drugs

Question 1

what opioids may be given in labour

Answer 1

morpheine, diamorphine, pethidine

Question 2

what is entonax

Answer 2

NO and O2 inhaled
usually reserved until in active labour
can feel giddy/intoxicated, risk of vomit

Question 3

what is involved in induction of labour

Answer 3

attempt made to instigate labour using medications / by artificial rupture of the amniotic membranes (amniotomy)

Question 4

what score is used to clinically assess the cervix

Answer 4

Bishops score

Question 5

what are absolute contraindications for induction of labour

Answer 5

abnormal lie
known pelvic obstruction - tumour, large ovarian cysts
placent praevia
fetal distress

Question 6

why is a previous caesarean section a relative contraindication for induction of labour

Answer 6

uterus scar is at risk of dehiscence/ rupture

Question 7

what 2 drugs are given to induce labour

Answer 7

PV prostaglandins - encourage cervical dilatation and effacement
IV oxytocin - initiates uterine contractions

Question 8

what are complications of use of oxytocin

Answer 8

uterine ehyperstimulation
hypotension
hyponatraemia

Question 9

when is augmentation of labour needed

Answer 9

contractions reduce in frequency or strength

full examine first

Question 10

what drug is used to augment labour

Answer 10

IV oxytocin

Question 11

when are women allowed to have physiological management of 3rd stage of labour

Answer 11

low risk of PPH to complications related to delivery of placenta

Question 12

what does active management of the 3rd stage of labour involve

Answer 12

early clamping and cutting of umbilical cord
uterotonic medications - syntometrine, oxytocin
delivery of placenta by controlled cord traction

Question 13

what medications are used in the active management of 3rd stage of labour

Answer 13

syntometrine - alpha agonist (smooth muscle contraction)

oxytocin - uterus contractions

Question 14

what medications can be given in the pharmacological management of PPH

Answer 14

oxytocin 
syntometrine
carboprost - prostaglandin
miso-rostov - prostaglandin
tranexamic acid - antifibrinolytic , reduce bleeding

Question 15

what drug is given to women at risk of pre term labour

Answer 15

steroids - betamethasone, dexamethasone

improve fetal lung development, improve other neonatal outcomes

Question 16

what drugs can be used for tocolysis (stop pre term birth)

Answer 16

CCB - nifedipine
oxytocin receptor antagonist
beta 2 agonist - relaxation of smooth muscle
indomethacin

Question 17

what anti-hypertensives are used in pregnancy

Answer 17

methyldopa, hydralazine, labetalol

Question 18

what is 1st line for hypertension in labour

Answer 18

labetalol - combined alpha and beta blocker

may be contraindicate in asthma and cardiac conditions

Question 19

what drug is given to women with symptomatic pre-eclampsia to prevent seizures

Answer 19

IV magnesium sulphate

Question 20

what anti-hypertensives are contraindicated in pregnancy

Answer 20

ACEi
ARB
spinolactone

Question 21

list some non - pharmacological methods of analgesia in labour

Answer 21

breathing exercises
aromatherapy
warm bath
TENS - transcutaneous electrical nerv Stimulation

Question 22

why is ibuprofen contraindicated in pregnancy

Answer 22

NSAIDs can cause premature closure of fetal ductus arteriosus
fetal oliguria
oligohydramnios

Question 23

what simple analgesics are used in pregnancy

Answer 23

paracetamol
codeine / dihydrocodeine (small risk of neonatal respiratory depression)
aspirin - not in labour

Question 24

what are side effects of giving opiates in pregnancy

Answer 24

N&V, drowsiness
respiratory depression
neonatal respiratory depression

Question 25

what are opioids usually co-prescribed with

Answer 25

anti- emetics

Question 26

do opiates cross the placenta

Answer 26

yes

Question 27

what is the antidote for opiates

Answer 27

naloxone

Question 28

what are signs of local anaesthetic toxicity

Answer 28

peri-oral tingling paraesthesia confusion, drowsiness, light headedness, seizures can lead to coma/ cardiorespiratory arrest

Question 29

what is an epidural anaesthetic

Answer 29

form of regional anaesthetic block | involves injection of local anaesthetic + opiate medications into epidural space using a catheter

Question 30

what are contraindications of an epidural

Answer 30

``` thrombocytopenia coagulopathy raised ICP local sepsis/ sepstic shock allergy to local anaesthetic lack of consent anticoagulants within 12 hours ```

Question 31

what drug is used for analgesia in most caesarean sections

Answer 31

spinal anaesthesia | local anaesthetic + opiate medication injected into subarachnoid space

Question 32

give advantages of epidurals

Answer 32

effective during labour good for baby can be topped up

Question 33

what are disadvantages pf epidurals

Answer 33

can fail to provide adequate anaesthesia cause hypotension reduces motility dural puncture headache

Question 34

what are advantages of spinal anaesthesia

Answer 34

good bilateral block | can stay awake and protect own airway during operation

Question 35

what are disadvantage of spinal anaesthesia

Answer 35

short duration small risk of inadequate pain relief need urinary catheter

Question 36

why is tetracycline contraindicated in breast feeding

Answer 36

risk of permanent tooth staining

Question 37

why is isoniazid contraindicated in breast feeding

Answer 37

risk of pyridoxine deficiency in the infant

Question 38

why is methadone contraindicated in breast feeding

Answer 38

risk of withdrawal

Question 39

why is iodine contraindicated in breast feeding

Answer 39

thyroid suppression

Question 40

why is propylthiouricil contraindicated in breast feeding

Answer 40

can suppress thyroid function in infants

Question 41

why should you always think about prescribing in women of a child bearing age

Answer 41

most pregnancies are unplanned

Question 42

if a women is on treatment for a chronic condition and falls pregnant, should she stop taking her medication?

Answer 42

no , worse for foetus

Question 43

what condition are woman with hypertension more likely to get

Answer 43

pre-eclampsia

Question 44

what are the ADME of pharmokinetics

Answer 44

absorption distribution metabolism excrection

Question 45

why may an oral absorption route be more difficult in pregnancy

Answer 45

morning sickness

Question 46

why may the absorption of IM drugs increase in pregnancy

Answer 46

blood flow increases

Question 47

why may the absorption of inhaled drugs be increased in pregnancy

Answer 47

increased cardiac output | decreased tidal volume

Question 48

why is the distribution of drugs changed in pregnancy

Answer 48

greater dilation of plasma volume - decrease plasma proteins

Question 49

what liver enzyme does oestrogen and progesterone have an effect on

Answer 49

p450

Question 50

why is there increased excretion of drugs in pregnancy

Answer 50

GFR increases 50% , reducing plasma concentration so may need to increase dose increased urination

Question 51

what things are factors in if the drug crosses the placenta or not

Answer 51

``` low molecular weight non polar lipid soluble protein binding duration of drug exposure state of fetal development ```

Question 52

what should you assume when prescribing in pregnancy

Answer 52

all drugs will cross the placenta

Question 53

what things about foetus effect drug distribution

Answer 53

different circulation less protein binding - more free drug less fat more blood flow to brain (bbb not formed)

Question 54

which way does the growing foetus excrete drugs

Answer 54

into amniotic fluid which is recirculated

Question 55

in what trimester are drugs teratogenic

Answer 55

1st trimester

Question 56

why is the biggest risk of teratogenicity the first 3-8 weeks

Answer 56

organogenesis occurring

Question 57

why are methotrexate, trimethoprim, phenytoin, carbamazepine and sodium valproate contraindicated in pregnancy

Answer 57

cause defaults in the folic acid pathway | - results in neural tube defects, oro-facial or limb defects

Question 58

why must girls taking retinoid drugs for acne e.g. isotretinoin be on contraception

Answer 58

cause neural crest cell disruption - problems including aortic arch anomalies, ventricular septal defects, craniofacial malformation, oesophageal atresia or pharyngeal gland abnormalities

Question 59

why are NSAIDs contraindicated in pregnancy

Answer 59

orofacial clefts | cardiac septal defects (ductus arterious)

Question 60

what is fetotoxixity

Answer 60

direct poisoning in 2nd and 3rd trimester

Question 61

what are possible side effects of fetotoxicity

Answer 61

``` growth retardation structural malformations fetal death functional impairment carcinogenesis ```

Question 62

why are ACEi/ ARBs contraindicated in pregnancy

Answer 62

can cause renal dysfunction and growth retardation especially in last trimester

Question 63

what defect is sodium valproate strongly associated with

Answer 63

neural tube defects 10% | alos carbamazepine and phenytoin

Question 64

what condition does alcohol in pregnancy cause

Answer 64

foetal alcohol syndrome

Question 65

describe the classes of fetotoxic drugs

Answer 65

``` A - safe B - safe to animals no data for humans C - no data D - risk but benefits outweigh in life threatening disorders X - foetal risk outweighs any benefit ```

Question 66

what drugs should be avoided in breast feeding

Answer 66

``` cytoxics immunosuppressants anti-convulsants opiates lithium amiodarone ```