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Flashcards in OB Pharmacology Deck (20)
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1

Spontaneous Abortion

Misoprostol (Cytotec) - prostaglandin E1 analog

Surgical, Medical, or Expectant (pass naturally)

2

Misoprostol (Cytotec)

Prostaglandin E1 analog - induces uterine contractions

For missed/incomplete abortion or unlabeled for cervical ripening or postpartum hemorrhage

Intravaginally is highly effective - 70-90% expulsion w/in 24 hours

3

Preterm Labor Drugs

Tocolytics

-Indomethacin

-Nifedipine

-Terbutaline

-Magnesium sulfate

Corticosteroids - Betamethasone (preferred)

4

Tocolytics

Goal: delay delivery 48 hours to allow lung maturity w/ steroids

Indomethacin

Nifedipine

Terbutaline

Magnesium Sulfate

5

Indomethacin

DOC for 24-32 weeks

Decreases prostaglandin productions through cyclooxygenase inhibition

Maternal SE: N, GERD, gastritis, emesis, platelet dysfunction

Fetal SE: ductus arteriosis constriction, oligohydramnios, necrotizing enterocolitis, PDA

CI: ASA allergy, GI ulcers, liver/kidney dysfunction, bleeding issue

Monitor fetus if given >48 hours

6

Nifedipine

1st line: 32-34 weeks; 2nd line: 24-32 weeks

CCB -> myometrial relaxation & peripheral vasodilation

Maternal SE: N, flushing, HA, dizzy, palpitations, HOTN

CI: HOTN, cardiac abnormalities/CHF, decreased ventricular contraction

Do no give w/ magnesium sulfate - synergists can cause respiratory depression

7

Corticosteroids

Reduced (50%) RDS, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neonatal mortality

Betamethasone - preferred

Dexamethasone in non-sulfide suspension to prevent fetal neurotoxicity

8

Group B Strep

Antibiotic prophylaxis w/ + culture or hx previous birth

Unknown status, maternal fever (>100.4), preterm labor, or PROM >18 hrs

Don't give w/ planned C-section unless PROM

PCN-G, Ampicillin, Cephazolin (Ancef), Clindamycin, Vancomycin w/ PCN Allergy

9

Premature Rupture of Membranes

Infection may be cause

1g Azithromycin + 2g Ampicillin + Amoxacillin 

OR

Clinda + Gent w/ Clinda f/u for 5 days

10

Postpartum Hemorrhage

Uterotonic Drugs

Oxytocin

Misoprostol

Methylergonovine

Carboprost Tromethamine

11

Oxytocin

Misoprostol

Methylergonovine

Carboprost Tromethamine

Oxytocin: DOC for PPH - infusion or IM; 1/2 life 1-6 minutes

Misoprostol: sublingual or per rectum; SE: GI, HA

Methylergonovine: Ergot alkaloid - acts on smooth muscle

-IM or Intramyometrial - severe HTN stroke if IV

-CI: Reynauds, HTN, Scleroderma

Carboprost Tromethamine: IM only; CI: Asthma, HTN, renal failure, decreased cardiac output

12

Preeclampsia - Severe HTN during labor

IV labetalol 

IV Hydralazine 

PO nifedipine

13

Magnesium Sulfate

Adjust with renal insufficiency

MOA: blocks neuromuscular transmission and decreases acetylcholine @ motor end plate

Get baseline DTRs

-Absent @ 8-10, respiratory paralysis @ 10-15

Calcium gluconate 1g IV to reverse

CI: heart block, myocardial damage, myasthenia gravis, CCB concurrent use

14

Induction of Labor

Oxytocin (Pitocin)

Activates G-protein coupled receptor that triggers increased calcium intracellular uterine contractions

Increases prostaglandin production

Maternal SE: arrythmia, HTN, N/V, pelvic hematoma, PPH, hypertonicity, uterine rupture; severe water intoxication w/ seizure/coma/death

Fetal SE:CV, CNS, Jaundice, retinal hemorrhage, death, low APGAR

15

Diarrhea

Constipation

Diarrhea: rehydration & diet change 1st line - loperamide (C) in small doses w/ severe cases only

Constipation: 1st line - increased fiber and fluids; bulk-forming laxatives preferred - not absorbed: Metamucil, Citrucel, Fibercon, Benefiber

-Mineral absorption: lactulose (B), ducolax

-Magnesium hydroxide crosses placenta - should be safe

-Avoid castor oil (stimulates contractions), mineral oil (decreased vitamin absorption)

16

GERD

Cold Symptoms

GERD: Lifestyle, Sulcrafate preferred - coats lining; TUMS ok

-H2 Blockers 2nd line - Zantax, Taganet

-PPI - Prevacid, Protonix Cat B

Cold Symptoms: warm humidified air, Acetaminophen for fever

-Ipratropium bromide for Rhinorrhea - cat B

-Single doses Sudafed in 3rd trimester ok

17

Analgesics

Acetaminophen (Tylenol) cat C - DOC for maternal pain & fever

-small correlation between use & ADD behavior in child, wheezing or asthma

NSAIDs - avoid

<30 weeks: Cat C -> may cause miscarriage, CV abnormalities, cleft lip/palate

>30 weeks: Cat D -> premature ductus closure, significant abnormalities

18

Drugs to stimulate ovulation

Clomiphene (Clomid)

Metformin (Glucophage)

19

Clomiphene (Clomid)

Ovarian stimulator, selective estrogen receptor modifier

Inhibits normal estrogenic negative feedback - increased GnRH => increased FSH and LH

-causes follicular growth and rupture

Pulse dosing on day 5 menstrual cycle for 5 days - intercourse 5-10 days after regimen complete

Can try again 30 days later - don't try >6 times

20

Metformin (Glucophage)

Biguanide

Increased menstrual cyclicity, decreased ovulation and androgen levels

Lower live birth rate than Clomid

Helps w/ insulin resistance and weight - used w/ PCOS