eye ointment (gonococcal prophylactic)
Vit. K to prevent bleeding
Hep. B vaccine

Question 26

Hypertensive drugs for pregnancy

Answer 26

Hydralazine
a-methyldopa
Labetalol
Nifedipine/Nitroprusside

“Hypertensive Mothers Love kNives and Nitro”