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OB/GYN > OB Pharmacology > Flashcards

OB Pharmacology Flashcards

(114 cards)

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1
Q

3 Ways Products of Conception are Evacuated

A

Surgical
medical
Expectant

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2
Q

Reasons for Surgical Removal of Product of Conception

A

Unstable
Significant bleeding
Infection
Want immediate treatment

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3
Q

Reason for Medical Removal of Products of Conception

A

Do not want to wait for spontaneous passage

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4
Q

Define Expectant Evacuation of Products of Conception

A

Will eventually pass naturally

Days to weeks

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5
Q

Main Drug for Medical Management of Spontaneous Abortion

A

Misoprostol

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6
Q

Uses of Misoprostol

A

Missed abortion
Incomplete abortion
Cervical ripening (unlabeled use)
Postpartum hemorrhage (unlabeled use)

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7
Q

What is misoprostol?

A

Prostaglandin E1 analog

Induces uterine contractions

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8
Q

Route of Misoprostol Administration

A

Vaginally

Every 4 hours x 4

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9
Q

Medication Classes for Preterm Labor

A

Tocolytics

Corticosteroids

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10
Q

Goals of Tocolytics

A

Delay delivery by at least 48 hours
Provide transport time for mother
Stop labor to clear underlying medical condition

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11
Q

Benefits need to Outweigh Risks for Administration of Tocolytics

A

NOT for >34 weeks

Controversial

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12
Q

Contraindications for Tocolytics

A 
Baby or mother unstable
Fetal demise
Lethal fetal anomaly
Non-reassuring fetal status
Severe pre-eclampsia or eclampsia
Maternal hemorrhage
Intra-amniotic infection
Maternal contraindication to drug
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13
Q

Drug of Choice for 24-32 Weeks of Gestation (Preterm Labor)

A

Indomethacin

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14
Q

MOA of Indomethacin

A

Decreases prostaglandin production through inhibition of cyclooxygenase

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15
Q

Administration of Indomethacin

A

PO

PR

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16
Q

Maternal SE of Indomethacin

A 
Nausea
GE reflux
Gastritis
Emesis
Platelet dysfunction
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17
Q

Fetal SE of Indomethacin

A

Constriction of ductus arterioles
Oligohydramnios
Neonatal complications

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18
Q

When does indomethacin constrict the ductus arteriosus?

A

If given for >48 hours

Give past 32 weeks

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19
Q

Why oligohydramnios with use of indomethacin?

A

Decreases fetal urine output

Decreasing amniotic fluid volume

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20
Q

Neonatal Complications with Indomethacin Use

A 
Bronchopulmonary dysplasia
Necrotizing enterocolitis
PDA
Periventricular leukomalacia
Intraventricular hemorrhage
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21
Q

Maternal Contraindications of Indomethacin

A 
Platelet dysfunction
Bleeding disorders
Hepatic dysfunction
GI ulcers 
Renal dysfunction
Asthma if sensitive to ASA
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22
Q

Second Line Therapy of Tocolytics

A

Nifedipine

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23
Q

MOA of Nifedipine

A

Myometrial relaxation

Peripheral vasodilation

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24
Q

Maternal SE of Nifedipine

A 
Nausea
Flushing
Headache
Dizziness
Palpitations
Can cause severe hypotension
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25
Contraindications of Nifedipine
Hypotension Preload dependent cardiac lesion Cautious with LV dysfunction or CHF
26
Precaution with Nifedipine
Do not use with magnesium sulfate | Act synergistically & result in respiratory depression
27
Pharmacokinetics of Nifedipine
Half life: 2-3 hours Peak plasma concentrations: 30-60 minutes Metabolized: liver Excreted: kidney
28
Drug of Choice for 32-34 Weeks Gestation (Preterm Labor)
Nifedipine
29
2nd Line Therapy for 32-34 Weeks Gestation (Preterm Labor)
Beta-adrenergic receptor agonists | Terbutaline
30
Maternal SE of Terbutaline
``` Tachycardia Palpitations Hypotension Tremor SOB Chest discomfort Hypokalemia Hyperglycemia ```
31
Contraindications of Beta Adrenergic Receptor Agonists
Tachycardia sensitive cardiac disease Uncontrolled hyperthyroidism or DM Caution in placenta previa or abruption due to hypovolemia & shock
32
Administration Routes of Terbutaline
SubQ | IV
33
Monitoring with Terbutaline
I/Os Maternal symptoms: SOB, CP, tachycardia Stop drug if maternal HR >120 Blood glucose & K+ every 4-6 hours
34
Why do we need to check potassium with terbutaline?
Potassium moves intra-cellularly
35
3rd Line Therapy for Prevention of Preterm labor
Magnesium sulfate
36
Corticosteroids Reduces Incidence of What in the Neonate?
``` Respiratory distress syndrome Intraventricular hemorrhage Necrotizing enterocolitis Sepsis Neonatal mortality ```
37
Antenatal Corticosteroids
Betamethasone**** | Dexamethasone
38
When can you give mom antenatal corticosteroids to help lung development of the fetus?
23-34 weeks
39
Indications for Antibiotic Prophylaxis for Group B Strep
Positive rectovaginal culture Positive history of birth of an infant with early onset GBS disease GBS bacteriuria during current pregnancy Unknown culture status AND maternal fever >100.4 OR preterm labor 18 hours)
40
Antibiotic Regimen for Group B Strep
Penicillin G or Ampicillin | PCN Allergy: cephazolin (Ancef), clindamycin, or vancomycin
41
Antibiotic Prophylaxis of Premature Rupture of Membranes
Azithromycin on admission + ampicillin x 48 hours + amoxicillin x 5 days PCN allergy: clindamycin x48 hours + gentamicin x48 hours + clindamycin x5 days
42
Additional Medical Therapy for Premature Rupture of Membranes
Tocolytics: delay delivery | Corticosteroids as indicated
43
Medications for Postpartum Hemorrhage
Oxytocin Misoprostol Carboprost tromethamine Methylergonovine maleate
44
Oxytocin Routes of Administration
IV | IM
45
Response time of IV Oxytocin
1 minute
46
Response time of IM Oxytocin
3-5 minutes
47
Half life of Oxytocin
1-6 minutes
48
MOA of Misoprostol (Cytotec)
Stimulates uterine contraction
49
Adverse Reactions of Misoprostol (Cytotec)
``` Diarrhea Abdominal pain Constipation Dyspepsia Flatulence N/V Headache ```
50
MOA of Methylergonovine (Methergine)
Acts on smooth muscle & increases uterine tone & strength & frequency of contractions
51
Routes of Administration of Methylergonovine (Methergine)
IM | Intramyometrial
52
Contraindications of Methylergonovine (Methergine)
HTN Raynaud's Scleroderma
53
Route of Administration of Carboprost Tromethamine (Hemabate)
IM
54
Contraindications of Carboprost Tromethamine (Hemabate)
Asthma HTN Renal failure Reduced cardiac output
55
Signs/Symptoms of 500-1000 mL Blood Loss in Postpartum Hemorrhage
Palpitations Light headedness Tachycardia
56
Signs/Symptoms of 1000-1500 mL Blood Loss in Postpartum Hemorrhage
Weakness Sweating Tachycardia
57
Signs/Symptoms of 1500-2000 mL Blood Loss in Postpartum Hemorrhage
Restlessness Confusion pallor Oliguria
58
Signs/Symptoms of 2000-3000 mL Blood Loss in Postpartum Hemorrhage
Lethargy Air hunger Anuria Collapse
59
Medications to Treat Severe HTN During Labor
IV lebetalol IV hydralazine PO nifedipine
60
Seizure Prophylactic Medication in Pre-Eclampsia
Magnesium sulfate
61
MOA of Magnesium Sulfate
Blocks neuromuscular transmission & decreases amount of acetylcholine at the end plate of the motor neuron impulse
62
Adverse Effects of Magnesium Serum Levels at 4 mEq/L
Deep tendon reflexes decrease
63
Adverse Effects of Magnesium Serum Levels Between 8-10 mEq/L
Deep tendon reflexes absent
64
Adverse Effects of Magnesium Serum Levels Between 10-15 mEq/L
Respiratory paralysis
65
Adverse Effects of Magnesium Serum Levels Between 20-25 mEq/L
Cardiac arrest
66
What medication can treat magnesium toxicity?
Calcium gluconate
67
Other SE of Magnesium Sulfate
``` Flushing Diaphoresis Warmth N/V Headache Muscle weakness Visual disturbance Palpitations ```
68
Contraindications of Magnesium Sulfate
Heart block Myocardial damage Myasthenia graves
69
What class of medications should you not use with magnesium sulfate?
Calcium channel blockers
70
Medication for Induction of Labor
Oxytocin (Pitocin)
71
MOA of Oxytocin (Pitocin)
Stimulates uterine contractions by activation of G-protein-coupled receptors that trigger increased intracellular calcium levels Increases prostaglandin production
72
Contraindications of Oxytocin (Pitocin)
Conditions to avoid vaginal delivery
73
Maternal Adverse Reactions of Oxytocin (Pitocin)
``` Arrhythmias HTN N/V Pelvic hematoma Postpartum hemorrhage Uterine hypertonicity Uterine rupture Severe water intoxication with seizure, coma & death (infusion over 24 hours) ```
74
Fetal Adverse Effects of Oxytocin (Pitocin)
``` Arrhythmia Bradycardia Brain damage Seizures Jaundice Retinal hemorrhage Death Low Apgar scores ```
75
Common Disorders to Treat with Pregnancy
``` Diarrhea Constipation GERD Cough & cold symptoms Analgesics ```
76
Pregnancy Category of Loperamide
Category C
77
Treatment of Diarrhea in Pregnancy
Oral rehydration* Dietary changes* Loperamide (only if symptoms are disabling)
78
Treatment of Constipation in Pregnancy
Increase dietary fiber* Increase fluids* Bulk forming laxatives
79
Bulk Forming Laxatives Used in Pregnancy
Psyllium (Metamucil) Methylcellulose (Citrucel) Calcium polycarbofil (Fibercon) Wheat dextrin (Benefiber)
80
Treatment of Refractory Cases of Constipation in Pregnancy
Lactulose Bisacodyl (Dulcolax) Magnesium hydroxide
81
Medications to Avoid when Treating Constipation in Pregnancy
Castor oil | Mineral oil
82
Pregnancy Category of Lactulose
Category B
83
Why avoid castor oil in the treatment of constipation in pregnancy?
Stimulates contractions
84
Why avoid mineral oil in the treatment of constipation in pregnancy?
Interferes with vitamin absorption
85
Lifestyle Modifications in the Treatment of GERD in Pregnancy
Elevation of the head of the bed, dietary modification, antacids PRN
86
Preferred Agent After Failure of Lifestyle & Antacids in the Treatment of GERD During Pregnancy
Sulcralfate
87
H2 Receptor Blockers to Treat GERD in Pregnancy
Ranitidine (Zantac) | Cimetidine (Tagamet)
88
Pregnancy Category of Ranitidine (Zantac)
Category B
89
Pregnancy Category of Cimetidine (Tagamet)
Category B
90
PPI's Used to Treat GERD in Pregnancy
Lansoprazole (Prevacid) Pantoprazole (Protonix) Omeprazole (Prolisec)
91
Pregnancy Category of Lansoprazole (Prevacid)
Category B
92
Pregnancy Category of Pantoprazole (Protonix)
Category B
93
Pregnancy Category of Omeprazole (Prilosec)
Category C
94
Treatment of Cold Symptoms in Pregnancy
Heated, humidified air: congestion Acetaminophen: sore throat, fever, headache Saline nasal spray or irrigation Ipratropium bromide (Atrovent) nasal spray: rhinorrhea Pseudoephedrine (Sudafed): nasal congestion
95
Pregnancy Category of Ipatropium bromide (Atrovent) Nasal Spray
Category B
96
Pseudoephedrine (Sudafed) for Nasal Congestion in Pregnancy
Avoid in 1st trimester
97
Treatment of Cough in Pregnancy
Inhalation of warm, humidified air Dextromethorphan (Robitussin) Guaifenesin (Mucinex)
98
Pregnancy Category for Dextromethorphan (robitussin)
Category C
99
Pregnancy Category for Guaifenesin (Mucinex)
Category C
100
Analgesics in Pregnancy
Acetaminophen (Tylenol)
101
Pregnancy Category of Acetaminophen (Tylenol)
Category C
102
Acetaminophen use in Pregnancy Lead to an Increased Risk of What Diseases
ADD behavior | Wheezing & asthma
103
Considerations for Treatment with Acetaminophen
Weigh risks vs. benefits when treating fever
104
What analgesics should be avoided?
NSAIDs
105
Pregnancy Category of NSAIDs Prior to 30 Weeks Gestation
Category C
106
Pregnancy Category of NSAIDs After 30 Weeks Gestation
Category D
107
Fetal SE of NSAIDs Prior to 30 Weeks Gestation
May cause miscarriage CV anomalies Cleft lip/palate
108
Fetal SE of NSAIDs After 30 Weeks Gestation
Premature closure of the ductus | Many other significant abnormalities
109
Drugs that Stimulate Ovulation
Clomiphene (Clomid) | Metformin (Glucophage)
110
MOA of Clomiphene (Clomid)
Inhibits normal estrogenic negative feedback | Increased pulsatile GnRH secretion
111
Class in which Clomiphene (Clomid) Belongs
Ovulation stimulator | Selective estrogen receptor modifier
112
Class in which Metformin (Glucophage) Belongs
Biguanide
113
Metformin (Glucophage) Associated With What
Increased menstrual cyclicity Improved ovulation Reduction in circulating androgen levels
114
Benefits of Metformin (Glucophage)
Reduction in insulin | Stimulate weight loss

OB/GYN (12 decks)

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