- 400mcg per vagina q4h x 4 - vaginal administration = highly effective - minimizes the risk of SE - expulsion rate = 70-90% within 24 hours - if during 2nd trimester = more likely to need hospitalization

OB PHARM Flashcards by Namitha Kache

spontaneous abortion treatment

misoprostol (cytotec)

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what else is misoprostol used for? patti’s lecture

for induction of labor - given with prostaglandin E to soften the cervix

then oxytocin given to start contractions

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PRODUCTS OF CONCEPTION ARE EVACUATED IN 3 WAYS

o Surgical = if pt is unstable, has significant bleeding, has an infection, or just wants immediate treatment

o Medical = those who don’t want to wait for spontaneous passage (expectant) = Misoprostol

o Expectant = will eventually pass naturally (takes days to weeks)

if pt is stable = give them the choice to do surgical, medical, or expectant. if unstable = surgical

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surgical evacuation of abortion is done if

pt is unstable
has significant bleeding
has an infection
or just wants immediate treatment

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medical evacuation of abortion is done in

pts who don’t want to wait for spontaneous evacuation (expectant

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expectant evacuation of abortion

conception products will eventually pass naturally (takes days - weeks to do so)

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MISOPROSTOL DOSING

400mcg per vagina q4h x 4
vaginal administration = highly effective
minimizes the risk of SE
expulsion rate = 70-90% within 24 hours
if during 2nd trimester = more likely to need hospitalization

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PRETERM LABOR TREATMENT

TOCOLYTICS + CORTICOSTEROIDS

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GOAL OF TOCOLYTICS

for preterm labor

delay delivery by at least 48 hours - to allow the administration of corticosteroids for fetal lung maturity
this allows time for transport of the mother to a higher level of care
this stops labor to allow the underlying medical condition that stimulated labor to clear

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tocolytics shouldn’t be used before _________ weeks, and shouldn’t be used after __________ weeks

22 weeks

or after 34 weeks

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tocolytics are contraindicated when:

contraindicated when the baby or mother are unstable
⦁ fetal demise, lethal fetal anomaly, nonreassuring fetal status, severe preeclampsia or eclampsia, maternal hemorrhage, intraamniotic infection, or maternal contraindication to tocolytic drug

**CI with preeclampsia/eclampsia because the only tx for those is delivery, so don’t want to delay delivery

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tocolytic drugs

to stop preterm labor

o NSAIDS = indomethacin
o CCB = nifedipine
o beta adrenergic receptor agonists = terbutaline
o magnesium sulfate

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TOCOLYTIC OF CHOICE AT 24-32 WEEKS GESTATION

INDOMETHACIN

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2ND LINE TOCOLYTIC

NIFEDIPINE (CCB)

associated with fewer maternal SE than Magnesium sulfate

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MOA OF INDOMETHACIN

to stop preterm labor

decreases prostaglandin production through inhibition of COX

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MATERNAL SE OF INDOMETHACIN

to stop preterm labor

⦁	nausea
⦁	GE reflux
⦁	gastritis
⦁	emesis
⦁	platelet dysfunction

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FETAL SE OF INDOMETHACIN

to stop preterm labor

⦁ Constriction of DA (if drug is given > 48 hrs; more likely to occur past 32 weeks)
- prostaglandins maintain PDA, Indomethacin closes DA

⦁ Oligohydramnios - drug decreases fetal urine output –> decreases amniotic fluid volume

⦁ Neonatal complications - bronchopulmonary dysplasia, necrotizing enterocolitis, PDA, periventricular leukomalacia, intraventricular hemorrhage

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MATERNAL CI FOR INDOMETHACIN

to stop preterm labor

⦁	platelet dysfunction
⦁	bleeding disorders
⦁	hepatic dysfunction
⦁	GI ulcers
⦁	renal dysfunction
⦁	Asthma if also sensitive to ASA

think platelet dysfunction/bleeding, GI, renal, hepatic

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monitoring for indomethacin

to stop preterm labor

o if given > 48 hrs = need fetal US to evaluate for oligohydramnios & narrowing of DA

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MOA OF NIFEDIPINE

to stop preterm labor

CCB –> results in myometrial relaxation & peripheral vasodilation

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DO NOT USE NIFEDIPINE WITH

to stop preterm labor

magnesium sulfate

can act synergistically to suppress muscle contraction and result in respiratory depression

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MATERNAL SE OF INDOMETHACIN

to stop preterm labor

Study These Flashcards

⦁	nausea
⦁	flushing
⦁	headache
⦁	dizziness
⦁	palpitations
⦁	can cause severe hypotension

CONTRAINDICATIONS FOR NIFEDIPINE

to stop preterm labor

Study These Flashcards

⦁ hypotension
⦁ preload dependent cardiac lesion
⦁ use cautiously in LV dysfunction or CHF

tocolytic of choice at 32-34 weeks gestation

to stop preterm labor

Study These Flashcards

nifedipine

2nd line tocolytic at 32-34 weeks gestation

Terbutaline (beta adrenergic receptor agonist)

MATERNAL SE OF TERBUTALINE to stop preterm labor

``` ⦁ tachycardia ⦁ palpitations ⦁ hypotension ⦁ tremor ⦁ SOB ⦁ chest discomfort ⦁ hypokalemia ⦁ hyperglycemia ```

CONTRAINDICATIONS TO TERBUTALINE to stop preterm labor

⦁ tachycardic sensitive cardiac disease (tachycardia / palpitations) ⦁ uncontrolled hyperthyroidism or DM (hyperglycemia) ⦁ Use with caution in placenta previa or abruption - risk of hypovolemia & shock

TERBUTALINE MONITORING to stop preterm labor

⦁ I&Os ⦁ Maternal symptoms of SOB, CP (chest pain), tachycardia ⦁ stop drug if maternal HR > 120 ⦁ check blood glucose and K+ every 4-6 hours (hypokalemia, hyperglycemia)

3rd line therapy for prevention of preterm labor

MAGNESIUM SULFATE

corticosteroids reduces the incidence of ________ by 50%

``` ⦁ respiratory distress syndrome ⦁ intraventricular hemorrhage ⦁ necrotizing enterocolitis ⦁ sepsis ⦁ neonatal mortality ```

antenatal corticosteroids given for preterm labor | - given at 23-34 weeks

o Betamethasone | o Dexamethasone

preferred antenatal corticosteroid for preterm labor

o betamethasone

dexamethasone has to be ____________ containing, otherwise it can be _________ to the fetus

non-sulfite neurotoxic

PREMATURE RUPTURE OF MEMBRANES TREATMENT

TREATMENT = ANTIBIOTIC PROPHYLAXIS (polymicrobial) ⦁ Azithromycin 1g on admission ⦁ Followed by Ampicillin IV x 48 hrs ⦁ Followed by Amoxicillin x 5 days (AAA - azithro / amp / amox - If PCN Allergy ⦁ Clindamycin IV x 48 hrs + Gentamicin x 48 hrs ⦁ Followed by Clindamycin PO x 5 days - Tocolytics are often given to delay delivery in the presence of uterine contractions - Corticosteroids may be indicated

POSTPARTUM HEMORRHAGE = WANT TO USE _____________ DRUGS

UTEROTONIC = cause uterus to contract

uterotonic drug of choice for postpartum hemorrhage

oxytocin

drugs to treats postpartum hemorrhage

⦁ Oxytocin ⦁ Misoprostol ⦁ Carboprost Tromethamine ⦁ Methylergonovine Maleate

SE of Misoprostol (Cytotec) - causes uterine contractions - given to induce labor, abortion, & PP hemorrhage

GI symptoms = diarrhea, constipation, N/V, flatulence, abdominal pain, dyspepsia CNS = headache

which uterotonic drugs = do NOT give IV

methylergonovine (methergate) give IM or intramyometrial AND Hemabate (Carboprost tromethamine) - give IM

CI TO METHYLERGONOVINE - for PP hemorrhage

- HTN - Raynaud's - Scleroderma

CI TO HEMABATE - for PP hemorrhage

- HTN - asthma - renal failure - reduced CO

TREATMENT FOR PREECLAMPSIA - severe HTN - DURING LABOR

⦁ IV Labetalol ⦁ IV Hydralazine ⦁ PO NIfedipine

All cases of preeclampsia should be treated with ______________ during labor to prevent seizures

magnesium sulfate - adjust dose with renal insufficiency

continue magnesium sulfate x ____ hrs after delivery

MOA OF MAGNESIUM SULFATE blocks neuromuscular transmission and decreases the amount of ________ at the end plate of the motor neuron impulse

acetylcholine

TREATMENT FOR TOXIC LEVELS OF MAGNESIUM

CALCIUM GLUCONATE

ADVERSE EFFECTS OF ELEVATED MAGNESIUM LEVELS

⦁ DTRs decrease (plasma level = 4) ⦁ DTRs absent (8-10) ⦁ Respiratory paralysis (10-15) ⦁ Cardiac arrest (20-25)

DO NOT USE MAGNESIUM SULFATE WITH

CCB (NIFEDIPINE)

therapeutic levels of Mag sulfate

4.8 - 8.4

CI to magnesium sulfate

heart block myocardial damage myasthenia gravis

SE OF MAGNESIUM SULFATE

flushing, diaphoresis, warmth, N/V, Headache, muscle weakness, visual disturbance, palpitations

induction of labor treatment

oxytocin (Pitocin)

maternal adverse reactions to oxytocin

⦁ CV – arrhythmias, HTN ⦁ GI – nausea, vomiting ⦁ GU – pelvic hematoma, postpartum hemorrhage, uterine hypertonicity, uterine rupture ⦁ Severe water intoxication with seizure, coma and death associated with a slow infusion over 24 hours

FETAL ADVERSE RXNS TO OXYTOCIN

``` ⦁ CV – arrhythmia, bradycardia ⦁ CNS – brain damage, seizures ⦁ Hepatic - jaundice ⦁ Ocular – retinal hemorrhage ⦁ Other – death, low Apgar score ```

OB PHARM Flashcards

(54 cards)