Pharmacology Flashcards
(35 cards)
<p>What antibiotics can you not give in pregnancy?</p>
<p>Trimethoprim and nitrofurantoin - teratogenic
Tetracyclines (e.g. doxycycline - affects baby's teeth)
Consider treating abx with cefalexin or amoxcillin</p>
<p>What antibiotics should be prescribed for PPROM?</p>
<p>Erythromycin 250mg QDS - prophylaxis to prevent chorioamnionitis
Suspect infection if high WCC, high CRP, maternal temperatures, fatal tachycardia</p>
<p>What antibiotics are given in caesarean sections?</p>
<p>1st gen cephalosporin (cefalexin) / penicillin </p>
<p>What steroids are given for fetal lung maturation and how?</p>
<p>Dexamethasone - 4X 6mg doses given as IM injections 12h apart
Beclametasone - 2X 12mg doses given 24h apart</p>
<p>What should you consider for the treatment of hypertension in pregnancy?</p>
<p>Labetalol 200mg TDS PO
Or Nifedipine 10mg OD-BD
Methyldopa 250mg BD or TDS PO (alpha 2 adrenergic receptor agonist)
IF SEVERE labetalol can be given IV or hydralazine or MgSO4</p>
<p>What can be given to help prevent pre-eclampsia?</p>
<p>Low dose aspirin (75mg)</p>
<p>What else is MgSO4 useful for?</p>
<p>NEUROPROTECTION - should be given to all women in pre-term labour BEFORE 30 weeks</p>
<p>What anti-emetics should be considered in hyperemesis?</p>
<p>Cyclizine 50mg TDS PO
Prochlorperazine 10mg TDS
Promethiazine 25mg TDS
Chlorpromazine 10-25mg
THEN
Metaclopramide (5-10mg) or ondansetron
THEN
Corticosteroids e.g. hydrocortisone (consultant decision)</p>
<p>What 2 laxatives should be considered in constipation in pregnancy?</p>
<p>BULK-FORMING (e.g. methycellulose)
| OSMOTIC eg. lactulose</p>
<p>What pharmacological treatment could you consider for obstetric cholestasis?</p>
<p>Ursodeoxycholic acid - reduces cholesterol absorption for the intestines helping with the dissolving of cholesterol
8-12mg OD before bed</p>
<p>What pharmacological treatments can be considered for PPH?</p>
<p>SYNTOMETRINE - (syntocinon + ergometrine = contraction of uterus)
CARBOPROST (PG analogue) - helps to contract down uterus 250mcg doses no less than 15mins apart no more than 2mg max
MISOPROSTOL 1000mcg rectal
TRANEXAMIC ACID
If these things fail consider surgical management - Intra-Uterine balloon tamponade, B-lynch sutures, uterine or iliac artery ligation, hysterectomy</p>
<p>When can a termination of pregnancy be managed MEDICALLY?</p>
<p>< 9 weeks</p>
<p>What is the first stage of treatment for a medical TOP?</p>
<p>Mifepristone 200mg - competitive progesterone receptor antagonist
- terminates pregnancy but need help to get it out hence next stage</p>
<p>What is the second stage of management for a TOP?</p>
<p>Misoprostol 800mcg - prostaglandin analogue, stimulates uterine contractions</p>
<p>When can a medical management of an ectopic pregnancy can be considered?</p>
<p>1) <35mm
2) Unruptured
3) No pain
4) BHCG levels are <1500
5) No FHR
6) If intra-uterine pregnancy has been effectively ruled out
**if a woman does not fulfil these criteria should consider surgical management of the ectopic either with salpingectomy or salpingostomy</p>
<p>What can be used to medically manage ectopic?</p>
<p>METHOTREXATE</p>
<p>What treatment options are there for heavy menstrual bleeding?</p>
<p>Tranexamic acid and mefenamic acid</p>
<p>How does tranexamic work? How is it taken?</p>
<p>TXA - is an anti-fibrinolytic
1g PO TDS-QDS
***Still able to take it if you are trying to conceive</p>
<p>How does mefenamic acid work and how is it taken?</p>
<p>NSAID and is one of the most commonly prescribed treatments for HMB
Production of both prostaglandins and thromboxanes are inhibited
500mg PO TDS</p>
<p>What are the high risk factors for VTE in pregnancy and what should be offered?</p>
<p>Previous history of VTE
| LMWH antenatally until 6 weeks post-partum</p>
<p>What are some intermediate risk factors for VTE in pregnancy?</p>
<p>Hospital admission
Single prev VTE related to major surgery
High risk thrombophilia
High risk co-morbidities (SLE, heart failure, cancer, T1DM, IBD, arthropathy, sickle cell disease, IVDU)
Surgical procedure</p>
<p>What are some low risk factors for VTE in pregnancy and how long would you give prophylaxis for if have: 2/more RF 3/more RF 4/more RF Any hospital admission</p>
<p>BMI >30 Age >35 Parity of 3 or more Smoker Gross varicose veins Immobility FH of unprovoked or oestrogen provoked VTE Current pre-eclampsia Low risk thrombophilia Multiple pregnancy IVF/ART
If 2/more - LMWH for at least 10 days
If 3/more - LMWH from 28 weeks till 6 weeks postnatal
If 4 OR MORE - LMWH immediately until 6 weeks postnatal
ANY ANTENATAL HOSPITAL ADMISSION = CONSIDER LMWH</p>
<p>If you decide a woman DOES NOT need VTE prophylaxis in pregnancy what advice can you give?</p>
<p>Stay mobile and hydrated</p>
<p>What are some high risk factors for VTE in the post-natal period? What prophylaxis should be given?</p>
<p>Previous VTE LMWH in pregnancy High risk thrombophilia Low risk thrombophilia + FH Give LWMH 4500 for at least 6 weeks</p>
What are some intermediate risk factor for VTE in the post natal period and what prophylaxis should you consider?
C-section BMI >40 Re-admission or prolonged admission (>3 days) in puerperium Surgery in puerperium apart from immediate perineal repair Medical comorbidities (cancer, SLE, nephrotic syndrome, T1DM, sickle cell disease, IBD and arthropathy) Give AT LEAST 10 days prophylactic LMWH
What are some low risk factors for VTE in the post-natal period and when should you consider prophylaxis?
Age >35 Obesity. BMI >30 Parity of 3 or more Smoker Elective c-section FHx VTE Low risk thrombophilia Gross varicose veins Systemic infection Immobility Current pre-eclampsia Multiple pregnancy Pre-term delivery in this pregnancy Still birth in this pregnancy Mid cavity rotation or operative delivery Prolonged labour >24h PPH >1L blood transfusion ``` IF 2 OR MORE RFx - 7-10 days LMWH If less than 2 advise mobility and hydration
What can Danazol be used to treat? | How does it work?
Endometriosis | Anti-androgen
What Abx are used for 3rd/4th perineal tears?
Cefuroxime + Metronidazole
What are is an example of gnrh agonist? What is it used for? Mechanism of action 3 SEs
Leuprorelin IM - Endometriosis - Ovarian suppression - hot flashes, headache, osteoporosis
When is oral iron recommended? | When is IV iron recommended?
T1: Hb <110, T2/3: Hb <105 | Hb <80 at 34 weeks
When is aspirin & how much?
From 12 weeks if high risk | Usually 75mg, but 150mg in future pregnancies if previously had pre-eclampsia
What medical management is used in urge & stress incontinence?
URGE 1) Anticholinergics - Oxybutynin Inhibit detrusor muscle contraction 2) Beta-3 agonist (alternative for frail older women) - Mirabegron - CI in uncontrolled HTN 3) Vaginal oestrogens ``` STRESS 1) Duloxetine - SNRI (Strengthens bladder neck)
Misoprostol 3 indications
1) TOP 2) Miscarriage 3) Haemorrhage
When is atosiban used? | Mechanism of action
Uncomplicated premature labour 24-33wk | Inhibits oxytocin & relaxes uterus
What 2 topical creams are given for genital warts?
1) Podophyllotoxin | 2) Imiquimod
