Pharmacology of Pregnancy - Linger

Question 1

lipophilic drugs

Answer 1

cross placenta easily

Question 2

small molecular weight

Answer 2

cross placenta easily

Question 3

polar compounds

Answer 3

need high concentration gradient to cross placenta

Question 4

fetal metabolism of drugs

Answer 4

slower rate

-due to lack of enzyme expression, reduced activity of metabolic enzymes, reduced availability of cofactors

Question 5

teratogen

Answer 5

results in characteristic set of malformation

• exerts effects at particular stage
• dose-dependent incidence

Question 6

prenatal death

Answer 6

1-2 weeks

Question 7

major morphologic abnormalities

Answer 7

3-8 weeks

Question 8

physiologic defects

Answer 8

> 9 weeks

Question 9

vit B6

Answer 9

pyridoxine

antiemetic drug

Question 10

MOA pyridoxine

Answer 10

precursor to pyridoxal - function in metabolism

also aids in release of liver and muscle glycogen and GABA synthesis and heme

Question 11

antihistamines

Answer 11

H1 antagonists

antiemetic

doxylamine
diphenhydramine
dimenhydrinate
meclizine

Question 12

diphenhydramine

Answer 12

H1 antagonist

Question 13

dopamine antagonists

Answer 13

used as antiemetic

promethazine
prochlorperazine
droperidol

muscarinic blocking

Question 14

ondansetron

Answer 14

serotonin antagonist

• selective for 5-HT3 receptor
• prevention of nausea and vomiting

Question 15

preeclampsia in pregnancy tx

Answer 15

tx if BP > 150/100
-severe HTN

labetalol - non-selective beta blockers
hydralazine - dilates arterioles
nifedipine and nicarpidine - CCBs

Question 16

nifedipine

Answer 16

CCB

tx for preeclampsia

Question 17

preexisting HTN tx in pregnancy

Answer 17

ACE (-), ARBs, direct renin inhibitor - NOT in pregnancy**

labetalol
methyldopa
nifedipine
thiazides

Question 18

methyldopa

Answer 18

reduces BP by stimulating central alpha adrenergic receptors
-decreased sympathetics to heart, kidney, vasculature

reduces peripheral vascular resistance
also reduction in HR and CO

undesired effect - sedation

Question 19

moderate to severe HTN in pregnancy

Answer 19

methyldopa

Question 20

thiazide MOA

Answer 20

inhibit NaCl cotransporter in distal convoluted tubule

Question 21

management of gestational DM

Answer 21

exercise

pharm - anti-hyperglycemics - insulin**

Question 22

insulin prep with low antigenicity

Answer 22

minimize transplacental transport

Question 23

rapid acting insulin analogs

Answer 23

lispro
aspart

both used for GDM

Question 24

leading cause of infant mortality

Answer 24

preterm birth

in US

Question 25

tocolytics

Answer 25

suppress preterm labor

Question 26

beta-adrenergic receptor agonists

Answer 26

bind beta2 receptors - increases adenylyl cyclase - increased cAMP - decrease myometrial contractility eventially desensitized

Question 27

ritodrine

Answer 27

beta-adrenergic receptor agonist - not in US

Question 28

adverse beta-adrenergic receptor agonists

Answer 28

tachy, low BP, bronchial relaxation

Question 29

mag sulfate

Answer 29

tocolytic - MOA unknown - thought to compete with calcium at plasma membrane - hyperpolarize membrane - inhibit myosin - reduce myometrial contractility

Question 30

CI for mag sulfate

Answer 30

mother with myasthenia gravis

Question 31

women with myocardial compromise or cardiac conduction defects

Answer 31

careful use of mag sulfate

Question 32

indomethacin

Answer 32

COX inhibitor -most commonly used tocolytic of this class reduce PG formation - reduce myometrium contraction

Question 33

concerns with indomethacin

Answer 33

constriction of ductus arteriosus and oligohydramnios

Question 34

oxytocin

Answer 34

induction of labor

Question 35

MOA oxytocin

Answer 35

stimulate uterine muscle contraction - activating oxytocin receptors - stimulates PG release - milk ekection

Question 36

misoprostol

Answer 36

prostaglandin E induction of labor ripen cervix

Question 37

management of pain during childbirth

Answer 37

systemic or local local - epidural, spinal - most popular neuraxial - local - most effective - bupivicaine, ropivacaine

Question 38

benzos and barbituates

Answer 38

not analgesis - anxiolytic | -cross placenta and affect fetus - bad

Question 39

systemic for pain

Answer 39

morphine fentanyl meperidine

Question 40

opiod agonist-antagonists

Answer 40

nalbuphine | butorphanol