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Year 4 Pharmacology > GOSH drugs > Flashcards

GOSH drugs Flashcards

1
Q

Indications for antenatal steroids

A

24+0 - 36+6 weeks

Pre-term labour
P-PROM
Expected preterm birth

Give IM

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2
Q

Purpose of antenatal steroids

A

Hasten the maturation of foetal lungs in anticipation of premature delivery.

Reduce likelihood of infant respiratory distress syndrome

Reduce mortality

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3
Q

Syntocinon MOA and indications

A

Synthetic oxytocin = Stimulates uterine contractions

Inducing labour (IV)

Augmentation of labour if hypotonic uterus (IV)

During C section (IV)

Prevention of PPH after delivery of placenta = active management (IV)

Treatment of PPH (IV)

Miscarriage

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4
Q

SE and CI of syntocinon

A

SE:

  • arrhythmias
  • headache
  • nausea and vomiting
  • uterine hyperstimulation (can cause foetal distress)
  • water intoxication

CI when labour/SVD inadvisable (e.g. placenta praevia, or foetal malposition)

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5
Q

Ergometriene MOA and indications

A

Ergot alkaloid = contracts uterine and vascular smooth muscle

PPH caused by uterine atony (given in 3rd stage of labour)

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6
Q

Ergometriene SE and CI

A

SE:

  • abdominal pain
  • arrythmias
  • coronary vasospasm
  • hypertension
  • dizziness, headache
  • dysponea
  • vasoconstriction

CI:

  • eclampsia/hypertension
  • first/second stage of labour
  • vascular disease
  • sepsis
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7
Q

Tocolytics MOA and indications

A

MOA: myometrial relaxants

Indications:

  • to postpone premature labour so that antenatal corticosteroids can be given
  • 24-33 weeks
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8
Q

Tocolytics of choice

A

1st line = nifedipine (Ca2+ channel blocker)

2nd line = atosiban (oxytocin receptor antagonist) if nifedipine CI

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9
Q

SE and CI of atosiban

A

SE:

  • dizziness/headache
  • hot flush
  • hyperglycaemia
  • hypotension
  • N+V
  • tachycardia

CI:

  • abnormal foetal HR
  • antepartum haemorrhage
  • eclapsia
  • itra-uterine foetal death
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10
Q

SE and CI nifedipine

A

SE:

  • constipation
  • oedema
  • vasodilation

CI:

  • acute angina
  • aortic stenosis
  • within 1 month of MI
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11
Q

Atosiban MOA and indications

A

Oxytocin receptor antagonist = competitively inhibits oxytocin (and vasopressin), providing a dose-dependent inhibition of uterine contractility.

Given as a tocolytic in premature labour to delay delivery until antenatal steroids can be given

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12
Q

Antenatal aspirin dose/indications

A

75-150mg from 12 weeks

If 1 high risk factor of developing pre-eclampsia:

  • HTN in previous pregnancy
  • chronic HTN
  • chronic kidney disease
  • T1/T2 DM
  • Autoimmune disease

If 1+ moderate risk factor of developing pre-eclampsia

  • BMI >35
  • Age >40
  • first pregnancy
  • pregnancy interval >10 years
  • FH of pre-eclampsia
  • multiple foetal pregnancy
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13
Q

Indications and MOA for tranexamic acid

A

PPH (>500ml after vaginal delivery)

Prevention of PPH after C section in high risk women

Heavy menstrual bleeding

MOA = anti-fibrinolytic

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14
Q

Indications and MOA of mefenamic acid

A

Dysmenorrhoea

NSAID = decreases prostaglandin synthesis, reduces pain

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15
Q

Misoprostol MOA and indications

A

MOA = prostaglandin analouge, softens cervix and stimulates uterine contractions.

Can be given vaginally or orally

Indications

  • medical management of miscarriage
  • termination of pregnancy (+ mifepristone)
  • induction of labour (vaginal)
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16
Q

Misoprostol SE and CI

A

SE:

  • heavy bleeding
  • pain
  • diarrhoea/vomiting

CI
- Caution in patients with CVD

17
Q

Indications for IM methotrexate

A

Medical management of ectopic pregnancy

If serum hCG 1500-5000 and surgical criteria not met

18
Q

Treatment of BV

A

Metranidazole PO (first line even in pregnancy and breastfeeding)

Clindamycin (2nd line) but can weaken condoms

19
Q

Treatment of vulval candida infection (thrush)

A 
Clotrimazole pessargy 500mg STAT
OR
Clotrimazole cream 
OR
Fluclonazole 150mg PO STAT (avoid in pregnancy)
20
Q

Treatment of trichomonas vaginalis

A

400mg Metranidazole PO BD for 5-7 days

21
Q

Treatment of chlamydia

A

100mg Doxycycline PO BD for 7 days

If pregnant azithromycin (1g day 1, 500mg day 2 and 3)

22
Q

Treatment of gonorrhea

A

1mg ceftriaxone IM STAT

Oral cefixime + oral azithromycin if injection refused

23
Q

GnRH analogues (e.g. goserelin (zoladex)) MOA and indications

A

MOA = inhibit oestrogen production

  • by inhibiting LH and FSH production
  • induce menopause (inhibit ovulation)

Indications

  • endometriosis
  • fibroids
  • severe PMS
  • first stage IVF (inhibit natural menstrual cycle)
24
Q

SE and CI of GnRH analogues

A

SE:

  • Initial worsening of symptoms (initially cause LH/FSH surge)
  • Menopause like symptoms (low oestrogen state) = HRT can be given alongside
  • Osteoporosis

CI:
- Undiagnosed vaginal bleeding

25
Q

Progesterones MOA and indications

A

MOA
- opposes the endometrial proliferative actions of oestrogen.

Indications

  • HMB
  • Endometrial hyperplasia
26
Q

Progesterone SE and CI:

A

SE:

  • menstrual irregularities
  • headache

CI:

  • breast cancer
  • acute porphyrias
27
Q

when is oestrogen only HRT indicated

A

ONLY if the uterus is absent

28
Q

Continuous combined HRT indications and MOA

A

Indications: established menopause
- >1 year since LMP
- >54
(will cause bleeding/spotting if younger/pre-menopausal)

MOA:

  • Continuous oestrogen and progesterone
  • No bleeding (endometrium becomes atrophied)
29
Q

Sequential combined cyclical HRT indications and MOA

A

Indications: <1 year since LMP

MOA:

  • Oestrogen daily
  • Progesterone for last 10-14 days
  • withdrawal bleed monthly (stimulates menstrual bleeding)
30
Q

Sequential long cyclical HRT

A
  • Oestrogen daily for 3 months
  • Progesterone last half of 3rd month
  • Bleed every 3 months
31
Q

Tibolone MOA

A

Synthetic steroids with oestrogen, progesterone and androgen properties

  • helps boost libido
  • no bleeding
32
Q

Risks of HRT

A
  • endometrial hyperplasia (always oppose oestrogen with progesterone)
  • breast cancer
  • VTE

NO RISK IF TAKING DUE TO PREMATURE MENOPAUSE (as only returning no normal levels)

33
Q

Antibiotic Tx of PID

A
  • Stat IM 1g ceftriaxone (gonorrhoea).
    • Doxycycline 100mg BD PO for 14days (chlamydia)
    • metronidazole 400mg BD for 7-14days (anaerobes)
34
Q

Metranidazole considerations

A

AVOID ALCOHOL

Give in pregnancy if risks outweight benefits

Safe in breastfeeding but may affect taste.

35
Q

Treatment of vaginal thrush

A
  • Clotrimazole pessary (500mg)
  • Vaginal clotrimazole cream
  • Fluconazole 150 PO (AVOID IN PREGNANCY)
36
Q

Doxycycline SE and CI

A

SE:

  • GI discomfort (take with glass of water)
  • diarrhoea

CI:

  • pregnancy
  • breast feeding (teeth discoloration)
37
Q

Co-amoxiclav in prengnancy

A

AVOID

can cause NEC in baby

Year 4 Pharmacology (6 decks)

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