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drugs Flashcards

1
Q

what opioids may be given in labour

A

morpheine, diamorphine, pethidine

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2
Q

what is entonax

A

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

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3
Q

what is involved in induction of labour

A

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

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4
Q

what score is used to clinically assess the cervix

A

Bishops score

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5
Q

what are absolute contraindications for induction of labour

A

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

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6
Q

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

A

uterus scar is at risk of dehiscence/ rupture

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7
Q

what 2 drugs are given to induce labour

A

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

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8
Q

what are complications of use of oxytocin

A

uterine ehyperstimulation
hypotension
hyponatraemia

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9
Q

when is augmentation of labour needed

A

contractions reduce in frequency or strength

full examine first

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10
Q

what drug is used to augment labour

A

IV oxytocin

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11
Q

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

A

low risk of PPH to complications related to delivery of placenta

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12
Q

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

A

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

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13
Q

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

A

syntometrine - alpha agonist (smooth muscle contraction)

oxytocin - uterus contractions

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14
Q

what medications can be given in the pharmacological management of PPH

A 
oxytocin 
syntometrine
carboprost - prostaglandin
miso-rostov - prostaglandin
tranexamic acid - antifibrinolytic , reduce bleeding
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15
Q

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

A

steroids - betamethasone, dexamethasone

improve fetal lung development, improve other neonatal outcomes

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16
Q

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

A

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

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17
Q

what anti-hypertensives are used in pregnancy

A

methyldopa, hydralazine, labetalol

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18
Q

what is 1st line for hypertension in labour

A

labetalol - combined alpha and beta blocker

may be contraindicate in asthma and cardiac conditions

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19
Q

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

A

IV magnesium sulphate

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20
Q

what anti-hypertensives are contraindicated in pregnancy

A

ACEi
ARB
spinolactone

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21
Q

list some non - pharmacological methods of analgesia in labour

A

breathing exercises
aromatherapy
warm bath
TENS - transcutaneous electrical nerv Stimulation

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22
Q

why is ibuprofen contraindicated in pregnancy

A

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

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23
Q

what simple analgesics are used in pregnancy

A

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

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24
Q

what are side effects of giving opiates in pregnancy

A

N&V, drowsiness
respiratory depression
neonatal respiratory depression

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25
Q

what are opioids usually co-prescribed with

A

anti- emetics

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26
Q

do opiates cross the placenta

A

yes

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27
Q

what is the antidote for opiates

A

naloxone

28
Q

what are signs of local anaesthetic toxicity

A

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

29
Q

what is an epidural anaesthetic

A

form of regional anaesthetic block

involves injection of local anaesthetic + opiate medications into epidural space using a catheter

30
Q

what are contraindications of an epidural

A 
thrombocytopenia 
coagulopathy 
raised ICP 
local sepsis/ sepstic shock 
allergy to local anaesthetic 
lack of consent 
anticoagulants within 12 hours
31
Q

what drug is used for analgesia in most caesarean sections

A

spinal anaesthesia

local anaesthetic + opiate medication injected into subarachnoid space

32
Q

give advantages of epidurals

A

effective during labour
good for baby
can be topped up

33
Q

what are disadvantages pf epidurals

A

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

34
Q

what are advantages of spinal anaesthesia

A

good bilateral block

can stay awake and protect own airway during operation

35
Q

what are disadvantage of spinal anaesthesia

A

short duration
small risk of inadequate pain relief
need urinary catheter

36
Q

why is tetracycline contraindicated in breast feeding

A

risk of permanent tooth staining

37
Q

why is isoniazid contraindicated in breast feeding

A

risk of pyridoxine deficiency in the infant

38
Q

why is methadone contraindicated in breast feeding

A

risk of withdrawal

39
Q

why is iodine contraindicated in breast feeding

A

thyroid suppression

40
Q

why is propylthiouricil contraindicated in breast feeding

A

can suppress thyroid function in infants

41
Q

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

A

most pregnancies are unplanned

42
Q

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

A

no , worse for foetus

43
Q

what condition are woman with hypertension more likely to get

A

pre-eclampsia

44
Q

what are the ADME of pharmokinetics

A

absorption
distribution
metabolism
excrection

45
Q

why may an oral absorption route be more difficult in pregnancy

A

morning sickness

46
Q

why may the absorption of IM drugs increase in pregnancy

A

blood flow increases

47
Q

why may the absorption of inhaled drugs be increased in pregnancy

A

increased cardiac output

decreased tidal volume

48
Q

why is the distribution of drugs changed in pregnancy

A

greater dilation of plasma volume - decrease plasma proteins

49
Q

what liver enzyme does oestrogen and progesterone have an effect on

A

p450

50
Q

why is there increased excretion of drugs in pregnancy

A

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

51
Q

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

A 
low molecular weight 
non polar
lipid soluble 
protein binding 
duration of drug exposure 
state of fetal development
52
Q

what should you assume when prescribing in pregnancy

A

all drugs will cross the placenta

53
Q

what things about foetus effect drug distribution

A

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

54
Q

which way does the growing foetus excrete drugs

A

into amniotic fluid which is recirculated

55
Q

in what trimester are drugs teratogenic

A

1st trimester

56
Q

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

A

organogenesis occurring

57
Q

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

A

cause defaults in the folic acid pathway

- results in neural tube defects, oro-facial or limb defects

58
Q

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

A

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

59
Q

why are NSAIDs contraindicated in pregnancy

A

orofacial clefts

cardiac septal defects (ductus arterious)

60
Q

what is fetotoxixity

A

direct poisoning in 2nd and 3rd trimester

61
Q

what are possible side effects of fetotoxicity

A 
growth retardation 
structural malformations
fetal death 
functional impairment 
carcinogenesis
62
Q

why are ACEi/ ARBs contraindicated in pregnancy

A

can cause renal dysfunction and growth retardation especially in last trimester

63
Q

what defect is sodium valproate strongly associated with

A

neural tube defects 10%

alos carbamazepine and phenytoin

64
Q

what condition does alcohol in pregnancy cause

A

foetal alcohol syndrome

65
Q

describe the classes of fetotoxic drugs

A 
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
66
Q

what drugs should be avoided in breast feeding

A 
cytoxics
immunosuppressants
anti-convulsants
opiates
lithium 
amiodarone

reproduction (6 decks)

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