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Repro 2 > Antenatal and Prenatal Pharm - Fitz > Flashcards

Antenatal and Prenatal Pharm - Fitz Flashcards

1
Q

Rating pregnancy categories of drugs does NOT take into account what?

A

Does not account for risks via breast milk spread of drugs or metabolites

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2
Q

Can drugs in classes C or D cause harm in pregnancy?

A

YES, just not to everyone

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3
Q

LAST organ to properly develop for extra-uterine life?

Problem with this?

Example of case where this will be relevant?

A

Lungs

Surfactant deficiency is common in premature babies (before 32 weeks), leading to RDS

Pre-eclampsia/HELLP –> preterm C-section

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4
Q

A mother has pre-eclampsia at 30 weeks (or any case requiring pre-term delivery) and requires pre-mature C-section. What is the baby at risk for?

Drug to give to help prevent this? When?

Which ones are ok? Why?

MoA?

A

RDS (surfactant deficiency)

Corticosteroids - PRIOR to delivery (antenatal)

Betamethasone or Dexamethasone – no mineralocorticoid action

Binds GCR, causing inhibitor (hsp90) disassociation, then translocation of active GCR into the nucleus, then transcription of surfactant in TYPE 2 pneumocytes

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5
Q

Risks of antenatal corticosteroids - single vs. multiple courses

A

Single course = NONE

Multiple courses = growth defects, sepsis, brain delay, adrenal insufficiency, enterocolitis, etc.

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6
Q

Contraindications of antenatal corticosteroids

A

Mother w/ TB or systemic infection

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7
Q

Why is simple cortisol not given in antenatal period for premies?

A

Inactivated by 11-beta-HSD2 in the PLACENTA, thus fetus only gets CORTISONE

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8
Q

Describe physiology of labor induction

A
  • Estrogen (ovaries) induces oxytocin receptor expression on uterus
  • Stretch receptors in uterus cause oxytocin release (P. pituitary)
  • Oxytocin causes BOTH uterine contraction AND PGF2-alpha release (placenta), which ALSO stimulates uterine contraction
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9
Q

What is the function of PGE2 in labor?

A

Cervical ripening

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10
Q

Drugs required for inducing labor (w/ MoA)

A

Dinoprostone (PGE2) or Misoprostol (PGE1) = cervical ripening

Oxytocin = uterine contractions

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11
Q

How is Dinoprostone administered?

Side effects?

So?

A

As suppository by the cervix

Diarrhea (stimulation of GI smooth muscle too) or uterine hyperstimulation

Has string attached to suppository for easy removal if side effects are bad

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12
Q

A deficit (natural or induced) in PGs will cause what in a pregnant woman?

An excess (natural or induced) in PGs will cause what in a pregnant woman?

A

Delayed birth

Premature labor/birth

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13
Q

What else is being monitored when using oxytocin for labor induction?

A

Fetal heart strength – oxytocin diverts blood from fetus to uterus, thus testing the fetal heart capability to respond

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14
Q

Tocolytic drugs - what are they?

One to use in Pre-eclampsia/HELLP? Why?

A

Labor-delaying drugs

Magnesium Sulfate – protects from seizures in eclampsia

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15
Q

4 different MoA’s of tocolytic drugs

A
  • Beta-2 agonists
  • Ca++ channel antagonists
  • COX inhibitors
  • Oxytocin receptor antagonists
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16
Q

Where does COX come from in labor induction?

A

Placenta and myometrium

17
Q

COX-1 inhibitors used as tocolytics

MoA

A

Indomethacin
Ibuprofen

Inhibit COX-1, thus reduce PGE2 and PGF2-alpha synthesis, thus reduce uterine contractions

18
Q

Oxytocin receptor antagonist used as tocolytic

MoA

A

Atosiban

Reduce uterine contractions

19
Q

Ca++ channel blockers used as tocolytics

MoA of each

A

Nifedipine
MgSO4

Nifedipine = directly inhibit voltage-gated L-type Ca++ channel entry into myometrium

MgSO4 = competitive inhibitor at Ca++ chanels

20
Q

Beta-2 agonists used as tocolytics

MoA

A

Ritodrine, Terbutaline, Salbutamol

Increased intracellular cAMP –> reducing uterine contractions

21
Q

Beta-2 agonists - side effects

A

Tachy, hypotension, HYPOKALEMIA, HYPERGLYCEMIA

22
Q

Indomethacin – used when (as tocolytic)?

Side effects (mother and fetus)

A

2nd trimester ONLY

Fetus – facial defect (1st trimester), premature closing of ductus arteriosus (3rd trimester)

Mother – bleeding, ulcers

23
Q

Ca++ channel blockers - side effects

A

Nifedipine – dizziness, hypotension

24
Q

MgSO4 – contraindication

A

Myasthenia gravis

25
Q

Physiology of DA closure

A

Inactivation of PGE2, causing closure

26
Q

Drug used to maintain PDA

In who?

A

Alprostadil (PGE1)

Congenital heart disorders (cyanotic, low PO2, need additional blood flow to heart) – until they can be cured surgically

27
Q

Side effects of Alprostadil

Limiting effect of Alprostadil administration

A

Hypotension, tachycardia, apnea, PYREXIA (fever)

Fever

28
Q

Drug used to close PDA

In who?

A

Indomethacin (NSAID)

PREMATURE infants that can’t close the DA on their own

29
Q

A woman gives birth to a baby at term (40 weeks). The baby’s PDA does not close at birth, and the baby begins to develop LE cyanosis and RVH. Treatment?

A

Surgery (NOT an NSAID - too late)

30
Q

Indomethacin (as PDA closer) – side effects

A

Renal vascular constriction (no COX-1) –> oliguria, edema, high creatinine, mild hypertension

31
Q

Any drug that is cleared _____ must be a reduced dose in kids under 6 months

A

Renally

32
Q

Sulfamethoxazole in infants

A

CONTRAINDICATED – kernicterus (inhibits ability to clear bilirubin in kids)

33
Q

Chloramphenicol in infants

A

CONTRAINDICATED - gray baby syndrome (V/D, circulatory collapse, abdominal distention, dusky gray color

34
Q

Class B antibiotics (pregnancy) - ok to use

A

Cephalosporins, Penicillins

35
Q

Class C antibiotics (pregnancy)

Risk?

A

Fluroroquinolones, Trimethoprim

Birth defects

36
Q

Class D antibiotics (pregnancy)

Risk?

A

Tetracyclines

Fatty liver (mother) hepatotoxicity

37
Q

Antibiotics contraindicated in children…

Under 8?
Under 18?

A

Under 18 = Fluroroquinolones (floxacin) (cartilage erosion)

Under 8 = Tetracyclines (bone and teeth deposits) AND Fluoroquinolones

38
Q

Trimethoprim – why contraindicated in pregnancy?

A

DHFR inhibitor = deficient folate = BIRTH DEFECTS (months 2 and 3) – CV defects and oral clefts

Repro 2 (28 decks)

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