OBI

Question 1

Clomiphene citrate (Clomid)

Answer 1

DOC Female ovulation
Mechanism of action: Binds to estrogen receptors in the pituitary gland, blocking them from detecting estrogen
Dosage: Variable; PO; Start on fifth day of menses with 50mg/day for five days; can increase dosage with next cycle if ovulation doesn’t occur
Side Effects: Vasomotor flushes, abdominal discomfort, N/V, breast tenderness, ovarian enlargement

Question 2

Facts about Infertility

Answer 2

If cause of ailment is known, goal of treatment is to address that cause
Increase correlated with increase in age

Question 3

Female infertility

Answer 3

Anovulatory (including intermittent) 
Clomiphene citrate (Clomid): stimulates ovulation; first-line; can lead to hyperstimulation and increased chance of multifetal pregnancy

Question 4

Treatment for PCOS (r/t infertility)

Answer 4

Clomid- Infertility

Metformin- Insulin resistance

Question 5

Unresponsive to Clomid (r/t infertility)

Answer 5

• Human menopausal gonadotropic (HMG), FSH, and rFSH for follicle stimulation
• HCG to induce ovulation
Others: Gonadotropin-releasing hormone (GnRH)-more aggressive therapy, progesterone, bromocriptine
GnRH- Daily estrogen monitoring and U.S.

Question 6

Pregnancy Category

Answer 6

• Drugs are tested with specific criteria.
• A being the best and X the worst.
• X- lost of human studies have shown fetal abnormalities

Question 7

Preterm Labor Meds

Answer 7

Antibiotics
Decrease Uterine Contractility (Tocolytics) 
Terbutaline 
Nifedipine 
Indomethacin 
Magnesium Sulfate 
Betamethasone

Question 8

Terbutaline

Answer 8

(IM) Preterm; Stimulates beta-2 adrenergic blockers, relaxing smooth muscle—stopping contractions; Monitor maternal and fetal HR)

Question 9

Nifedipine

Answer 9

(PO) Preterm; Ca channel blocker; blocks calcium flow into smooth muscle; Monitor for s/sx of hypotension

Question 10

Indomethacin

Answer 10

(PO) Preterm; blocks prostaglandin synthesis; Caution against long-term use due to fetal closing of Ductus arteriosus which could lead to pulmonary hypotension
a/e: gastric irritation, interstitial nephritis

Question 11

Magnesium Sulfate

Answer 11

(IV) Preterm; Probably competes with calcium to decrease contractions; Not the most effective method of tocolysis; Monitor for s/sx of toxicity)
Helps stabilize blood flow in the baby to prevent complications if baby was to be born
Protect fetal development
Neuroprotective; protects against cerebral palsy
Maternal s/e: transient hypotension, flushing, head ache, dry mouth, feeling of lethargy
Contraindicated in: myasthenia gravis, hypocalcemia, renal failure
Monitor deep tendon reflexes-hypermagnesmia

Question 12

Betamethasone

Answer 12

(IM) Preterm; Promotes fetal surfactant development; 23-34 weeks EGA
Nitro Patch TD Preterm; could cause headache and hypotension

Question 13

Cervical Ripening

Answer 13

Intrapartum; Goal is to soften cervix to prepare it for dilation and delivery
-Prostaglandin synthesis by:
Dinoprostone- E2-
      Endocervical gel (Prepidil)
      Vaginal suppository (Cervidil)
Misoprostol-E1 (Cytotec)-

Question 14

Dinoprostone- E2-

Answer 14

Intrapartum; Vaginal suppository (Cervidil)-10mg suppository q12 hours on until onset of labor; 
Endocervical gel (Prepidil)-1mg in the posterior fornix, can repeat once in 6hrs; Pts need to be monitored after placement, lay supine for approx. 30 min Gel is applied intracervically via catheter

Question 15

Misoprostol-E1 (Cytotec)-

Answer 15

Intrapartum; PO or vaginal-25-50mcgs vaginally; GI Drug-off-label use- induce cervical ripening also for abortions
Stored at room temp; more convenient, less expensive
-Not recommended for those with prior uterine surgery

Question 16

Oxytocin (Pitocin)-Action, Route

Answer 16

DOC induction of labor
Used to establish an adequate labor pattern
titrated IV; Stimulates contractions by activating G-protein-coupled receptors that trigger increases in intracellular calcium levels in uterine myofibrils –promotes contractions and milk ejection

Question 17

Oxytocin (Pitocin)- Warnings and cautions

Answer 17

One of the WHO’s most dangerous medications;
can cause tachysystole or uterine rupture if not carefully monitored and managed
In large doses could cause water intoxication due to antidiuretic effect
During infusion- constant monitoring
Maternal: BP, HR, Uterine Contraction (frequency)
Fetal: HR, Rythum- Stop infusion if fetal distress

Question 18

Narcotics (IV)-

Answer 18

usually short-acting, can enhance with synergistic meds like Phenegran, caution giving close to delivery, b/c it could go to baby; nalbuphine (Nubain), butorphanol (Stadol), morphine

Question 19

Epidural/Spinal -

Answer 19

long-acting for labor/surgery; local anesthetic combined with another opioid to increase effectiveness without prolonging motor function recovery; example: bupivacaine and fentanyl.
bed-bound
Spinal is more invasive/deeper that epidural

Question 20

General Anesthesia-

Answer 20

Only used in emergent situations where time is a factor or if epidural/spinal is contraindicated like clotting disorder, or spinal surgery, or rods in the spine/back

Question 21

Magnesium sulfate

Answer 21

• Other Use: (IV); Used to treat pre-eclampsia by decreasing calcium activity and minimizing risk of seizures

Question 22

Antibiotics-Penicillin G

Answer 22

(IV; GBS 5 million units loading, 2.5 million units q4 until delivery), gentamicin, ampicillin, clindamycin
Bacteria found in 10-15% women can harm baby- go septic; test done towards end of pregnancy, and abx administered if present.

Question 23

Antiemetics-

Answer 23

Ondansetron (IV, Zofran), metoclopramide (IV, Reglan), sodium citrate/citric acid (PO, Bicitra)

Question 24

Oxytocin (Pitocin)-

Answer 24

Postpartum IV (bolus depending on hospital policy) or IM (10 units); MOA-increase uterine contractility

Question 25

Misoprostol (Cytotec)

Answer 25

-Postpartum Rectal 600-1000 mcg once- MOA-increase uterine contractility
S/e: shivering, Increase in temp

Question 26

Carboprost tromethamine (Hemabate)-

Answer 26

Postpartum Deep IM 250mcg every 15-90 minutes PRN, max 8 doses; MOA-increase uterine contractility; caution in pts with asthma d/t bronchoconstriction or HTN- causes vasoconstriction and bronchospasm
s/e: Monitor for SEVERE GI UPSET- diarrhea
GI reactions common; admin antiemetic and antidiarrheal prophylactically
Contraindicated in PID(Pelvic Inflammatory disease)- acute disease of heart, lungs, kidneys liver; asthma, HTN, DM, uterine scarring

Question 27

Methylergonovine (Methergine)-

Answer 27

Postpartum IM 0.2mg q2-4hrs PRN; MOA-increase uterine contractility; caution in pts with HTN and CAD d/t increased risk of vasospasm

Question 28

Postpartum Pain Management

Answer 28

Depends on route of delivery, surgical anesthesia, degree of laceration, etc.
Witch hazel pads (Tucks)- comfort pads are good for moms who have hemorrhoids
benzocaine spray (Dermoplast)- laccerations

Question 29

C-Section: Pain Management

Answer 29

Ketorolac (Toradol) 30mg IV q6hrs and oxycodone/acetaminophen (Percocet)1-2 tabs PO q4-6 for the first 24 hours; following 24 hours, switch to ibuprofen and Norco(hydrocodone/acetaminophen) or Tylenol #3 (codeine/acetaminophen) protocol. b/c can’t send them home an IV, need PO meds

Question 30

Vaginal delivery: Pain Management

Answer 30

Ibuprofen 600mg PO q6hrs for most, can also have opioids PO depending on situation (hydrocodone/acetaminophen (Norco) or codeine/acetaminophen (Tylenol #3); 1-2 tabs PO q4-6hrs PRN
b/c can’t send them home an IV, need PO meds